People who disagree with the concept of mental illness and with the associated idea of psychiatric diagnosis call psychiatric diagnoses "labels". Such critics allege psychiatric "diagnoses" or labels are no more scientifically valid than pejorative nonscientific insults. As psychologist Jeffrey Schaler said in 2006, "Think of how when people get angry with one another, they inevitably resort to some kind of diagnosis. They say, 'You're crazy! You're mentally ill! You're paranoid!' Can you imagine somebody getting angry with someone and saying 'You have diabetes! You have Parkinson's Disease!'" ("Jeffrey A. Schaler, Ph.D., Professor of Psychology", YouTube.com, accessed Sept. 1, 2012). Accusing someone of mental illness is an insult. Accusing someone of having diabetes or Parkinson's Disease or any other physical illness is not.
Because we do not live our lives in isolation but in a society of other people, and because a psychiatric "diagnosis" changes how other people treat a person, a psychiatric "diagnosis" can deprive a person of many of life's most important opportunities and can harm or ruin a person's life. The childhood taunt, "Sticks and stones can break my bones, but words can never hurt me" simply is not true if the words are a psychiatric "diagnosis":
The problem with psychiatric diagnoses is not that they are meaningless, but that they may be, and often are, swung as semantic blackjacks: cracking the subject's dignity and respectability destroys him just as effectively as cracking his skull. The difference is that the man who wields a blackjack is recognized by everyone as a thug, but the one who wields a psychiatric diagnoses is not. [Thomas Szasz, M.D., The Second Sin, Anchor Press 1973, p. 71]
Psychiatric "diagnosis" can result in a person who seems normal to the average person, and who is law-abiding, spending his or her whole life imprisoned in a mental institution rather than living in freedom. Psychiatric "diagnosis" can defeat the proper functioning of the system of justice, examples being a person being found not guilty by reason of insanity and avoiding punishment for a serious crime, or a good parent losing custody of his or her child. (See, for example, Chapter 8 "In the Best Interests of the Child - Parental Rights and Psychoexperts" in Whores of the Court - The Fraud of Psychiatric Testimony and the Rape of American Justice, Regan/HarperCollins 1997, by Boston University psychology professor Margaret Hagen, Ph.D.) Psychologist Paula Caplan, Ph.D., highlighted the gravity of psychiatric "diagnosis" in an interview on February 11, 2012 (MindFreedom Live Free Web Radio: "Paula Caplan v. Psychiatric Labeling!", archived at blogtalkradio.com):
Not until recently did very many people understand that psychiatric diagnosis is the fundamental building block of everything else bad that happens in the mental health system. If you don't get a label, you can't get put on drugs that might help you but are more likely to hurt you. If you don't get a label, then you can't lose your job or custody of your kids or your legal rights because of having a label. ... When you hear somebody say "I lost custody of my children because I had a label that I thought was pretty mild, but you know what!: It 'proved' that I'm mentally ill, and they took my children away from me." ... You can't hear these stories, and year after year, more and more, and not try to do something about it. ... people's lives have been destroyed by getting a psychiatric label.
In his book Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, published in 2013 (Harper Collins pp. xi, xii, 277), psychiatrist Allen Frances, M.D., says this:
I led the Task Force that developed DSM-IV [American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] and also chaired the department of psychiatry at Duke [University], treated many patients ... DSM has gained a huge societal significance and determines all sorts of important things that have an enormous impact on people's lives like...who gets to be hired for a job, can adopt a child, or pilot a plane, or qualifies for life insurance ... Done poorly, psychiatric diagnosis can be an unmitigated disaster leading to aggressive treatments with horrible complications and life-shattering impact. ... Psychiatric diagnosis is a serious business with major and often lifelong consequences.
In Chapter 3 of Saving Normal, "Diagnostic Inflation", Dr. Frances includes a section quite appropriately titled "The Power to Label Is the Power to Destroy" (p. 109).
Because of the damaging, even life-ruining power of psychiatric "diagnosis" (or of psychiatric "labels"), the validity, accuracy, reliability, and predictability of psychiatric "diagnosis" is important. Investigations repeatedly reveal psychiatric diagnosis has no reliability or validity.
In 1887 Nellie Bly (1867-1922), a newspaper reporter, feigned insanity to gain admission to New York's Blackwell's Island Insane Asylum. She described how she did it and what she saw at the Asylum in a book titled Ten Days in a Mad House (available from amazon.com and free on the Internet). "I had little belief in my ability to deceive the insanity experts," she wrote in Chapter 1, and in Chapter 2, "to be examined by a number of learned physicians who make insanity a specialty, and who daily come in contact with insane people! How could I hope to pass these doctors and convince them that I was crazy?" In Chapter 6, while at Bellevue Hospital, after it was apparent she had succeeded, before her transfer to Blackwell's Island, she wrote: "And so I passed my second medical expert. After this I began to have a smaller regard for the ability of doctors than I ever had before, and a greater one for myself. I felt sure now that no doctor could tell whether people were insane or not".
In chapter 7, listening to Tillie Mayard, a fellow patient at Bellevue Hospital, who had just found out she was in an insane asylum, after being told she was going to a "convalescent ward to be treated for nervous debility", Nellie Bly heard Ms. Mayard say to a doctor, "If you know anything at all you should be able to tell that I am perfectly sane. Why don't you test me?" Bly said the doctor "left the poor girl condemned to an insane asylum, probably for life, without giving her one feeble chance to prove her sanity." In Chapter 8, Bly describes this same Tillie Mayard pleading with a doctor after arriving at Blackwell's Island Insane Asylum:
I could hear her gently but firmly pleading her case. All her remarks were as rational as any I ever heard, and I thought no good physician could help but be impressed with her story. ... She begged that they try all their tests for insanity, if they had any, and give her justice. Poor girl, how my heart ached for her! I determined then and there that I would try by every means to make my mission of benefit to my suffering sisters; that I would show how they are committed without ample trial.
