Book Reviews

Who's Normal?

They Say You're Crazy; How the World's Most Powerful Psychiatrists Decide Who's Normal by Paula J. Caplan, Ph.D.
Peaking out: How My Mind Broke Free from the Delusions in Psychiatry by Al Siebert, Ph.D.
Practical Psychology

Here are two books from PhD psychologists, one American, one Canadian, which raise the question, "Who decides who is normal?"

Both authors vigorously challenge the generally accepted view that psychiatrists are best-placed to decide who is normal and who is not.

Are psychiatrists (and other therapists) themselves "normal"? Hardly. How can anyone who chooses to listen to other peoples' miseries day in and day out, be considered normal, if by that we mean "average" or "typical"? We therapists are clearly not normal, we are a minority and we are unique. So are people in other professions. So are you.

Normality is notoriously difficult to define. What we usually mean by "abnormal" is insane, psychotic, mentally ill. Some authors [most notably psychiatrists Thomas Szasz (The Myth of Mental Illness) and Peter Breggin (Toxic Psychiatry)] attack the very concept of "mental" illness, saying this is a metaphor mistakenly made concrete, or that drug treatment only adds to a sufferer's woes, that so-called mental illness is more appropriately called "problems in living" and "treated" either by the courts or with exceptional care, empathy and understanding.

Thirty years ago Dr Siebert was commited to hospital as a "paranoid schizophrenic." He claims he was sane, that at the time he was going through a "developmental crisis". His book, written in an engaging as-told-to fashion with colleague Sam Kimball, PhD., recounts his experience -- and the ideas which led to his (semi-voluntary) incarceration.

Clearly Dr Siebert, at the time about to begin a post-doctoral fellowship, upset his psychiatric colleagues with his unusual ideas and his wife with his mysterious silences. Dr Siebert was caught up with his insight that basically we are all selfish, that even so-called altruistic behaviour is based on self-interest. (This became the foundation of his work and book on The Survivor Personality).

Peaking Out vividly describes life in a psychiatric ward. While benevolent, his keepers nevertheless labelled Dr Siebert as mentally deranged and could not see beyond the label. His claim of curing -- by suspending labelling and truly listening to -- a woman who heard the voice of God, was ignored by the authorities.

It is not clear why Dr Siebert chose to publish this book now (and reveal "a secret kept hidden for thirty years"). But his indignation at what he considers the abuse of power by some psychiatrists on his person is matched, if not exceeded, by the wrath of Dr Paula Caplan about the audacity of psychiatrists to decide who is not normal, not through science and evidence, but through bias and politics.

Dr Caplan, a Canadian with equally impressive authoral and teaching credits to Dr Siebert, attacks the process by which psychiatrists devise the content of the Diagnostic and Statistical Manual of Mental Disorders, popularly know as the DSM.

This volume purports to define mental illness with the same certainty and precision with which physical illness is described. It is an obvious attempt to achieve a degree of respect and scientific authority similar to that which is generally awarded to other medical doctors.

But the DSM IV, like its predecessors, is a farce. This is the only conclusion you can reach after reading Dr Caplan's very detailed account of the partisan bargaining ("horse-trading") that goes on in the determination of what will and what will not be included in the volume.

An expert in research, Dr Caplan points out the dearth of data on which DSM IV is based. She became involved a few years ago when the committee (all white men of a certain age) sought to make PMS a mental disorder. The fight was tough, the feminists lost, but not until furious arguments had been aired from both sides in psychological journals and the media.

Only arrogance (or desperation) can explain how male (and some female) psychiatrists dare to pretend that human mental disorders can be reduced to the kind of specific disease data applicable to say, measles.

Dr Caplan goes out of her way to be charitable about the motives of the perpetrators of DSM IV. Nevertheless, one has to suspect that power and money (DSM IV sells hundreds of thousands of copies and is a required reference point for much insurance reimbursement, not to mention hospital funding etc., especially in the United States) are main motivations ofDSM's authors.

Perhaps, as Dr Siebert claims regarding his persecutors, DSM authors have convinced themselves of their righteousness and of the need to force good upon sufferers, even if the sufferers have not requested such help.

History, including the history of psychiatry and "mental health," is replete with examples of well-meaning people forcing what they thought was right onto bewildered victims. The perpetrators are deaf to any ideas other than their own. Belief systems are notoriously hard to change.

Look at Sigmund Freud's absurd notion that little girls want to have sex with their fathers. I was astonished by Dr Caplan's assertion that many therapists still practice orthodox Freudianism: hiding behind a couch, refusing to believe their patients' accounts of incest, etc. Perhaps this horror persists only in Toronto?

Two examples will suffice to demonstrate the arbitrary nature of DSM IV: over the years homosexuality has gone from being classified as a mental disorder to being covertly included, to being not listed in the currentDSM. Can a disease cease to be a disease? Either homosexuality never was a mental illness, or psychiatrists bowed to public pressure. Obviously, though, the inclusion or exclusion of homosexuality was not based on science.

The other example is the rebuff with which Dr Caplan and her colleagues were met when they tried to have the stereotypical "female" descriptors in DSM matched with a description of typical male behaviour as a mental illness.

Surely the biggest irony about the dangerous DSM IV is that, while it purports to list every mental disorder in exhaustive detail, it offers no solutions, no treatment guidelines. Could this be because, in reality, we know so little about the mind -- and even less how to cure its disorders?

Most of what we as therapists do is art, intuition, relationship. Medicalising problems in living, as DSM disciples are wont to do, is a disservice to clients and to therapists. Clients, because they need care, not categories. And therapists, because such illusory certainty leads us, like Dr Siebert's colleagues or Dr Caplan's detractors, to join together in a collective delusion of being scientific.

Read Dr Caplan's book and weep for the thousands of people (mostly women, of course) whose lives have been damaged by being labelled with the stigma of a mental illness, when in reality their only problem was that, like Dr Siebert, they dared to be different. Or human.