International Group of Scientists to Push for PAS Inclusion in DSM
Bernet is leading an effort to add "parental alienation" to the next edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association's "bible" of diagnoses, scheduled for 2012. He and some 50 contributing authors from 10 countries will make their case in the American Journal of Family Therapy early next year. Inclusion, says Bernet, would spur insurance coverage, stimulate more systematic research, lend credence to a charge of parental alienation in court, and raise the odds that children would get timely treatment.
This article is a serious discussion of Parental Alienation Syndrome and parental alienation generally (U.S. News and World Report, 10/29/09). Although it tends to elide the difference between the two, it's balanced, doesn't promote an agenda, but does understand the reality of PAS and the pain it can cause. As the article shows, parental alienation can come in a variety of forms, from the unintentional and trivial to the malicious and psychologically damaging. As to whether a discrete syndrome can be manifested by children of alienating parents, the article takes no stand. Clearly, that question has yet to be decided by the community of mental health professionals.
And the caution expressed by former American Psychiatric Association president, Elissa Benedek, is commendable. Ever-increasing diagnoses of mental illness inevitably result in the ever-increasing treatment thereof, often by psychotropic medication. Mistaken diagnoses of PAS in cases of appropriate anger on a child's part about divorce, or the simple preference for one parent or the other would be inevitable. As always, there is behavior that is appropriate to trying circumstances and behavior that's not. Knowing the difference can be tricky and not all mental health professionals will get it right.
And other diagnoses can look suspiciously like societal preference for controlling obstreperous masculine behavior. After decades of diagnoses under a variety of names, Attention Deficit Disorder was first included in the DSM in 1980 and changed to Attention Deficit Hyperactivity Disorder in 1987. And, as Dr. Christopher Lane of Northwestern University has written,
But since ADHD was officially defined as a mental disorder in 1980, the number of diagnoses each year has skyrocketed—there's simply no other word for it. When a mental disorder mushrooms by hundreds of percent each year, as in this case, it's in everyone's interests to pay attention—even to ask what's going on, and why. Is there a major uptick due to recognition, finally, of a once-hidden, underrecognized phenomenon? Or does the issue also involve a bandwagon effect, where aggressive direct-to-consumer marketing, patent cycles, media interest, "diagnostic bracket creep" (Peter Kramer's term in Listening to Prozac), and even in this case education policies and practices seem to prioritize certain disorders and treatments over others.
Vastly more boys than girls are diagnosed with ADHD. And therefore, vastly more boys than girls are treated with psychotropic drugs for the condition. The psychological profession wonders why that should be, but generally fails to look at the possibility of anti-male bias in society. As a colleague of Dr. Lane's once put it, "We used to have a word for sufferers of ADHD; we called them boys." The implication is that what was once understood as acceptable masculine behavior is now considered unacceptable masculine behavior. Are we entirely surprised that the skyrocketing diagnosis of ADHD coincided with the rise in the general societal distaste for behaviors identified as masculine?
So I, like Dr. Benedek, am nervous about expanding diagnostic categories in the behavioral sciences. But I'm all in favor of recognizing parental alienation when it occurs. In short, I'd prefer to place the emphasis on the person doing the alienating rather than the one alienated. After all, if we want to control or alter someone's behavior, let's go to the source, the cause. And the cause of an alienated child is not the child, but the parent. That, of course is not to say that alienated children shouldn't receive appropriate care. Obviously, they should, but we must never ignore the alienating parent in favor of psychotropic drug therapy to control understandable behavior in alienated children.
Whatever the process of the PAS diagnosis in the future, it's good to see sane, balanced articles on the subject. With the trend toward recognizing the phenomenon, whether it's finally defined as a "syndrome" or not, articles like the recent op-ed in the Christian Science Monitor that seek to deny the existence of alienation altogether will, I suspect, finally fade to black.
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