David Shaffer of Columbia University’s psychiatry department led the development of the TeenScreen program, a controversial mental health screening tool. TeenScreen is controversial for a plethora of reasons, including matters of parental rights, the dangers of drugs used to treat symptoms of “mental illness” and suspicious connections of TeenScreen’s personnel with the various drug manufacturers that stand to make billions from TeenScreen’s success.
The controversy on each of these issues could fill a book. Yet, the most interesting thing about TeenScreen is its origin, the science (or lack of science) with which it was developed.
TeenScreen certainly wants the public to believe that the program is scientifically based. Their 2004 Annual Review contained no less than NINE instances of the word “science” in its four pages of text. TeenScreen hired Rabin Strategic partners, a New York PR firm, to attempt to make the subject palatable to the public and the schools so they could be sold on the program. Is this overuse of the term “science” just slick marketing from the PR firm or is there some real science to be found somewhere? And what is this science? Finding the answer requires considerable research, as TeenScreen’s website and publications are bereft of any actual reference to what this science might be.
The Search for TeenScreen’s Science
David Shaffer’s history yields the first clue, reprinted here from TeenScreen’s own website, “He (Shaffer) has been co-chair of the DSM-IV Child and Adolescent Disorders Work Group.” The DSM-IV is the latest and current version of the standard handbook of "mental illnesses" as determined by the American Psychiatric Association (APA). The DSM lists “mental disorders”, assigning each one a number and defining each as a list of symptoms. For example – 296.2, Major Depressive Disorder Single Episode, 300.02, Generalized Anxiety Disorder, and the very unscientific 300.9, Unspecified Mental Disorder (nonpsychotic).
The write-up of Dr. Shaffer’s history continues with this statement: “Other research interests have included the development of computerized diagnostic instruments (the NIMH DISC) and psychiatric classification.” NIMH is the National Institute of Mental Health and DISC is the Diagnostic Interview Schedule for Children. The NIMH DISC is based on the diagnoses of mental disorders in the DSM, as documented by the National Assembly on School-Based Health Care (NASBHC), “The DISC is a highly structured, diagnostic instrument that assesses thirty-four of the most common psychiatric diagnoses of children and adolescents. Based on diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders IV, III-R (an earlier edition), and ICD-10 (the British equivalent of the DSM).
TeenScreen is based on the DISC and the DISC is based on the DSM. TeenScreen’s computer-based questionnaire is called the DPS (Diagnostic Predictive Scale). The DPS is derived directly from the DISC, as documented by NASBHC, “The DISC (Diagnostic Interview Schedule for Children) Diagnostic Predictive Scales (DPS) are brief questionnaires that indicate the likelihood of a psychiatric diagnosis in young people aged 8 to 18. All DPS questions come directly from the extensively tested and researched DISC. Analysis was done to find out which questions best predicted a full diagnosis.”
Questionable Suicide Studies
In the development of TeenScreen, Shaffer and crew performed a “psychological autopsy” study of 120 teen suicides in the metropolitan New York area. A psychological autopsy is defined by McGraw-Hill’s Online Learning Center as “An analysis of a decedent’s thoughts, feelings, and behavior, conducted through interviews with persons who knew him or her, to determine whether a death was an accident or suicide.” This action is commonly used by insurance companies to determine whether to pay a claim but rarely, if ever, used in any scientific work. There is no physical autopsy involved, merely interviews with friends, co-workers and relatives consulting their memory and opinion.
Reportedly, with this study, they found that approximately 90% of youth who die by suicide suffer from a diagnosable and treatable mental illness at the time of their deaths (Shaffer et al., 1996). They conclude that they could have correctly identified and treated the suicide victims. Yet, this conclusion was drawn without any direct observation of an actual suicidal teen, any attempt at diagnosis, and no attempt at treatment. This seems an exaggeration at best, or wishful thinking, akin to a fireman showing up 20 minutes late and saying “I coulda saved those victims”.
This peculiar approach is very illogical until some basic information about the DSM and psychiatry in general is added. The DSM defines 374 mental “disorders”. Each is a list of symptoms and if a person is found to have more than half of the symptoms for a particular disorder he “has” it. This is the criteria used by Shaffer and his fellow researchers to determine that the victims were “diagnosable”. It means they were able to find enough acquaintances to “verify” their idea that the victim felt and acted according to certain items on a list.
Questioning the DSM
The so-called “scientific” basis for the TeenScreen Program’s evaluation of “mental health” is the DSM. The question though, is whether there is any scientific validity to the DSM’s diagnoses. Each of the 374 has been approved and certified as real by the American Psychiatric Association (APA). There should be science behind that. Certainly, there are studies aplenty on symptoms and how symptoms can be manipulated with drugs and other duress but there is no proof that even one “disorder” is anything other than a list of symptoms. They are voted in by committee, so that if a majority vote that a particular list of symptoms “is” a disorder, then it “is” and everyone who has a majority of those symptoms “has” that disorder.
