First published in madinamerica.com
The Great "Crazy" Cover-up and Its Human Costs
Paula J. Caplan
Psychiatric diagnosis is fiction sold to the public as fact.
-- Gary Greenberg (2013, p.333)
[Psychiatry] has something rotten at its foundation: its have-it-both-ways, real-until-it-isn't diagnostic manual.
--Gary Greenberg (2013, p.351)
Is anything less regulated than the financial giants that have so damaged the United States economy? The enterprise of psychiatric diagnosis.
Does that
matter? Aren't those who seek help in the mental health system safe in the
hands of people who have committed their lives to being helping professionals?
The tragic answer is "no."
In the land of total lack of regulation, bizarre things transpire. History is
rewritten. Cover-ups of facts that destroy people's lives are the rule. There
are no black-box warnings. In the brouhaha leading up to the 2013 publication
of the Diagnostic and Statistical Manual
of Mental Disorders-5 (DSM-5), absence
of regulation was not mentioned. Furthermore, the cockfight among the most powerful men in the realm of
psychiatric diagnosis, with two previous DSM
chiefs trashing the newest ones, pulled the focus from what matters most, that
people's lives are being destroyed, and no one with power is taking steps to
redress past harm or prevent future harm. Even some of the previously most
trenchant critics of psychiatric diagnosis have seemed blinded to crucial
aspects of the history by the recent drama. [1]
With crucial portions of the history of psychiatric
diagnosis dramatically rewritten, falsehoods have been widely accepted by the
public and professionals as truth.
People whose version of history is considered true wield enormous power. The great journalist I.F. Stone (1907-1989) rigorously checked a person's claims and statements against what they had said previously and against the facts. Those who maintained power by rewriting history had much to fear from Stone. His approach is too much missing [2] from the DSM-5 debate (APA, 2013), its absence especially alarming because the previous edition, DSM-IV, led for nearly two decades to psychopathologizing of millions more people than ever before in history, and the consequences for many have been tragic ( Caplan, 2012a, 2012b).
This article is less about the specific people who do the rewriting -- although some are especially culpable -- than about the forces they embody and the power they have to invent history that becomes the basis for wrong assumptions, for misplaced outrage, for lack of outrage where it is justifiable, and for failure to take action aimed to prevent harm.
It is a major and dangerous myth to assume that psychiatric diagnosis is scientific and always or usually helpful and never harmful and that the traditional approaches of psychotherapy and drugs are the most effective and safe ways to reduce suffering. That combination of myths is used to justify depriving psychiatrically labeled people of their human rights on the grounds that it is good for them, for society, for both (Caplan, 2013b).
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