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Why the Myth of Mental Illness Lives On (Part 2) – The Inadequacy of Rule of Law

Why the Myth of Mental Illness Lives On (Part 2) – The Inadequacy of Rule of Law

Wayne Ramsay, J.D.


In Part 1 of this essay (8/6/2019)1, I described several reasons the myth of mental illness persists: (1) the effects of repetition of the myth by many people over time, particularly by opinion leaders, (2) disapproval from others for anyone who questions widespread myths, including the myth of mental illness, (3) support for the myth stated by those perceived as experts — in this case psychiatrists, psychologists, and social workers, (4) the desire of some people to avoid personal responsibility for their actions and their lives, (5) there being more comfort in believing a myth than in acknowledging ignorance, and (6) drug companies using huge advertising budgets to perpetuate the myth of mental illness and biological theories of mental illness for the purpose of increasing psychoactive drug sales and maximizing drug industry revenues and profits.

Here in Part 2. I will focus on another of the most important reasons the myth of mental illness persists: the inadequacy of rule of law.

“Rule of law” is a sacred concept in American jurisprudence.  On the day she was sworn-in as a U.S. Supreme Court justice, Sonia Sotomayor spoke eloquently about how deeply and sincerely she believes in rule of law. With the exception of civil commitment and involuntary guardianship laws, American courts invalidate laws that fail to put people on notice of what is required or prohibited on the ground they are void for vagueness. An example is Papachristou v. City of Jacksonville wherein a unanimous U.S. Supreme Court overturned the decision of lower courts and declared a Jacksonville, Florida vagrancy ordinance unconstitutionally vague.  The Supreme Court said this:

This ordinance is void for vagueness, both in the sense that it “fails to give a person of ordinary intelligence fair notice that his contemplated conduct is forbidden by the statute,” and because it encourages arbitrary and erratic arrests and convictions.  Living under rule of law entails various suppositions, one of which is that “[all persons] are entitled to be informed as to what the State commands or forbids.”2

Judged by this standard, all laws authorizing civil commitment for mental illness, or involuntary guardianship (of adults), or other loss of rights because of supposed mental illness, are void for vagueness and unconstitutional because they do not allow people of ordinary intelligence to know in advance what behavior or expression of ideas or outward display of emotions may result in losing their liberty or civil rights because of a “diagnosis” of “mental illness” or mental incapacity.

One might argue the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) delineates what is and is not a mental disorder, and hence what speech and behavior is and is not allowed, and that therefore the DSM provides the constitutionally required notice of what the state commands or forbids. However, the “Cautionary Statement” at the beginning of DSM-IV-TR explicitly disclaims the manual provides guidance for legal purposes:

It is to be understood that inclusion here, for clinical and research purposes, of a diagnostic category such as Pathological Gambling or Pedophilia does not imply that the condition meets legal or other non-medical criteria for what constitutes mental disease, mental disorder, or mental disability.  The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments, for example, that take into account such issues as individual responsibility, disability determination, and competency.3

An introductory chapter in DSM-5, published in 2013, includes a similar disclaimer titled “Cautionary Statement for Forensic Use of DSM-5”:

...it is important to note that the definition of mental disorder included in DSM-5 was developed to meet the needs of clinicians, public health professionals, and research investigators rather than all of the technical needs of the courts and legal professionals.  ...  When DSM-5 categories, criteria, and textual descriptions are employed for forensic purposes, there is a risk that diagnostic information will be misused or misunderstood.  These dangers arise because of the imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical diagnosis.  In most situations, the clinical diagnosis of a DSM-5 mental disorder such as intellectual disability (intellectual developmental disorder), schizophrenia, major neurocognitive disorder, gambling disorder, or pedophilic disorder does not imply that an individual with such a condition meets legal criteria for the presence of a mental disorder or a specified legal standard (e.g., for competence, criminal responsibility, or disability).  For the latter, additional information is usually required beyond that contained in the DSM-5 diagnosis ...  assignment of a particular diagnosis does not imply a specific level of impairment or disability.  ...  Nonclinical decision makers should also be cautioned that a diagnosis does not carry any necessary implications regarding the etiology or causes of the individual’s mental disorder or the individual’s degree of control over behaviors that may be associated with the disorder.4

Even if the DSM is nevertheless accepted as a valid standard for legal judgments, it fails to provide the constitutionally required notice of what the state commands and forbids, failure to comply with which may result in forced treatment or loss of liberty, because the DSM does not state which supposed disorders justify involuntary commitment, or loss of civil rights, and which do not.

In The Manufacture of Madness in 1970, psychiatry professor Thomas S. Szasz, M.D., said, “psychiatry shows an unmistakable tendency to interpret all kinds of deviant or unusual behavior as mental illness.”5  When Dr. Szasz wrote those words, homosexuality was an example.  Would it have been appropriate to subject all homosexuals to involuntary treatment prior to the American Psychiatric Association’s vote in 1973 to de-designate homosexuality as a mental disorder? The DSM-II, published in 1968, said homosexuality was a mental disorder,6 but it did not say all homosexuals should be treated involuntarily if they refused treatment for their homosexuality.  However, it probably happened to homosexual adolescents whose parents were upset by their homosexuality. Some of those adolescents may even have been lobotomized (yes: lobotomized) as treatment for their homosexuality: In Psychosurgery—Damaging the Brain to Save the Mind in 1992, Joann Ellison Rodgers of The John Hopkins Medical Institutions says in the middle of the 20th Century:

Rapists, pedophiles, homosexuals, exhibitionists, and transvestites were all candidates for lobotomies. ...  Many lobotomies, for example, were performed on the institutionalized mentally ill to stop or limit ‘bizarre’ sexual behavior, which at that time meant masturbation, homosexuality, and for women, almost any overt desire for sexual release.

Similarly, in 2005 Emad N. Eskandar, M.D., G. Rees Cosgrove, M.D., and Scott L. Rauch, M.D., of Massachusetts General Hospital and Harvard Medical School said:

Psychiatric neurosurgery was first introduced as a treatment for severe mental illness by Egas Moniz in 1936.  ...  despite a lack of objective therapeutic benefit, psychiatric neurosurgery was enthusiastically adopted by practitioners of the day.  At the height of enthusiasm, psychiatric neurosurgery was recommended for curing or ameliorating schizophrenia, depression, homosexuality, childhood behavior disorders, criminal behavior and uncontrolled violence.7

Lobotomizing people as treatment for masturbation, homosexuality, or normal heterosexual desire is an example of harm caused by psychiatric “diagnosis” that is based on deviance from cultural norms or values rather than demonstrated biological abnormality.  It is also an example of why I call psychiatry evil.

I have uncovered no 21st Century reports of involuntary psychosurgery, but brain-damaging “medication” and electroshock are given to people over their objection every day in the U.S.A., either of which is capable of inflicting brain damage as severe as occurs with psychosurgery.


LOBOTOMY AS TREATMENT FOR HOMOSEXUALITY?


People are committed involuntary to mental hospitals every day in the U.S.A. because they have “suicidal ideation” despite the fact that neither the DSM nor civil commitment laws put people on notice they are allowed to think about some things but not other things.  Where is it written, even in the DSM, that Americans are not permitted to even think about ending their own lives—and that, if they do, loss of liberty may be the consequence?

This leaves aside the equally important question of whether the there is a right to freedom of thought under U.S.A.’s First Amendment (made applicable to the states by the Fourteenth Amendment), similar state constitutional provisions (e.g., Article 1, Section 8 of the Texas Constitution), or constitutional provisions in other countries, that should take precedence over psychiatry’s supposedly diagnostic (but actually only descriptive) classification system and the State’s statutory involuntary commitment criteria.

It should be obvious that one of the purposes of the DSM is to allow mental health professionals to bill health care insurance companies and government programs such as Medicare and Medicaid for virtually anything (which is one reason health care insurance premiums are exorbitant, and one reason health care and health care insurance are bankrupting the U.S. government and bankrupts many Americans).  Much normal human thinking and behavior at least arguably falls within a category of mental disorder in the DSM.  The supposedly diagnostic (but actually only descriptive) criteria in the DSM are so broad that many commentators and critics have correctly said there probably is no human being alive who falls within none of the DSM’s various categories of mental disorder, and most people meet the criteria for several psychiatric diagnoses simultaneously.  For example, “In court testimony, under oath, Jay Katz, a professor of psychiatry at Yale, admitted that ‘If you look at DSM-III you can classify all of us under one rubric or another of mental disorder’”.8 In his book The Hyperactivity Hoax, board-certified neurologist and psychiatrist Sydney Walker III, M.D., said:

The other major flaw of DSM, related to the first, is that it labels virtually everything as some type of disorder.  Thus, a child who sees a DSM-oriented doctor is almost assured of a psychiatric label and a prescription, even if the child is perfectly fine.9

According to Marcia Angell, M.D., Senior Lecturer in Social Medicine at Harvard Medical School and former editor-in-chief of The New England Journal of Medicine, in her endorsement on the dust cover of Dr. Allen Frances’ book, Saving Normal, Dr. Frances “was once the most influential psychiatrist in the country, as head of the task force that compiled the last [fourth] edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM)”.  Yet even this highly esteemed psychiatrist, Dr. Frances, says he “met many other friends working on DSM-5 who were similarly excited by their pet innovations and soon discovered that I personally qualified for many of the new disorders that were being suggested by them for inclusion for DSM-5.”10 Dr. Frances cites “a study that found 83 percent of kids qualify for mental disorder diagnosis by the time they are twenty-one.”11 In 2013 in their book Mad Science: Psychiatric Coercion, Diagnosis, and Drugs, three American professors of social work and social welfare said:

According to the latest American Psychiatric Association methods of diagnosing mental illness, nearly one hundred million people, 25 to 30 percent of the US population, have a mental illness during any one year, and half of the population will have a mental illness during their lifetime.12

Similarly, in 2011 Dr. Vernon Coleman, a British physician, wrote that “diagnostic symptomotology is so vague and far reaching that I could, without much difficulty, find some definable mental illness in every person in the UK.”13

In 1997 in Whores of the Court: The Fraud of Psychiatric Testimony and the Rape of American Justice, Boston University psychology professor Margaret A. Hagen, Ph.D., said:

The newest (1994) Diagnostic and Statistical Manual of Mental Disorders provides the civil litigant with literally hundreds of possible disorders, each neatly laid out with the necessary symptoms.  It is hard to imagine that anyone could live in today’s society and not be diagnosed with at least one of these many disorders.14


THE DSM LABELS VIRTUALLY EVERYTHING
AS SOME TYPE OF DISORDER


DSM-5 broadens the categories of mental disorder even more than DSM-III, DSM-IV or DSM-IV-TR.  According to Dusan Kecmanovic, professor of psychiatry and political psychology at Sarajevo University, “it will be difficult to be normal after the publication of DSM-5.”15  (Americans should keep this in mind when considering laws to keep guns out of the hands of “the mentally ill”: Since nearly everyone qualifies as mentally ill under current criteria, such laws could in application be a de facto repeal of the Second Amendment.)  In her book, The Trouble With Drug Companies, Dr. Marcia Angell says, “few psychiatric disorders have objective criteria for diagnosis”.16  Actually, none do.  The vague, unreliable, unpredictable, and invalid nature psychiatric diagnosis enables and encourages arbitrary “diagnosis” and arbitrary involuntary treatment.  That violates the constitutional standard stated by the Supreme Court in Papachristou.

The constitutional law requirement that government must tell you what is and is not allowed before it may do anything to you as a consequence of your failure to act as expected is only fair. That’s why the U.S. Supreme Court has declared it to be constitutionally required.

There is, however, a problem with this constitutional requirement, or said another way, there is a problem with rule of law: We can’t always anticipate and articulate, in advance, everything a human being might possibly say or do that other human beings, upon being made aware of it, will consider unacceptable.

This epiphany came to me in 1992 when I was sitting at a table in a restaurant in Manhattan with the woman I was dating at the time.  Our table was located next to a window on the other side of which was a sidewalk.  A man who looked like he was homeless put his face very close to the window as he stared at us, pointed at us, made funny faces, and did an odd sort of dance. His behavior was distracting and inappropriate, but how would one write a law prohibiting what he was doing?: Don’t look into or get too close to restaurant windows?  Don’t point at people?  Don’t make funny faces?  Don’t dance on the sidewalk?

Similarly, I once saw a man sleeping on the floor in a hotel corridor with his face against a dirty carpet.  At first I thought he might be dead, but after several seconds of observation I could see he was breathing. I advised the hotel front desk clerk who roused the man and told him he couldn’t sleep there and told him to go sleep in his hotel room.

The next day in a Subway Sandwich Shop a patron who looked like he was homeless began singing loudly and vastly off-pitch along with the music playing on speakers in the ceiling of the shop, disturbing everyone in the shop.

Examples abound in the evidence introduced at involuntary commitment and involuntary guardianship hearings.  After I think I’ve heard and seen everything, the behavior or ideas of a proposed patient in an involuntary commitment for supposed mental illness or of the proposed adult ward in an involuntary guardianship trial confronts me with yet another example of unacceptable thinking or behavior I wouldn’t have thought of had I been given the job of writing a state’s criminal code and other laws.  It is largely because of this difficulty that we have the concept of mental illness.

Sociologist Thomas Scheff has defined mental illness as “residual rule-​breaking”: “After crime,” wrote two of his critics, “perversion, drunkenness, bad manners, there are always those diverse grab-bag violations for which the culture has no explicit label—the ‘residual rules’ broken by those deemed mentally ill.”17 The concept of mental illness allows us, as a society, to impose sanctions, that is, punishment (called “therapy”) on law-abiding people who fail to live in accordance with our expectations about what conduct people should and should not engage in, and what beliefs or thoughts people should or should not express.  As psychiatry professor Thomas Szasz said in 1994, “when I grew up in Hungary—1920s, 1930s—it was very, very clear that psychiatry was essentially a jail function.  There were blue coated policemen and white coated policemen.”18 In "Mental Illness as Brain Disease: A Brief History Lesson," Dr. Szasz says “The contention that mental illness is brain disease is as old as psychiatry itself: it is an integral part of the grand lie that psychiatry is a branch of medicine and healing, when in fact it is a branch of the law and social control.”19

Similarly, in 2011 three authors including psychology professor Mark Rapley and psychiatrist Joanna Moncrieff call psychiatry “the enterprise of policing human conduct”.20

British psychiatrist Suman Fernando says “psychiatry...from the very beginning...has been concerned with social control.”21

In Madness—A Brief History, Roy Porter, Professor of the Social History of Medicine at the University College, London says “To many the psychiatrist seemed to have been reduced to acting as society’s policeman or gatekeeper, protecting it from the insane.”22 

The role of psychiatrists as police is also underscored by the subtitle of Louise Armstrong’s book And They Call It Help—The Psychiatric Policing of America’s Children.23

Blue-coated police enforce written laws.  White coated police—psychiatrists and those who work with them—enforce unwritten laws prohibiting thinking and behavior we either didn’t think to write a law against or choose not to (for reasons discussed below) or for which we just can’t find the right words (like my above examples).  Psychiatry’s roles as (1) part of the medical profession and (2) de facto police who enforce society’s unwritten laws are obfuscated and confused, resulting in violators of society’s unwritten laws not having the benefit of the protections that exist in criminal law.  Violating society’s unwritten laws is called mental illness or mental disorder.  The punishment is imprisonment called involuntary hospitalization and psychological and physical misery and brain damage caused by “involuntary medication” or involuntary electroconvulsive “therapy”.

