The Psychopath Test: A Journey Through the Madness Industry (31 page)

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Authors: Jon Ronson

Tags: #Social Scientists & Psychologists, #Psychopathology, #Sociology, #Psychology, #Popular Culture.; Bisacsh, #Social Science, #Popular Culture, #Psychopaths, #General, #Mental Illness, #Biography & Autobiography, #Social Psychology, #History.; Bisacsh, #History

BOOK: The Psychopath Test: A Journey Through the Madness Industry
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“Anyway,” he said, “there was nobody vying for the job. It wasn’t regarded as a very important job.”
What nobody knew was that Spitzer had a plan—to remove, as much as he could, human judgment from psychiatry.
 
 
For the next six years, from 1974 to 1980, he held a series of
DSM-III
editorial meetings inside a small conference room at Columbia University. They were, by all accounts, chaos. As
The New Yorker
’s Alix Spiegel later reported, the psychiatrists Spitzer invited would yell over each other. The person with the loudest voice tended to get taken the most seriously. Nobody took minutes.
“Of course we didn’t take minutes,” Spitzer told me. “We barely had a typewriter.”
Someone would yell out the name of a potential new mental disorder and a checklist of its overt characteristics, there’d be a cacophony of voices in assent or dissent, and if Spitzer agreed, which he almost always did, he’d hammer it out then and there on an old typewriter, and there it would be, sealed in stone.
It seemed a foolproof plan. He would eradicate from psychiatry all that crass sleuthing around the unconscious. There’d be no more silly polemicizing. Human judgment hadn’t helped his mother. Instead it would be like science. Any psychiatrist could pick up the manual they were creating—
DSM-III
—and if the patient’s overt symptoms tallied with the checklist, they’d get the diagnosis.
And that’s how practically every disorder you’ve ever heard of or have been diagnosed with came to be invented, inside that chaotic conference room, under the auspices of Robert Spitzer, who was taking his inspiration from checklist pioneers like Bob Hare.
“Give me some examples,” I asked him.
“Oh . . .” He waved his arm in the air to say there were just so many. “Post-Traumatic Stress Disorder. Borderline Personality Disorder, Attention Deficit Disorder . . .”
Then there was Autism, Anorexia Nervosa, Bulimia, Panic Disorder . . . every one a brand-new disorder with its own checklist of symptoms.
Here, for instance, is part of the checklist for Bipolar Disorder from
DSM-IV-TR
:
Criteria for Manic Episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week.
Inflated self-esteem and grandiosity.
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
More talkative than usual or pressure to keep talking.
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
 
 
With Melancholic Features
Loss of pleasure in all, or almost all, activities.
Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens).
Excessive or inappropriate guilt.
 
Problems include school truancy, school failure, occupational failure, divorce, or episodic antisocial behavior.
“Were there any proposals for mental disorders you rejected?” I asked Spitzer.
He thought for a moment.
“Yes,” he finally said. “I do remember one. Atypical Child Syndrome.”
There was a short silence.
“Atypical Child Syndrome?” I said.
“The problem was when we tried to find out how to characterize it. I said, ‘What are the symptoms?’ The man proposing it replied, ‘That’s hard to say because the children are very atypical.’ ” He paused. “And we were going to include Masochistic Personality Disorder, but there were a bunch of feminists who were violently opposed.”
“Why?”
“They thought it was labeling the victim.”
“What happened to it?”
“We changed the name to Self-Defeating Personality Disorder and put it into the appendix.”
 
 
I’d always wondered why there had been no mention of psychopaths in the
DSM
. It turned out, Spitzer told me, that there had indeed been a backstage schism—between Bob Hare and a sociologist named Lee Robins. She believed clinicians couldn’t reliably measure personality traits like empathy. She proposed dropping them from the
DSM
checklist and going only for overt symptoms. Bob vehemently disagreed, the
DSM
committee sided with Lee Robins, and Psychopathy was abandoned for Antisocial Personality Disorder.
“Robert Hare is probably quite annoyed with us,” Spitzer said.
“I think so,” I said. “I think he feels you plagiarized his criteria without crediting him.”
(I later heard that Bob Hare might get his credit after all. A member of the
DSM-V
steering committee, David Shaffer, told me they were thinking of changing the name of Antisocial Personality Disorder—it sounds so damning—and someone suggested calling it Hare Syndrome. They’re mulling it over.)
 
 
In 1980, after six years inside Columbia, Spitzer felt ready to publish. But first he wanted to road test his new checklists. And there were a lot.
DSM-I
had been a sixty-five-page booklet.
DSM-II
was a little longer—134 pages. But
DSM-III
, Spitzer’s
DSM
, was coming in at 494 pages. He turned the checklists into interview questionnaires and sent researchers out into America to ask hundreds of thousands of people at random how they felt.
It turned out that almost all of them felt terrible. And according to the new checklists, more than 50 percent of them were suffering from a mental disorder.
DSM-III
was a sensation. Along with its revised edition, it sold more than a million copies. Sales to civilians hugely outweighed sales to professionals. Many more copies were sold than psychiatrists existed. All over the western world people began using the checklists to diagnose themselves. For many of them it was a godsend. Something was categorically wrong with them and finally their suffering had a name. It was truly a revolution in psychiatry, and a gold rush for drug companies, who suddenly had hundreds of new disorders they could invent medications for, millions of new patients they could treat.
“The pharmaceuticals were delighted with
DSM
,” Spitzer told me, and this in turn delighted him: “I love to hear examples of parents who say, ‘It was impossible to live with him until we gave him medication and then it was night and day.’ That’s good news for a
DSM
person.”
 
