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.

The Symptoms of PAS: The Spread of the Animosity to the Friends and/or Extended Family of the Alienated Parent

This is the eighth in a series of eight posts devoted to discussion of the eight symptoms originally described by Richard Gardner, MD in 1985. As a quick sidebar, I would like to also point out that while Gardner’s model has drawn some fire regarding the use of the word “syndrome”, much of such objection is smoke and mirrors, in my opinion. Before Amy Baker’s important book Adult Children of Parental Alienation Syndrome, I had an opportunity to read the pre-publication manuscript. When I did so, I called Amy and said something like, “are you saying that your research is confirming much of what Dr. Gardner was saying?” Her response was that her research confirmed all of what Dr. Gardner was saying. In fact, in Johnson and Kelly’s “reformulation” of PAS, their descriptions of the symptom pattern of alienation mirrors much if not all of what Gardner described. Regardless if you call it Parental Alienation Syndrome or Child Alienation a la Johnson and Kelly, the phenomenon is basically the same. The behaviors that alienated children engage in and its progressive course is tightly patterned and therefore predictable. There is little controversy about this. But on to this last symptom. The eighth symptom is The Spread of the Animosity to the Friends and/or Extended Family of the Alienated Parent. With this symptom, we see once loved grandparents, aunts, uncles and cousins being rejected by the alienated child. I recently had the honor and opportunity to speak to a group of Alienated Grandparents in Naples, FL, who have organized into a kind of movement to address the heartbreak of this eighth symptom. Although I was the official speaker at their meeting in Naples, I am quite sure that I learned more from them than they did from me. Their comments and questions revealed that they had mapped the severing of relationships with grandchildren, and often also with their own children. This is something that has not been studied, and such study is certainly warranted. Suffice it say, this last symptom is responsible for much of the heartbreak and tragedy of parental alienation. While it is obviously heartbreaking for the now rejected grandparents, aunts and uncles and cousins, it is devastating for the alienated child. Such a rejection, which they have been programed to execute, cuts them off from the many and unique lessons and gifts that can come from a loving extended family. In short, the lives of these alienated children become much smaller and more one dimensional. They lose the benefit of watching multiple adults living their lives and negotiating issues. Since the most basic form of learning engaged in by children is imitation, such a loss is tragic and damaging. As with the prior discussions, I would appreciate any feedback regarding your experience with this.

The Symptoms of PAS: The Presence of Borrowed Scenarios

This is the seventh in a series of eight posts on the eight symptoms of the Parental Alienation Syndrome, as first described by Richard Gardner, MD. This seventh symptom is The Presence of Borrowed Scenarios. This refers to to the false and distorted stories and things “absorbed” by alienated children about the targeted parent. One of the most common examples of this is when an alienated child announces that the targeted parent did not want for them to be born, and that they wanted the mother to have an abortion. This obviously could have only come from the alienating parent or her minions. This symptom may also be identified by the age inappropriate use of language by children. For example, I had a 4 year old child tell me that she had nightmares when she was at her father’s house (the targeted parent in this particular case). When I asked her about her nightmares, she said that she did not know, and that I should ask her mother because this is who told her that she was having nightmares at her dad’s. Borrowed scenarios may also be thought of as being the result of coaching. The notion of coaching, that is the alienating parent, either directly or indirectly saying things to the child for the purpose of negatively influencing their perception of the targeted parent, is a hallmark of the alienation process. In terms of the research performed by Amy Baker, PhD regarding the strategies for creating PAS, the concept of coaching may be found in some of the more common and frequent ones, such as Badmouthing, which is statistically the most common strategy employed. Since such badmouthing often involves negative and distorted (or manufactured) stories about the targeted parent, the result would be what Gardner referred to as the Presence of Borrowed Scenarios. It has been my experience that this symptom is easiest to clearly convey to the court when the children in question are very young since the content of the allegations are often clearly age inappropriate, which may be strongly conveyed. However, when children become, say teenagers, this symptom can be more easily hidden. That said, the evidence of this symptom can often be found in the now ubiquitous digital communications of texting, email and social media, which are so strongly engaged in by teenagers. These messages, if obtainable, can be powerful pieces of evidence that can tell the story of alienation in very compelling ways to the court. i have seen this be the case in many such instances. Psychologically however, the presence of the distorted reality found in this symptom, can become a serious obstacle to the reunification process. If, for example, a young girl comes to believe that she was somehow assaulted by her father, when she in fact was not, this persistent false perception can become a serious issue for this young girl. Not only can it make her reunification with her father more problematic, but it can also effect her view of relationships with the opposite sex as well as with authority figures, as well as with her ability to trust in a more global way. So while the symptom of borrowed scenarios may begin as a tactic to gain advantage in a custody dispute, it can also burrow itself deeply into a child’s psyche, where it can inflict more long term harm to the child. Believing one was the victim of abuse tends to have the same psychological impact as if the abuse had actually occurred. I believe that if judges understood this, that they would react more swiftly to intercede into the alienation. As with my earlier posts, I would appreciate any thoughts any of you may have on this topic. Thank you.

