They Say You're Crazy: How The World's Most Powerful Psychiatrists Decide Who's Normal [Paperback]

Paula J. Caplan (Author)

Book Description

Publication Date: March 4, 1996

How are decisions made about who is normal? As a former consultant to those who construct the “bible of the mental-health professions,” the DSM (Diagnostic and Statistical Manual of Mental Disorders), Paula Caplan offers and insider’s look at the process by which decisions about abnormality are made. Cutting through the professional psycho-babble, Caplan clearly assesses the astonishing extent to which scientific methods and evidence are disregarded as the handbook is developed. A must read for consumers and practitioners of the mental-health establishment, which through its creation of potentially damaging interpretations and labels, has the power to alter our lives in devastating ways.

Editorial Reviews

From Publishers Weekly

Self-Defeating Personality Disorder, Nicotine Dependence, Hypoactive Sexual Desire Disorder, Premenstrual Dysphoric Disorder-these are some of the 400 "mental illnesses" described in the American Psychiatric Association's diagnostic bible, Diagnostic and Statistical Manual of Mental Disorders (DSM). Caplan (The Myth of Women's Masochism), a psychologist and former consultant to the DSM, compellingly argues that "much of what is labeled 'mental illness' would more appropriately be called problems in living." In a disturbing insider's look at how the mental health establishment decides who is normal and who is "sick," she charges that the DSM board's decision-making process, dominated by a handful of conservative white male psychiatrists, is arbitrary, condescending, profit-driven and riddled with personal biases and political consideration. Facile labeling of personality problems, she shows, can cause personal suffering as well as material harm because DSM categories figure prominently in who wins child custody, who gets hospitalized against their will and whose psychotherapy is covered by insurance. Author tour.
Copyright 1995 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

From Booklist

Psychologist Caplan shows how the American Psychiatric Association's bible, the Diagnostic and Statistical Manual of Mental Disorders, lacks the scientific basis claimed for it. Drawing on her years as an adviser-consultant to various related APA committees, she brings to light the association's lack of interest in outsiders' views and the sloppy design and execution of the research it accepts as authoritative. Caplan cites two diagnostic entities, self-defeating personality disorder and premenstrual dysphoric disorder, not only to demonstrate the association's narrow-mindedness and sloppy scientific manners but also to underline the dangers of labeling individuals or groups with such designations. The APA is aided, wittingly or not, by news media reliance on association news releases and the association's biased use of language, and the problems caused thereby affect women in particular, for APA material is also used for political and social purposes. William Beatty --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 382 pages
• Publisher: Da Capo Press (March 4, 1996)
• Language: English
• ISBN-10: 0201488329
• ISBN-13: 978-0201488326
• Product Dimensions: 8.3 x 5.6 x 0.8 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 3.5 out of 5 stars  See all reviews (6 customer reviews)
• Amazon Best Sellers Rank: #329,550 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

29 of 30 people found the following review helpful:

4.0 out of 5 stars Shocking! Makes you think about ALL categorizations we use., April 3, 2004

By 

Ksuzy (Oklahoma) - See all my reviews

This review is from: They Say You're Crazy: How The World's Most Powerful Psychiatrists Decide Who's Normal (Paperback)

Caplan spends a lot of time developing an ideology around what American society views as normal and what it doesn't, and how we come up with those categories, as well as the consequences for those who don't happen to fit into the "normal" category. One of her main premises is that because of the categories in the DSM, women can almost never be categorized as normal. She further describes her journey in trying to keep particular categories out of the book that would have marginalized women further, using scientific data that actually refuted the non-scientific process the psychiatrists used to place categories and their criteria in the book. It was sometimes something as "lofty" as, "My wife has that symptom." "Oh, well, we'll take that one out then."

Her book is powerful, because it demonstrates the social construction of concepts like "normal," the power of labeling people "abnormal," the relative power and authority one must have to label someone "abnormal," and how much easier it has been for males to do it to females in the medical (esp. the mental health) establishment because until recently, females have been kept out of medicine.

Because her book is coming from such a strong "powerful vs. the powerless" perspective, it does lack a strong point that could have made this a more balanced view, and that is how individuals, even though they may lack power relative to the "labelers," can be complicit in their labeling. There can be benefits to being labeled, such as that it can legitimize women's complaints to have an official diagnosis, it can relieve individuals of full responsibilities for their actions or duties, it can give people an identity, and give people the illusion that the problems are contained within themselves rather than the environment or social structure in which they live, which probably won't change. All of these reasons help explain why people might accept a label or even label themselves. Caplan only seems to suggest that people are labeled against their wills and that's the end of it.

25 of 27 people found the following review helpful:

4.0 out of 5 stars They Say Women are Crazy, October 31, 2002

By 

Richard J. Brzostek (New England, USA) - See all my reviews
(VINE VOICE)    (REAL NAME)   

This review is from: They Say You're Crazy: How The World's Most Powerful Psychiatrists Decide Who's Normal (Paperback)

Paula J. Caplan's book They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal questions the validity of the DSM. Although psychiatrists claim that their manual is based on science, this is not always the case. Dr. Caplan describes how psychiatrists that decide who is normal "...too often slot people into categories for politically, economically, and emotionally charged reasons while pretending that they are operating in a solidly scientific way" (p. 34).

Caplan is a clinical psychologist and a feminist that criticizes mental disorders that are specifically for women. Regardless of the author's motivation for fighting these "disorders" and speaking out against them, she exposes many startling aspects of psychiatry. Disorders are voted into existence with little or no empirical evidence. Caplan comments on the DSM:

"To the untutored eye, and even to many mental health personnel, the DSM appears grounded in science, although many features that give this impression turn out on inspection to provide only a veneer of scientific sheen rather than genuine, carefully supported research. (p.186)"

Perhaps the most interesting parts of the book were where the author describes her personal experience working with the DSM committees for PMDD and SDPD. However, it is not much of a story because the committees did not really want her involvement, and left her out of most of the process. This aspect of the book is a unique contribution to the works of DSM criticism.

2 of 2 people found the following review helpful:

4.0 out of 5 stars Protester turned participant turned whistle-blower, July 10, 2011

By 

Mira de Vries - See all my reviews

This review is from: They Say You're Crazy: How The World's Most Powerful Psychiatrists Decide Who's Normal (Paperback)

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 that stand on foundations the very validity of which one rejects? 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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