Of herself, Bly wrote in Chapter 1, "From the moment I entered the insane ward on the Island, I made no attempt to keep up the assumed role of insanity. I talked and acted just as I do in ordinary life. Yet strange to say, the more sanely I talked and acted, the crazier I was thought to be by all except one physician, whose kindness and gentle ways I shall not soon forget." Of her own departure from Blackwell's Island, after intervention by her editor, she said:
I left the insane ward with pleasure and regret - pleasure that I was once more able to enjoy the free breath of heaven; regret that I could not have brought with me some of the unfortunate women who lived and suffered with me, and who, I am convinced, are just as sane as I was and am now myself.
A similar experiment was done in the 1970s by Stanford University psychology professor David Rosenhan and his colleagues and published in the January 19, 1973 issue of Science magazine ("On Being Sane in Insane Places", Vol. 179, pp. 250-258). Dr. Rosenhan and seven of his colleagues who had no history of or evidence of mental illness, called "pseudopatients" in the study, went to 12 different psychiatric hospitals on the East and West coasts of the U.S.A. as inpatients where they remained as long as 52 days. They found that no matter how normally they behaved they were not recognized as normal by the psychiatrists and other mental health professionals they came in contact with. Despite being normal, all were prescribed psychiatric drugs: "All told, the [eight] pseudopatients were administered nearly 2100 pills, including Elavil, Stelazine, Compazine, and Thorazine", which undermines the commonly held belief psychiatric drugs are given only to people who need them. (A more important question is whether anybody needs psychiatric drugs: See Peter Breggin, M.D., Psychiatric Drugs - Hazards to the Brain (Springer 1983) or Brain Disabling Treatments in Psychiatry, Second Edition (Springer 2008) or Joanna Moncrieff, M.D., The Myth of the Chemical Cure - A Critique of Psychiatric Drug Treatment (Palgrave Macmillan 2007). When the results of this experiment were revealed to the psychiatrists and other staff members of another psychiatric hospital, they "doubted that such an error could occur at their hospital." Dr. Rosenhan said "The staff was informed that at some time during the following 3 months, one or more pseudopatients would attempt to be admitted into the psychiatric hospital." During that time the hospital staff identified "Forty-one patients...with high confidence, to be pseudopatients ... Twenty-three were considered suspect by at least one psychiatrist. ... Actually," said Dr. Rosenhan, "no genuine pseudopatient (at least not from my group) presented himself during this period." Dr. Rosenhan concluded the inability of psychiatrists and other mental health professionals to distinguish normal persons such as himself and his colleagues from true mental patients is "frightening." He said:
How many people, one wonders, are sane but not recognized as such in our psychiatric institutions? How many have been needlessly stripped of their privileges of citizenship, from the right to vote and drive to that of handling their own accounts? How many have feigned insanity in order to avoid the criminal consequences of their behavior, and conversely, how many would rather stand trial than live interminably in a psychiatric hospital but are wrongly thought to be mentally ill? How many have been stigmatized by well-intentioned, but nevertheless erroneous, diagnoses?
In his book Psychiatry - The Science of Lies (Syracuse University Press 2008, pp. 67-68), psychiatry professor Thomas Szasz, M.D., says "The assertion rests on an erroneous premise, namely, that the doctors were interested in distinguishing insane inmates properly committed from sane inmates falsely detained. The whole history of psychiatry belies this assumption. ... each time experience was consulted, it showed that the experts were unable to distinguish the sane from the insane".
The following described study titled "Suggestion Effects in Psychiatric Diagnosis" by psychologist Maurice K. Temerlin, Ph.D., was published in The Journal of Nervous and Mental Disease in 1968 (Vol. 147, No. 4, pp. 349-353): "In order to explore interpersonal influences which might affect psychiatric diagnosis, psychiatrists, clinical psychologists and graduate students in clinical psychology diagnosed a sound-recorded interview with a normal, healthy man." When a group of psychiatrists, psychologists, and psychology graduate students heard the tape-recorded interview after introductory remarks by "a professional person of high prestige" saying the interview was with a perfectly healthy man, the "psychologists, psychiatrists, and graduate students agreed unanimously." When the tape-recording was heard by a group of psychiatrists, psychologists, and psychology graduate students after introductory remarks by "a professional person of high prestige" saying the recorded interview was with a man who "'looked neurotic but actually was quite psychotic' ... diagnoses of psychosis were made by 60 per cent of the psychiatrists, 28 per cent of the clinical psychologists, and 11 per cent of the graduate students", even though they had listened to the same tape-recording. This study like others shows psychiatric "diagnosis" has no reliability and no validity.
It is probably because nothing can be found wrong in the body including brain of supposedly mentally ill people, and because psychiatry has no biological tests distinguishing people who have so-called mental illnesses from those who do not, and therefore has no genuine illnesses or diseases to describe or "diagnose", that the American Psychiatric Association calls its manual the "Diagnostic and Statistical Manual of Mental Disorders", not the "Diagnostic and Statistical Manual of Mental Illnesses" nor the "Diagnostic and Statistical Manual of Mental Diseases". Even calling it a "diagnostic" manual is pretentious and factually incorrect if true diagnosis indicates the cause of a problem. The "diagnoses" in the DSM do not do that. The DSM is a manual of descriptions, not diagnoses. It could be more accurately named the American Psychiatric Association's "Mental Disorders Description Manual", or even more candidly, the American Psychiatric Association's "Disapproved Behavior Description Manual".
