For what it's worth

Editorials by Ed Note

The Intoxicating Power of the DSM

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Bias in Psychological Evaluations

The DSM by itself has no power.  It derives its power from the powerful that created it, a select group of psychiatrists and psychologists and the powerful who use - or rather misuse it.  As noted, these powerful misusers are not just the therapists; they are also insurance companies, institutions and corporations who obtain grants to study and research the various abnormalities within the DSM, the courts, and the hospitals who get paid to hold and treat those diagnosed. 

 

Case in point; Patrick Wells, who after being told by a psychologist that he should seek some help for depression, checked himself into a hospital in Florida, thinking it would be for a couple of weeks.  Therapists at the hospital, using DSM criteria, however determined that he was “much worse”  than previously diagnosed and held Mr. Wells and collected insurance fees, for two years.  It was Wells who eventually managed to get a Writ out of the hospital and a judge's ruling releasing him to another hospital. The later hospital, upon reevaluation, found Wells to be in "perfect mental health" and released him.  (St. Petersburg Times, Former Patient Sues Anclote Manor, by Teresa Burney, August 16, 1989, pg 5b).

It is not uncommon to use psychology "experts" against people for subjective motives, most prominently in the courtroom setting, whether criminal or civil. Many court cases rely on expert testimony to prove culpability or responsibility.  According to the often-referenced case, Daubert vs Merrell Dow Pharmaceuticals, Inc., courts typically consider therapists' opinions as expert opinions because of an assumption that they are based on scientifically verified research, which satisfies the standards of evidentiary reliability.

Contrariwise, T. W. Campbell informs in The Daubert Decision and Its Effects on Expert Testimony, that scientific evidence is frequently disregarded by therapists.  They are more inclined to embrace unverified theory and judge patients during the evaluation process by whatever symptoms the patient displays that coincide with particular diagnostic criteria for some personally preferred disorder.  Doing so affords therapists to find evidence of a disorder, not because it really exists, but because they wanted to find it - wanted it to exist.

Voting on What Is Normal

The use of the DSM diagnostic categories in court proceedings shows how psychology is a self-serving business with far reaching effects.  Just being labeled abnormal causes some people to seek therapy, which in turn affords therapists to expand the diagnosed ailment and prolong treatment - and of course their fees. And labeling is easy when criteria and the abnormality itself have been created by the very association that will be the sole practitioners to deal with the abnormality.

The creation of these abnormalities and their admission into this bible' of diagnostic classification is done by periodical vote and/or presidential proclamation.  Peter Breggin is quoted from Toxic Psychology, "...only in psychology is the existence of a physical disease determined by APA presidential proclamation, by committee decisions, and even at times by a vote of the members of the APA not to mention the courts.”  More on courtroom involvement later. Interesting to note here is what Matthew Dumont of the APA wrote in 1987, " while this manual provides a classification of mental disorders... no definition adequately specifies precise boundaries of the concept... there is no assumption that each mental disorder is a discrete entity with sharp boundaries between it and other mental disorders."

Therefore it is realistically possible that these proclaimed disorders are nothing more that fabrications derived from the desire to create business, justify existing business, or to afford a showing of expertise that otherwise would not exist.  Diagnostic categories can so easily be manipulated that even the most inexperienced therapist can give a profound showing of importance and professionalism to an otherwise unknowing society.

All Are Intoxicated

Consider the helplessness a person must feel who finds himself before a court with a label - a mental abnormality - imposed upon him based on a criteria which was created by a presidential proclamation or popular vote based on what is or isn’t popular at the time. 

Then the court makes a judgment and issues consequences for having this alleged mental abnormality.  A very realistic consequence would be indefinite detention in a mental hospital (institution) or prison pending a decision, once again by some therapist usually the same one who diagnosed the abnormality in the first place, that you are cured or no longer severely suffer from the abnormality. Don’t lose sight of the fact this therapist gets paid for each and every step of this process, including any follow-ups, re-evaluations, or court appearances should he decide you need further attention and any future court appearances etc. ad infinitum. 

Taking this nightmare even further, what if shortly or worse years after the sanctions have been imposed by the courts, based on the therapist's opinion, derived from criteria of an abnormality voted into the DSM, that abnormality is voted out? Then what?  You have already suffered, not only your own self-imposed emotional, psychological, and physical ramifications, but those endured as a result of the trauma of a public hearing, sentencing, and finally whatever inhumane treatment and abuse you endured while detained in the mental hospital or prison. Are you suddenly become 'cured' because the mental abnormality no longer exists?  Do you suddenly recover from all the abuse and the lost years and disenfranchisement?  Do you get let go?  And just what happens if these psychological wizards decide to revisit the particular disorder as a prospect for re-submittal into the DSM?

 

This does happen as it did so with Depressive Personality Disorder.  This disorder was removed from the DSM in 1980 only to be reintroduced since as a possible topic of investigation.  Sidney Walker, 111, M.D. wrote in A Dose of Sanity how the voting in and out of mental disorders is influenced even by popular demand.  Self Defeating Personality Disorder according to Dr. Walker was voted in as a mental disorder to be listed in the DSM in 1987.  Then because it was unpopular with women who devoted their lives to their husbands and families to be called abnormal it was voted back out in 1988.  These things either are or are not mental abnormalities, which need attention.  Louise Armstrong, who authored such books as, Rocking the Cradle of Sexual Politics: and They Call It Help: the Psychiatric Policing of America’s Children once asked, "How can that which millions of Americans had embraced as there, spent millions of hours grappling with, wrestling with, struggling to tame, and sometimes finally declaring conquered... suddenly be said never to have been in the first place?" The powerful authors of the DSM care not about any residual or direct consequences of adding or subtracting abnormalities from their book of power.

As was touched on earlier, not all therapists are money grubbing, self-aggrandizing, self-centered, deceiving, and manipulative power and control freaks with their clients and themselves.  Some actually are caring, well meaning, and honest. Of course, these ordinary caring therapists who are not intoxicated by the power of the DSM, only us it, if their workplace has a contractual obligation that requires it. In fact, one study determined that 55% of clinical social workers felt the diagnoses in the DSM failed to reflect their clients' problems.  But unfortunately, we are addressing the many others who consciously misuse the DSM for their own personal gain or due to laziness.

This laziness is addressed by John H. Blume and David P. Voisin who co-authored Avoiding or Challenging a Diagnosis of Antisocial Personality Disorder. They wrote, "The APD (Antisocial Personality Disorder) is not only harmful, but it is frequently wrong ...it is often 'the lazy mental health professional’s diagnosis.'" It is said that APD is the most misused diagnosis, especially in the courtroom setting. Interpreting this as by sheer laziness and deliberate indifference and individual can dictate the future or lack thereof of another.  The DSM allows therapists to make whatever diagnosis they so choose, often motivated by personal desire to look or feel professional or knowledgeable and in sync with the attitudes and behaviors of influential, famous, and of course wealthy colleagues.

 

Personal wealth is a major motivator for therapists' refusal to consider the harm their labeling may produce. It is no surprise that with each issue of the DSM, there are more disorders than in the last. In the DSM Ill there were 265 mental disorders, in the DSM III-R 297 the in the DSM IV there are 374 according to some sources. This obviously affords therapists a larger net to entrap more clientele into some form of treatment regime and thereby generate greater fees.  The more abnormalities, the more need and thereby the more power for therapists.  This is clear as with each new issue of the DSM the number of abnormalities increases.  Their jobs are very secure even as they profess mankind is not.

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