 
But then something began to go wrong.
 
 
Gary Maier—the psychiatrist who invented the dream workshops and the chanting rituals at Oak Ridge and was eventually fired for giving LSD to twenty-six psychopaths simultaneously—was recently invited for lunch by some drug company reps. He works at two maximum-security prisons in Madison, Wisconsin, now and his department had just made the decision to have nothing more to do with the drug companies. So a few of the reps invited him for lunch to find out why.
“It was two beautiful women and a pretty nice guy,” Gary told me after the lunch was over.
“What did they say?” I asked him.
“Well, if you look for me on the Internet, you’ll find essays I’ve written about Indian effigy mounds,” he replied. “They’re my hobby. So the two beautiful women spent most of the lunch asking me about effigy mounds. They had me drawing pictures of effigies on the tablecloth.”
“And then what?” I asked.
“Then they got down to it,” he said. “Why wasn’t I using their products? I said, ‘You guys are the enemy. You’ve hijacked the profession. You’re only interested in selling your products, not in treating patients.’ They all had a run at me. I held my ground. Then the bill came. We were ready to go. And then the more attractive of the two women said, ‘Oh! Would you like some Viagra samples?’”
Gary fell silent. Then he said, with some fury, “Like street pushers.”
 
 
Gary said he has nothing against checklists: “A good checklist is useful. But now we’re flooded with checklists. You can read them in
Parade
magazine.”
And a surfeit of checklists, coupled with unscrupulous drug reps, is, Gary said, a dreadful combination.
 
 
There is a children’s picture book,
Brandon and the Bipolar Bear
, written by a woman named Tracy Anglada. In it, little Brandon flies into a rage at the slightest provocation. At other times he’s silly and giddy. His mother takes him and his bear to a doctor, who tells him he has bipolar disorder. Brandon asks the doctor if he’ll ever feel better. The doctor says yes, there are now good medicines to help boys and girls with bipolar disorder and Brandon can start by taking one right away. He asks Brandon to promise that he’ll take his medicine whenever he’s told to by his mother.
 
 
Were Brandon an actual child, he would almost certainly have just been misdiagnosed with bipolar disorder.
 
“The USA overdiagnoses many things and childhood bipolar is the latest but perhaps the most worrying given the implications.”
Ian Goodyer is a professor of child and adolescent psychiatry at Cambridge University. He—like practically every neurologist and child psychiatrist operating outside the U.S., and a great many within the U.S.—simply doesn’t believe that childhood bipolar disorder exists.
“Epidemiological studies never find anything like the prevalence quoted by the protagonists of this view that there are bipolar children,” he told me. “It is an illness that emerges from late adolescence. It is very, very unlikely indeed that you’ll find it in children under seven years of age.”
Which is odd, given that huge numbers of American children under seven are currently being diagnosed with it.
These children may be ill, some very ill, some very troubled, Ian Goodyer said, but they are not bipolar.
 
 
When Robert Spitzer stepped down as editor of
DSM-III,
his position was taken by a psychiatrist named Allen Frances. He continued the Spitzer tradition of welcoming as many new mental disorders, with their corresponding checklists, into the fold as he could.
DSM-IV
came in at 886 pages.
Now, as he took a road trip from New York down to Florida, Dr. Frances told me over the phone he felt they’d made some terrible mistakes.
“It’s very easy to set off a false epidemic in psychiatry,” he said. “And we inadvertently contributed to three that are ongoing now.”
“Which are they?” I asked.
“Autism, attention deficit, and childhood bipolar,” he said.
“How did you do it?” I asked.
“With autism it was mostly adding Asperger’s, which was a much milder form,” he said. “The rates of diagnosis of autistic disorder in children went from less than one in two thousand to more than one in one hundred. Many kids who would have been called eccentric, different, were suddenly labeled autistic.”
I remembered my drive to Coxsackie Correctional Facility, passing that billboard near Albany—EVERY 20 SECONDS A CHILD IS DIAGNOSED WITH AUTISM.
Some parents came to wrongly believe that this sudden, startling outbreak was linked to the MMR vaccine. Doctors like Andrew Wakefield and celebrities like Jenny McCarthy and Jim Carrey promoted the view. Parents stopped giving the vaccine to their children. Some caught measles and died.
 
 
But this chaos, Allen Frances said, pales next to childhood bipolar.
“The way the diagnosis is being made in America was not something we intended,” he said. “Kids with extreme irritability and moodiness and temper tantrums are being called bipolar. The drug companies and the advocacy groups have a tremendous influence in propagating the epidemic.”
 

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