Oddly, violators of our unwritten laws tend to be punished more harshly than those who violate our written laws: Would anyone advocate drug or electroshock induced brain damage as punishment for bank robbery or even murder?

New York (or whatever state’s) Penal Code
Punishment for a Class A misdemeanor shall be involuntary administration of a neurotoxic medication until brain damage and permanent neurological disease or disability including uncontrollable muscle movement (dyskinesia) is achieved.

Such a law would probably be declared a violation of the U.S. Constitution’s Eighth Amendment prohibition of cruel or unusual punishment. However, inflicting exactly this on a person becomes acceptable when administered as “therapy” for “mental illness,” and it is commonplace, even though mental “illness,” like crime, is nothing more than violating society’s (other people’s) rules.

Our current approach of calling prohibited thinking or behavior “mental illness” circumvents the difficult task of defining, in advance, what is and is not permitted, and it permits us to impose especially severe punishments.  It is easier to call people mentally ill and incarcerate and punish them with supposed treatment for their supposed mental illness than it is to anticipate everything people might do that is unacceptable and enact laws prohibiting the behavior.


PSYCHIATRISTS AND THEIR CO-WORKERS ARE
WHITE-COATED POLICE WHO ENFORCE SOCIETY’S UNWRITTEN LAWS


Sometimes belief in mental illness, or a pretense there is such a thing as mental illness, is the only way we can impose sanctions for disliked speech or behavior because, if we were to write laws clearly describing what is prohibited, it would be obvious we are violating the constitutional rights of the accused with such laws. For example, people are often forced into psychiatric “treatment”, including involuntary hospitalization, because of what they say rather than because of what they do.  Does this violate the First Amendment guarantee of freedom of speech?  Does the First Amendment protect only speech other people consider sane or rational?

Refusing to speak when other people think you should is another example. In 2011, I was an observer at an involuntary commitment hearing of a man whose “Selective Mutism” (rarely saying a word to anyone, DSM-IV-TR diagnosis 313.23)24 was his main supposed symptom of supposed mental illness, and at that hearing (after expiration of the time he could be held on a criminal charge) he was involuntarily committed to Kerrville State Hospital. In 1977, in Wooley v. Maynard, the U.S. Supreme Court said, “the right of freedom of thought protected by the First Amendment against state action includes both the right to speak freely and the right to refrain from speaking at all.”25  Texas Jurisprudence, a legal encyclopedia, says, “Liberty of silence is included by the guarantee of liberty of speech.”26  Because it would be unconstitutional, nobody is going to write a law saying you must speak with people. Nevertheless, engaging in normal conversation with those around you is an expectation nearly everyone has.  Therefore, mutism or selective mutism can become “mental illness” motivating involuntary “treatment” and did in this case despite the constitutional right to, in the U.S. Supreme Court’s words, “refrain from speaking at all.”  It is possible to incarcerate a person because he exercises a constitutional right such as refusing to talk if the ostensible or supposed reason is “mental illness” rather than the constitutionally protected action or inaction.

We could enact criminal laws against mutism, or unconventional religious or philosophical beliefs, or converting to a religion your family abhors, or loudly expressing nonreligious beliefs most people disagree with, or being grandiose or obnoxious, or revealing oneself to be excessively unhappy (“depressed”), or talking aloud to oneself with others present, or admitting to thinking about suicide, or attempting suicide.  We don’t, because writing such laws wouldn’t seem right.  In many cases such laws would be an admission of how narrow-minded, intolerant, authoritarian, and even despotic we sometimes are, including in nations like the United States of America where freedom is frequently touted as the reason for American patriotism. Frequently, such laws would be impossible to reconcile with America’s First Amendment guarantee of freedom in thought and expression or similar guarantees in other democracies and Article 19 of the United Nations Universal Declaration of Human Rights adopted by the United Nations General Assembly in Paris on December 10, 1948:

Everyone has the right to freedom of opinion and expression;  this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media...

State and federal laws authorizing civil commitment for mental illness in the United States of America and other nations routinely violate this right to freedom of opinion and expression.  Freedom of thought, opinion, and expression is respected in the U.S.A. if a person thinks Jesus is the Son of God but not if he thinks he is the Son of God, or if he thinks others are persecuting him (and others disagree), or if he thinks his life is not worth living (and others disagree), or if he has other thoughts other people consider crazy or bothersome.  As psychiatry professor Thomas Szasz wrote in 1973: “If you talk to God, you are praying; If God talks to you, you have schizophrenia.”27 We on the Western side of what was once (prior to the breakup of the USSR) called the Iron Curtain like to think of ourselves as freedom-loving people who uphold human rights.  The concept of mental illness permits us to violate our professed values about freedom and disregard the principal of rule of law without admitting to ourselves this is what we are doing.  It permits us to violate what the American Declaration of Independence of July 4, 1776 says are the God-given and unalienable rights of all men (and women): “...that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.”  The myth of mental illness permits us to deprive law-abiding people of their supposedly unalienable right to liberty and pursuit of happiness, and because of fatal effects of psychiatric “treatment” such as sudden death caused by neuroleptic “medications” effect on the heart, or neuroleptic malignant syndrome, or electroshock, or physical restraint (causing asphyxiation), sometimes even their right to life, by pretending we are “treating them for their mental illness.”  Ron Leifer, M.D., a psychiatrist, said it well in 2000:

The problem is that society demands a greater degree of social control than law allows.  The public wants to be protected from unconventional, threatening, and dangerous behavior.  There is, thus, a public mandate for a covert form of social control which supplements rule of law.  Medical-coercive psychiatry, in alliance with the state, performs this function disguised as medical diagnosis and treatment.  ...  involuntary, coercive psychiatry serves society by providing a supplemental form of social control which, because it is covert or disguised, preserves our national pride by giving us the appearance of being a nation of free individuals under law.  On the other hand, when the covert is exposed it can be seen to violate the honored values on which this nation was founded.28

An example that was prominently featured in news reports in New York City in 1987 was the use of the concept of mental illness to get homeless people off the streets and out of the public parks of the City.  A New York Times article called it “a Koch administration program to involuntarily hospitalize severely mentally ill homeless people living on city streets.”29 Rather than admit the real motive was getting rid of these people whose presence was irritating to other people, New York City Mayor Ed Koch asserted the purpose was to get them “hospitalized” (involuntarily, of course) for allegedly needed “mental health” treatment.  It was a classic case of oppression disguised as benefaction.  New York lawmakers could have created a law making it illegal to be homeless or to sleep on park benches, sidewalks, or in subway stations and swept homeless people into detention facilities of some kind.  But they couldn’t or didn’t want to accept the moral implications of such a choice and therefore preferred to use mental illness as an excuse to justify incarcerating homeless people.  This was intellectually dishonest, because the real reason was disapproval of or annoyance with homeless people, and because imprisonment does not become benign merely because it is called hospitalization.

Even if it were possible to anticipate everything people might do that we as a society want to prohibit, and even if we didn’t care if writing such laws clearly and explicitly reveals we are violating human and constitutional rights with such laws, in many cases it would be impossible to write a statute that would prohibit the behavior we want to prohibit without encompassing other behavior we do not want to prohibit.  An example is crying in public.  A person who cries in public too often, or for reasons with which few others sympathize, or for reasons others don’t understand, bothers other people.  Few would advocate making it illegal to cry in public, because there are circumstances in which most people think crying in public is understandable and acceptable and shouldn’t be prohibited.  People are expected to intuitively know when it is okay to cry in public and when it isn’t.  A person who cries in public for reasons with which others are unsympathetic or at times others dislike, or more often and more loudly than other people think is appropriate, is breaking a residual rule of behavior, that is, a rule that isn’t written anywhere but which people are nevertheless expected to know about and abide by.  Violating this unwritten expectation may result in punishment called involuntary psychiatric treatment, including involuntary “hospitalization” for major depressive disorder or some other supposed diagnosis.  How and when and how loudly to express one’s anger, even verbally and without threatening others with physical harm, is also the subject of residual rules of conduct the violation of which might result in involuntary psychiatric “treatment”, including involuntary “hospitalization” or an involuntary outpatient commitment court order compelling a person living in his own house or apartment to appear at a clinic for bi-weekly or monthly injections of a long-acting drug intended to treat a supposed mental illness such as inappropriately expressed anger.


THE CONCEPT OF MENTAL ILLNESS PERMITS US TO VIOLATE OUR PROFESSED VALUES ABOUT FREEDOM AND RULE OF LAW WITHOUT ADMITTING TO OURSELVES THIS IS WHAT WE ARE DOING


In a letter dated October 14, 2009, I proposed the above ideas to retired psychiatry professor Thomas S. Szasz, who I had shortly before visited in his home town of Manlius, New York:

I believe the reason the myth of mental illness continues is not only or even mainly because people do not understand its scientific invalidity, although that is of course a factor.  I believe one of the most important reasons the concept of mental illness continues to be accepted legally and otherwise is it is impossible to write into criminal codes and other laws all commonly held expectations of behavior—and people’s desire to enforce these unwritten expectations. Mental illness is the rationalization used to punish people who violate unwritten rules—with punishment called involuntary hospitalization, and with torture inflicted as punishment but called treatment for the supposed but actually nonexistent “mental illness”.  ...  I think overcoming this problem is an important challenge facing people like you and me who want America and other nations to be governed by rule of law rather than arbitrary after-the-fact determinations of what behavior was right or wrong.

With my above letter I gave Dr. Szasz a tape recording I had made of the speeches including his own at the Thomas S. Szasz Tribute Dinner I had attended in Manhattan in 1990.  Dr. Szasz’s reply in an e-mail on October 19, 2009 was “Dear Mr. Ramsay, Many thanks for the tape - and your letter, with which I agree completely.  Marginal rule violation and its punishment is the name of the game.  Best wishes, Thomas Szasz”


MARGINAL RULE VIOLATION AND ITS PUNISHMENT
IS THE NAME OF THE GAME


We as a society and as citizens of democracies would be more honest if we discard the myth of mental illness, repeal our civil commitment laws, and in their place enact a criminal law that openly acknowledges legislators are unable to anticipate and write a law against every act that should be prohibited.  Such a law might be titled “Criminal Conduct NOS."  It seems the majority of psychiatric diagnoses in involuntary civil commitment for mental illness I have seen end with the letters NOS, e.g., Personality Disorder NOS or Psychotic Disorder NOS.  In his book Hippocrates Cried: The Decline of American Psychiatry in 2013 psychiatrist Michael Alan Taylor, M.D., says “upward of a third of psychiatric patients end up being given the label NOS (Not Otherwise Specified).”30  Even with the ever-increasing number of supposedly diagnostic categories with each new edition of the American Psychiatric Association’s DSM, resulting in each edition being a bigger book with more diagnoses (or descriptions) than the last, psychiatrists continue to find it necessary to use “NOS” diagnoses. If we are going to incarcerate people on the basis of a supposed diagnosis ending with the letters NOS, why not have a criminal law with a name ending in NOS that does the same thing?  Criminal Conduct NOS might be defined as “an act not mentioned in this Penal Code but which the defendant knew or if he was a reasonable person of ordinary intelligence would have known he should not have performed.”  Replacing civil commitment law with a criminal or penal code provision such as Criminal Conduct NOS would represent a constriction of the power of families and government to incarcerate and punish people for (otherwise) lawful but bothersome behavior, or what Dr. Szasz called marginal rule violation, compared with today’s laws authorizing civil commitment for supposed mental illness, for these reasons: To obtain a conviction for Criminal Conduct NOS, the prosecution would be required to prove the defendant was guilty of specific past act rather than allowing imprisonment (called involuntary “hospitalization”) and corporal punishment and psychological torture (called involuntary “medication” or involuntary electroshock) for an alleged, arbitrarily and often vaguely defined state of mind such as depression or schizophrenia or bipolar or personality disorder, or predicted future conduct—“dangerousness.”  The “clear and convincing” standard of proof permitted by the U.S. Supreme Court in civil commitment for supposed mental illness in Addington v. Texas31 and employed in many states of the U.S.A., would be replaced with the more stringent standard of proof “beyond a reasonable doubt” that applies in criminal cases. Most Americans have a right to trial by jury in civil commitment for mental illness, but many do not.  If civil commitment laws are repealed and Criminal Conduct NOS is added to each state’s criminal code, the defendant’s right to trial by jury would be respected to the same extent it is in other criminal cases, because legislators and judges would no longer be playing word games or employing deceptive semantics to avoid respecting defendants’ constitutional rights, including the right to trial by jury, by calling the proceedings “civil” or “special” rather than criminal.  The judge or jury would be required to find the defendant not only did the act alleged but also at the time knew what he did was wrong or that a reasonable person of ordinary intelligence would have known what he did was wrong.  To avoid convicting a person who lacked the mental capacity of a reasonable person of ordinary intelligence of a “criminal” offense, the judge or jury would need to be empowered to find the defendant did the act alleged, that a reasonable person of ordinary intelligence would have known the act was wrong, but that the defendant lacked the mental capacity of a reasonable person of ordinary intelligence, withhold adjudication of a “criminal” offense, and sentence the defendant to a type of incarceration or program deemed educational or therapeutic.

Some will object to this approach because it does not allow intervention to prevent future acts.  My response is we can’t predict a person’s future conduct reliably enough to justify incarceration as a preventive measure.  In the words of a clergyman whose Sunday sermon I saw on C-Span on January 1, 2012, “The only evidence of what a person will do in the future is their record of what they have done in the past.”32 A person’s future conduct cannot be proved by any burden of proof, not even “preponderance of the evidence”, unless perhaps he says he is going to do something, or he has a long history of similar acts in the past.33

Substituting a criminal law titled Criminal Conduct NOS for current civil commitment law is only a partial solution, because sometimes people’s behavior is bothersome but does not justify criminal prosecution, including Criminal Conduct NOS.  Enforcement of private property rights that give property owners authority regarding what can be done on their property may be the best solution in some situations.

Because there is no credible evidence of any so-called mental illness being caused by biological abnormality, so-called mental illness is definable only as thinking or behavior that is considered unacceptable.  Without a biological abnormality proved to be the cause of the behavior or supposed symptoms, a supposed mental illness does not qualify as true illness or as true disease.  The word “mental” implies non-physical: A person can no more have “mental illness” than he can have mental cancer.  It is possible to have brain cancer but not mental cancer.  For similar reasons, it is possible to have a brain disease but not a mental disease.  Likewise, it is no more possible to have a “mental” illness than it is possible to have a “religious illness” or a “political illness.” Mental illness exists only as a concept in the minds of people who believe in mental illness. Involuntary psychiatric “therapy” is punishment for thinking or behavior people dislike, not health care as people like to think and as legislators and judges assume.  If the so-called professionals in what we call mental health allowed themselves to use only the term brain disease (not “mental illness”) and refused to believe a brain disease is present unless true physical, biological (not merely mental, emotional, or behavioral) evidence is found, most if not all psychiatric and psychological “diagnosis” (confusing values with health) would cease.  But then, as psychiatrist Ronald Leifer pointed out (above), we as a society would be stuck with rule of law, and “the public will be deprived of an extra-legal means of maintaining domestic tranquility.34

Belief in mental illness continues for all of the above reasons, none of which are valid from a logical or scientific or legal and constitutional standpoint.


