Must read: Paula J. Caplan says the DSM has always done more harm than good

DSMs%201 4 1 - Must read: Paula J. Caplan says the DSM has always done more harm than good
More harm than good

Writing in the Washington Post, Paula Caplan recalls the story of a mother who had been labled bi-polar and put on psychiatric medication – when in fact her problems were more mundane. She was a new mother; she was sleep deprived; she was working full-time and caring for her dying grandmother.

Since the 1980s, Caplan said she has met hundreds of people given diagnoses that fit their symptoms but not their conditions: there was nothing wrong with their brains, just something wrong with their lives.

At a time when about half of all Americans get a psychiatric diagnosis at some point in their lifetimes, this isn’t just bound to happen: it’s guaranteed. The system of psychiatric diagnosis is set up in a way to encourage just this kind of mistake.

In the case of this particular patient, as with many others, the result was disastrous:

Over the next 10 months, the woman lost her friends, who attributed her normal mood changes to her alleged disorder. Her self-confidence plummeted; her marriage fell apart. She moved halfway across the country to find a place where, on her dwindling savings, she and her son could afford to live. But she was isolated and unhappy. Because of the drug she took for only six weeks, she now, more than three years later, has an eye condition that could destroy her vision.

“It would be less troubling,” Caplan writes, “if such diagnoses helped patients, but getting a label often hinders recovery. It can lead a therapist to focus on narrow checklists of symptoms, with little consideration for what’s causing the patient’s suffering.”

Or as Saybrook professor emeritus Art Bohart liked to put it: modern psychiatry would give anti-depressants to a woman living under the Taliban in Afghanistan, believing the problem to be her brain.

Caplan’s point is one that is often lost in the struggle over the DSM-V. Yes the DSM-V, with its bold attempt to pathologize so much more of life than ever before and its financial ties to the drug companies, is particularly egregious.

But in fact the entire DSM project itself is flawed. “I now believe that the DSM should be thrown out,” she writes.

An undeserved aura of scientific precision surrounds the manual: It has “statistical” in its title and includes a precise-seeming three- to five-digit code for every diagnostic category and subcategory, as well as lists of symptoms a patient must have to receive a diagnosis. But what it does is simply connect certain dots, or symptoms — such as sadness, fear or insomnia — to construct diagnostic categories that lack scientific grounding. Many therapists see patients through the DSM prism, trying to shoehorn a human being into a category.

People cannot be reduced to their symptoms. Good therapy acknowledges this. Bad therapy doesn’t.
Kaplan’s article provides much needed clarity in a larger struggle for the soul of mental health practice. Pass her article around.

— Benjamin Wachs

Remember that you can follow media coverage of the DSM-V with The New Existentialists.

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