THE DSM IS A MANUAL OF DESCRIPTIONS, NOT DIAGNOSES
The word "disorder" is the word "order" with the prefix "dis-", which means the opposite of. "Disorder" therefore is the opposite of order. To say something is "dis"-order is to say the opposite is proper. But who is to say what is proper behavior? Is it right for a private unelected organization to decide what behavior is permitted? Isn't that the responsibility of democratically elected law makers or legislators? Why should a private unelected organization such as the American Psychiatric Association (APA) be empowered to say what behavior is allowed and what behavior is prohibited in America or anywhere else? Who are they? Does the fact that the APA defines as "Hording Disorder" the keeping so many belongings in your house or apartment they "congest and clutter active living areas and substantially compromises their intended use" (DSM-5, p. 247) mean you don't have a right to keep as many belongings in your home as you want? This isn't merely theoretical: I have a video court reporter record (on DVD) of a 72 year old man in Vancouver, Washington who was placed under an involuntary guardianship in 2011 in large part because he was said to have a "hording disorder." An article in Carol's Home News (October 2011, p. 2) says "Are you a night owl? ... It's not laziness, or simple insomnia, but a condition doctors call Delayed Sleep Phase (DSP) Disorder." In DSM-5, published a year and half after the quoted article, it is called one of the "Circadian Rhythm Sleep-Wake Disorders" (p. 390), specifically "Delayed Sleep Phase Type". It is defined as "a history of a delay in the timing of the major sleep period (usually more than 2 hours) in relation to the desired sleep and wake-up time", even though "When allowed to set their own schedule, individuals with delayed sleep phase type exhibit normal sleep quality and duration for age" (p. 391). Does a group of doctors deciding going to sleep at 4 a.m. and sleeping until noon is a disorder mean you don't have the right to sleep the hours you want? Should you be subjected to involuntary treatment if you do? Legislators' delegation of their law-making power to a private organization such as the American Psychiatric Association or to individual physicians, as legislators have with laws authorizing involuntary "hospitalization" or involuntary outpatient "treatment" of people whose behavior or expression of ideas (or sleep schedule) falls within a category of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is an arguably illegal, unconstitutional delegation of legislative authority.
Persons no less authoritative than the chairpersons of groups that created the third and fourth editions of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, and their revisions (DSM-III, DSM-III-R, DSM-IV and DSM-IV-TR) have admitted the scientific invalidity their own (supposedly) diagnostic systems. In the Foreword to The Loss of Sadness - How Psychiatry Transformed Normal Sorrow Into Depressive Disorder by Alan V. Horwitz, Ph.D., and Jerome C. Wakefield, Ph.D., D.S.W. (Oxford University Press 2007, pp. vii-viii), Robert L. Spitzer, M.D., Professor of Psychiatry at New York State Psychiatric Institute says this:
I was the head of the American Psychiatric Association's task force that in 1980 created the DSM-III (i.e., the third edition of the Diagnostic and Statistical Manual of Mental Disorders, the Association's official listing of recognized mental disorders and the criteria by which they are diagnosed). ... the very success of the DSM and its descriptive [as opposed to diagnostic] criteria at a practical level has allowed the field of psychiatry to ignore some basic conceptual issues that have been lurking at the foundation of the DSM enterprise, especially the question of how to distinguish disorder from normal suffering. ... My involvement in an earlier debate over whether to remove homosexuality from DSM-II in 1973 led me to grapple with the question of how to define mental disorder. I formulated the definitions of mental disorder in the introductions to the DSM-III, the DSM-III-R (the DSM's third edition revised), and the DSM-IV, which aim to explain the reasons that certain conditions were included in and other types of problems excluded from the Manual. Since then, Dr. Wakefield has critiqued my efforts in ways that I have largely become convinced are valid.
Allen Frances, M.D., was chairperson of the American Psychiatric Association's DSM-IV Task Force, making him the lead author and editor of DSM-IV (1994) and DSM-IV-TR (2000). Psychologist Paula Caplan, Ph.D., in her presentation at the 2012 National Association for Rights Protection and Advocacy Conference, accused Dr. Frances of being the single person most responsible for the pathologizing of normality in psychiatry (at least, prior to the publication of DSM-5). However, in a series of articles criticizing the newest version, DSM-5, many of them available at psychologytoday.com and psychiatrictimes.com and elsewhere on the Internet, Dr. Frances has vigorously criticized the lack of science and the pathologizing of normality in DSM-5, much of the time seemingly overlooking the fact that many of his criticisms are equally true of DSM-IV and DSM-IV-TR for which he as much as anyone is responsible. Many silly supposed diagnoses in DSM-5 are also found in DSM-IV and DSM-IV-TR: I'll be giving you examples later in this essay. At other times, however, Dr. Frances has accepted responsibility for the psychiatric pathologizing of normal people. In a lecture at the University of Toronto on May 6, 2012, Dr. Frances said "I'm responsible for some of these changes, and in some cases I'm not too proud of the results ... mea culpa ... We're giving too much treatment to people who don't need it" ("Allen J. Frances on the overdiagnosis of mental illness", YouTube.com, at 2:55, 11:00 & 29:30). In his book Saving Normal - An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, Dr. Frances says his own DSM-IV "probably resulted in more harm than good ... DSM-IV did not save normal, or even protect it very well. ... Our [the DSM-IV Task Force's] changes contributed directly to the false epidemics of autistic, attention deficit, and adult bipolar disorder, and we did nothing to prevent the overdiagnosis of several other disorders" (HarperCollins 2013, pp. xiv, 73, 75). On November 8, 2011 he said "Since the DSM-5 suggestions will all broaden the definition of mental disorder, why should we not worry about diagnostic inflation and the massive mislabeling of normal people as mentally ill?" ("APA Responds Lamely to the Petition to Reform DSM-5", psychiatrictimes.com, bold print in original). In an article titled "The User's Revolt Against DSM-5: Will It Work?", psychiatrictimes.com, on November 10, 2011, Dr. Frances wrote "When it comes to DSM-5, experience has proven conclusively that the American Psychiatric Association (APA) will not attend to the science, evaluate the risks, or listen to reason. A user's revolt has become the last and only hope for derailing the worst of the DSM-5 suggestions. ...DSM-5 is such a mess."