1Wayne Ramsay, J.D., “Why the Myth of Mental Illness Lives On (Pt. 1), ISEPP Bulletin July 2019, https://psychintegrity.org/why-the-myth-of-mental-illness-lives-on-part-1
2Papachristou v. City of Jacksonville, 405 U.S. 156 at 162 (1972), citations omitted
3Diagnostic and Stastical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR, American Psychiatric Association 2000), p. xxxvii
4Diagnostic and Stastical Manual of Mental Disorders, 5th edition (DSM-5, American Psychiatric Association 2013), p. 25
5Thomas S. Szasz, M.D., The Manufacture of Madness (Harper & Row 1970), p. 68)
6Diagnostic & Statistical Manual of Mental Disorders — Second Edition (American Psychiatric Association 1968), p. 44
7Emad N. Eskandar, M.D., G. Rees Cosgrove, M.D., and Scott L. Rauch, M.D., “Psychiatric Neurosurgery”, neurosurgery.mgh.harvard.edu, accessed February 5, 2014, underline added
8Prof. Jay Katz, quoted in Thomas Szasz, Insanity—The Idea and It’s Consequences (Syracuse University Press 1997), p. 57
9Sydney Walker III, M.D., The Hyperactivity Hoax (St. Martin’s Press 1998), p. 23. Italics are Dr. Walker’s.
10Allen Frances, M.D., Saving Normal—An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life (HarperCollins 2013), p. xvii
11Id., p. 177: Journal of American Academy of Child and Adolescent Psychiatry: “Cumulative Prevalence of Psychiatric Disorders by Young Adulthood: A Prospective Cohort Analysis from the Great Smoky Mountains Study”, Vol. 50, No. 3, (2011) pp. 252-261, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049293/
12Stuart A. Kirk, et al., Mad Science: Psychiatric Coercion, Diagnosis, and Drugs (Transaction Publishers 2013, p. vii
13Vernon Coleman, MBChB, D.Sc.(hon), Do Doctors and Nurses Kill More People Than Cancer?, (European Medical Journal 2011), p. 32
14Margaret A. Hagen, Ph.D, Whores of the Court: The Fraud of Psychiatric Testimony and the Rape of American Justice (ReganBooks 1997), p. 250
15Dusan Kecmanovic ,“DSM-5: The More It Changes The More It Is the Same”, Psychiatria Danubina, 2013; Vol. 25, No. 2, pp. 94-96
16Marcia Angell, M.D., The Truth About Drug Companies—How They Deceive Us and What To Do About It (Random House 2005), p. 88
17Rael Jean Isaac & Virginia C. Armat, Madness in the Streets (Free Press/Macmillan 1990), p. 49
18“Thomas Szasz on Socialism in Health Care”, https://www.youtube.com/watch?v=FC9r3Gs8XuU, at 1:24:42
19Thomas Szasz, M.D., “Mental Illness as Brain Disease: A Brief History Lesson”, http://www.szasz.com/freeman13.html, accessed September 16, 2020
20Mark Rapley, et al., Medicalizing Misery, Palgrave Macmillan 2011, p. 4
21Id., p. 50
22Roy Porter, Madness—A Brief History, (Oxford University Press 2002), p. 186
23Louise Armstrong, And They Call It Help—The Psychiatric Policing of America’s Children (Addison-Wesley Pub. Co. 1993).
24DSM-IV-TR diagnosis code 313.23 appears on p. 125
25Wooley v. Maynard, 430 U.S. 705 at 714 (1977)
269 Tex.Jur. Constitutional Law §91, p. 525
27Thomas Szasz, M.D., The Second Sin (Anchor/Doubleday 1973), p. 113
28Ron Leifer, M.D., “A Critique of Psychiatry and an Invitation to Dialogue”, Ethical Human Science and Services, December 27, 2000, available at www.critpsynet.freeuk.com/critique.htm
29Josh Barbanel, “New York Ordered to Find Care for Homeless Woman”, The New York Times, November 25, 1987, p. B3
30Michael Alan Taylor, M.D., Hippocrates Cried: The Decline of American Psychiatry (Oxford University Press 2013), p. 39
31Addington v. Texas, 441 U.S. 418 (1979)
32Rev. Bill Tvedt, Jubilee Family Church, Oskaloosa, Iowa
33See Is Involuntary Commitment for “Mental Illness” or “Dangerousness” a Violation of Substantive Due Process?, www.wayneramsay.com/due-process.htm
34Ron Leifer, M.D., “A Critique of Psychiatry and an Invitation to Dialogue”, Ethical Human Science and Services, December 27, 2000, www.critpsynet.freeuk.com/critique.htm, accessed March 9, 2013.

My Ramblings About Psychiatric Drugs

My Ramblings About Psychiatric Drugs

Lloyd Ross, Ph.D.


According to the research I have read and my experience as a therapist, when people take SSRI anti-depressants their emotions are blunted, especially the emotions of guilt, shame, and conscience. They don’t care about things that they would have cared about had they not been on SSRIs. Some people would define that as feeling better.

If you take normal puppies and remove them from their mothers, like pups of most species, they will frantically scream. If for a while you feed them SSRIs, they will not react when they are removed from their mothers. Many call these drugs “well whatever” drugs. A “well whatever” drug enables normal pups to not be upset when they are removed from their mother.

A colleague who took an SSRI medication so he could relax during a vacation became alarmed after he returned because, when he was listening to patients talk about their problems, he kept thinking, “who cares.”

Many children with whom I work whose mothers are on SSRIs have said to me that they wish that their mothers were not taking those pills. When I ask them why, they invariably say, “they just don’t seem to care as much about me.”

If “get better” means to feel better or not feel so bad because the patient has taken a medicine that dulls his feelings, he or she is getting in the way of a finely tuned mechanism that has been evolving over 200 million years to help human organisms protect themselves, avoid threats, and get what they want. That’s a big price to pay for “feeling better.” And, of course, that is what all psychotropic drugs do - including alcohol, marijuana, cocaine, ecstasy, heroin, sedatives and stimulants – they help people avoid their feelings. That’s why the majority of men who beat up their wives are drunk when they do it.

And the idea that the SSRIs are correcting some kind of chemical imbalance in a very precise, carefully honed way is an illusion. A patient being given a drug that will dull his reaction to what has been upsetting to him will approach it very differently than a patient given a different spin, that the drug is treating a chemical imbalance that is causing his ailment. They will give drug treatment a second thought if warned that SSRI anti-depressants might affect their judgement. These drugs are totally misnamed. They are neither selective in their approach, nor do they cure depression. They merely create a feeling of “apathy” or “well whatever” along with some unpleasant side effects.

And what about the 1 out of 4 people who develop suicidal or homicidal ideation and agitation (akathisia) after taking SSRIs. This also happens at the same rate in subjects who have never been depressed. And keep in mind that SSRI anti-depressants are associated with a much higher relapse rate than is therapy. We have to approach problems in living, not use a reductionistic disease model. Restraint is not treatment, especially since these drugs suppress our humanity. And how about reinforcing the notion that the way to deal with uncomfortable feelings is to take a drug that makes them go away? What do you say to your kid who is smoking dope?

A Time for Humor

A Time for Humor

Lloyd Ross, Ph.D.


Hi Folks:

Time for another episode of my ramblings with some humor thrown into the mix. In this one I will try to be philosophical. This is especially to the point since most of you are just sitting around snacking and waiting for the pandemic to be over. This piece is dedicated to Jim Gottstein and if you want to know everything about it, read his new book about the Zyprexa Papers.

In the beginning, God created the heavens and the earth with broccoli, cauliflower and spinach, green and yellow vegetables of all kinds, so man and woman would live long and healthy lives.

Then, using God’s great gifts, Satan created Ben and Jerry’s ice cream and Krispy Cream Donuts. And Satan said: “You want chocolate with that?” And man said: “As long as you’re at it, add some sprinkles.” And they gained 10 pounds.

And Satan smiled.

And God created healthful yogurt that woman might keep the figure that man found so fair.

And Satan brought forth white flour from the wheat, and sugar from the cane and combined them...and woman went from size 6 to size 14.

So God said: “Try my fresh green salad.”

And Satan presented thousand island dressing and buttery croutons and garlic toast on the side. And man and woman unfastened their belts following the repast.

God then said: “I have sent you healthy vegetables and olive oil in which to cook them.

And Satan brought forth deep fried fish and chicken fried steak so big, it needed it’s own platter. And man gained more weight and his cholesterol went up.

And God created a light, floppy white cake, named it “Angel Food Cake,” and said: “It is good.”

Satan then created chocolate cake and named it “Devil’s Food.”

God then brought forth running shoes so that his children might lose those extra pounds.

And Satan gave cable TV with a remote control so man would not have to toil changing the channels. And man and woman laughed and cried before the flickering blue light and gained pounds.

Then God brought forth the potato, naturally low in fat and brimming with nutrition.

And Satan peeled off the healthy skin and sliced the starchy center into chips and deep fried them.

And man gained pounds.

God gave lean beef so that man might consume fewer calories and still satisfy his appetite.

And Satan created McDonalds and its 99 cents double cheeseburger. Then he said: “You want fries with that?”

And man replied “yes, and super-size them.”

And Satan said: “It is good”

And man went into cardiac arrest!

God sighed and created quadruple bypass surgery.

Then Satan created HMOs.

Then God created caring people to talk to about your problems and feelings.

Then Satan created Zyprexa, and marketed it aggressively, for every ailment. People took it and everyone developed additional obesity, diabetes, tardive dyskinesia, and went into aggressive diabetic shock, and died.

And Satan smiled.

Not that I want to pick on the poor people who run Eli Lilly, but they certainly deserve it. So I would like to tell you this little story.

An engineer, a physicist, and a lawyer were being interviewed for the CEO job of a humungous drug company. The engineer was interviewed first and was asked many questions. The last question was: “How much is two and two?” The engineer excused himself, made a whole series of measurements and calculations, and finally came back and answered: “four.”

The physicist was interviewed next and he was asked a long list of questions, ending with: “How much is two and two?” He also excused himself and went to the library, where he did a great deal of research after a consultation with the U.S. Bureau of Standards. After further calculations, he also announced: “The answer is four.”

Next, the lawyer was interviewed. Again, the final question was: “How much is two and two?” The lawyer got up and drew all the shades in the room and looked outside to make sure no one was there. He then checked the telephone for listening devices and finally whispered: “How much do you want it to be?”

The group immediately said: “YOU’RE HIRED!”

The triumph of the pharmaceutical industry over science and reason is akin to the triumph of sugar over diabetes. The people who become Big Pharma CEOs live by a four commandment code:

Here it is:

Commandment I - First get your facts. Then you may distort them at your leisure.

Commandment II - If at first you don’t succeed, destroy all the evidence that you tried.

Commandment III - If you can ask the wrong questions, you don’t have to worry about the answers.

Commandment IV - The last stage of fitting the drug to the market is fitting the market to the drug.

Finally, A new study done at Duke University showed that diet and exercise work much better to relieve depression that Paxil and Zoloft. That being the case, ask your doctor if getting off your ass is right for you.

NPR Perpetuates the Myth

NPR Perpetuates the Myth

David Walker, Ph.D.


This is a reprint of an email I sent to NPR after they published an article about ecstasy and PTSD. The article showcased a woman who felt she benefited from this novel "treatment." In response, I wrote a brief blurb to NPR characterizing the story as “bullshit.” I was surprised to receive a note back asking if I could move beyond harsh language to explain my objections. This was my response.



NPR Public Editor
Re: My Complaint

Dear Elizabeth:

As I did not expect to hear back from NPR, I did not elaborate on the use of my term, "bullshit," in relation to the recent article on MDMA for PTSD. You may be surprised to hear that I was not just emoting but applying the word in deference to Princeton philosopher Harry Frankfurter’s description of any system that refuses to explain itself while trying to circumvent or overpower its skeptics. Specifically, Dr. Frankfurter called bullshit “a greater enemy of truth than lies.” In 2016, Australian critical psychiatrist Niall McLaren elaborated on this same idea in his article, “Psychiatry as Bullshit” for Ethical Human Psychiatry and Psychology, a journal for which I serve as an advisory editor. So what I said is what I meant.

Over the last decade, fractures have developed in the bio-reductionist ideology that dominates the U.S. mental health system. I can summarize them to you as follows: challenges to SSRI antidepressant and psychiatric drugs generally in regards to efficacy and linkages to violence and suicide; poor science across the entire realm of biological psychiatry and behavioral genetics; and the frequent use of psychiatric taxonomy to explain itself.

Shortly before the DSM-5 was released in 2013 by the American Psychiatric Association, the National Institute of Mental Health announced it would no longer use DSM labels like PTSD, ADHD, Bipolar, etc., in its research. The public was not sufficiently advised by the media, including by NPR, that this was a fracture in this system. In truth, this shift had to do with the exceptionally poor scientific validity and reliability of psychiatric labels - labels that continue to this moment to stigmatize, limit employment, housing, and self-worth for millions of Americans.

That NIMH made this move in the hopes of further isolating some sort of underlying brain pathology or chemical process, using its ample dollars by which to substantiate the very old mythologies of psychiatric icon Emil Kraepelin, is a chimera biological psychiatrists have been allowed to chase for over sixty years at public expense without result. The DSM-IV, for example, was positioned by its authors as “Neo-Kraepelinian” in its underlying philosophy.

NPR may be unaware that in 2013 the British Psychological Society and over fifty mental health organizations across North America and around the world objected formally to the DSM-5. At least this was never a topic your reporters chose to cover.

“Trauma” at the brain level is entirely a cultural metaphor. The “traumatic stress” identified in brain scans to which your reporters so often refer is, in reality, “diffuse stress” we would see in anyone experiencing violence, loss, or hardship. It is not “abnormal,” and it is entirely non-specific in relation to PTSD or Bipolar or any other psychiatric label. In fact, most DSM labels correlate with activity at the brain level when a person is under stress, a finding which is completely unsurprising.

No DSM label can be specifically depicted through neural research or any other biological research – except, of course, conditions brought about by substantiated brain diseases like the dementias or toxin exposures such as alcohol, amphetamine, or psychiatric drugs themselves. The “HPA axis,” the amygdala, being “triggered,” the fight-flight response, are simply a cultural language for intense emotional pain, defined subjectively.

The historical roots of PTSD go back to American psychiatry’s complicity in marginalizing and segregating people considered “moral imbeciles” with “psychopathic constitutions.” It is in psychiatry’s best interests to maintain its charade of locating the “weak” and susceptible as a target “population” for its “treatments,” as Smith Jeliffe and William Alanson White did back in 1910, in finding them among the classes “of the juvenile delinquents, of the recidivist type of criminal, of the paupers and prostitutes, of the ne’er-do-wells, the black sheep of the family, and at the higher levels, of erratic half-genius, half-crazy persons with brilliant spots here and there, but without continuity, whose efficiency is materially impaired and who live often a more or less wandering existence.”

What I mean is that the soldier who suffers due to voters electing hawkish leaders who put him or her into combat will be blamed as “disabled” for reacting emotionally to war’s brutality and hardship, just as women who are raped, first by a violent perpetrator and then again by a justice system that fails to hold perpetrators accountable, will carry in their bodies the emotional stigmata of American society’s unwillingness to protect them, children facing epidemic sexual abuse in this country will be asked to do the same, and Katrina survivors will hold the original lack of accountability of the Army Corps of Engineers in managing Louisiana levees aimed at poor people.

