They Say You’re Crazy

How the World’s Most Powerful Psychiatrists Decide Who’s Normal

Paula Caplan, Ph.D.

Reviewed by Mira deVries

When Caplan, professor of psychology, psychotherapist, and feminist, contacted the American Psychiatric Association (APA) to protest inclusion of premenstrual syndrome in the DSM, she was surprised to be invited to join two committees for reviewing such diagnostic categories. This provided her with an insider’s look at how the DSM is compiled.

Although the APA repeatedly chants the mantra of the DSM's scientific basis, it fails to produce evidence. The DSM does not even achieve its claimed major accomplishment, namely reliability in diagnosis, which supposedly furthers the cause of scientific study. Its content is decided upon arbitrarily by a handful of powerful big shots on the basis of consensus and bias. The scant research made available to the various committees is methodologically faulty and funded by interested parties. The influence of pharmaceutical $$$ speaks louder than reason. A complicated bureaucratic network of manipulated due dates, false promises, double-standards, changing labels, and intimidation prevent objections raised by committee members from being taken into account. "Nixon-like claims about the righteousness and scrupulousness of the DSM committee's procedures [are] unjustified." Of the long list of weighty professionals whose names are listed as participating in the decisions, most probably had no influence, and agreed to have their names included anyway for the sake of professional prestige and income. Caplan, on the other hand, quit, and refused to have her name associated with the DSM.

Caplan argues persuasively that “mental illness” is a construct, an idea, not a scientifically provable fact. This construct harms people more than it helps them. It is often used to “blame the victim,” that is, to ascribe problems in living to a fault within the person. For instance, a battered wife is told that she brings her husband's violence upon herself by unconsciously enjoying the battery. Caplan seems to think that depression, contrary to other DSM entries, is a real condition rather than a construct, but nowhere does she suggest it is an illness, caused by faulty brains or heredity, or treatable with drugs. On the contrary, she seems to consider it a form of unhappiness, and doesn't think drugs can cure it. Even when there is something inside the person which makes him different, this cannot be reliably identified by using DSM criteria, nor are they helpful in solving the person's problems, Caplan argues, disparaging the "mythical uniformity of human beings."

In her only reference to involuntary commitment, the author lists it together with several other types of legal decisions based on the DSM which harm people's legitimate interests and pervert justice. She admits that therapists, including herself, have little to no understanding of their clients' problems or how to help them. "Humans’ psychological functioning is so complex and unpredictable that current scientific techniques can reveal only a fraction of what therapists need to know" and the evidence provided by research "is often inaccurately reported because it is presented by drug companies or groups that have various stakes in the research." Caplan warns, "it is advisable to be cautious about therapists of all kinds."

She repeatedly refers to the side effects and dangers of drug therapy, including antidepressants. "It isn't safe to assume that drug companies' claims and popular media reports about medications are true." Antidepressants were still relatively new when she wrote “They Say You’re Crazy.” Even now, a decade later, the medical establishment is still only slowly and reluctantly recognizing these dangers “in a small minority of vulnerable patients.” If Caplan clearly knew these dangers ten years ago, physicians could have known them as well. She does think people should have access to drugs if they want them provided they are fully informed about them.

The strange thing about Caplan is that she insists she is not out to trash all of psychiatry or therapy. How can one not propose trashing professions of which one rejects the very validity of the foundations on which they stand? That's like saying you don't oppose driving cars, provided those cars' wheels are first removed. She argues that psychiatric labeling is fraudulent and treatments futile. How can she fail to reach the conclusion her own excellent arguments make inescapable?

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