The Symptoms of PAS: Absence of Guilt over Cruelty to and/or Exploitation of the Alienated Parent

This is the sixth in a series of posts about the eight symptoms of Parental Alienation Syndrome, first described by the late Richard Gardner, MD. The sixth symptom, and the subject of this post is Absence of Guilt over Cruelty to and/or Exploitation of the Alienated Parent. This symptom is typically found in the more severe end of the spectrum of parental alienation. It is manifested through the alienated child’s angry and critical tirades against the targeted parent. Under these circumstances, the severely alienated child will hurl hateful and demeaning comments directly to the targeted parent and will express or experience no guilt or remorse for doing so. One vivid example I recall from many years ago was a young man who, through the manipulation of the Family Court system, was allowed to testify as to why he did not wish to see his father, who was sitting some 10 feel away from him with his lawyer. The young man stated that he hated his father, that he never loved him, that his father disgusted him and that if his father died suddenly, that he would not attend his funeral and would be happy about his demise. The father, who had spent untold money, time and energy in the attempt to maintain a relationship with his son, was understandably crushed at hearing these cruel messages, all delivered in a cold and hateful tone. The judge commented on how this young man’s delivery and overall demeanor during this exchange was actually chilling. Interestingly, some months later, I learned that this young man had reached the age of majority, had moved out of his mother’s home and was now living with and working for his father. Obviously, in spite of the cruel and chilling speech in the courtroom, once the environment changed, this young man was able to essentially become himself again. I frequently tell parents who have received such cruel treatment, that underneath all of this is most likely an entirely different child. Perhaps one of the most striking aspects of this symptom is that appears so very convincing. In many respects, severely alienated children operate in a kind of trance state where they too may believe the things they are saying, when they are saying them. However, as with trance states in general, once the trance has passed the person returns to their normal state of being. Obviously, in the case of parental alienation, this return to themselves becomes less likely the longer the alienated environment which produces this trance state is maintained. This is one reason why reunification therapy should not be gradually and slowly engaged. This gradual and slow engagement actually helps to maintain the alienating environment and the trance like state that it produces. Some years ago, there was professional discussion about the importance of the alienated child recanting the horrible things that may have been said via this symptom. The general consensus now is that such recantation is not to be sought, as this will most likely re-engage the alienation. Perhaps one way of thinking of this is that the horrible things said via this symptom should be treated more as a bad dream. It should simply be released. As before, I would appreciate any feedback and comments about this most disturbing symptom of the PAS.