Let's look at examples of what Dr. Frances is talking about that show how unbelievably broad he and his colleagues and successors at the American Psychiatric Association have made the concept of mental illness or disorder. Open almost any page of DSM-5 and it becomes apparent the psychiatrists and others who wrote it appended the term "disorder" or "syndrome" to the words or phrases that describe almost all of life's ordinary and normal problems, challenges, and temptations, regardless of how minor. In addition to carrying forward supposed disorders in DSM-IV-TR few persons outside psychiatry would consider mental illness or disorder, DSM-5 creates more.
One of the new mental disorders created with the publication of DSM-5 in 2013 is "Tobacco Use Disorder". You probably never thought a person who enjoys smoking cigarettes, pipes, or cigars, or using chewing tobacco has a mental disorder for only that reason, but now that DSM-5 has been published, they do. The "Diagnostic Criteria" for "Tobacco Use Disorder" (p. 571) say a person has the disorder (or illness?) if he or she manifests at least 2 of 11 criteria. The first 4 of the 11 are: "1. Tobacco is often taken in larger amounts or over a longer period than was intended."; "2. There is a persistent desire or unsuccessful efforts to cut down on or control tobacco use"; "3. A great deal of time is spent in activities necessary to obtain or use tobacco"; "4. Craving, or a strong desire or urge to use tobacco." Probably all tobacco users qualify as mentally disordered under these criteria.
In DSM-IV-TR (p. 631) and DSM-5 (p. 404), nightmares that cause you distress qualify you as having a mental disorder. In DSM-5 "Nightmare Disorder" is defined as "Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity" even if "On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert" if "The sleep disturbance causes clinically significant distress..."
Going to bed late and sleeping late is a "Circadian Rhythm Sleep Disorder...Delayed Sleep Phase Type" in both DSM-IV-TR (2000, p. 622) and DSM-5 (2013, pp. 390-391), but what if you're an early riser? Might that also be a "disorder"? Yes, in this case the diagnosis (actually description) is "Circadian Rhythm Sleep-Wake Disorder ... Advanced Sleep-Wake Type" (DSM-5, p. 393; in DSM-IV-TR, p. 624, it is one of the "Unspecified Type" Circadian Rhythm Sleep Disorders). DSM-5 says "Advanced sleep phase type is characterized by sleep-wake times that are several hours earlier than desired or conventional times" and that "Individuals with advanced sleep phase type are 'morning types'" (p. 393). According to psychiatry's current "diagnostic" standards, if you don't sleep and wake up at "conventional times" you have a mental disorder.
Lying or malingering is not just a moral problem but is "Factitious Disorder" in both DSM-IV-TR (p. 517) and DSM-5 (pp. 324-325).
In DSM-5 (p. 462) the criteria for "Oppositional Defiant Disorder", a supposed disorder in children, include "Often loses temper. ... Is often touchy or easily annoyed. ... is often angry and resentful" but only "with at least one individual who is not a sibling." In DSM-5, arguing with siblings is okay, but if you are a child, arguing with a parent or an adult means you have a mental disorder. Oppositional Defiant Disorder also appears in DSM-IV-TR (p. 102) but without the exemption for arguing with siblings.
Becoming angry too often is "Intermittent Explosive Disorder" in DSM-IV-TR (p. 663) and DSM-5 (p. 466).
Do you or have you ever suspected your spouse or intimate partner of infidelity? In that case you have or had "Obsessional jealousy", a subtype of "Other Specified Obsessive-Compulsive and Related Disorder" defined as "nondelusional preoccupation with a partner's perceived infidelity" (pp. 263-264). No, that's not a misprint: This particular disorder is defined as "nondelusional", but it is still a mental disorder in DSM-5, as if a person should not care very much about a spouse's or intimate partner's infidelity.
Do you often like to get yourself a midnight snack? In that case you have "Night eating syndrome" defined as "Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal" (DSM-5, p. 354).
In DSM-5, "General Personality Disorder" (p. 646) is defined as "An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture." What does conformity with the expectations of the individual's culture have to do with health?
Consider "Social Anxiety Disorder (Social Phobia)": DSM-5 (pp. 203) says "The essential feature of social anxiety disorder is a marked, or intense, fear or anxiety of social situations in which the individual may be scrutinized by others" one example being "performing in front of others (e.g., giving a speech)." DSM-5 (p. 203, bold print in original) says "Specify if: Performance only: If the fear is restricted to speaking or performing in public." That used to be called "stage fright". Now it is, supposedly, a mental disorder. Stage fright is uncomfortable, but is it a "disorder"? Isn't it normal?
According to Tony Dokoupil in his article "Is the Onslaught Making Us Crazy?", (Newsweek, July 16, 2012, p. 24 at 27-28):
When the new DSM [DSM-5] is released next year , Internet Addiction Disorder will be included for the first time, albeit in an appendix tagged "for further study." China, Taiwan, and Korea recently accepted the diagnosis, and began treating problematic Web use as a grave national health crisis. ... two psychiatrists in Taiwan made headlines with the idea of iPhone addiction disorder.
