Parental Alienation and the DSM

By now I would assume that most of you have been made aware that the American Psychiatric Association’s Task Force on the DSM 5, which is due to be published in May of next year, has announced that parental alienation will not be included as a mental disorder. What does this actually mean? Specifically, they are saying that when a child becomes alienated from a parent primarily due to actions of the other parent, that what happens within that child is not a uniform syndrome or disorder. Rather, they are proposing that it be listed in a new category of disorders referred to as Relational or Relationship disorders. While I personally disagree with their decision, I believe that it is important to understand that the DSM committee is not saying that the phenomenon of alienation does not exist. All authorities - both friendly to PAS as well as those hostile to it - agree that the phenomenon of parental alienation exists. Some prefer to call it Child Alienation, but all in the field agree that it exists. Last year’s annual meeting of the Association of Family and Conciliation Courts (AFCC) devoted their entire meeting to the phenomenon of parental or child alienation. If it did not exist, such a meeting would not have occurred. The DSM committee is simply saying that alienation is not a uniform and predictable disorder that follows a predictable path within the child. Again, while I disagree with this conclusion, I believe at this point it is most important for all concerned to understand that no one is saying that parental alienation does not exist. It is well known that it does and this is not disputed. But why would the DSM Task Force come up with this conclusion? If you scan the recent news articles about this, it is often framed that the DSM committee did not bend to the influence of pressure of those saying that it did. In actuality, I believe that they did in fact bend to such pressure, except from the other direction. Why? I believe that the answer lies in just what the American Psychiatric Association, the group behind the writing of the DSM, is all about. First and foremost, it is in every sense a trade association. It is the association that represents Psychiatrist’s interests and profession, pure and simple. Granted it is steeped in science and evidence based research, but we must not loose sight of the fact that at its core, it is there to protect the interests of Psychiatrists. It is a trade association. The first and most important founding principle of trade associations is to have members. Without members, trade associations simply wither, become irrelevant, and eventually die. If one looks into other types of trade associations, one will find that, in their interest of attracting and maintaing members, they tend to never take controversial positions. Controversial positions become lightening rods that can potentially loose members. Therefore they are avoided. Take for example the American Psychological Association, the professional trade association for Psychologists in this country. If one scours the various positions of the APA (American Psychological Association) one finds that its position regarding parental alienation, and parental alienation syndrome are actually hard to find. There are no official statements supporting it or denying it. The closest thing one will find is the statement that it is still being researched. The APA knows that if it endorses the reality of parental alienation that it stands to lose members who take opposing views of this. Conversely, if the APA says that parental alienation does not exist, that it will loose members and credibility. So what does the APA do? This is interesting. If one examines the APA’s Guidelines for the performance of Custody Evaluations, one finds that attached to it is a reading list of endorsed references that are to be used as references in the performance of such Custody Evaluations. These are the “gold standard” documents and references to be used by custody evaluators. This elite reading list contains just over thirty resources and the only author that is listed three times is Richard Gardner, MD. Among the references listed is his seminal volume entitled The Parental Alienation Syndrome. In other words, in a effort to maintain its credibility with its members, it passively and quietly endorses the works of Gardner that are the cornerstone of what we understand parental alienation to be. I believe that while the American Psychiatric Association, being the trade association for Psychiatrists, attempts to base their findings and conclusions in empirically based research, that it is very much subject to political pressures that can effect its credibility and existence. It simply cannot make a heroic stand. It will become a target. I am sure you all can relate to that. While I do not present this as an excuse, i believe that it is important to understand it as a reason. When I was in graduate school the DSM II was in place. The DSM II was a slim volume of 134 pages, published in 1968. I still have my copy. In it homosexuality was considered a psychopathology. It fell within the category of “Personality Disorders and Certain Other Non-Psychotic Mental Disorders”. Its diagnostic code was 302.0. It was considered a mental illness. When the DSM III came out, about a decade later, homosexuality was only considered a mental illness if that person effected by it did not wish to be homosexual. It was termed “Ego-dystonic Homosexuality”. In other words, it one was comfortable being homosexual, then it was not longer a mental illness. If we consider American culture and its attitude regarding homosexuality from the mid 1960’s through the 1970’ and 1980’s in fact we find that the cultural attitude about homosexuality evolved and changed. Still however, we must be reminded that the DSM II and DSM III were science based and beyond bias. Right. While they were science based, it is clear that cultural bias is present. So why the big controversy concerning parental alienation? I believe that there is an answer for this. What happens when, typically in the context of divorce, a child becomes rather suddenly alienated from a once loved parent, who is then typically falsely accused of inappropriate behavior? Since this is most likely to happen within the context of the Family Court system, the court would often appoint someone to evaluate what was happening with this family and them make recommendations to the court as to what should be done about it. If that evaluator understood the dynamics of parental alienation (and had read the list of references endorsed by the APA), then that evaluator would likely determine that one parent, often termed the alienating parent, was improperly influencing the child to vilify what we might term the targeted parent. If that evaluator was candid and direct in its recommendations to the court, that alienating parent would be cast in a very negative light to the court, and the court might do all sorts of things that this alienating parent would not like. If all of this occurred, then that evaluator would then become the target of that alienating parent. It is important to understand that the concern of becoming the target of an angry alienating parent is very real to custody evaluators. Such angry parents tend to file complaints and lawsuits. As a consequence, many such evaluators would tend to produce a rather “vanilla” report that fails to clearly identify the actions of the alienating parent. In other words, if you are operating with a concept of parental alienation that “calls out” the alienating parent, the messenger, the custody evaluator is also “called out”. Therefore, if the American Psychiatric Association included Parental Alienation Disorder in its list of individual disorders, then the person making this diagnosis would also find themselves in the cross hairs of that alienating parent. This may seem far fetched, but I believe that it is not at all. But there are other reasons as well. Many powerful organization have taken a position regarding parental alienation. The National Organization for Women (NOW) has taken a very adversarial position regarding this issue. The NOW chapter of California was responsible for attempting to pass legislation that would have made it a felony to use the term “parental alienation” in evaluations. This did not pass, but is not political, then please give me a better example. So if the American Psychiatric Association included parental alienation in its list of disorders, the they too would have been attacked by NOW. No question about it. To return to my main point: Do not let this news disturb you if you are battling parental alienation. This is not a disaster, it is only a slight bump in the road, if even that.