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Human Rights, Disclosing the Truth, and Psychiatric Diagnosis

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First posted March 21, 2015 at click here

by Paula J. Caplan, Ph.D.

There is far too much covering-up of human suffering and of what the so-called helping professions do and do not have to offer.

When I turned on NPR recently and heard the tail-end of an interview with a psychiatrist and former American Psychiatric Association president about his new book -- Shrinks: The Untold Story of Psychiatry -- my first thought (will I ever learn?) was a hopeful one: "At last, someone high up in that power structure is telling the truth!"

As I listened, though, I heard the author, Jeffery Lieberman, state that psychiatry is a medical discipline just like other medical disciplines. I began to suspect that my first thought was wrong. I became convinced that I was wrong when he went on to say that psychiatry has treatments that "truly work beyond a shadow of a doubt" but then failed to explain that when it comes to human suffering, nothing works beyond a shadow of a doubt, and when he also failed to explain that not psychotropic drugs or forced confinement but loving support, respectful listening, provision of housing, food, employment, healthcare, community, and such alternatives as mindfulness, exercise, involvement in the arts, and service animals often help people heal and do not have negative effects.

I felt so sad as I listened, and when the interview ended I dreaded having to read Lieberman's book and write about it. I know that many people share my feelings of frustration and exhaustion about the ongoing misuses of the power, not only by some of the most powerful psychiatrists, but also some of the most powerful psychologists and members of other professions as they distort the facts and consistently close their ears to people whom their systems have harmed as those people speak the truth. When Dr. Dave Holmes invited me to write a chapter for his wonderfully-titled book, Power and the Psychiatric Apparatus: Repression, Transformation, and Assistance I wrote about some energetic but failed attempts to make real change, and called my chapter "When you try to speak truth to power, what happens if the powerful turn off their hearing aids?"

Gratitude was what I felt when I saw that Robert Whitaker had taken on the important task of actually reading Shrinks and writing the truth about it. No one is in a better position than Whitaker to comment on claims about the field of contemporary psychiatry having found what works "beyond a shadow of a doubt."

One bit of Whitaker's review that jumped out at me was his reference to the addresses given by each year's president of the American Psychiatric Association. That brought back memories for me. I had read every word of each of those, as well as of each year's address by the APA presidents-elect, from 1988 when work began on DSM-IV for almost the next quarter of a century. If you want to be bored to tears -- as well as appalled by displays of arrogance and public relations assertions -- have a look at most of those addresses.

Why did I read them? I read them in connection with my attempts to assist eight women (only women volunteered bravely to do this) who each filed a complaint with the American Psychiatric Association's Ethics Committee about damage done to her -- or in one case, to her brother, leading to his death -- that had all begun with being given DSM-IV labels.

Some of their heartbreaking stories are told in brief videos, some by the women themselves, some by actors, here. When helping to prepare those complaints, I read the annual lectures in order to see whether any president or president-elect spoke the truth about the lack of scientific foundation of the DSM-IV's contents, the fact that they had been shown to be not valid or even reliable (that is, two therapists seeing the same patient at the same time were unlikely to give them the same diagnosis), or the fact that they cause so much harm.

In all those years of speeches, with only one exception, every address either contained a patently false claim that psychiatric diagnosis had become increasingly scientific or contained no mention whatever of psychiatric diagnosis. The latter is especially stunning in light of the vast sums of money the selling of DSM brings to the APA's coffers -- said to be more than $100 million for DSM-IV.

It is appropriate and responsible to warn of the negative consequences that any drug can have, even while one defends the sufferer's right to try or use anything that turns out to help them, but in all the outcry about psychiatric drugs in recent years, what has too often been ignored is the enormous number of other troubling results of getting a label. These include problems with employment, losing custody of a child, losing or failing to get security clearance, losing the right to make decisions about one's medical and legal affairs.

And as is just now starting to be recognized, when people -- especially women -- are sexually assaulted on campuses, in the military, or elsewhere, if they go for "professional help" because they are understandably devastated by the assault, they are likely to be diagnosed as mentally ill, and this damages their credibility on those all-too-rare occasions when the perpetrator is brought to trial.No therapist is supposed to treat you in any way until they have first labeled you, so because of harm not only from drugs (which do occasionally help some people, but as Whitaker has shown, harm far more than they help) but also from a wide array of other results from being diagnosed, people throughout the world are suffering because of receiving those labels.

None of this would be much cause for concern if unfounded claims about effectiveness of treatment and risks of harm were simply ivory-tower debates among academics, but every time any therapist or physician or well-meaning family member or friend urges a suffering human being to try X or Y in order to feel better, that sufferer has the right to know the whole truth about the basis for the recommendation -- which usually begins with a diagnosis -- and about the known potential benefits and negative effects of that approach and also about the huge number of approaches that have been shown to be helpful and do not require calling the person mentally ill.

Copyright 2015 by Paula J Caplan All rights reserved

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Paula J. Caplan, Ph.D., is an advocate, activist, clinical and research psychologist, and awardwinning nonfiction author and playwright. She is Associate at the DuBois Institute, Harvard University, and a past Fellow in the Harvard Kennedy (more...)

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