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Day 5: Paula Caplan on Bias in Psychiatric Diagnosis

The future of mental health interview series, day 5

Eric Maisel
Source: Eric Maisel

The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.


Interview with Paula Caplan

Activists in what is variously called the critical psychology, critical psychiatry or antipsychiatry movement tend to agree that what is called “psychiatric diagnosis” is more a linguistic game and a power play than anything scientific or medical. Here researcher and activist Paula Caplan shares her views on the unscientific nature of so-called psychiatric diagnosis.

EM: You’ve written on the subject of bias in psychiatric diagnosis. Can you share some of your headlines on that subject?

PC: Despite what is widely believed, psychiatric diagnosis (1) is unscientific, (2) almost never leads to reduction of human suffering, and (3) carries a wide array of risks of harm, including death. If they do not diagnose you, they cannot "treat" or treat you, but once they diagnose you, they can justify just about anything on the grounds that they are treating a mental illness. Psychiatric diagnosis is entirely unregulated, making it even less regulated than the financial institutions that so damaged the U.S. economy. As a result, those who are harmed have no recourse.

I organized the filing of nine complaints with the American Psychiatric Association (because it publishes and massively profits from the Diagnostic and Statistical Manual of Mental Disorders), and they dismissed them on totally absurd grounds and with no attention to their merits. The U.S. Department of Health and Human Services’ Office of Civil Rights did the same with the five complaints I helped file there. This provides a paper trail proving that no one is regulating psychiatric diagnosis or providing redress from harm or trying to prevent future harm, and no one with any power intends to do so. Lawsuits must be filed to stop this.

EM: You’ve also written about mending the mother-daughter relationship. What in your view can help heal that relationship?

PC: Understanding that in our still sexist society, mothers and daughters are often set up against each other by a set of myths about mothers, and understanding those myths can help lead to healing of rifts between them. Mothers and daughters are often, and have the potential to be, each other’s advocates.

EM: You take a special interest in veterans’ issues. What are your thoughts on the emotional and mental health of veterans?

PC: Active duty military people and veterans—like many people who have not served in the military—are overwhelmingly often diagnosed as mentally ill when in fact their suffering is actually the manifestation of understandable responses to trauma (often war trauma or rape trauma) or other upsetting, disorienting experiences such as the huge culture shocks of going from civilian life to the military and back again … with the many changes and losses that that can involve. I believe it is unconscionable for therapists to classify such reactions as mental illness, because (1) psychiatric diagnosis is unscientific and almost never leads to reduction of suffering, (2) psychiatric diagnosis often leads people in wrong and harmful directions to try to alleviate suffering, leading them away from the huge array of alternative, non-pathologizing approaches that are low-risk or no-risk (such as those shown in the brief videos at the Harvard Kennedy School conference, "A Better Welcome Home," that I organized in 2011), and (3) classifying someone as mentally ill adds to their burden, because now they are given the message that there is something strange or inappropriate about their reactions. That is one reason I created The Welcome Johnny and Jane Home Project, in which someone who is not a veteran simply listens in total, respectful silence with 100% of their attention and their whole heart to anything that a (combat or noncombat) veteran wishes to say.

EM: What are your thoughts on the current, dominant paradigm of “diagnosing and treating mental disorders” and the use of so-called “psychiatric medication” to “treat mental disorders” in children, teens and adults?

PC: This one is partly answered above but feels too huge to answer adequately in a brief space. Let me just say the following. So-called psychiatric medication has been shown—most notably in Robert Whitaker's excellently researched book, Anatomy of an Epidemic—to help some people sometimes, at least for awhile and maybe for longer but far more often to cause more harm than good. As Whitaker showed with World Health Organization and National Institute of Mental Health data, if one compares the rates of remission and of long-term disability between the time before each class of such drugs went on the market and the present time, one finds that the rates of remission have plummeted and the rates of going on long-term disability have skyrocketed.

EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?

PC: I would recommend that for anyone in emotional or mental distress, I would want to know if they are living and/or working in unsafe places and if they are, to help them get out. If they are poor or are victims of violence or sexism, racism, homophobia, ageism, classism, or mistreatment based on their appearance, I would want to make sure they know that their upset is not a form of mental illness. Consider any of the 28 different non-pathologizing, low-risk or no-risk approaches shown in these brief videos...or others not included there, such as gardening, singing, playing music, or having friends, a job, or a good place to live. (These 28 approaches were presented at our conference about veterans and their families but all are certainly helpful to anyone.)


Paula J. Caplan is a clinical and research psychologist, activist and advocate, award winning nonfiction writer, playwright, and screenwriter. She is currently Associate at the DuBois Institute, Harvard University and blogs at and Psychology Today.,,


Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at, visit him at, and learn more about the future of mental health movement at To learn more about The Future of Mental Health: Deconstructing the Mental Disorder Paradigm visit here.

To see the complete roster of interview guests, please visit here:

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