By Paula J. Caplan
Tuesday, May 16, 2006
During mental-health awareness month Paula J. Caplan argues women are over-diagnosed with psychiatric syndromes and symptoms. Many problems, she writes, are not inside women's heads. They are in external conditions crying out for remedy.
(WOMENSENEWS)--May is mental-health awareness month, but sadly, much of the publicity and public "education" connected with it consists of trying to persuade people they are mentally ill and need medication and psychotherapy. What is little known but frightening is the damage often done to many women simply by giving them psychiatric diagnoses.
Because they received psychiatric diagnoses, women have lost health insurance or had skyrocketing premiums, lost jobs, lost the right to make decisions about their medical and legal affairs and lost, or nearly lost, their lives. Last month, a woman on the West Coast went to court after losing child custody on the basis of having been psychiatrically labeled.
An enormous amount of research--including in the 2004 book I edited, "Bias in Psychiatric Diagnosis"--has shown that women are at even greater risk than men of attracting many serious psychiatric labels.
Even women who never enter a therapist's office run the risk of being branded by family or friends with one type of demeaning non-psychiatric label or another, such as "cold, bitchy and rejecting" or "overemotional, overly sensitive and needy," so that even an average woman's emotions and behavior look pretty terrible compared to those of an average man. It should not be surprising, then, that the psychiatric field is riddled with diagnoses that are used to demean and pathologize women.
Like every therapist I know, I've had women come to see me, after having seen another mental health professional, and introduce themselves by saying, "My name is Maude. I'm bipolar," or "I'm Lula, and I'm a borderline personality." They do not regard themselves as women who have some problems. Instead, their whole identity has come to be connected with a mental illness.
Then, having been told they are sick, many women--like second-class citizens everywhere--think in terms of how they can change themselves rather than thinking that another person or, in many cases, a system (such as public assistance) or a setting (such as the workplace or the family) is the source of the trouble. Often feeling powerless to change the major systems that oppress them or to escape from harassment or violence, they try to maintain control over their lives.
For instance, women whose partners batter them often think--indeed, therapists or well-meaning but misguided loved ones may tell them--that they must be masochists and bring the violence on themselves. Women who are harassed at work but cannot afford to lose their jobs--often because they are financially supporting others, as recently dramatized in the movie "North Country"--may become seriously depressed or frightened because there is no satisfactory way to escape the harassment.
Mothers who go on welfare immediately learn that our federal government does not give them enough money to provide sufficient healthful food and a halfway decent place to live. Many internalize the message that it is they who are inadequate, not the system.
It may be natural but it is counterproductive and often harmful for people who feel unable to change external realities to seek some sense of control by aiming to alter themselves.
The social and political sources of much of women's emotional pain are obscured by the application of psychiatric diagnoses, which locate the problem within the woman herself. Thus, diagnosis deflects energies that could be used for social and political change.
On our PsychDiagnosis Web site you can read, among many other things, more than 50 stories about the vast array of damage that have resulted from receiving a psychiatric diagnosis. These include a woman who nearly died and accrued a quarter-million dollar hospital bill because doctors had labeled her mentally ill and thus failed to recognize that she had the serious physical condition called Wilson's disease, which causes copper to accumulate in body tissue and can cause psychosis as a side effect.
This harm is largely hidden from public view. The continuing low status of women overall obscures much of their suffering. Many psychiatrically labeled women become seriously isolated because they have been branded as pathological. Especially in our highly psychiatrized society, laypeople often think that those who are "mentally ill" should confine talk about their problems to therapists' offices or residential institutions.
The mental health establishment has been wildly successful in leading the public to believe mistakenly that psychiatric diagnosis is a science, and the drug companies have happily promoted that view because it helps them with their multi-billion-dollar business of marketing drugs for specific diagnoses.
A bible of the psychiatric trade is a compendium of 374 categories of alleged mental illnesses. Titled the "Diagnostic and Statistical Manual of Mental Disorders," or the DSM, it was published in three new editions in one 14-year period, and the next one is now in preparation. With each new edition, therapists, libraries, insurance companies and government employees have to buy the new one, which brings millions of dollars in profits to the publisher, the Washington-based American Psychiatric Association.
Many therapists do not know how unscientific and highly political the DSM actually is. Shoddy research has been used to support the addition of increasing numbers of diagnoses that expand the territory and increase the income of psychiatrists and other therapists.
A particularly dangerous label for women was the invention--reportedly by two men on a fishing trip--of the notion of a premenstrual "mental disorder," which entered the manual in 1985. We are not talking about bloating and breast tenderness and some irritability, like what used to be meant by "premenstrual syndrome," but rather a psychological disorder.
Even though vast amounts of research have failed to prove that there is such a mental illness, or even that women are more likely to experience cyclical moods, Premenstrual Dysphoric Disorder is in the DSM anyway.
As soon as PMDD appeared in the DSM, pharmaceutical company Eli Lilly worked with the DSM committee to make the case that the Food and Drug Administration should approve Prozac to treat this non-existent condition, and thus they got an extension on the Prozac patent. Lilly rushed a pink-and-purple Prozac renamed "Sarafem" to market and in the first seven months, more than 200,000 prescriptions for it were written.
Hordes of women who watched Lilly's commercials that showed angry women who "had PMDD" and "needed" Sarafem rushed to their doctors, hoping that this pill would help them get rid of their "unfeminine" anger. The European Union's drug regulator--the Committee for Proprietary Medicinal Products--found that PMDD was not a well-established entity and forced Lilly to tell health professionals to stop prescribing Prozac for that "condition." However, Lilly took no such steps in the United States.
Meanwhile, other companies have geared up to promote generic versions, and companies that market similar drugs--such as Zoloft and Celexa--have for some years been pushing those drugs to treat this nonexistent entity of PMDD.
Since the whole enterprise of psychiatric diagnosis is entirely unregulated, in March 2005, I issued a press release--supported by more than 40 organizations and 175 individuals--calling for congressional hearings about this subject. Such hearings will only happen if a member of an appropriate congressional committee makes them happen, but in the meantime, the very act of calling for the hearings has given rise to a good deal of public education.
Paula J. Caplan, Ph.D., is a clinical and research psychologist, author of 11 books--including "They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal," her expose of the DSM. She is a former full professor of applied psychology at the University of Toronto. At Harvard University, she recently finished teaching a course she designed, called "Psychology of Sex and Gender."
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