The list goes on and on, and PTSD - which originated out of Post-Vietnam Syndrome, and was feared as a label by many vets for its potential to take a morally sick society off the hook while blaming the veteran - has become just that and is now widely applied where once we had Rape Syndrome and Battered Child Syndrome. At least those labels depicted a point of origin for personal anguish… but this has never been the actual goal of contemporary psychiatry. Instead, this guild has actively sought to obscure the true sources of emotional pain and upheaval coming out of social conditions by cooking them down into alleged “brain disorders” and “chemical imbalances.” And NPR has moved unquestioningly along with the psychiatric guild and its propaganda for as many decades as this effort has been underway.

So when I turn to the recent MDMA article, I find NPR colluding with psychiatry once again in redefining the horrific violence, loss, and tragedies faced by a young woman as a problem of her overactive amygdala. The drug itself is positioned as a “treatment” that “allows” her to speak of her painful experiences to a trusted professional who adds another “treatment” consisting of words and support. That MDMA “tamps down activity in the amygdala, a part of the brain that processes fear” leading “to a state characterized by heightened feelings of safety and social connection” is a very elaborate way of saying it’s a sedative.

Thus, what the article is really saying is that taking a sedative so as to be able to talk about terrible events in one’s life might make it easier – but of course, we’re dealing with the need to obscure the language by using pseudoscientific brain research metaphorically. Thus, PTSD, a metaphor in itself, goes into “remission” through the use of MDMA, which through its sedating properties, miraculously allows people to talk more easily about the kinds of violence in their lives that American society ignores, stigmatizes, or responds to unjustly.

The only thing required of the “PTSD sufferer” is accepting the ideological reality of their alleged “lifelong condition,” allowing themselves to be labeled and stigmatized, and submitting their bodies to psychopharmacological experimentation. Fortunately, “unlike street drugs, which may be adulterated and unsafe, researchers use a pure, precisely dosed form of the drug.” In other words, they sell better MDMA than what you can get on the street.

Heavy sigh. In my own practice as a psychotherapist, I deliberately seek to avoid the bullshit inherent in this kind of language. This is because the clients seeking my collaboration are often struggling with trying to climb out of various self-medicating behaviors and addictions, street and psychiatric, your MDMA article promotes. They’ve often been duped by psychiatry’s promotion of so-called “anti-psychotics,” “anti-depressants,” and “anti-anxiety” drugs – and they are dealing with intense withdrawal syndromes, drug-related emotional syndromes, sexual dysfunction, and other issues. Ah, but these are not topics you choose to cover.

That is, they are often dealing with a greater enemy of truth than lies – a system that refuses to explain itself while trying to circumvent or overpower its skeptics.

NPR has acted as a lackey for this system for many years now. I hope my complaint is better explained to you now. Your journalistic irresponsibility has duped and hurt many people. Please let me know if you have any questions.

Sincerely,

David Edward Walker PhD
Seattle WA


Harry G. Frankfurt, On Bullshit (Princeton, NJ: Princeton University Press, 2005), 61.

Niall McLaren, “Psychiatry as Bullshit,” Ethical Human Psychology and Psychiatry 18, no. 1 (2016): 48–57, doi: 10.1891/EHPP.18.1.

Smith E. Jellife and William A. White, Disease of the Nervous System (Philadelphia, PA: Lea & Febiger, 1935), 910–11.

Behavioral Neuroscience: The Path Forward

Behavioral Neuroscience: The Path Forward

Steve Spiegel


In his classical dissertation on scientific paradigms, eminent philosopher of science Thomas Kuhn describes the difficulty in understanding social influences that skew science theory.1 Popular behavioral neuroscience theory is a classical paradigm; it is a complete world view that is supported by terms with interrelated connotations and contexts that reinforce the status quo. Scientific paradigms are homogeneous; it is difficult to recognize a false assumption of a paradigm from within. In the arduous challenge (and valiant effort) to understand our behavior, it is far easier to theorize about behavior science and neuroscience and their relationship than to theorize about theoretical problems underlying the established paradigm. Eminent philosopher of science Karl Popper understood the difficulty of identifying false assumptions when he advocated the accepted Philosophy of Science principle of “falsifiability.”2 Philosophy of Science advocates that real science theories can be differentiated from ad hoc theories by falsifying them — explaining how to disprove them.  The process of describing how to disprove a theory identifies assumptions that are potential sources of error. Unfortunately, the admirable endeavor to understand behavioral neuroscience has not been falsified to identify assumptions of the prevailing paradigm for critical consideration. 

Behavioral neuroscience investigates complex principles of molecular neuroscience, cellular neuroscience, and systems neuroscience while the philosophy of informing sciences implores consideration of simple principles of tissue neuroscience and systems neuroscience. Scientific logic, the philosophy of science, a philosophy of natural science, and the philosophy of physiology beg for consideration of simple binary tissue neuroscience. The philosophy of a science is the science’s most fundamental principle; it defines and frames a science with an unprovable underlying assumption. An anomaly of the philosophy of a science taints all of the science that is built upon it; as information technologists advocate, “garbage in, garbage out.”3 In the following three sections, this thesis addresses scientific anomalies hidden deep in the foundation of the current behavioral neuroscience paradigm. The following sections advocate that popular neuroscience theory contradicts: 1) basic science logic when it assumes complex brain principles and ignores simple binary science, 2) the philosophy of (general) science and a philosophy of natural science when it assumes complex brain principles and ignores simple binary science, and 3) the philosophy of physiology when it ignores tissue neurophysiology — the function of whole nervous tissues and their interaction. Basic science logic and accepted science tenets implore consideration of beautifully simple binary tissue neuroscience to understand behavioral neuroscience. 

First, popular behavioral neuroscience investigations contradict basic science logic while they continue a long tradition of assuming complex brain principles while brain principles are unknown.  Full stop.

Moreover, popular neuroscience investigations continue to contradict basic science logic while they assume complex brain principles while modeling the brain with computers that operate on the simple principle of binary science.  Again, full stop.

It may appear that simple brain principles would be obvious to scholars but appearances are often deceiving. It is extremely difficult to reverse-engineer a system that produces a complex product based on a simple principle especially when the simple principle is not sought.

The first sentence of the recent PBS series on the brain (The Brain with David Eagleman) advocates the common assumption of complex brain principles but scientific logic demands consideration of gloriously simple binary neuroscience.

Second, besides contradicting scientific logic, behavioral neuroscience investigations also continue to contradict the philosophy of science and a philosophy of natural science when assuming complex brain principles and ignoring simple binary neuroscience. All science theory is based on the principle of parsimony — Occam’s razor: “All other things being equal, simpler theories are better science”, or more accurately, “Fewer assumptions make better science.” Unfortunately, accepted neuroscience investigations are comfortable with increasing complexity and a related increase in unidentified assumptions; parsimony and falsifiability are not considerations. Popular behavioral neuroscience research contradicts the philosophy of science while embracing complexity and failing to consider beautifully simple binary neuroscience.

Besides contradicting the philosophy of science while assuming complex brain principles, neuroscience investigations similarly contradict a philosophy of natural science. The philosophy of natural science advocates that our environment is best understood with a singular focus on the natural (physical) world, but there is a secondary philosophy of natural science. Our most eminent natural scientists (Einstein, Brian Greene, Steven Weinberg, Walter Lewin) also advocate that human nature is based on eloquently simple principles that are hidden beneath an appearance of complexity.4  Natural scientists contend that simple principles produce the complex manifestations of nature including human nature (binary neuroscience beyond binary neurons).  One hundred trillion neural connections produce complex thinking and complex behavior but do not prove a complex brain principle.  Moreover, only simple brain principles promote the natural science requisite of “functional resilience” (proper operation over time); consistently, maintenance engineers advocate simple engineering with the mantra (acronym) “KISS”: “Keep it simple, stupid!”  Eminent natural scientists advocate simple brain principles; assuming complex brain principles and ignoring gloriously simple binary science is pseudo natural science.

Regardless of a long, painful history of problematic oversimplification in science, it is unscientific to assume that only complex brain principles can produce complex thinking and complex behavior. The philosophy of science and a philosophy of natural science implore consideration of a simple principle of binary neuroscience.

Third, besides contradicting basic science logic, the philosophy of science and a philosophy of natural science, popular behavioral neuroscience investigations also contradict the philosophy of physiology when addressing molecular neuroscience, cellular neuroscience and complex systems neuroscience rather than whole nervous tissues and simple systems neuroscience.  Considering the physiology of simple systems neuroscience and entire nervous tissues (and their interaction) may seem confusingly abstract compared to finite or abstract investigations but the philosophy of physiology implores the focus. The philosophy of physiology explains organisms at different organizational levels of the body with each organizational level explaining the entire organism. Anatomy and physiology texts explain humans at different organizational levels of descending sizes and ascending complexity; they explain organisms at organizational levels of body systems, tissues, cells, and molecules.5 Physiology texts explain organs with body systems, explain body systems (including organs) with tissue physiology, explain tissue physiology with cellular physiology, and explain cellular physiology (theoretically) with molecular physiology. The philosophy of physiology completely explains organisms at different organizational levels and explains organs with the organizational levels of body systems (or “organ systems”) and tissues.

Physiologists investigate organisms at different organizational levels of the body and explain the function of all organs at the largest level — the level of body systems (organ systems). The nervous system at the organizational level of body systems is “systems neuroscience.” Consistently, physiology explains systems neuroscience (the brain at the organizational level of body systems) as: the brain receives information about the environment through the peripheral nervous system, processes the information, and sends related information back through the peripheral nervous system to affect behavior towards species survival. Current theory seeks to explain a complex systems neuroscience while physiology explains systems neuroscience with simplicity. Physiology investigates the human organism at different organizational levels and can explain all organs of the body at the largest organizational level of body systems.

Besides explaining all organs of the human body at the organizational level of body systems, physiologists can also explain all organs besides the brain at the level of body tissues. All organs of the body besides the brain are explained by four kinds of tissues: muscle tissues, connective tissues, epithelial tissues and nervous tissues. For example, after explaining the heart at the organizational level of body systems (as a pump that shoots nourishment and draws waste), physiologists explain the function of the heart with the increased specifics of tissue physiology. Physiologists explain the heart with the interaction of (whole) tissues as: 1) muscle tissues create the general structure of a pump while flexed muscle tissues push nourishment throughout the body and pull waste, 2) nervous tissues create a periodic electric spark to flex heart muscle tissues, 3) connective tissues create valves in the pump structure to produce directional flow, and 4) epithelial tissues encase muscle tissues and create pipes to carry nourishment and waste. The organizational level of tissues completely explains all organs with a macro-perspective of tissue physiology that is more detailed than the organizational level of body systems that also completely explains organs.

Physiologists explain all organs of the body except the brain with tissue physiology (the physiology of entire tissues and their interaction) but are unable to explain any organ with a smaller, more complex organizational level.  Cellular physiology explains tissue physiology that explains organs, but cellular physiology cannot skip a “generation” of information about tissues to directly inform about organs. Consistently, investigating molecular physiology to understand an organ skips two generations of information (about tissues and the cells that comprise tissues). Molecular physiology cannot yet explain any cell of the body; it is illogical to believe that it can explain a tissue, much less an organ. Investigating molecular neuroscience to understand the brain is analogous to investigating the molecular structure of steel to understand the purpose (function) of an automobile engine. Investigating cellular and molecular neurophysiology to understand behavioral neuroscience contradicts the philosophy of physiology that explains organs with tissues — the physiology of whole tissues and the physiology of their interaction.

Popular behavioral neuroscience investigations contradict the philosophy of physiology when brain research fails to theorize about a macro-perspective of whole nervous tissues and their interaction.

In conclusion, scientific logic dictates that the tenets of a science are the most important guidelines to follow since everything emanates from foundational principles. Unfortunately, the distinguished endeavor to understand behavioral neuroscience is hindered by critical, long-established scientific anomalies hidden deep within accepted theory. Neuroscience investigations continue to contradict basic scientific logic and the philosophy of (general) science, a philosophy of natural science and the philosophy of physiology. It is illogical and unscientific for accepted neuroscience theory to assume complex brain principles and ignore magnificently simple binary science when: 1) brain principles are unknown, 2) eminent natural scientists advocate simple brain principles, and 3) neuroscientists model the brain with computers that operate through binary science. Equally important, popular behavioral neuroscience theory contradicts the philosophy of physiology while investigating molecular neurophysiology, cellular neurophysiology and complex systems neuroscience rather than whole tissue neuroscience.

Science logic and the tenets of informing sciences implore consideration of binary tissue neuroscience to understand behavioral neuroscience.  For instance, neuroscientists should consider the binary science of “motivated-thinking” wherein the thinking process is somehow separate from the motivation that directs it.  With an example like motivated-thinking, neuroscientists should consider whether nervous tissue structured for motivation (like the limbic system) directs nervous tissue structured for thinking (like the cerebral cortex).  Scientific truth can radically improve community mental health; binary tissue neuroscience is the foundation of a breakthrough theory that explains all human psychology (free at NaturalPsychology.org).


1 Kuhn, T. (1962). The Structure of Scientific Revolutions, University of Chicago Press.

2 Popper, K. (1959). The Logic of Scientific Discovery, reprinted 2002 by Routledge.

Eysenck, H.J. (1978). An Exercise in Mega-Silliness, American Psychologist, vol. 33(5), May 1978, 517; Ioannidis, J. A. (2016). The Mass Production of Redundant, Misleading, and Conflicted Systematic Review and Meta-analyses. The Milbank Quarterly94(3), 485-514. doi:10.1111/1468-0009.12210.

4 Greene, B. (1999). The Elegant Universe, Norton, New York; Lewin, W., N. Buckner & R. Whittlesey (1998). Mysteries of the Universe, A Science Odyssey, (part 1), a PBS film; Weinberg, S. (2003). The Elegant Universe, Nova, a PBS film by Brian Greene.

5 Marieb, E. & K. Hoehn (2012), Human Anatomy and Physiology, Benjamin-Cummings Pub. Co, (9th Edition); Martini, F. et al. (2011). Fundamentals of Anatomy and Physiology. Benjamin Cummings   Publishers, (9th Edition); Tortora, G. & B. Derrickson. (2012). Principles of Anatomy and Physiology.  New York: Harper and Row (13th Edition).

Is There Such a Thing as a Normal Woman? Part 2: Mother-blame and Psychological Theory and Research

Is There Such a Thing as a Normal Woman? Part 2: Mother-blame and Psychological Theory and Research

Paula J. Caplan, Ph.D.


In Part 1 of “Is There Such a Thing as a Normal Woman?” (ISEPP Bulletin December 2019), I addressed many of the ways that psychiatric diagnoses are used to pathologize women, demean them, challenge their credibility and motivation and feelings, and deprive them of everything from self-respect to their human rights to their very lives.

Mother-blame1

It doesn’t require a psychiatric diagnostic handbook or even a therapist to pathologize women. The fact that every female either is a mother or can be regarded as a potential mother or at least as mother-like, can be assumed to be hormonally, cognitively, and emotionally preprogrammed to be mother-like, is often all that is needed to cast women as inadequate, inferior, harmful, even grotesque. I will focus primarily in this section on women who have in fact had children, but it is important to keep in mind that nearly everything negative that is attributed to mothers is often also attributed to women who are not mothers, solely because the latter are also female. In other words, what is often considered the essence of femaleness includes inclinations or predispositions toward behaving in motherly ways, and then most of what is associated with that essence is considered negative. Sometimes the lengths to which people go to pathologize anything associated with mothers is astounding.