"Internet Addiction Disorder" does not appear in the index of the final published edition of DSM-5, and I'm not finding it anwhere in the book. In Saving Normal (p. 225), Dr. Frances says "DSM-5 finally did back down on many of its worst suggestions when these were scorched in the press." While the DSM-5 Task Force may have been shamed or ridiculed out of the idea of Internet Addiction Disorder, "Internet Gaming Disorder" does appear in DSM-5 as a proposal requiring further study. The "Proposed Criteria" for Internet Gaming Disorder (pp. 795-796) are as follows:
Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) of the following in a 12 month period:As mentioned in the above proposed criteria for Internet Gaming Disorder, "Gambling Disorder" also appears in DSM-5, and not merely as one of the "Conditions for Further Study". Gambling Disorder is listed in DSM-5 (pp. 585-589) as a 100% valid and not merely proposed mental disorder. In DSM-IV-TR (2000) it was called "Pathological Gambling" (p. 671). Gambling Disorder in DSM-5 has "Diagnostic Criteria" that are similar to those for internet Gaming Disorder: "Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress ... Has made repeated unsuccessful efforts to control, cut back, or stop gambling. ... Lies to conceal the extent of involvement with gambling" (etc.)
1. Preoccupation with Internet games. (The individual thinks about previous gaming activity or anticipates playing the next game; Internet gaming becomes the dominant activity in daily life).
Note: This disorder is distinct from Internet gambling, which is included under gambling disorder.
2. Withdrawal symptoms when Internet gaming is taken away. (These symptoms are typically described as irritability, anxiety, or sadness, but there are no physical signs of pharmacological withdrawal.)
3. Tolerance - the need to spend increasing amounts of time engaged in Internet games.
4. Unsuccessful attempts to control the participation in Internet games.
5. Loss of interests in previous hobbies and entertainment as a result of, and with the exception of, Internet games.
6. Continued excessive use of Internet games despite knowledge of psychosocial problems.
7. Has deceived family members, therapists, or others regarding the amount of Internet gaming.
8. Use of Internet games to escape or relieve a negative mood (e.g., feelings of helplessness, guilt, or anxiety).
9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in Internet games.
Note: Only nongambling Internet games are included in this disorder. Use of the Internet for required activities in a business or profession is not included, nor is the disorder intended to include other recreational or social Internet use. Similarly, sexual Internet sites are excluded.
In an article published on psychiatrictimes.com on August 14, 2012, Dr. Frances says this:
DSM-5 proposes to introduce a category of "Behavioral Addictions," with gambling as the first member and Internet addiction standing next in line to become a possible second. Behavioral Addictions could eventually easily expand to include passionate attachments to many other common activities. If we can be addicted to gambling and the Internet, why not also include addictions to shopping, excise, sex, work, golf, sunbathing, model railroading, you name it? All passionate interests are at risk for redefinition as mental disorders. ... It should not be counted as a mental disorder and be called an "addiction" just because you really love an activity, get a lot of pleasure from it, and spend a lot of time doing it. ... It is not "addiction" whenever someone gets into trouble because of over-spending, golfing too much, or having repeated sexual indiscretions. That's our human nature, derived from many millions of years of evolutionary experience...
The title of the above quoted article is "Internet Addiction - The Next New Fad Diagnosis". In his book Saving Normal, Dr. Frances says "Fads in psychiatric diagnosis come and go. All of a sudden everyone seems to have the same problem. Quack theories explain the outbreak; quack treatments presume to provide cure. ... psychiatric diagnosis has always been, and still is, so faddish" (pp. 117 & 136). Harvard psychiatry professor Blaise A. Aguirre, M.D., makes a similar observation in his book Borderline Personality Disorder in Adolescents (Fair Winds Press 2007, p. 15):
Psychiatric diagnoses appear to be like cultural fads that come and go. There was a time in child and adolescent psychiatry when everyone had post-traumatic stress disorder (PTSD), and then everyone had bipolar disorder, then Asperger's syndrome, and surely the next big diagnosis will come and go.
Can you imagine a physician saying "There was a time in medicine when we diagnosed everyone as having cancer, and then we started diagnosing everyone as having heart disease, and then we decided everyone had diabetes"? Dr. Aguirre blames "problems in diagnosing psychiatric disorders and the general absence of accurate diagnostic tools and procedures" in psychiatry (Id).
Appearing for the first time in DSM-5 is a childhood disorder called "Disinhibited social Engagement Disorder" (DSM-5, pp. 268-270). Like Gambling Disorder, General Personality Disorder, and Social Anxiety Disorder, Disinhibited Social Engagement Disorder is listed as a 100% valid and not merely proposed mental disorder. According to DSM-5, "The essential feature of disinhibited social engagement disorder is a pattern of behavior that involves culturally inappropriate, overly familiar behavior with relative strangers (Criterion A)." The "Diagnostic Criteria" for this supposed disorder are as follows:
A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:Such supposedly diagnostic criteria obviously have nothing to do with real illness, disease, disorder, or any biological problem and are only deviance from what is considered wise or expected behavior, along with psychological theorizing about how a young person learned to behave this way. Frequent changes in adult care givers, making a young person too comfortable with new, unfamiliar adults, becomes "pathogenic".
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
3. Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
B. The behaviors in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behavior.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
3. Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
E. The child has a developmental age of at least 9 months.
The lack of anything abnormal from a biological perspective is also apparent in the sex-related "diagnoses" in DSM-5, some of which are amusing:
DSM-5 includes "Voyeuristic Disorder", defined as "recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors" (p. 686). Perhaps this could have been called Peeping Tom Disorder. (If manifested only by fantasies or urges, and not actual behavior, it could and I think should be considered a type of Orwellian thought crime.)
