Customer Reviews

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

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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.

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.

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?

Copyright © MeTZelf

There are some good points in this book, some very good points, about how the people who write the DSM are not writing the manual of psychiatry that they say they are.

Then there are the parts of the book that truly confused me. Caplan tells the story of how she went through a period of sadness after finding out that a friend was terminally ill. Because of her sorrow about her friend, Caplan was experiencing sleeplessness and breathing problems. When she went to the doctor, he prescribed her tranquilizers, known as Halcion, which Caplan was all but dead-set against taking. She said, "There I was, an experienced psychologist who had never taken medication for an emotional upset and not want to, and I didn't think that that was what I was doing." Then she goes on to relate how the pills caused even greater depressive symptoms than she had previously experienced. The next day, Caplan described her symptoms to her naturopath, and the naturopath looked up the side effects and found that this is what was causing Caplan to be even more depressed.

I found myself wondering about several things after reading this paragraph. How could someone who is a psychologist herself not know:

a) what the drug Halcion was, considering its possible psychological side effects

b) how to find out the side effects of Halcion, as any psychologist in the country should know of, and possess a copy of the Physician's Desk Reference, a book that contains the descriptions, side effects, etc. of nearly every major drug on the market

c) how a woman of Caplan's stature, schooling, and self-confidence allowed herself to be talked into taking drugs that she didn't want to take, that she knew nothing about, and didn't bother to try to find anything about before she took them

This seems odd behavior for someone who is a fully trained psychologist, and leaves me questioning both Caplan's objectivity and reasoning.

For those reasons, as well as the fact that the book is sometimes unrelentingly dull, I gave the book only 2 stars.

A well-researched, inside view of how psychological diagnoses are created. Paula Caplan, an APA "Eminent Psychologist", clearly explains the pitfalls and dangers inherent in the process, and the implications for the lives of millions of clients.

Ms. Caplan, at several points in the book, indicates that she ordinarily trusts authority implicitly, which is why her outrage is at Their malfeasance is so profound. This statement seems intended to assure us that this is no rebellious screed, but rather a critical expose.

What Ms. Caplan discovers is that the making of psychiatric diagnoses is not scientific, but political, and that the suffering of historically marginalized groups is often included as the symptoms of various psychiatric disorders.

For reasons that I <and, perhaps, others out there> cannot fathom, she is surprised by this.

Psychiatry has without doubt benefited many people. However, the scientific foundation of the majority of practiced psychiatry is weak. It is very difficult to do double blind studies on human minds.

To be surprised that the naming of diagnoses is unscientific indicates a global misunderstanding of the content of the DSM <even though the DSM itself claims that it! is scientific, informed observers cannot help but salt this heavily>.

There are some good feminist nuggets herein, and the process of diagnosis creation is displayed. This reader, at least, found the events described by the book were as comedic as tragic. Since Ms. Caplan only excoriates the process, rather than giving it the good mocking it sometime deserves, her book is more boring than it should have been.