Early in my career as a psychologist, I worked at a clinic where we had interdisciplinary teams whose members took turns conducting assessments of people referred by the courts. Each team would sometimes watch one of its members interview a family that included a teenager who had been in trouble with the law, and after the interview, the team would discuss what had transpired. I had two young children at the time, which probably led me to observe the following pattern: If a mother sat right next to the teen who was the “identified patient,” the team members would conclude that her having sat next to her child indicated that she was controlling, intrusive, and/or smothering. If a mother did not sit next to the teen who was the “identified patient,” they construed that as evidence that she was cold and rejecting – and if the teen was male, that the mother was castrating. “Hmm,” I asked myself, “where does a good mother sit? On the ceiling?”

I broached the subject of this constant pathologizing of mothers with the psychiatrist who was my team leader (it was always a psychiatrist who was the team leader), and he informed me that obviously, my reason for thinking this was that I was a mother. Did he mean by this that due to being a mother, I was understandably observant about how mothers were being treated? No. He meant that I was distorting the truth because I was a mother.

Mother-blame Research

This was one of those times when I was glad I had earned a research degree. Ian Hall-McCorquodale and I decided to survey clinical journals and see if we found much mother-blame. We developed 63 categories related to mother-blame and classified each of 125 articles according to each category. We found overwhelmingly that mothers were blamed for virtually anything, in fact for 72 different kinds of problems in their children, ranging from bedwetting to “schizophrenia,” from inability to deal with color blindness to aggressive behavior, from learning problems to “homicidal transsexualism.”2 In one study, the authors said they wanted to find out whether the fathers’ having been prisoners of war affected their children. They reported that the children indeed had some emotional problems, but here was their explanation of those problems: The fathers were often emotionally distant from their family members, even when physically present, and this upset the mothers and thus interfered with their parenting, which is what harmed the children. Although our research was done in the mid-1980s, mothers are still more likely to be blamed, and this is due to the history of mother-blame among clinicians; the continuing tendency for mothers to do more of the child care than fathers – and thus to be the ones the therapist sees when the child has difficulties, so they are available for study and thus for pathologizing; and the ongoing mother-blame and misogyny in general in society.

The Mother Myths3

That research prompted me to consider mother-blame more broadly, and in the book I wrote about it and how it interferes with mother-daughter relationships (much of which applies to mother-son relationships as well), I recounted the Mother Myths that are widespread and that seep into all of us by osmosis as well as by explicit statements and that pervade the zeitgeist simultaneously. These myths I divided into two groups; Perfect Mother and Bad Mother.

What I call the Perfect Mother myths are those that set standards so high that no human being could ever meet them, thus paving the way for all mothers to be deemed inadequate if not simply bad. These are: (1)The measure of a good mother is a “perfect” daughter; (2)Mothers are endless founts of nurturance; (3)Mothers naturally know how to raise children; and (4)Mothers (and “good” daughters) don’t get angry.

The Bad Mother myths encourage us to take anything a mother might do, including what ought to be considered good things, and transform them into “proof” of mothers’ inferiority or harmfulness. They are: (5)Mothers are inferior to fathers; (6)Only the experts know how to raise children; (7)Mothers (and daughters) are bottomless pits of neediness; (8)Mother-daughter closeness is unhealthy; (9)Women’s power is dangerous; and (10)Both stay-at-home mothers and mothers with paid jobs are bad mothers.

A look at the two sets of myths reveals two pairs of myths that would seem to cancel each other out. These are: (a)That mothers are endlessly nurturant (Good Mother myth) and that mothers are bottomless pits of neediness (Bad Mother myth),though based on simple physics principles of vectors, one can hardly be constantly giving while constantly taking and (b)That mothers naturally know all they need to know about raising happy, healthy children (Good Mother myth) and that mothers need experts’ advice in order to raise happy, healthy children (Bad Mother myth). How can these contradictory myths exist simultaneously?

Consider this: In any power structure, those who have the most power usually want to maintain their position. Choosing scapegoats to whom to attribute any problems that might arise is one way to keep their power, because they can say, “Don’t blame me! It’s their fault.” Mothers have been a convenient group to scapegoat, not only because they have traditionally been held responsible for everything bad that happens to their children but also because they have not tended to come together to advocate for mothers, to try to persuade people to look in a more balanced way at the wide variety of potential causes of their children’s – and thus society’s – problems.

For those in power, it is dangerous if scapegoats do things that are obviously good. So beliefs arise – sometimes consciously and purposefully created – that, in essence, provide a myth for every occasion; thus, no matter what a mother does, there is a myth that makes it easy to cast it as something bad. Thus, for instance, if she is a caring, loving mother whose adult offspring demeans or distances her, it’s easy to avoid concluding that the offspring was in the wrong by claiming that the mother loves being a martyr (this is a form of the myth of women’s masochism that was addressed in my previous essay4).

An example of the bizarre transformation of even good behavior into proof of bad mothering is the myth that "Mother-daughter closeness is sick." During my book tour for Don't Blame Mother, women media interviewers often got me alone and confessed, "I talk to my mother every day." When I asked how they felt after those talks with their mothers, they usually said something like, "Great! She's warm and funny, and we trade advice and stories and really enjoy our conversations." I would then ask, "Do you have a best friend or an intimate partner" "Yes." "Do you talk to them every day?" "Yes." "Are you embarrassed about that?" "No!" "Then why," I would ask, "did you confess to me that you talk to your mother every day? Why did you seem embarrassed about your regular conversations with her?" The answer was usually, "Because I know that means I am dependent and immature." Daughters who had been in therapy often said, "It means we are enmeshed or symbiotically fused."  Notice how, simply by replacing a mother-offspring relationship for any other relationship, we introduce pathology.

In light of all this, it is remarkable that mothers ever manage to do a decent job of raising children, since nearly every mother I’ve ever heard from has told me some version of this: “I feel like nothing I do is ever right. There’s always like a little bird on my shoulder telling me I am doing too much of this or not enough of that.”

Mother-blame as Hate Speech5

Many years after I started noticing the pervasiveness and poisonousness of mother-blame, it struck me that mother-blame often is hate speech. Consider that hate speech is aimed at a person because of their membership in a particular group and is intended to silence, intimidate, shame, and/or terrify. All a stand-up comedian has to do is say, “Let me tell you about my mother,” eyes will roll, and many people will laugh. If the phrase were, “Let me tell you about my father,” can you imagine the same kind of response?

Mother-blame in the Courts

In the courts, serious problems emerge from the existence of the Mother Myths combined with the misogynist psychiatric diagnosis enterprise addressed in my previous essay6. Having served as an expert witness in child custody cases in which the mother alleges that the children’s father has abused them sexually or in other physical ways are likely to be lost by the mother because – though this may sound unbelievable – the very fact that she has reported his abuse is construed as proof that she is “mentally ill” (often, the diagnosis of “Munchausen’s Syndrome by Proxy” is used or others are applied). Thus, her attempt to protect her children is used to transfer custody to the abuser. All this is done in order to allow to hold sway the notion that fathers would never do terrible things to their children.

In one case in which I was an expert witness, there was strong evidence that the father had abused the children, and although the mother was the farthest thing from vengeful, she wanted to protect her children from further mistreatment. In court, the judge transferred their custody from her to their abuser. How could this happen? In part, it was because their guardian ad litem, who is supposed to speak for the children or with regard to their welfare, had told me on the phone that he could not believe what the mother claimed was true, because he himself was a father and would never have done anything like that to his kids. In addition, after I testified that I had conducted a psychological evaluation of the mother and found no indication that she had emotional problems – other than, of course, fear for her daughters’ welfare – and no sign whatsoever that she was inclined to lie or distort the truth, the father’s lawyer began to cross-examine me. Rather than challenging any of my professional, academic, or clinical qualifications, he simply asked, “Dr. Caplan, isn’t it true that you are a feminist?” I answered truthfully that that was true. I had a sinking feeling right then that the mother would lose custody, given that that judge was then going to be likely to discount everything I said.

Lawyers representing abusive parents, who are overwhelmingly likely to be male, often grasp at any chance to portray the protective mother as “mentally ill.” Decades ago, Richard Gardner made up what was presented as a psychiatric disorder he called “Parental Alienation Syndrome (PAS).”7 Disproportionately used, with his endorsement of the practice, to use a mother’s report that her child was being abused by its father to “prove” that the mother was fabricating in order to hurt the father and turn the child against him, PAS has come to be used frequently in the courts. What frequently happens, then, is that the judge transfers custody of the children to the abusive father, on the grounds that the allegations of his abuse were surely false and put forward by the mother for the purpose of turning the children against their father. I have seen decisions that claimed that the father was clearly the better parent, because he had no qualms about allowing his children to visit with their mother, were he to have custody, whereas the mother had put up roadblocks about their visits with him.

Some jurisdictions have prohibited use of PAS, a good thing, given that it has no scientific basis and is used in such biased ways. It is poignant, however, that many a mother in such situations have been so upset that their offspring’s abusive father has won custody and turned them against her, that they have chosen to accuse the father of PAS, thereby helping to perpetuate the use of this unscientific, profoundly misogynist term. I urge mothers in such situations to use different words instead of “PAS,” such as saying that the father is turning the children against them.

A case in Canada that drew extensive media coverage illustrates the ways that clinicians who conduct psychological evaluations in child custody cases can base their recommendations on deeply sex-biased and unfounded principles. A couple with four children was divorcing. The mother had been the ideal stay-at-home mother, and the father had financially supported the family but been far less emotionally involved with the children. Over time, the mother and father each connected with a new partner, and a court battle for child custody began. A white, male psychologist was brought in to conduct evaluations of the parties and make a custody recommendation. Hard though it may be to believe – and keep in mind that this is by no means the most extreme example of biased evaluations that I have seen – his report included the following:

(1)   The father admitted the truth of the mother’s allegation that he had physically attacked her in front of witnesses, but no doubt he attacked her because she must be a masochist who somehow got him to do it.

(2)   The psychologist had been about to recommend, based on the history of who had been the primary parent, that custody of all four children go to the mother, but then he learned that she was pregnant and that her partner, an aboriginal Canadian man, was the father. Stating that the more children one has, the less love one has to give them, he said that for that reason, he was recommending that two of the four children live with the father and two with the mother. It’s noteworthy that neither parent had ever suggesting splitting up the children, and the four had very close, loving relationships with each other.

The psychologist’s “reasoning” in (1) was clearly based on the unfounded and deeply misogynist myth that women enjoy suffering.8 As for what he said in (2), there was of course no foundation for that claim; it is hard to imagine that he would have said the same thing if the father and his new partner were expecting more children, since men continue to be less often expected to do the lion’s share of childcare; and it is possible that some racism about the stepfather’s race/ethnicity may have entered into the equation.

Psychological theories about personality and interpersonal interactions tend to fall roughly into two categories: For one, there is at least some scientific basis, and for the other, there is no scientific support. A clinician conducting a custody – or other psychological – evaluation thus can choose to justify conclusions on the basis of empirical observations or of a theory falling into one or the other group. Clearly, the psychologist in the above example chose to use unfounded theories, and where there is no scientific basis for judgments, every kind of bias easily swooshes in.

In another such example, a heterosexual couple with two children had divorced. The mother had always been the primary caregiver for the kids and was in fact home-schooling them, based on a decision the parents had made jointly. She went to great lengths to ensure that the children would have lots of extracurricular activities with friends. When the father acquired a new girlfriend well after the couple split up, he sued for custody. The public school system representative had told the mother that her teaching of one of the children was inadequate, and she promised to do exactly what they wanted her to do. However, the father said the children should instead be sent to school. The judge transferred custody from the mother to the father on the grounds that the mother’s decision to persist in home-schooling her children revealed that she was overly involved with them. I have never seen anything like that alleged about a father. It’s not hard to imagine that if the parents’ roles had been reversed, the father would have been praised by the judge for devoting so much time to home-schooling the kids and for his determination to improve in doing so.

Mothers and Other Women in the Military9

Increasingly these days, women serve in the military. Mothers whom the military requires to leave their children behind during periods of their service of course miss them terribly and often feel guilty and ashamed for being away from them, since a good mother is expected to be constantly on duty. When they are upset, they may seek or be ordered to seek help from a military therapist, and the stories of such therapists diagnosing mothers as mentally ill are legion. Then, as in civilian life, therapists are very likely to prescribe psychiatric drugs for these women, and though there is some disagreement about this, in at least some cases, the women are in danger of being punished for refusing to follow an order if they decline the drugs. When the mothers return home to their children, there are often understandable problems with readjustment on the parts of all family members, and if there is a separation or divorce and a child custody dispute, the fact that the woman had been given a psychiatric label tends to be used as reason to limit her access to and control over her children.

Something similar happens to women even if they are not mothers but are in the military, where rates of sexual assault against women are high, as is retaliation for those who report the assaults.10 Once again, the deeply human upset they experience because of the attack and often the fear of or dealing with retaliation lead them to see a therapist, and the terrible sequence described above occurs. When they leave the military or come home on leave, they are subject to all of the kinds of harm that result from getting a psychiatric label that were described in Part 1 of this essay.11

A Brief Note about Psychological Theories and Research

Space limitations make necessary just the briefest description of some aspects of sexism in psychological theories and research.

Language, Research, and Theories of Behavior and Emotions

Dr. Jeri Dawn Wine and her colleagues were pioneers of critical thinking about published research about alleged sex differences,12 and they highlighted the crucial role that language plays in the interpretation of behavior as positive or negative. Working at a time when it was widely believed (even more than today) that men were innately more assertive than women and women more dependent than men, they carefully studied the definitions of assertiveness and dependency used in the studies. With respect to assertiveness, they found that the studies fell into two categories: In one, the behavior examined was the tendency to interrupt, give monosyllabic responses, and so on, and in the other, the behavior examined was the statement of one’s beliefs or feelings and sticking to it. Men did more of the former, which often amounted to aggressiveness and rudeness, than did women, and women did as much as or a bit more of the latter than did the men. The latter of course would more reasonably be called “assertiveness.” Results of the two kinds of studies tended to be lumped together, and there were more of the former, so it was concluded that men were more assertiveness than women, and often what was also concluded was that that difference was innate. This was a powerful way to cast women as inadequate, even not fit for the public world including the workplace.

Similarly, in their analysis of studies of “dependency,”13 they found that what was often called dependency – and said to be more common in women than in men – actually included such things as  attention to and concern with the feelings of others, listening and responding respectfully, smiling, having positive and encouraging interactions with others, and accurately sending and interpreting emotion-related messages. Calling such kinds of behavior “dependency” and noting that they were more frequent in women was another major way of casting women as deficient, even childlike.

In my son’s and my simply written, short textbook called Thinking Critically about Research on Sex and Gender, we examine in brief chapters a wide range of research, from studies of the brain and cognition (including math, spatial, and verbal abilities) through emotions and interpersonal interactions.14 For each topic, we illustrate how traditional assumptions about sex and gender differences have led to seriously biased definitions, research hypotheses and designs, data analyses, and interpretations of findings. Nearly always, outcomes have been some form or other of pathologizing or demeaning of girls and women.