Exhibitionism, a relatively minor sex crime that is still found in the penal codes of many states of the U.S.A., is now a mental disorder. In DSM-5, "Exhibitionistic Disorder" is defined as "recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting person" (p. 689).
DSM-5 defines "Frotteuristic Disorder" as "recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person" (p. 691). In DSM-IV-TR it was called "Frotteurism" (p. 570). When I was a teenager this was called "copping a feel". Now it's a mental disorder.
If Frotteurism or Frotteuristic Disorder is a diagnosable mental disorder, why isn't rape? In fact that proposal has been made. In Whores of the Court The Fraud of Psychiatric Testimony and the Rape of American Justice (Harper Collins 1997, p. 286) psychology professor Margaret A. Hagen, Ph.D., says the "American Psychiatric Association almost put the 'uncontrollable' desire to rape in the last DSM as a mental disorder. Perhaps it will make it into the next [fifth] edition." It didn't, but if rape ever does make it into a future edition of the DSM, maybe it will be called Paraphilic Rape Disorder. DSM-5 says "The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners" (p. 685, which after the American Psychiatric Association vote de-illness-izing homosexuality in December 1973 may be of either sex). Rape has in fact been called "Paraphilia Not Otherwise Specified, Nonconsent" by some psychologists: According to psychiatrist Allen Frances, M.D., "The proposal to create a mental disorder for rapists has been raised and unequivocally rejected 5 times" by the writers and editors of various editions of the DSM but "These repeated repudiations haven't prevented poorly trained psychologists testifying as alleged experts ... inventing the fake diagnosis 'Paraphilia Not Otherwise Specified, Nonconsent' and using it as an excuse to justify what are in fact unjustifiable psychiatric commitments" ("DSM-5 Confirms That Rape Is Crime, Not Mental Disorder", psychiatrictimes.com, February 23, 2013). However, there isn't much logic in including Frotteuristic Disorder and not Rape Disorder as a "diagnosis", so the reason we have Frotteuristic Disorder and not Rape Disorder in the DSM is probably more political and strategic than scientific: Defining rape as a mental disorder would get too much attention and discrediting news media coverage. It also would mean rapists are by definition mentally ill or disordered and therefore not criminally responsible for their crimes (and might cause legislators dumb enough to take psychiatric "diagnosis" seriously to delete rape from state criminal codes!)
Comedians will find a treasure trove of material in DSM-5.
Dr. Frances' criticisms were for the most part ignored, and as the 2013 publication date for DSM-5 approached, in an article published February 13, 2013, Dr. Frances said this ("DSM5 in Distress", psychologytoday.com):
DSM 5 remains a reckless and poorly written document that will worsen diagnostic inflation, increase inappropriate treatment, create stigma, and cause confusion among clinicians and the public. ... My view is that DSM 5 has taken a fatal hit internationally and is greatly discredited in the US. ... My mission now changes. The people working on DSM 5 are no longer my primary audience... My main job now is to alert the public and clinicians on ways to contain diagnostic exuberance and to fight back against excessive and misdirected treatment for people who are essentially normal.
Psychologist Paula Caplan, Ph.D., on February 11, 2012 on "MindFreedom (MF) Live Free Web Radio: Paul Caplan v. Psychiatric Labeling!" (archived at blogtalkradio.com, at the 12 minute, 58 second point), said this about the DSM:
I started out as an advocate of the DSM because I believed their advertising, that it was scientifically grounded, and that it would help us help people, so that's why I was in that kind of work. And then when I was on two committees of DSM-IV, I was just horrified. One of my specialties is research methods, and I was appalled to see that when the science is good, but it doesn't fit with what they want, then they ignore it, they distort it, or they lie about it. And when the science is awful, I mean just poorly done, then they'll use that, if it fits with what they want to do.
In his book Psychiatry: The Science of Lies (Syracuse University Press 2008, pp. 18-19) psychiatry professor Thomas Szasz, M.D., says "Modern psychiatry with its Diagnostic and Statistical Manuals of nonexisting diseases and their coercive cures is a monument to quackery on a scale undreamed of in the annals of medicine."
Psychiatrist Ronald W. Pies, M.D., in an article titled "Can Psychiatry be Both A Medical Science and A Healing Art? The Case of Polythetic Pluralism", published October 19, 2011, at psychiatrictimes.com, said this:
...the last two DSMs [DSM-III and IV] can hardly be seen as exemplars of instantiations of "the medical model." As McHugh and Slaveney point out, DSM-III was primarily interested in enhancing diagnostic reliability - essentially, agreement on diagnosis among observers - and not in establishing the biological validity of any condition. Nor have biological factors been a central (or even a peripheral) part of DSM criteria from DSM-III to the expected DSM-5. [italics in original]
Similarly, Robert L. Spitzer, M.D., Chairperson of the American Psychiatric Association's Task Force on Nomenclature and Statistics in the Introduction to DSM-III (1980, p. 8) says this:
Diagnostic Criteria. Since in DSM-I, DSM-II, and ICD-9 [International Classification of Diseases, 9th edition] explicit criteria are not provided, the clinician is largely on his or her own in defining the content and boundaries of the diagnostic categories. In contrast, DSM-III provides specific diagnostic criteria as guides for making each diagnosis since such criteria enhance interjudge reliability. It should be understood, however, that for most of the categories the diagnostic criteria are based on clinical judgment, and have not yet been fully validated by data... [bold print in original, italics added]
Similarly, in his book Saving Normal, DSM-IV and DSM-IV-TR Task Force Chairperson Allen Frances says "Reliability means agreement and consistency - will different clinicians seeing the same patient arrive at the same diagnosis. Validity means truth" (Harper Collins 2013, p. 25). In an article in 2011 he says "For no apparent reason, the [DSM-5] field trials address the (really who cares) question of reliability and will offer nothing at all on the (really essential) questions of validity" ("DSM5 in Distress", psychologytoday.com, November 8, 2011).
