Today’s psychiatry undermines self-reliance and morality.

Everyone on the Couch

by Theodore Dalrymple 

Allen Frances, the psychiatrist who edited the fourth edition (1994) of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders(commonly known as theDSM-IV), once tried to insinuate a new diagnosis—masochistic personality disorder—into the third edition (1980). Frances, a vocal critic of the newDSM-5, released this year, now believes that no such condition exists and is glad that he failed—though he failed for reasons other than the manual’s scientific integrity.

Masochistic personality disorder, as Frances then conceived it, “diagnosed” those whose typical behavior brought them unhappiness, principally by “self-sacrifice in the service of maintaining relationships or self-esteem.” He was thinking of—or many took him to be thinking of—women who put up with violently abusive lovers or husbands, or repeatedly chose such men as sexual partners, despite previous bad experience. Feminists attacked the proposed diagnosis, arguing that it blamed women for their own abuse. And it was on those grounds, not scientific ones, that the 1980 DSMexcluded the diagnosis.

In fact, the pattern of behavior that Frances’s disorder sought to categorize is common—I encountered it often in my clinical practice. “His eyes suddenly go funny,” a patient would say of a violent boyfriend, “like he’s having a fit. He stares, he doesn’t blink, and then he starts to strangle me. I don’t think he knows what he’s doing.” “Would he do it in front of me, then?,” I would ask, and the scales would fall, at least temporarily, from her eyes. But the willingness to excuse abusive behavior was often astonishing. I recall one patient with an arm and a jaw broken by a man just out of prison after a long sentence for killing another woman. She rejected our warning that she was in imminent danger and walked out of the hospital arm in arm with her abuser, proclaiming her love for him. And, in fact, no convicted serial killer fails to receive written declarations of love and offers of immediate marriage from women outside the prison walls.




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