Pathologizing through Theorizing

To address another vast and important topic briefly, I begin by considering that the traditional theories of human development were based on the notion that the aim of growth and maturity was increasing separateness, individuation, and development of “the self.” Beginning in the 1980s and early 1990s, a number of women created work that ought to revolutionize the entire field. Psychologist Carol Gilligan15; psychiatrist Jean Baker Miller, and the Wellesley College Stone Center group that included Miller and psychologists Judith Jordan, Alexandra Kaplan, Irene Stiver, and Janet Surrey16; and social worker Rachel Josefowitz Siegel17 in various ways drew attention to the strengths that girls and women were socialized to have, leading to the recognition that, as I once heard Miller say in a lecture (but put here in my own words):

"Although it makes sense that – even from the evolutionary standpoint of thinking about who survives – it is important for humans to develop capacities to function on their own, there are a parallel track and aim of human development that is at least as important, and that is to develop the capacity to express and identify a range of emotions and the abilities to form relationships with others and repair problems in those relationships. This parallel track also makes sense from the standpoint of how they enhance the likelihood of survival."

That kind of approach provides a perspective from which it is harder to pathologize and dismiss girls and women and our strengths and from which it is easier to understand the importance of teaching people regardless of sex the skills involving connections with and consideration of others.


1 Much of this section is adapted from Caplan, Paula J. (2000). THE NEW Don't Blame Mother: Mending the Mother-Daughter Relationship.  Routledge. 

Caplan, Paula J., & Hall-McCorquodale, Ian.  (1985). Mother-blaming in major clinical journals. American Journal of Orthopsychiatry, 55, 345‑353; and Caplan, Paula J. & Hall-McCorquodale, Ian.  (1985). The scapegoating of mothers:  A call for change. American Journal of Orthopsychiatry, 55,  610‑613.

3 Much of this section is adapted from Caplan, Paula J. (2000). THE NEW Don't Blame Mother: Mending the Mother-Daughter Relationship.  Routledge. 

4 Caplan, Paula J. (2019). Is There Such a Thing as a Normal Woman? Part 1: Sexism in Psychiatric Diagnosis. ISEP Bulletin. December 2019.

5 Caplan, Paula J. (2007). Mocking Mom: Joke or hate speech? RejectedLettersToTheEditor.com, Vol. 1, No. 4. http://rejectedletterstotheeditor.com/ June 23.

6 Ibid.

7 I extensively review and critique the concept and use of “Parental Alienation Syndrome” in: Caplan, Paula J. (2004). What is it that’s being called “Parental Alienation Syndrome”? In Caplan, Paula J., & Cosgrove, L. (Eds.) Bias in Psychiatric Diagnosis, pp.61-7.. Rowman and Littlefield.

8 Caplan, Paula J. (2005)  The Myth of Women’s Masochism (latest edition with new preface). iUniverse.

9 Caplan, Paula J. (2012). Mothers and the military: What it’s like and how it needs to be. What do mothers need? Motherhood activists and scholars speak out on maternal empowerment for the 21st century. Andrea O’Reilly (Ed.). Bradford, Ontario: Demeter Press, pp. 97-106.

10 Caplan, Paula J. (2013). Sexual trauma in the military workplace: Needed changes in policies and procedures. Women’s Policy Journal of Harvard 10, 10-21; and Caplan, Paula J. (1994). They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal. Addison Wesley.

11 Caplan (2019), op. cit.

12 Smye, M.D.; Wine, J.D.; & Moses,B. (1980). Sex differences in assertiveness: Implications for research and treatment. In Stark-Adamec, C. (Ed.), Sex Roles: Origins, Influences, and Implications for Women, pp. 164-75. Eden Press.

13 Wine, J.D.; Moses, B.; & Smye, M.D. (1980). Female superiority in sex-difference competence comparisons: A review of the literature. In Stark-Adamec, C. (Ed.), Sex Roles: Origins, Influences, and Implications for Women, pp.148-63. Eden Press.

14 Caplan, Paula J., & Caplan, Jeremy B. (2009)  Thinking Critically about Research on Sex and Gender. (Third edition). Pearson.

15 Gilligan, Carol. (1982). In a Different Voice: Psychological Theory and Women’s Development. Harvard University Press.

16 Many of the Wellesley College Stone Center papers appear in these two collections: Jordan, J.; Kaplan, A.; Miller, J.B.; Stiver, I.; & Surrey, J. (Eds.) (1991). Women’s Growth In Connection. Guilford Press; and Jordan, J. (Ed.) (1997). Women’s Growth in Diversity. Guilford Press. See also Miller, Jean Baker. (1976). Toward a New Psychology of Women. Beacon Press.

17 Rachel Josefowitz Siegel’s crucially important papers include but are not limited to: Siegel, R.J. (1988). Women’s “dependency” in a male-centered value system: Gender-based values regarding dependency and independence. Women and Therapy 7, 113-123; Siegel, R.J. (1986). Anti-semitism and sexism in stereotypes of Jewish women. In Howard, D. (Ed.) A Guide to Dynamics of Feminist Therapy. Harrington Park Press; Siegel, R.J. (1990). Old women as mother figures. In Knowles, J.P., & Cole, E. (Eds.), Woman-defined Motherhood. Harrington Park Press; and Siegel, R.J. (1999). Silencing the voices of older women. In Tavares, J. (Ed.), Aging in a Gendered World: Issues and Identity for Women, INSTRAW/UN Publications.

Where Did the Term “Schizophrenia” Come From?

Where Did the Term “Schizophrenia” Come From?

Ty Colbert, Ph.D.
Until the end of the 19th century, the different forms of what we now call psychosis were generally considered to be the result of a single disease. But after studying hundreds of subjects and their seemingly unlimited behaviors and/or symptoms, Emil Kraepelin proposed the concept that there were three separate psychoses representing three separate disease entities: dementia praecox, paranoia, and manic depressive psychosis. In reference to the condition of dementia praecox, Kraepelin believed that this illness normally began in adolescence and that it involved irreversible mental deterioration.
Within a few years after Kraepelin’s dementia classification, many researchers, including Eugen Bleuler, began to realize that Kraepelin was wrong on both accounts; that indeed some individuals contracted this so-called disease later in life, and that many individuals recovered. Quoting directly from Bleuler,
"There is hardly a single psychiatrist who has not heard the argument that the whole concept of dementia praecox must be false because there are many catatonics and other types who, symptomatologically, should be included in Kraepelin’s dementia praecox, and who do not go on to complete deterioration. Similarly, the entire question seems to be disposed of with the demonstration that in a particular case deterioration has not set in precociously but only in later life."1
Bleuler then proposed the adoption of a new term. Again, quoting directly from his writings, 
"We are left with no alternative but to give the disease a new name, less apt to be misunderstood. I am well aware of the disadvantages of the proposed name but I know of no better one. I call the dementia praecox 'schizophrenia' [from the Greek words schizein, meaning “to split,” and phren, meaning “mind”] because the “splitting” of the different psychic functions is one of its most important characteristics.2
Because of the dissatisfaction of Kraepelin’s term dementia praecox, Bleuler began to search for a better understanding of this condition. To do so, he enlisted help from some bright young physicians. To begin this investigation, in 1900 he sent Franz Riklin to Heidelberg to learn about the association testing that Kraepelin was using in his laboratory.
It was also at about this same time that right after graduating from medical school, Carl Jung arrived at the clinic Bleuler was directing, to help him with his research. When Riklin returned from Heidelberg, he and Jung began developing their own word association tests. Quoting from an article by Moskowitz,
"They set about their task, which Bleuler hoped would inform his developing theory, systematically—first recording the associations of non-psychiatric subjects under a range of conditions before moving on to psychiatric subjects. Their studies formed the basis for a series of publications in the early 1900s, ultimately released in book form under the title of 'Diagnostic Association Studies'. During the course of these studies, which diverged from prior associational research by focusing not only on the time delay between the stimulus word and its response, but also on the personal meaning of the response and whether the subject could recall their response on subsequent trials, Jung developed the concept of a feeling-toned or emotionally-charged complex. This important concept… was to become central to Bleuler’s developing concept of schizophrenia."3
In the application of word association tests, a subject is given a word, and then the investigator records such data as the time delay between when the word is given and the person’s response, as well as the possible personal meaning of the response. Here is a perfect example that I also used in my book Healing Runaway Minds.
A father once brought his psychotic 23-year-old son, Mark, to me for an evaluation. Mark had been living on the streets of Hollywood for several years and had prostituted himself as a way of supporting himself and his drug habit. Although he had been free of street drugs for several months, his previous drug use complicated the attempt to isolate the origin of his psychotic symptoms. As I talked with Mark, he continually switched from a state of coherency to a state of extreme delusion, euphorically describing his extraordinary relationship with Jesus.
He shared that, at certain times, a glorious light beam would appear from the sky and envelop him. Within this beam, Jesus would then appear to purify him. Initially, it appeared that his psychotic behavior came out of nowhere, perhaps as a result of his use of street drugs. As I continued to listen to and observe Mark, paying close attention to his body language and the specifics of the conversation, I discovered a very precise link between his emotional pain and his psychotic behavior. If I directed the conversation to topics devoid of any strong emotional content (foods, music, etc.), he remained relatively free of any psychotic symptoms. But the moment I approached certain areas of his painful life (e.g., “Was it hard to support yourself on the street?”), he immediately escaped into a religious delusional monologue.
“Hollywood” would obviously not be a term Jung would use, but it can represent a fairly neutral word for one individual and obviously, a trigger word for this young man. So if I presented that word to a person who had lived his entire life in New York and had no strong emotional connection to Hollywood, he may respond with, “Oh, a place where movie stars live.” In addition, he may take a quick moment or two to think how he may want to respond, since he had no strong emotional connection to the place. But when I mentioned the word “Hollywood” to my client, Mark, he almost instantly began to talk about the “light of Jesus.”
Along the same lines, when I ask a person in therapy an emotionally-charged question, and that person is not ready or able to give me a truthful “feeling” response, I will usually receive one of three responses. The person will (a) give me a very quick, superficial response, (b) just not answer me, or (c) change the subject. In such a situation, the person is not deliberately acting dishonestly. The unconscious part of his or her mind quickly takes over before any painful feelings can surface, resulting in a response that helps push the feelings back down before they can fully surface. These kinds of behaviors are what Jung referred to as a “feeling-toned or emotionally-charged complex.” Thus, to me, what Bleuler identified as the “splitting of the different psychic functions” was no more than the person’s mind deliberately running off or hiding from the powerful and terrifying feelings locked up or dissociated off from the person.
Consequently, as Bleuler and Jung used a non-medical, non-biological test to notice that certain words triggered an emotionally reactive response resulting in an abnormal, often bizarre behavior, Bleuler searched diligently for the proper term to describe such behavior and came up with the term “schizophrenia.” Thus, the origin of the term was based on an emotional-dissociative model, not a disease or biological model.

1 E. Bleuler, Dementia Praecox or the Group of Schizophrenias (1911), J. Zinkin, Trans. (New York: International University Press, 1950), p. 8.
2 Ibid., p.6.
3 A. Moskowitz and G. Heim, “Eugen Bleuler’s Dementia Praecox or the Group of     Schizophrenias (1911): A Centenary Appreciation and Reconsideration,” Schizophrenia Bulletin, Vol. 37, No. 3 (May 2011), retrieved July 21, 2014, from www.ncbi.nlm.nih.gov/pmc/articles/PMC3080676.

Turning a Child’s Intensity Into Their Greatness

Turning a Child’s Intensity Into Their Greatness

Howard Glasser

My passion in the medication debate stems from my clinical work with families with challenging and intense children. I got to see that with 2-3 weeks – at most within 2-3 months for the most difficult children – that the very same intensity that had gone awry became the very fuel for that child’s greatness. And I got to see that their extra added intensity was therefore a great blessing, rather than cause to label them with a diagnosis – predicated upon a view of the symptoms as pathology requiring medications.

I got to see that entirely different course of action could light up an infinately greater runway for a child and their family instead of taking a course of actions that so often endangers a child with unforeseen side-effects, perhaps the worst of which is the meta message to the child that something is drastically wrong with them in regard to their life force because neither they or their parents or teachers can handle it – we need to make their intensity go away.

If we really saw life force/ intensity as a blessing that could be transformed into greatness we would never ever dream of doing that. Life force is precious. It is common to us all and some simply have the gift of having more than others. Without it we’d be lost. Without it we might not even be able to get out of bed. Without it we wouldn’t be able to live our dreams or live or fulfill our passionate lives. We need our future generations of children to have their intensity intact so that can do the great things we need them to do. We can’t afford for future generations to be lost with their intensity suppressed.

Besides, at most medications simply give the illussion of improvement. In a way “improvement” pale in comparison to what I found to be consistently obtainable “transformation.” Before the meds kick in and after they wear off the problems are still there – nothing has changed and there has been zero healing. Isn’t healing what we want. Don’t parents and teachers deep down simply want all along to see this child use their intensity in great ways. With medications the parent is none the wiser on how to best help this child nor is the child any the wiser on how to best help themselves. There must be a better way and there is.

The reason I can say this is that by grace I stumbled upon devising a method of helping these children that I came to eventually call The Nurtured Heart Approach and that is what I will write about mostly in this blog. I will do my best to tell you how the approach came to be and what kinds of impacts it is having, as well as giving you some sense of what it is and how it works. As this is my first blog I will save most of it for subsequent notes but for now I want to say that what I found through this work has given me great hope and that is what I want to inspire in you.

I don’t want to waste my time fighting the pharmaceutical companies. Other people have that talent and I applaud that. I simply want to show over and over again that with the right kind of approach these very same children of concern can easily be “transformed” to be the best children on the planet.

I’ll give you one example for now – Tolson Elementary in Tucson, Arizona – has been using this approach now for over 10 years and in since that time, as a school with well over 80% free and reduced lunch and other demograpgics that go with an at-risk population, they went from a school with the highest rates of suspensions, bullying, teacher attrition, use of diagnosis and medications in their large school district – a school designated as failing and with a high rate of special education – to a school that is designated as excelling – going from over 15% special education to less than 2%, to almost zero bullying, suspesions, teacher attrition, with zero use of diagnosis and medications and more.

They did this because they began changing drastically the way they relate to children. This is what I will describe as these blog posts unfold and evolve.

I certainly believe in symptoms. I believe there are kids loaded with symptoms that frustrate, annoy and drive parents and teachers to distraction. However I also believe that the energy that drives these very same symptoms can be rerouted to greatness. Greatness can be awakened in the most difficult children with methods that are geared to how these children respond to relationship and energy. Then we don’t have to hope that they will find a “way” to channel their energies to activities like scouting or dance, baseball or soccor or any other activity. Not that these are bad. It’s just that there’s a better solution – where the child awakens to who they really are as a great person and as that assimilates and integrate then we will have a child who acts-out in an entirely different way – they act-out in greatness and manifest that wherever they go.

Heading Off Complaints of “Anti-Psychiatry Bias”

Heading Off Complaints of “Anti-Psychiatry Bias”

Niall McLaren, MBBS, FRANZCP
Psychiatrist, Brisbane, Australia

The 2017 report of the Special Rapporteur to the UN Human Rights Commission on the "right of everyone to the enjoyment of the highest attainable standard of physical and mental health" (UN Human Rights Council, 2017) attracted very strong criticism from mainstream psychiatrists (Dharmawardene and Menkes, 2018). It was seen as biased against the biomedical model of mental disorder in general, and against psychiatrists in particular. This criticism was completely misdirected (Cosgrove and Jureidini, 2019; McLaren, 2019). A further report has just been released (UNHRC July 2019) but, before leaping to the barricades, it is most important that psychiatrists fully understand the meaning and significance of these reports.