The Symptoms of PAS: The Reflexive Support of the Alienating Parent in the Parental Conflict

This is the fifth in a series of post devoted to the symptoms of Parental Alienation Syndrome as originally described by Richard Gardner, MD. This fifth symptom is Reflexive Support of the Alienating Parent in the Parental Conflict. Within the context of parental dispute, be it divorce or post divorce, unless there as been actual abuse and or neglect in the extreme, children will typically contort themselves to not takes sides in the parental dispute. If a child feels one parent is being ganged up on in some way, they will often go to their aid and support their position. This reaction is certainly common but not universal. In cases where abuse has been present, one may see the child taking the side against the abuser, however this is still more the exception than the rule. However when abuse is not present, this reflex to take one parent’s side will simply not be absent. Suffice it to say, children like to stay out of the middle of their parents disputes. They want nothing to do with it, and will typical head for their rooms or some other exit to get away from it. One of the reasons for this reflex of avoidance of parental conflict is the possibility that they may get drawn into it. If, for example, during an argument between two parents, one parent looks at the child and asks for confirmation of their position, any such confirmation will typically represent a betrayal of the other parent. Again, this is something that children will contort themselves to avoid. It is from this backdrop then, that this symptom of Reflexive Support of the Alienating Parent in the Parental Conflict finds its greatest resonance. When an alienated child actively and even aggressively takes whatever position that the alienating parent takes, we can see how unnatural this is. When this symptom is present, the alienated child will support even the most absurd position if it is offered by the alienating parent. In group settings or family counseling settings, even when the child is offered indisputable proof that the position of the alienating parent is impossible, they will continue to support it. It is under these extreme circumstances that the depth of the pathology of alienation is exposed. As Gardner originally described, the parental alienation dynamic is a fear driven phenomenon. That is the alienated child is fearful of displeasing the alienating parent, and this fear is at the core of alienation. As this process takes root and grows, this fear of the alienating parent operates something like the fear of reprisal that a gang member would feel if he or she disobeyed the group. When we are speaking about children and the “gang” is a parent with whom they spend most if not all of their time, the fear is palpable. It is this level of fear and its consequent “identification with the aggressor” or alienating parent, that drives the pathological behavior and distorted thinking of the alienated child. This symptom is one very clear expression of this. This symptom can be baffling and dangerously distorting to the naive custody evaluator who is not familiar with parental alienation. Under this circumstance, they are likely to take what the alienated child says at face value. This symptom is therefore very important for the evaluator, the guardian or whomever else the court should appoint to help determine the best interest of the child to understand. As with the previous posts, I would appreciate any feedback regarding this symptom. Thank you.

The Eight PAS Symptoms: Independent Thinker Phenomenon

This is the fourth post in a series of eight centered on the eight symptoms identified by Richard Gardner, MD in 1984, which he coined as being the Parental Alienation Syndrome. The fourth symptom is referred to as the Independent Thinker Phenomenon. Again, we should be reminded that as Gardner saw case after case of divorcing families where a once loving child would suddenly profess antipathy for their once loved parent, patterns were noticed. The pattern became the eight symptoms of the Parental Alienation Syndrome, or PAS, for short. As a clinician, I can verify that after one sees hundreds and hundreds of patients, in a given context, that the effect of this sort of experience is that one begins to notice repetitive patterns of symptoms and behaviors. When one sees these repetitive patterns, clinical insight begins to develop about what the patient is experiencing. I know that this is exactly the experience that Gardner began to have in the 1970’s, ultimately leading to his first publication regarding PAS in 1984. I mention this because the symptom of this post, the Independent Thinker Phenomenon, is a symptom that can be easily missed, or perhaps given less significance than it deserves. The Independent Thinker Phenomenon refers to the consistent behavior seen in alienated children where they claim that their resistance to seeing the unfavored or targeted parent derives from their own independent thought and is not the result of the other parent’s influence. Very often, this symptoms appears as the child - very much out of the blue - announces that no one told them to say this, and that this is his or her own thought. The significance of this “out of context” expression is that it reveals an agenda, on the part of the child, to carry out their assignment of: (1) arguing that their resistance to seeing the unfavored parent is their independent thought, and (2) that this thought is not result of the influence of the other parent. While these two components are in many ways overlapping, their separate expression is consistent with the kind of urgency that only alienated children experience. The purpose of this symptom is to convince the audience - very often court appointees - that they should not have to see their once loved parent. The urgency that is the fuel for this symptom is simply unseen in other contexts of divorce. When parents divorce and parental alienation is not present, this phenomenon is inconceivable. When parental alienation is not present, and divorce is in process, children make every effort to stay out of the middle, never taking a position in the parental conflict. This symptom is the opposite of this. In so being, it is a quiet hallmark of parental alienation. In this context, the custody evaluator, that is those evaluators who have an understanding of parental alienation, often see this symptom as the spontaneous statement, “you know, no one told me to say this” or perhaps, “my (mother or father - alienating parent) did not influence me”. Again, we see the completely unnatural favoring of one parent and the commensurate rejecting of the other, in one simple statement. I would be appreciative of any feedback about the appearance of this symptom in your experience. Thank you.