Dr. Frances is right on this point: Only validity (truth) matters. If all the observers are wrong, their determinations or "diagnoses" have zero percent validity even if they have 100% agreement and therefore 100% "reliability". For example, at the time of the witch trials, inquisitors familiar with the criteria in the Malleus Maleficarum, a manual describing the characteristics of witches, might have had 100% agreement on who was a witch, but because witchcraft was a myth, and there were in fact no witches, their determinations that certain persons were witches had zero percent validity even if 100% of them were in agreement, and they therefore had 100% "reliability". This is the situation in which modern psychiatry, and those subjected to psychiatric "diagnosis" and "treatment", find themselves: The concept of mental "illness" or "disorder" is as invalid as the concept of witchcraft at the time of the witch trials. Some critics have argued that the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders is similar to the Malleus Maleficarum. For example, in his essay "Notes on Psychiatric Fascism" Don Weitz says "The DSM is the equivalent of the Malleus Maleficarum in the middle ages, which Spanish inquisitors used to identify, target, stigmatize and burn witches and heretics" (antipsychiatry.org/weitz2.htm, accessed June 10, 2013).
THE CONCEPT OF MENTAL "ILLNESS" OR "DISORDER"
IS AS INVALID AS THE CONCEPT OF WITCHCRAFT
AT THE TIME OF THE WITCH TRIALS
According to U.S. National Institute of Mental Health (NIMH) director Thomas Insel, M.D., in an article published on the NIMH web site on April 29, 2013, "The strength of each of the editions of DSM has been 'reliability' each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity." For this reason, he says, the "NIMH will be re-orienting its research away from DSM categories" ("Director's Blog: Transforming Diagnosis", nimh.nih.gov). No less than America's preeminent mental health government agency has rejected American Psychiatric Association DSM "diagnosis".
Unfortunately, Dr. Insel seeks to substitute an equally invalid approach: In the same article he says "Mental disorders are biological disorders involving brain circuits" and that the NIMH will seek to create "a new nosology" that is more scientific than that of the DSM, one based on biological factors. Because the defining characteristic of a mental "illness" or "disorder" is merely disapproval, and biology is no more the cause of mental illnesses or disorders than electronics are the cause of bad television programs, this NIMH effort is doomed to failure.
Contrary to Dr. Insel's observation, the DSM-5 interjudge "reliability" results were actually poor, at least in the opinion of DSM-IV and DSM-IV-TR Task Force chairperson Allen Frances, M.D. In his book Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (Harper Collins 2013, p. 175) Dr. Frances says this:
APA [American Psychiatric Association] flunked - instead of admitting that its reliability results were unacceptable and seeking the necessary corrections that might meet historical standards, the goalposts were moved. Declaring by fiat that previous expectations were too high, DSM-5 announced it would accept agreements among raters that were sometimes barely better than two monkeys throwing darts at a diagnostic board.
In an article titled "A Response to 'How Reliable Is Reliable Enough?'" published at psychiatrictimes.com on January 18, 2012, Dr. Frances says-
In the past, "acceptable" meant kappas of 0.6 or above. ... For DSM-5, 'acceptable' reliability has been reduced to a startling 0.2-0.4. This barely exceeds the level of agreement you might expect to get by pure chance. ... Can "accepting" unacceptably poor agreement uphold the integrity of psychiatric diagnosis?
So actually DSM-5 "diagnosis" not only has no validity but also no "reliability".
Because of the lack general agreement in psychiatry exemplified by Dr. Frances' criticisms and rejection of DSM-5 "diagnosis" by the National Institute of Mental Health, and because of psychiatry's lack of scientific validity, psychiatric testimony does not meet legal criteria for acceptance as scientific or expert evidence in courts of law under either of the standards applied by courts in the U.S.A., namely, the "general acceptance" standard of Frye v. U.S., 293 F. 1013 (D.C. Cir. 1923) that is still used in some states, nor the scientific validity standard of Daubert v. Merrell Dow Pharmaceuticals, 509 U.S. 579 (1993) that applies in federal courts and other states of the U.S.A. Courts should recognize this and stop accepting psychiatric testimony. (See Frye standard in Wikipedia). Involuntary commitment law typically requires commitments be based on "competent psychiatric testimony". For example, Texas Constitution Article 1, Sec. 15-a provides that "No person shall be committed as a person of unsound mind except on competent medical or psychiatric testimony." However, there is no such thing as "competent psychiatric testimony" any more than there is, for example, "competent astrology testimony" or "competent palm reader testimony". In her book Whores of the Court The Fraud of Psychiatric Testimony and the Rape of American Justice (ReganBooks 1997, p. 99), Boston University psychology professor Margaret A. Hagen, Ph.D., says "Upon finishing graduate or medical school" mental health professionals "are not trained to perform the myriad tasks the legal system asks them to perform because no body of knowledge exists to support such training." She says testimony in court by mental health experts such as psychiatrists and psychologists "do not even come close to meeting the current criteria for admissibility as expert testimony demanded by our courts" (Id., p. 301), and -
When the law welcomes the astrologer into the courtroom as possessing the same status as the astronomer, when the court listens to the priest with the same critical judgment it applies to the testimony of the physicist, then and only then will the testimony of clinical psychologists about the formation and functioning of the human mind in general or in a particular individual make sense as expert testimony. [Id., p. 301]
Dr. Hagen laments the fact that "we buy the accreditation of psychiatry at medical schools as if it were on the same standing as any other medical specialty" notwithstanding the fact that it is not (Id., p. 303). She says "Judges and juries, the people alone, must decide questions of insanity, competence, rehabilitation, custody, injury, and disability without the help of psychological experts and their fraudulent skills" (p. 313). Of psychiatrists
and psychologists as "expert" witnesses in court she says "That courtroom diagnosticians ignore even the wispiest constraints of reality in reaching their diagnoses is truly frightening" (Id., p. 262). She says that by accepting psychiatrists and psychologists as expert witnesses in court, "Society has created its own monster" (Id., p. 310).