Firstly, the Special Rapporteur, appointed in 2014, is Prof. Dainius Puras, a distinguished Lithuanian child and adolescent psychiatrist and epidemiologist, and a person with the highest international credentials to chair this type of project. As a working psychiatrist, it is not rational to belittle his conclusions as "anti-psychiatry" although it is true that he is resolutely opposed to bad psychiatry. It is also factually wrong to see these reports as open to the "bias" of a single individual. Second, for readers in Australia and New Zealand, his conclusions must be seen in the context of the often bitter criticism of mainstream psychiatry drawn forth by two current enquiries, the Australian Productivity Commission Enquiry into Mental Health (2019) and the Victorian Royal Commission into Mental Health (2019). Psychiatrists who believe they are offering the best of all possible treatments for the best of all possible reasons, and are thus above criticism, urgently need to read the public submissions before delving into the latest UNHRC report.

The intellectual basis of Puras' current report includes many propositions with which there will be no disagreement, as per the following items:

1. ....In the present report, the Special Rapporteur highlights the importance of the social and underlying determinants of health in advancing the realization of the right to mental health...

7. ...States also have an obligation to create supportive and enabling environments that foster mental health and well-being....

21.... States do not invest enough resources in mental health in general...

28. Actions taken to realize the right to mental health must be of good quality, and they require evidence-based data and information that is multidisciplinary....

However, the main thrust of the report will cause angst among many psychiatrists, to wit, that the ever-growing emphasis on a biomedical approach to mental disorder is inappropriate:

1. ...A rights-based approach to the promotion of mental health offers an alternative to the biomedical, disease-oriented model that adopts a narrow, individual focus on the prevention of mental health conditions....

19.... the outsized influence of pharmaceutical companies in the dissemination of biased information about mental health issue...(leads to an) overreliance on coercive, punitive and overmedicalized measures... (which) demonstrate a lack of political will to support, replicate and sustain evidence-based social interventions that foster well-being, prevent discrimination and promote community inclusion.

21.... States do not invest enough resources in mental health in general... a larger proportion of available resources are directed to ineffective systems, reliant on excessive medicalization, coercion and institutionalization, breeding stigmatization, discrimination, disempowerment and helplessness.

28....Responses to mental health conditions that are based on the use of coercion... are becoming the rule. Continued investment in policies and services, with prevailing patterns of coercion, excessive medicalization and institutionalization, are a serious obstacle to the effective realization of the right to mental health. Such systems reinforce vicious cycles of stigmatization, discrimination and social exclusion, and may be more detrimental than the mental health conditions they are supposed to treat.

For the many psychiatrists who firmly believe that biological reductionism is not just the correct approach to mental disorder, but the only conceivable approach, these are inflammatory remarks. The idea that our forms of treatment could, on balance, be inequitably distributed, do more damage than good, at greatly excessive short- and long-term cost, and with dismal efficacy, will be reflexly rejected. This defensive response would, however, be exceedingly unwise. All is not well in psychiatry, as the existence of the above-mentioned enquiries indubitably demonstrates.

If, however, psychiatrists manage to convince themselves the enquiries are just some bothersome window-dressing from which no good will emerge, there is ample, highly reliable evidence that theirs may not be the best of all possible worlds.

1. The Royal College of Psychiatrists was recently forced to acknowledge that, despite its previous attempts to deny the possibility, antidepressants are addictive (RCPsych 2019). This accounts in part for the relentless increase in numbers of people taking these drugs in Western countries (now 16% of adult population in UK). At the same time, there is emerging evidence that people taking antidepressants are likely to have a worse outcome (Hengartner, Angst and Rössler 2018).

2. Antipsychotic drugs shorten the lifespan (Correll et al 2015). That is, people who, for example, are detained and compelled to take drugs against their will just on the basis of potential "reputational damage" (whatever that means) are likely to die younger as a direct result, albeit with their reputations intact. At the same time, recent studies have added to the already strong evidence that antidepressant drugs are neither as effective nor safe as the manufacturers claim. Hengartner and Plöderl (2019) concluded:

The data presented herein suggest that antidepressants significantly increase the suicide risk in adults with major depression.

3. Drug companies in the US have acted unethically and, in at least some cases, illegally, to produce an "epidemic" of opiate addiction which now claims about 50,000 lives a year and shows no signs of abating. As a result, the life expectancy in the US has declined for several years in a row, the first time this has ever happened in a developed country in peace time. This is part of a pattern of scandalously venal and/or illegal conduct by drug companies for which they have been fined a collective $42billion in the US over the past ten years (Gotzsche, 2015; Whitaker and Cosgrove, 2015).

4. The argument that ECT is "essential and irreplaceable" in treatment of mental disorders evaporates under close scrutiny (Read and Arnold, 2017). It should be noted that the recent Guidelines on ECT issued by the Royal Australian and New Zealand College of Psychiatrists (RANZCP 2019) do not address the critical point of whether ECT is necessary. In fact, analysis of readily available figures reveals that it is not, that the main driver for the rapidly increasing use of ECT in Australia is the financial rewards it generates for the private psychiatric industry (McLaren, 2018).

5. The relentlessly expanding list of diagnostic categories of mental disorder has long passed the limits of common sense. What we are now seeing is the medicalisation of normality (Horwitz and Wakefield, 2007; Frances, 2013).

6. Long-term use of drugs with strong anticholinergic effects, such as antidepressants and antipsychotics, is associated with an increased risk of dementia (Coupland et al 2019). Overwhelmingly, these drugs are approved on the basis of short-term trials, often only weeks, whereas large numbers of people take them for decades. Long-term studies demonstrate that their efficacy is grossly over-rated  (Wunderink et al, 2013) while reanalysis shows that many trials are unreliable (Le Noury et al, 2015).

7. With the NIMH Research Domain Criteria project (Insel et al, 2010), psychiatry has committed itself to a project of biological reductionism which is hugely expensive, has no rational basis and can never succeed (McLaren, 2011). This is not a matter which can be countered by claims such as: "They used to say that heavier-than-air flight was impossible, too." It is the case that mental properties cannot be  reduced to or explained away by their physical mechanism (Stoljar, 2010). No psychiatrist has ever argued a remotely plausible case that the ordinary, or even extraordinary, techniques of laboratory science will ever tell us anything interesting about mental disorder, let alone explain it with no questions unanswered, yet the great bulk of psychiatric research funding will now be directed to basic biological sciences.

8. On March 6th 2018, the RANZCP issued a press statement claiming inter alia that:

The prescription of antidepressant or antipsychotic medications is something that a psychiatrist only ever does in partnership with the patient and after due consideration of the risks and benefits (RANZCP 2018, emphasis added).

This claim was manifestly untrue and it was impossible for those who authorised it to believe otherwise. 

This strongly suggests that even though psychiatrists are very happy with their work and don't see any need for criticism, many people on the receiving end of it aren't quite so enthralled. By effectively abandoning the psychosocial elements in their former mantra, psychiatrists have painted themselves into a biological corner, but there is no Plan B. For anybody who takes psychiatry seriously, I see grounds for despair. Psychiatrists more and more are showing at best, the trappings of a medieval guild (Cosgrove and Whitaker 2015) or, at worst, an ideology or cult (McLaren 2013). Blame for this rests squarely on psychiatry's lack of a model of mental disorder and its adamantine refusal to accept the criticism which is the only path to rectifying that deficiency (McLaren, 2018).

Science proceeds by criticism of the status quo; in the canon of science, not even that proposition is beyond criticism. Attacking critics such as Puras will never conceal the intellectual hole at the heart of modern psychiatry. Indeed, the extreme defensiveness of psychiatrists attests to their intellectual insecurity. As psychotherapist and author Gary Greenberg noted:

It's the universal paranoia of psychiatry that everybody who disagrees with them is pathological. You can't disagree with a psychiatrist without getting a diagnosis... (they) diagnose the critic (Reece 2013).

If and when, by their constant breaching of the most fundamental rules of the conduct of science, psychiatrists succeed in destroying public confidence in their profession, it will be both supremely ironic and a tragedy for the mentally-disturbed.


References:

APC Enquiry into Mental Health (2019). https://www.pc.gov.au/inquiries/current/mental-health#draft.  Accessed July 14th 2019.

Correll, CU et al. (2015) Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry. Jun; 14(2): 119–136. https://doi.org/:10.1002/wps.20204.

Cosgrove L, Jureidini J (2019). Why a rights-based approach is not anti-psychiatry. Australian and New Zealand Journal of Psychiatry 53: 503-504. https://doi.org/10.1177/0004867419833450.

Coupland, CA et al (2019). Anticholinergic Drug Exposure and the Risk of Dementia. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2019.0677. Published online June 24, 2019.

Dharmawardene, V, Menkes, DB (2019) Responding to the UN Special Rapporteur’s anti-psychiatry bias. Australian and New Zealand Journal of Psychiatry 53: 282–283.

Frances, A (2013).  Saving Normal: An Insider's Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. New York: Wm. Morrow.

Gotzsche Peter (2015). Deadly Psychiatry and Organised Denial. London: Artpeople.

Hengartner M, Angst J and Rössler W (2018). Antidepressant use prospectively relates to a poorer long-term outcome of depression: Results from a prospective community cohort study over 30 years. Psychotherapy and Psychosomatics. Published online April 20, 2018. https://doi.org/10.1159/000488802.

Hengartner, M. P., & Plöderl, M. (2019). Newer-generation antidepressants and suicide risk in randomized controlled trials: A re-analysis of the FDA database. Psychotherapy & Psychosomatics. Published online June 24, 2019. https://doi.org/10.1159/000501215.

Horwitz AV, Wakefield JC. The Loss of Sadness: how psychiatry transformed normal sorrow into Depressive Disorder.New York: Oxford University Press, 2007.

Insel, TR et al (2010). Research Domain Criteria (RDoC): Toward a New Classification Framework for Research onMental Disorders. American Journal of Psychiatry 167: 748-751

Le Noury, J et al  (2015) Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015; 351 https://doi.org/10.1136/bmj.h4320.

McLaren, N. (2011). Cells, circuits and syndromes. A critique of the NIMH Research Domain Criteria project.  Ethical Human Psychology and Psychiatry 13: 229-236.

McLaren, N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18.

McLaren, N (2018). Electroconvulsive Therapy: A Critical Perspective. Ethical Human Psychology and Psychiatry 19: 91-104

McLaren, N (2018). Anxiety: The Inside StoryAnn Arbor, MI: Future Psychiatry Press.

McLaren, N (2019). Criticising psychiatry is not ‘antipsychiatry’  Australian and New Zealand Journal of Psychiatry 53: 602-603.    https://doi.org/10.1177/0004867419835944.

RANZCP (2018) Press release March 6th 2018: RANZCP deeply concerned over stigmatising reporting of mental health treatment. Since deleted; available at https://www.MIA.com/2018/03/psychiatrist-writes-ranzcp/.

RANZCP (2019). Professional practice guidelines for the administration of electroconvulsive therapy.  Australian and New Zealand Journal of Psychiatry 53: 609–623

RCPsych (2019). Position statement on antidepressants and depression. PS04/19. Royal College of Psychiatrists, London.

Read, J, and Arnold, C (2017). Is electroconvulsive herapy for depression more effective than placebo? A systematic review of studies since 2009. Ethical Human Psychology and Psychiatry 19: 5-23.

Reece, H. (2013). Interview Gary Greenberg, The Atlantic, May 2nd 2013. https://www.theatlantic.com/health/archive/2013/05/the-real-problems-with-psychiatry/275371/.

Stoljar D (2010). Physicalism. Oxford: Routledge.

The Royal Commission into Victoria’s Mental Health System (2019). https://www2.health.vic.gov.au/mental-health/priorities-and-transformation/royal-commission. Accessed July 14th 2019.

UN Human Rights Council (2017, 2019) Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

(2017) UNHRC Document A/HRC/35/21 , available at: http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/35/21.

Whitaker R, Cosgrove L (2015). Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform. New York: Palgrave MacMillan.

Wunderink, L et al (2013). Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2013.19Published online July 3, 2013.

Is There Such a Thing as a Normal Woman? Part 1: Sexism in Psychiatric Diagnosis

Is There Such a Thing as a Normal Woman? Part 1: Sexism in Psychiatric Diagnosis

Paula Caplan, Ph.D.


Note: Part 1 is about sexism in psychiatric diagnosis. Part 2, to appear in the next issue of the Bulletin,  is about sexism in relation to mother-blame and psychological/psychiatric theory and research, with suggested solutions for these realms. Portions of this article are based on the author’s September 28, 1999, keynote address of the same title to the Department of Health and Human Services-sponsored New England Conference on Women and Mental Health, Hartford, CT.

Even this far into the 21st century, if one examines psychiatric diagnoses, stereotypes and myths about and expectations of mothers, and classic theories of psychological development, it is hard to find any possibilities for women to be considered normal. Instead, they are usually considered pathological or otherwise deficient.

The ways that psychiatric diagnoses are conceived, constructed, and applied leave the field wide open for sexism and indeed for every conceivable form of bias. Mother-blame in clinical journals and mother-blame as hate speech result in the pathologizing of virtually anything that mothers might do. And classic theories of psychological development and designs of research questions and methodologies have often been profoundly sexist. None of this is surprising, since the vast majority of the world continues to be pervaded by sexism, so it naturally shapes virtually every realm.

Sexism Due to Lack of Science in Psychiatric Diagnoses

The Diagnostic and Statistical Manual of Mental Disorders, often called the therapist’s Bible, is widely used to pathologize all women (and many men). It is a product that is a multi-million-dollar business, because it has been translated into two dozen languages for global use, and it is marketed by its publisher, the American Psychiatric Association (APA), as a scientifically-based document. The APA’s profits come not only from publication of the manual itself but also from sales of a variety of related books and other products. I was a consultant to two committees that produced DSM-IV, but I resigned after learning of the profoundly unscientific way the manual was put together and the dishonesty of its head and many of its members about the lack of science and the harm it causes.1 What I saw as an insider was that, when junk science can be described in a way that supports the aims of the select few who make the final decisions, it is presented as good science, and when well-done research conflicts with their aims, they ignore, distort, or lie about it. I have said that that process should be called "Diagnosisgate" for these reasons.(See ISEPP's position on the DSM here).

To give just one rather representative illustration of how unscientific the manual is (for far more examples, see citation in Endnote1), let us consider how the DSM authors dealt with their idea of creating a category now called Premenstrual Dysphoric Disorder. That category, according to the DSM committee's own published information, would apply to at least a half-million North American women.3 The category first went into the DSM at a time when Robert Spitzer, then DSM head and one of the originators of this category, acknowledged in a press conference that psychiatrists had no cure to offer for this disorder beyond the nutritional, vitamin, and self-help suggestions published in the pages of women's magazines. However, he said that the category needed to go into the manual so that psychiatrists could find out how to help women who suffered from "it". The scientific basis (or its lack) was not really examined until seven years later, when the next edition of the DSM was being prepared. At that time, DSM-IV head Allen Frances had cannily appointed an all-woman committee to evaluate the research, and they were longtime experts on the subject, most or all of whom received money from Big Pharma. The PMDD committee wrote a report approximately 125 pages long and including a review of more than 400 research articles. It looked impressive.4 In their own summary, the committee said outright that almost none of the papers was relevant to the question of whether there is a premenstrual mental disorder. Many of the papers were instead related to such premenstrual physical experiences as bloating, breast tenderness, and food cravings -- or even to reports of increased irritability, for instance, but by no means to anything one might conceivably consider a "mental illness". The committee said that the few reports that were relevant were "preliminary" and had many methodological problems. On that basis, one might have expected the committee to tell Dr. Frances that there was no scientific justification for claiming there is a premenstrual mental illness. Instead, they reported that they could not reach a consensus.

