Sexism in Mental Health Practice

It should have been a sign that not all was what it seemed: During the middle of the 20th century, when the stay-at-home wife and mother was said to be serene and happy, some psychiatrists and other physicians prescribed for women vigorously- marketed tranquilizer pills in huge quantities. Unhappy women were more likely than unhappy men to be put on such pills, many of which can cause physiologically-based addiction within a very brief time and can be hell to withdraw from. Some doctors handed them out like candy to women who were bored, suppressed, or abused. (http://whp-apsf.ca/pdf/coopProceedingsEN.pdf)

As decades passed, successive editions of the manual of psychiatric diagnosis ballooned in size, swollen as more and more unvalidated categories of alleged mental illness (Stuttering, Nicotine Dependence Disorder, Caffeine-Induced Sleep Disorder, Major Depressive Episode that applied on the first day of bereavement, etc.) were put into the manual that the American Psychiatric Association and its leaders touted as scientifically based (even while many simultaneously covered their bases by saying it was really only a common language). Increasingly, research revealed the sexism pervading so many of the categories—the way they were designed, the way they were assigned, or both. (See Bias in Psychiatric Diagnosis for many chapters about sexism in diagnosis, as well as some on racism, classism, ageism, and homophobia in diagnosis http://www.amazon.com/Bias-Psychiatric-Diagnosis-Paula-Caplan/dp/0765700018)

Last Saturday on NPR I caught the last bit of an interview with Jeffery Lieberman, a past president of the American Psychiatric Association (publisher of the diagnostic manual, theDSM). His new book, Shrinks: The Untold Story of Psychiatry, is apparently intended to elevate psychiatry to the level from which it has dropped in recent decades due to many discoveries about the mental health system’s lack of science, influence of politics, and harm caused by—to be fair—not only some psychiatrists (please note the word “some,” because others are helpful) but also some psychologists, social workers, marriage and family therapists, and even pastoral counselors. (http://www.jeffreyliebermanmd.com/shrinks.html)

I want to address here one claim I heard him make in the NPR interview (http://www.npr.org/blogs/health/2015/03/14/392798128/from-freud-to-posse…) and, this being Women’s History Month, to focus on how they relate to sexism in our field. This is not, of course, to say that some of the biases in mental health practices are not harmful to men, as well as the other forms of bias noted above are not also alarming.

Lieberman stated that psychiatry is a medical discipline just like other medical disciplines. In fact, as is often pointed out, despite some claims to the contrary, even the American Psychiatric Association has admitted that there is no laboratory test that reveals a braindefect that gives rise to any of the hundreds of alleged mental illnesses listed in the DSM. Checklists of kinds of behavior and feelings compiled by slapping together those listed in the DSM are not helpful, because all they do is help the therapist who has bought into theDSM system to decide which of the hundreds of labels to apply. The symptom clusters that comprise the DSM categories are not and never have been scientifically based.

What happens when there are no solid scientific, objective standards for deciding whether or not we want to call someone mentally ill… and if we do, which of the hundreds of labels to apply? Into the vacuum created by the absence of science and objectivity there swooshes every conceivable kind of bias. Thus, for instance, women who have been sexually assaulted are often labeled with “Bipolar Disorder” rather than told that of course they sometimes feel devastated—they have, after all, been raped. And often, mothers serving in the military whose jobs send them far from their children on deployments find that, when they go to see a military therapist because they miss their children and/or feel they are terrible mothers for being so far away, the therapist diagnoses them as mentally ill with Major Depressive Disorder or Generalized Anxiety Disorder (if not worse) rather than confirming that these are natural, understandable feelings. In these ways, women having deeply human reactions of distress now have the added burden, shame, and fearcaused by being told, in essence, that there is something wrong with them, since they are not handling the situation “better.” The Bias in Psychiatric Diagnosis book required a great many chapters about sexism in the field in order to document just a small fraction of its manifestations.

Psychologist Carol Tavris, author of the classic book The Mismeasure of Woman(http://www.amazon.com/The-Mismeasure-Woman-Carol-Tavris/dp/0671797492), has for decades been a perceptive analyst of sexism in the mental health field and psychological/psychiatric research. In her recent review of Lieberman’s book (http://www.wsj.com/articles/book-review-shrinks-by-jeffery-a-lieberman-w…), she writes that its story is not untold but has been told many times, and that is certainly true of the special harms done to women.

Sexism—like all forms of bias and oppression—is never acceptable. But as long as girls and women continue to be more likely than boys and men to be socialized to be nice, to know that they will be seen as shrill and strident and—horrors!—unfeminine and unattractive if they raise questions about how authorities treat them, the misogyny in the mental health system will render them vulnerable because of their greater reluctance to challenge  their diagnoses and the treatments that are prescribed. To see compelling 10-minute videos made by or about some of the many women who bravely filed with the American Psychiatric Association’s ethics committee complaints about the harm done to them—or in one case to a brother—that began when they were classified under DSM labels, please have a look at http://psychdiagnosis.weebly.com/stories-of-harm.html

To read more about what happened with the complaints the women filed with the APA … and then with the Office of Civil Rights of the Department of Health and Human Services, go to:

Caplan, Paula J. (2012). Will the APA listen to the voices of those harmed by psychiatric diagnosis? Mad in America: Science, Psychiatry, and Community. October 1.http://www.madinamerica.com/2012/10/will-the-apa-listen-to-the-voices-of…

Caplan, Paula J. (2012). The APA refuses to listen to the voices of those harmed by diagnosis…and refuses and refuses. Mad in America: Science, Psychiatry, and Community. November 19.  http://www.madinamerica.com/2012/11/the-apa-refuses-to-listen-to-voices-…