Tag Archives: Diagnostic and Statistical Manual of Mental Disorders

US psychologist Dr. Paula Caplan PhD’s praise for my 2015 book “Depression Delusion Volume One: The Myth of the Brain Chemical imbalance”

Dr. Paula Caplan Ph. D. is an American clinical and research psychologist and social justice and human rights activist. I first came across Paula and her work about 20 years ago. At that time, I was rapidly losing faith in my medical training in mental health. I was becoming increasingly disillusioned with the medical approach to human distress, including the whole medical approach to psychiatric diagnosis, which made progressively less sense to me the more I critiqued it. Back then, I was grateful to find principled mental health professionals like Paula Caplan and Peter Breggin.

Paula Caplan’s CV is impressive.  She was previously professor of psychology, assistant professor of psychiatry and head of the Center for Women’s Studies at the University of Toronto. She has received much recognition for her work including an Eminent Woman Psychologist award in 1996 from the American Psychological Association, a 1995-96 Presidential Citation for Contributions as Chair of Sexism in Diagnosis Task Force, and a Distinguished Career Award in 2008 from the Association for Women in Psychology.

Paula Caplan was a consultant to two committees appointed by the DSM-4 Task Force’s lead psychiatrist Allen Frances to adjudicate on what should be included in the DSM-4 which was published in 1994. As she subsequently explained, Paula Caplan resigned from these committees on principle:

“I resigned from those committees after two years because I was appalled by the way I saw that good scientific research was often being ignored, distorted, or lied about and the way that junk science was being used as though it were of high quality . . . if that suited the aims of those in charge. I also resigned because I was increasingly learning that giving someone a psychiatric label was extremely unlikely to reduce their suffering but carried serious risks of harm, and when I had reported these concerns and examples of harm to those at the top, they had ignored or even publicly misrepresented the facts. I wrote about what I learned from my insider’s position in my book, They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal (Caplan, 1995).” http://freakoutcrazy.com/category/paula-caplan/ 

I have not yet have the pleasure of meeting Paula, though I’m sure that our paths will cross, given our shared passion for truth in mental health. We have been in regular contact over the years.

I am delighted that Paula felt it appropriate to write the following about my new book Depression Delusion Volume One: The Myth of the Brain Chemical Imbalance on the Stop Psychiatric Diagnosis Harm Facebook page https://www.facebook.com/groups/PLAN.T.Alliance/  (posted 24th October 2015):

“I just finished reading Dr. Terry Lynch’s phenomenal, compelling, scrupulously argued book, Depression Delusion. It is clearly written and hard to put down. It is encyclopedic in that he seems to have read every claim ever made about depression being due to a chemical imbalance in the brain, and he does all the work for us — citing each of these appalling quotations and then walking us step by step through their failures of logic and the stunning lack of evidence behind them. This book is not to be missed! If your library doesn’t have it, urge them to order it right away, and make sure you are first on the list to get it.”

For more information on my books, visit my website https://doctorterrylynch.com/ , where you can download two free chapters, one from each of my most recent books, Depression Delusion and Selfhood.  

 

Depression diagnosis: If you think the diagnosis of depression is scientific, think again

Many people are under the false impression that the diagnosis of depression is solidly grounded upon scientific principles.

What follows is a passage from my new 2015 book Depression Delusion Volume One: The Myth of the Brain Chemical Imbalance: 

“Science plays no part in the diagnosis of depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists nine criteria which psychiatrists have decided provide evidence of depression. Neither laboratory investigations nor physical findings specific to depression receive a mention in any of these nine criteria.

Criterion 1 describes the mood in a major Depressive Episode as ‘depressed, sad, hopeless, discouraged’, or ‘down in the dumps’, feeling ‘blah’, having no feelings or feeling anxious, irritability, and bodily experiences such as aches and pains.

Criterion 2 refers to loss of interest or pleasure, including a loss of interest in hobbies.

Criterion 3 describes changes in eating habits, either an increase or a decrease in appetite or weight.

Criterion 4 refers to sleep disturbance such as insomnia or oversleeping.

Criterion 5 describes bodily expressions of distress including ‘agitation, e.g. the  inability to sit still . . . or retardation e.g. slowed speech, thinking or bodily movements’.

Criterion 6 refers to decreased energy, tiredness and fatigue.

Criterion 7 includes a ‘sense of worthlessness or guilt, unrealistic negative evaluations of one’s worth’, and ‘guilty preoccupations or ruminations’ about the past.

Criterion 8 describes people’s reported ‘inability to think, concentrate or make decisions’, appearing ‘easily distracted’, or ‘memory difficulties’.

Criterion 9 speaks of ‘thoughts of death, suicide ideation, or suicide attempts’.

The Diagnostic and Statistical Manual of Mental Disorders asserts that a diagnosis of a Major Depressive Episode can be made when the severity and duration of a person’s mood meets Criterion 1 and the person is experiencing four of the remaining eight criteria.

In my book Beyond Prozac: Healing Mental Distress (2001, 2004 {UK} and 2005), I questioned many aspects of the diagnostic approach to depression, including the following:

Why did the American Psychiatric Association select five criteria as the magic figure? What is the difference between a person who meets six criteria—and is therefore diagnosed as having a Major Depressive Episode and needing antidepressant treatment—and one who meets four criteria, and therefore receives no psychiatric diagnosis or treatment? Why five criteria? Why not three? Or seven? How valid are these criteria? [i]

Nine years later in his 2010 book Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis, American psychiatrist Daniel Carlat asked similar questions and went one better. Carlat interviewed Robert Spitzer, lead psychiatrist of the DSM-3, the 1980 edition of the DSM in which this approach to depression was first set out as the way to diagnose depression. Here is an extract from that interview: [ii]

Carlat: How did you decide on five criteria as being your minimum threshold for depression?

Spitzer: It was just consensus. We would ask clinicians and researchers, “How many symptoms do you think patients ought to have before you would give them a diagnosis of depression?” And we came up with the arbitrary number of five.

Carlat: But why did you choose five and not four? Or why didn’t you choose six?

Spitzer: Because four just seemed like not enough. And six seemed like too much.

Carlat commented that ‘Spitzer smiles mischievously’ as he uttered the last sentence above. This is the quality of the “science” upon which the diagnosis of depression is based ” (end of quote).

“The arbitrary number of five”, “It was just consensus”, “four seemed like not enough”, “six seemed to much”–does this rationale fall within your definition of science?

Not for one second am I questioning the realness of these experiences and behaviours, but I most certainly am questioning the medical profession’s interpretation of these experiences and behaviours.

[i].   Terry Lynch, Beyond Prozac: Healing Mental Distress, Ross-on-Wye: PCCS Books, 2004, p. 103.

[ii].   Daniel Carlat, Unhinged: The Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis, London: Free Press, 2010, pps. 53-4.