Frances then announced that he had appointed two other people to decide the fate of this category, but he refused to name those people. I telephoned him, said the debate about this category had perhaps become unnecessarily adversarial, and suggested that we try together to focus on the welfare of the women who might be given this label, since both his group and opponents of the category were presumably most concerned about those women. I pointed out that I had given his PMDD committee documentation of the harm that had already been caused to women who had received this label. I said it would be reassuring if he could present some evidence at least that more women had been helped than harmed by this diagnosis. He responded, "Well, of course, there's no way of knowing that." But of course, there is a way of knowing that. That is what scientific research is for, and scientific research is supposed to be the basis for decisions about the DSM.5

Ultimately, under media pressure, Frances announced the names of the two persons who would decide the fate of the PMDD category. Psychiatrist Nancy Andreasen was a longtime advocate of the notion that all emotional problems are caused by brain disorders and had served on DSM committees with Spitzer, one of the category's inventors. Psychiatrist A. John Rush specialized in research about “depression” and had received Big Pharma funding for research about it. This pair recommended that the category be included in the DSM-IV and that it go not just in the appendix that was said to be for disorders requiring further study but also in the main text of the manual, which is supposedly reserved for well-supported categories. Further, they said it should be listed under Depressive Disorders -- even though, astonishingly, one did not have to be depressed to meet the PMDD criteria. (But remember, A. John Rush received Big Pharma funding to study “depression.”) This was particularly disturbing in view of the fact that it has been documented that women who report feeling upset premenstrually are significantly more likely than other women to be in abusive or other upsetting life situations. Therefore, diagnosing them as premenstrually mentally ill leads us in the wrong direction, away from focusing on the real sources of their problems.

Around that time, the DSM people began to claim – though evidence on this point was appallingly poor, and there was even evidence disproving it – that “antidepressant” drugs were the most important treatment for women given this label, and committee members accompanied Eli Lilly staff to a meeting where they persuaded the FDA to approve repackaging and renaming (in pink and purple) of Prozac to be called Sarafem and prescribed for women labeled with PMDD.6

When women tell me they feel badly premenstrually, I believe them. I know that hormonal changes can affect one's feelings. But so, for instance, can a sprained ankle, and sprained ankle is not included as a mental illness in the DSM, nor are the vast majority of other physical problems.

What Allen Frances and his colleagues did with the science related to "PMDD" is just one example of how fast and loose they played with the research, a pattern that leads to other problems. If one imagines the enterprise of psychiatric diagnosis as a sphere, consider that the DSM marketers claim it is filled with good science, but we know that is not true. If one removes from that sphere all of what is wrongly called good science, it leaves a vacuum. What goes into a void where there is no objectivity? Every conceivable form of subjectivity and bias. It is unsurprising, then, that sexism – as well as racism, classism, ageism, heterosexism and homophobia, and others – pervades the creation and application of psychiatric labels.7

Harm from Psychiatric Diagnoses

The DSM is probably the single most powerful source of support for the medical model of emotional anguish, with the strikingly similar psychiatric listings in the International Classification of Diseases adding still more force. It  is deeply worrying that use of the medical model for emotional problems increases the likelihood of therapists unthinkingly prescribing psychotropic drugs (inappropriately, without obtaining fully-informed consent and/or without explaining to the person the full range of possibly helpful options), even electroshock, and ignoring the potentially negative consequences of applying a diagnostic label. The vast range of kinds of harm that begin with the labels includes the person's loss of custody of their children, loss of employment, loss of health insurance or skyrocketing of premiums on the grounds that the person has a pre-existing condition (the mental illness), and legal rights to make decisions about what happens to them, such as whether to have electroshock, take medication, and be physically confined, isolated, or restrained. Other adverse consequences of labeling include the dehumanizing of the labeled person and creation of a we/they world, in which therapists are more likely to feel superior to and qualitatively different from the people they are supposed to help. These are not inevitable consequences of labeling, but they are common ones.

Vast numbers of women (and men) who have real but undiagnosed physical health problems are inaccurately diagnosed as having mental disorders instead.  Some physicians are quick to assume that any woman with complaints of any sort is hysterical, dependent, and attention-seeking and thus mentally ill. Other physicians' intentions may be more honorable, but when their training has not included the physical symptom picture presented by a given patient, they mistakenly conclude that nothing physical can be wrong and that therefore the problem can only be psychological. These phenomena account for many women being regarded as mentally disordered.

Many well-meaning therapists tell me that they believe they minimize risk from diagnosis by classifying all of their patients as having Adjustment Disorder, because it sounds so innocuous. However, a lawyer told me the following story about a client of his. The client, a woman who had recently moved to his state to begin a graduate program in psychotherapy, was told during the first week of classes by the program director that any student who had not been a therapy patient should seek some therapy sessions right away, just to see how it felt. The rationale was, "Soon you will be a therapist, so you need to have that experience of being a patient." The obedient student went promptly to a walk-in clinic at the local hospital and explained to the psychiatrist on duty why she was there. The psychiatrist agreed to see her for some sessions, during which they discussed anything that was bothering her, such as feeling lonely after having moved to a new place where she knew no one. Subsequently, the patient was in a vehicle accident and incurred physical injuries, for which she was treated at the same hospital. She was bewildered to receive a letter from her health insurance company, in which she was told they would not pay her medical bills from the accident because she had lied to them on her insurance application form. When she contacted them to protest that she had not lied, they replied that she had denied that she had a mental illness on the form when she applied to their company for insurance. "But I don't have a mental illness," she replied. The insurance company employee said that she clearly did have a mental illness, because her hospital chart showed that the psychiatrist had given her a DSM label. "But the psychiatrist knew I wasn't there because of a mental illness," she protested. That did not matter. The insurance company officials claimed that, simply by virtue of some therapist's having assigned her a DSM label (which the therapist likely did so that the insurance company would pay for the therapy), this woman was now irrevocably considered mentally ill. What power the DSM has! It is far too often erroneously assumed that anything in the DSM is true and that any therapist who uses a label from that manual is using it accurately.

I am aware that some people feel that receiving a label, or receiving a label and then psychotropic medication, has been extremely helpful to them, and I do not question that. But in general, psychiatric labeling tends to narrow our vision of the causes of women's and men's pain and anguish and of the ways we might help. 

Sexism and Specific Diagnoses

The DSM is the most influential basis for how we as a society decide who is normal, but the very foundation of the book is nebulous. "Mental illness" is a construct, and even the DSM authors acknowledge the impossibility of creating a good definition of it. When that overarching construct is ill-defined, how can each of the hundreds of categories and subcategories of alleged mental illness have any validity? Here follow just a few examples of labels that were constructed and/or are applied in sexist ways – Post-traumatic Stress Disorder, Borderline Personality Disorder, Self-defeating Personality Disorder, Major Depressive Disorder, Generalized Anxiety Disorder, and Premenstrual Dysphoric Disorder.

Post-traumatic Stress Disorder used to be the "normal reaction" in the DSM, because it was described as likely to develop in anyone who had experienced major trauma. However, Dr. Allen Frances in DSM-IV removed the statement that the criteria are normal reactions to an abnormal situation, and the statement was not restored in DSM-5. This is devastating for battered, raped, or severely emotionally and verbally abused women as well as for others, such as people who have been traumatized by war, because it means that deeply human reactions to trauma are classified as mental illness at the drop of a hat.8 This is not only inaccurate but also severely damaging, because in addition to struggling with the effects of trauma, the labeled person now has to grapple with feeling something is wrong with them for not being “over it” yet.9

Borderline Personality Disorder is a label often given to victims of battering, abuse, and severe harassment -- most often women -- making it another classification that conveys the messages that “You should get over it” and “You are seriously defective, probably with a chemical imbalance in your brain.”10 From my own experiences listening to many traditional therapists, I have observed that it is a label they often give to patients they dislike.

Self-defeating Personality Disorder appeared in the appendix for categories requiring further study in DSM-III-R but not in subsequent editions. It was a slightly masked title for what was originally called “Masochistic Personality Disorder” and was to be applied to people who, for instance, put others’ needs ahead of their own and settled for less when they could have more. The danger of this category was especially great for women, who are traditionally socialized to fit these patterns, and even more for victims of wife battering, rape, and child sexual abuse, who are more likely to be women.11 The absence of the term from the current manual by no means prevents practitioners from using this label – or even if not using the label itself, interpreting women’s suffering as caused by a sick enjoyment of the abuse, failure, deprivation, or other harm they suffer. In addition, the use in the current manual of terms like “unspecified” or “other” disorders in practice allows the professional to call anything at all a mental disorder.

The sexism in the DSM  is illustrated by the fact that there is no male equivalent in the DSM of either Premenstrual Dysphoric Disorder (for instance, no Testosterone-Based Aggressive Disorder) or Self-defeating Personality Disorder (since Self-defeating Personality Disorder is in many ways a somewhat exaggerated form of traditional female socialization, a male equivalent might be called John Wayne Syndrome or Macho Personality Disorder). Sociologist Margrit Eichler and I decided, for educational and consciousness-raising purposes, to design an alleged mental disorder we called Delusional Dominating Personality Disorder (DDPD), the consequences of a somewhat exaggerated form of traditional male socialization.12 We designed DDPD using the DSM format and submitted it to the DSM committee for inclusion in DSM-IV. We pointed out that not all men suffer from DDPD and that some women do. We also noted that DDPD is frequently seen in major military and political leaders and the heads of large corporations. For brevity’s sake, I shall only list here the first four of the 14 proposed criteria for DDPD. They are:

1. Inability to establish and maintain meaningful interpersonal relationships.

2.Inability to identify and express a range of feelngs in oneself (typically accompanied by an inability to identify accurately the feelings of other people).

3. Inability to respond appropriately and empathically to the feelings and needs of close associates and intimates (often leading to the misinterpretation of signals from others).

4. Tendency to use power, silence, withdrawal, and/or avoidance rather than negotiation in the face of interpersonal conflict or difficulty

(The full list of criteria is included in Caplan, 1995, cited in endnotes.)

We created the category more than two decades ago, and I began to speak about it in lectures. Every time I read the full list of criteria to any group of any kind, as I read the first few, people would laugh. As I read the next few, they would fall silent and appear to be listening carefully. By the time I would get to the last ones, they were shouting out things like, "I KNOW people like this! Why aren't they considered a problem?!" Needless to say, the DSM committee gave no sign that they even considered it for inclusion in the manual. Although virtually everything that women may do can qualify for "mental disorder" according to the DSM, traditionally-socialized masculine behavior that often causes pain, physical harm, and even physical illness in people who meet DDPD criteria and to the people with whom they live and work is far less often considered pathological by those who create the official diagnostic categories. That is why people laughed when they heard the first criteria of DDPD: They were surprised that anyone might suggest calling hurtful or inhumane "masculine" behavior a mental disorder. It is encouraging that in recent years, there has been increasing recognition of the harm caused by what has come to be called toxic masculinity, though it is important to recognize that this is a widespread social problem and should not be called a mental illness, lest the methods for reducing such social problems be overlooked rather than implemented.

Major Depressive Disorder (MDD) is a category leading to dangers for girls and women, because in a sexist society such as ours, there are a great many causes for grief, sadness, a sense of helplessness or hopelessness, feelings of worthlessness, irritability, difficulties with sleeping or eating, and other emotions, beliefs, and problems listed under this category in the DSM.  Since having such feelings after bereavement or other major loss are deeply human ones and should not be called signs of mental illness, it is important to mention a particular part of MDD’s descriptions in the current and previous editions of the DSM. There has been a justified outcry that in DSM-5, it is said that MDD should not be diagnosed if the person has been bereaved less than two weeks. It is both absurd and dangerous to consider these kinds of feelings pathological as soon as the first two weeks after the loss are over. But what should also be known is that in DSM-IV, Allen Frances’s edition specified that MDD could be diagnosed in a bereaved person as long as the person had any of the following: “marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.” Since these are very common characteristics of bereavement, the DSM-IV allowed for application of the MDD label to a person on the first day of their loss, making it in that way even worse than DSM-5.14 This matters, because in all of the justified outcry about the two-week limit in DSM-5, it is crucial not to render invisible the suffering of all of the bereaved people who were hurtfully diagnosed with MDD based on DSM-IV.

Generalized Anxiety Disorder is similar to Major Depressive Disorder, given that what is called “anxiety” is usually fear, and in a sexist and violent society, there are myriad reasons for girls and women to be afraid.

Premenstrual Dysphoric Disorder’s unscientific nature, described earlier, is not the only problem with the category. Because its name confines its application exclusively to women, who have menstrual periods through many decades of their lives, it has opened the floodgates for the pathologizing of nearly everything about women. Most women have had the experience of their legitimate feelings and concerns being dismissed on the grounds that they must be premenstrual. And as the medical community has joined with Big Pharma, both “peri-menopause” (the time recently delineated for purposes of pathologizing as when hormones start to change when women move toward cessation of menstruation) and menopause itself (the cessation of menses) have been treated as causes of “mental illness,” and there is a long tradition of demeaning and pathologizing older and old women based on the notion that without the hormonal levels typical of women who are still menstruating, they are unfeminine, unwomanly, “dried up,” somehow less than human. I am not being entirely flippant when I suggest that it’s only a matter of time until the APA creates a category of psychiatric disorder for girls from birth till their first menstrual period and attributing it to the fact that their hormone levels differ from those of menstruating women.

 

In summary with regard to psychiatric labeling, once you add to all who have been or could be diagnosed with the labels discussed above,  plus all the women who could qualify for any of the other hundreds of mental disorders listed in the DSM, is there any chance we could find a normal woman?

As if the ways described here of pathologizing women were not enough, myths and stereotypes about mothers and sexism in psychological theories and research add much to that pathologizing, and some of these will be addressed in Part 2 of this two-part essay, which will appear in the Bulletin’s next issue.


1Caplan, Paula J. (1995). They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal. DaCapo/Perseus Books.

2Ibid.

3Ibid.

4Ibid.

5Ibid.

6Ibid.

7Caplan, Paula J., & Cosgrove, L., Eds.sp (2004). Bias in psychiatric diagnosis. Rowman and Littlefield.

8Ibid. and Caplan, Paula J. (2005). The myth of women’s masochism. iUniverse.

9See Caplan, 1995, and Caplan, Paula J. (2016). When Johnny and Jane come marching home: How all of us can help veterans. Open Road.

10Becker, Dana, & Lamb, Sharon. (1994). Sex bias in the diagnosis of Borderline Personality Disorder and Posttraumatic Stress Disorder. Professional Psychology: Research and Practice 25, 55-61. Becker, Dana. (1997). Through the looking glass: Women and Borderline Personality Disorder. Westview.

11Caplan, 1995.

12Caplan, 1995.

13Hickey, Philip. (2017). Elimination of the bereavement exclusion: History and implications. Madinamerica.com, October 5. https://www.madinamerica.com/2017/10/elimination-of-the-bereavement-exclusion-history-and-implications/