The Eight PAS Symptoms: Lack of Ambivalence

This is the third in a series of eight posts which correspond to the eight symptoms of Parental Alienation Syndrome, as originally described by Richard Gardner. In spite of the fact that the use of the word “syndrome” has fallen out of favor in some camps, it is important to realize that even Gardner’s critics describe alienation in much the same terms as does Gardner. The difference lies primarily in the competing theories as to what causes children to become alienated, but that is perhaps for another post. Suffice it to say that these eight symptoms described by Gardner are substantively similar if not identical to those described in the literature by the so-called reformulation theory psychologists. But this too is perhaps the subject of another post. Back to the eight symptoms. The third one is referred to as Lack of Ambivalence. This symptom refers to the child having no emotional connection to the targeted or unfavored parent. In some respects, this symptom can be a little misleading since severely alienated children can express hatred for the target parent, which is a connection, albeit not a loving one. The term “ambivalence” has a special meaning within the world of psychiatry, psychology and psychotherapy. It refers to a remaining emotional positive connection between a person and what is referred to as a “love object” which is a psychoanalytic way of saying, the other person, even in moments of anger and conflict. When human relationships develop and evolve and deep emotional connections are made, the maintenance of an ambivalent connection, even in moments when one is angry with that person, is perfectly normal and healthy. Most have experienced being in a conflict with a loved one, feeling angry or even worse with the other person, but yet still not wanting an end to the relationship. Most parents have experienced their angry teen exclaim anger, disdain or even hatred, yet still remain connected to them. This is all normal. As a contrast to what Gardner was saying about this symptom, we might consider the abusive relationship, where one person is frankly abusive to the other person. In the abusive relationship, the ambivalent connection often actually strengthens, however in a very unhealthy way, such that the abuse victim begins to feel unworthy and somehow responsible for the way they are treated. Such adult abuse victims will go out of their way to avoid triggering the disapproval of the abusive person. In so doing, they essentially give up pieces of themselves and take on the self critical messages they have been receiving. They typically only leave these relationship after considerable abuse, if they leave at all. When children are abused by a parent, they tend to contort themselves into whatever they think the abusive parent wants them to be. When abused children do finally reject an abusive parent, it is typically only after a great deal of real and intense abuse over a very long period of time. Therefore, when we consider that in the context of parental alienation, the deep ambivalent connection between a child and a once loved parent is gone, it simply does not make sense, according to what we know about deep human relationships. In my view, the alienated child’s lack of ambivalent connection to the once loved parent is essentially unnatural. It simply cannot be the result of occurrences only between that child and that parent. Parent-child relationship are simply not that fragile. The deterioration must come from another source. Obviously that source is the alienating parent. When this symptom is present, the child can find no positive thing to say about the targeted parent, past or present. They can offer no positive or endearing quality regarding that parent, nor can they describe any positive or even “light” experience with them. This is one of the most severe symptoms of parental alienation, and I have found it only in severe cases. When these children are questioned about their once loved, now reviled parent, they will go on incessantly and will do their best to convince their audience of how much they should never have to see that parent. One can see that when this child sits before a therapist who is naive about parental alienation, that they can be easily swayed into believing the legitimacy of the child’s feelings. These naive therapists often become then, part of the problem and therefore part of the alienation. I believe that it is often the urgency contained in the Lack of Ambivalence that is so convincing. Anything you can share in your experience with this symptom or this overall dynamic is appreciated.