WASHINGTON — Charging sexism, elitism and exclusionary practices on the part of psychiatrists, a group of psychologists attending the 94th annual convention of the American Psychological Assn. last week launched a major attack on three categories proposed for inclusion in the American Psychiatric Assn.'s Diagnostic and Statistical Manual (DSM), viewed widely as the bible of mental health diagnosis.
The protest over ethical and legal ramifications of categories for periluteal phase dysphoric disorder, self-defeating personality disorder and sadistic personality disorder was echoed by the Psychological Assn.'s council of representatives. In a resolution adopted in the final hours of the five-day conference, the council called the diagnoses "without . . . any scientific basis" and "potentially dangerous to women" and urged that the three categories be omitted from the Psychiatric Assn.'s DSM-IIIR, an interim revision, scheduled for publication in early 1987.
Used by Courts, Firms
After several revisions, the Psychiatric Assn. has tentatively decided to include the three categories in the appendix of the newest edition of the manual first drafted to establish classifications of mental illness in 1952. The widespread use of the manual by insurance companies, the courts and state and national policy makers is in large part what has prompted fears on the part of some psychologists that the new terminology will "stigmatize" women, possibly serving as a barrier to employment or public service.
"The fact is," said Renee Garfinkel, director of the Psychological Assn.'s women's program office, "words, names and labels are very powerful."
The new categorization "reinforces stereotypes," said psychologist Sheryle Alagna of the Uniformed Services University of the Health Science in Bethesda, Md. "Clinically, it could be misused, obscuring significant contributions of the social context."
"If you wonder how many people believe these words and labels," said Laura Brown, a clinical and forensic psychologist in practice in Seattle, "think about how many of the notions that come from psychiatric thinking that we take for granted: the Freudian slip, the interpretation of dreams. The theories and notions of our profession have moved into the general culture and vocabulary."
Said Brown: "These things creep down into the culture."
In Philadelphia, psychiatrist Dr. Paul Fink, chairman of the ad hoc committee to review the DSM-IIIR, had this response to the debate: "The argument now is on a hysterical level. It's not rational. If you read it (DSM-IIIR) through, those categories do not represent an anti-woman bias, and in my opinion they don't have the potential for abuse."
At the American Psychiatric Assn., public affairs director John Blamphin was of a similar mind: "We think there is a lot of feminist extremism in the reaction of a small group. We feel we have resolved the issues."
200 Changes Proposed
The controversy surfaced late last year, when more than 200 changes and clarifications were proposed for the updated psychiatric diagnostic manual. "Amongst the 200 proposals," Blamphin said, "there were maybe 20 that were controversial, including the three the psychologists referred to." After additional reworking, most of the controversies were ironed out, Blamphin said, leaving about five or six.
One argument was over masochistic personality disorder. After still more review and field studies, the committee of psychiatrists agreed to retitle this category self-defeating personality disorder. While clinical and forensic psychologist Lenore E. Walker of Denver, for one, blasted that category as anti-female, saying it "blames the victim, not the perpetrator" of violence against women in particular, psychiatrist Fink was firm in saying that, "This is not a female illness."
Fink, vice president of the Psychiatric Assn. and chairman of psychiatry at Albert Einstein Medical Center in Philadelphia, said, "We make it very clear that anyone who has been abused cannot be given this label. The abused people are excluded."
One study--"not perfect," Fink said--"showed that 35% of the people so labeled were men, and 65% were women. Most of the patients in my personal practice who have self-defeating personality disorder are men.
"Because of the pressure, we changed the term so it would not be confused with early psychiatric ideas that all women were born masochists."
But critics were unconvinced. Joining in the protest, the 100,000-member National Assn. of Social Workers issued a statement declaring, "We feel that the diagnostic criteria for the self-defeating personality disorder describe what social workers know to be the transient effects of battering or sexual assault on women's functioning. Describing it as a personality disorder implies grave and unchangeable psychopathology and it could be used against women in custody battles, self-defense murder cases and sexual harassment litigation."