THERE IS NO SUCH THING AS "COMPETENT PSYCHIATRIC TESTIMONY" ANY MORE THAN THERE IS "COMPETENT ASTROLOGY TESTIMONY" OR "COMPETENT PALM READER TESTIMONY"
How much of a monster we have created by recognizing psychiatric and psychological "diagnosis" as valid when it is not is illustrated by Robyn M. Dawes, Ph.D., a psychology professor at Carnegie-Mellon University, former head of the psychology department at the University of Oregon, and former president of the Oregon Psychological Association, in his book House of Cards Psychology and Psychotherapy Built on Myth (Free Press 1994, p. 153-154). In his critique of psychological testing he says this:
I would like to offer the reader some advice here. If a professional psychologist is "evaluating" you in a situation in which you are at risk and asks you for responses to ink blots or to incomplete sentences, or for a drawing of anything, walk out of that psychologist's office. Going through with such an examination creates the danger of having a serious decision made about you on totally invalid grounds. ... Let me share an example of what can happen - it did happen.
He goes on to tell a true story of a young woman whose IQ he tested as 126, placing her in the ninety-fifth percentile, meaning her intelligence was superior to all but 5% of the population, who was determined to need involuntary commitment to a state mental hospital because of her interpretation of a single inkblot in what is known as the Rorschach inkblot test. While 40 of her 41 inkblot interpretations were reasonable, she thought inkblot number eight looked like a bear when it didn't to anybody else. Dr. Dawes says at a clinical staff meeting "the head psychologist displayed card number eight to everyone assembled and asked rhetorically: 'Does that look like a bear to you?'" On the basis of this one inkblot interpretation the young woman was "diagnosed" as schizophrenic and (italics are Dr. Dawes'): "The staff over my objection further agreed that if her parents were ever to bring her back, she should be sent directly to the nearby state hospital. ... she may well have been condemned to serve time in that snake pit on the basis of a single Rorschach response."
INVOLUNTARY COMMITMENT TO A MENTAL HOSPITAL
BECAUSE OF WHAT A PERSON SEES IN AN INKBLOT?
Because of such observations, Dr. Dawes says in the Preface, "My own decision to write this book has been motivated by two factors in particular: anger, and a sense of social obligation. ... far too much professional practice in psychology has grown and achieved status by espousing principles that are known to be untrue and by employing techniques known to be invalid." He agrees wholeheartedly with Boston University psychology professor Margaret A. Hagen (quoted above) about courtroom testimony by mental health professionals such as psychiatrists and psychologists, of which he says -
But are they really the experts they claim to be? ... Should their opinions be recognized in our courts as having any more validity than the opinions of anyone else? In particular, are their opinions any better than those of judges, who have been selected on the basis of their legal record to make tough social decisions? Can these mental health practitioners, for example, make a better determination of whether a young child has been sexually abused than can be made of a careful consideration of the evidence without considering their opinions?
These questions have been studied quite extensively, often by psychologists themselves. There is by now an impressive body of research evidence indicating that the answer to these questions is no. ... Professional psychologists and other mental health experts are often willing to testify, and they have a profound impact on others' lives in the absence of any evidence that what they do is valid. ... Lacking such evidence, [they] should be thrown out of court. [pp. 4, 25]
The absurdity of many of the so-called mental disorders in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders makes it seem the psychiatrists and others who wrote it did so as a joke, and (really!) I have often laughed heartily while looking through DSM-5. In fact, the laughs I've gotten while reading DSM-5 have been worth the $149 I paid for the book. However, the consequences of psychiatric and psychological "diagnosis" are often anything but a laughing matter. The authors of the various editions of the DSM including DSM-5 have written a ridiculous book, but their "diagnoses" are accepted as valid in American courts and elsewhere. Having one of the "mental disorders" in the DSM too often results in a life-changing psychiatric "diagnosis", a lifetime of incarceration or involuntary outpatient treatment, or loss of many of life's most important opportunities, such as admission to medical, law, or other school, or qualifying for licensure in a lucrative occupation, or being hired for a job.
This review of the lack of reliability and validity of psychiatric diagnosis and the absurd notions in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders shows psychiatric diagnosis has nothing to do with health, nothing to do with anything abnormal in the body including brain, nothing to do with science, often nothing to do with common sense, and everything to do with currently prevailing ideas about how a person ideally "should" be as perceived by the people who wrote the various editions of the DSM and those who use it for "diagnosis".
The bottom line is this: Psychiatric "diagnosis" is nonsense and should be ignored by all. Psychiatric "diagnosis" serving as the basis of state and federal laws and judgments of courts is the triumph of pseudoscience over justice.
Permission to reproduce is granted
provided the reproduction is accurate
and proper credit is given
The author is a volunteer (pro bono) attorney for the Law Project for Psychiatric Rights (psychrights.org) and may be reached at wayneramsay (at) mail (dot) com