The DSM-II listed homosexuality as an abnormal behavior under section "302. Sexual Deviations." It was the first deviation listed. After much political pressure, a committee of the APA met behind closed doors in 1973 and voted to remove homosexuality as a mental disorder in the new DSM-III. “Opponents of this effort were given 15 minutes to protest this change”, according to Dr. Jeffrey Satinover, in Homosexuality and the Politics of Truth. Homosexuality was labeled as deviant behavior with no scientific basis, then removed in response to protest and political pressure. This is a polarizing issue amongst the public with strong opinion on both sides. Psychiatry has alienated both sides with their non-scientific methods.
Harvard Medical School’s Joseph Glenmullen, M.D., says that in psychiatry, “all of its diagnoses are merely syndromes [or disorders], clusters of symptoms presumed to be related, not diseases.” –” from Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and other Antidepressants with Safe, Effective Alternatives
Even Columbia University acknowledges the unscientific nature of the DSM in their annual report of 2001, “Problems with the current DSM-IV categorical (present vs. absent) approach to the classification of personality disorders have long been recognized by clinicians and researchers.” Among the problems, they list “arbitrary distinction between normal personality, personality traits and personality disorder” and point out the interesting fact that the most commonly diagnosed personality disorder is 301.9, Personality Disorder not Otherwise Specified.
"The field of mental health is highly subjective, capricious, and dominated by whims, mythologies, and public relations. In many ways it is a pop culture with endless fads but with no real substance." –” Dr. Walter Fisher, Assistant Superintendent, Elgin State Hospital, Power, Greed, and Stupidity in the Mental Health Racket
"Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than scientific document. … It is the way to get paid." –” Loren R. Mosher, M. D., Former Chief of the Center for Studies of Schizophrenia, The National Institute of Mental Health, in his letter of resignation to the APA
While critics question its science, the DSM’s validity is endorsed by the APA, and the diagnosis numbers are generally accepted by insurance companies for billing purposes. Drug companies use DSM diagnoses to justify the need for their highly profitable psychotropic drugs, helping to build and maintain the multi-billion dollar psychotropic drug industry. "The way to sell drugs is to sell psychiatric illness." –” Dr. Carl Elliot, University of Minnesota Bioethicist, as quoted in Drug Ads Hyping Anxiety Make Some Uneasy, Washington Post 2001
On a personal level, the psychiatrist or physician tells the patient that he or she has a disease, with a learned-sounding name. They hand that person a prescription for the specific drug that is supposed to treat that particular “mental illness”. No actual medical tests are performed, only the list of symptoms from the DSM is used. If one exhibits the list of symptoms, he is deemed to have the disease. If the psychiatrist reports to the insurance company, Medicare or Medicaid that the patient has the right symptoms, it will pay the bill. True to Dr. Elliot’s observation, this is certainly the successful way to sell drugs.
The DSM has shown to be a useful tool for those who derive their living from “treating” people who experience difficulties in life. Despite the controversy and questions, the DSM is broadly used to label and prescribe treatment, usually drugs, to millions of patients. The DSM diagnoses are also used by the research community as justification for millions in public and private research dollars.
One of the toughest question the DSM faces is the “science” or lack thereof that the APA uses to determine what is a disorder and what isn’t. Does even one of the 374 “disorders" or "mental illnesses" actually exist? Are they diseases of the brain or simply lists of symptoms with a number of potential causes?
Paul Genova, associate professor of psychiatry at the University of Vermont, made the following astounding remarks in Psychiatric Times, April 2003, in an article entitled Dump the DSM: "The American Psychiatric Association’s DSM diagnostic system has outlived its usefulness by about two decades. It should be abandoned, not revised. . . . it is time for the arbitrary, legalistic symptom checklists of the DSM to go. . .. The aggregate is an awkward, ponderous, off-putting beast that discredits and diminishes psychiatry and the insight of those who practice it." Consider the fact that your clinical practice is governed by a diagnostic system that:
- is a laughingstock for the other medical specialties;
- requires continual apologies to primary care doctors, medical students, residents, and the occasional lawyer or judge;
- most of our thoughtful colleagues privately rail against;
- insists upon rigid categories that often serve only to confuse and misinform patients and their clinical workers (sometimes abetted by televised drug advertising);
- is so intellectually incoherent as to raise eyebrows among the well-educated, critical thinkers in our own psychotherapy clientele;
- persuades the world at large that psychiatry no longer has anything of interest to say about the human condition.
The DSM diagnoses are compiled and voted in by committees at the APA convention. Voting is done by a show of hands on whether or not a new category should be created and what its symptoms should be. As psychiatrist and founder of the International Center for the Study of Psychiatry and Psychology (ICSPP), Peter Breggin, stated in the book, Toxic Psychiatry, "Only in psychiatry is the existence of physical disease determined by APA presidential proclamations, by committee decisions, and even, by a vote of the members of APA…”
The first two editions of the DSM categorized mental illnesses according to the conventional psychiatric ideology of its time. Difficulties were split into psychoses and neuroses. Then, with the introduction of the DSM III in 1980, the new "medical model" (chemical imbalance theory) became the norm, while dozens more categories of “mental illness” were added. This was a revolution in the way the “mentally ill” were studied and treated, yet no evidence was provided for this new convention. The DSM-III stated, "For most of the DSM-III disorders . . . the etiology (the actual cause of a disease) is unknown. A variety of theories have been advanced, buttressed (supported) by evidence not always convincing to explain how these disorders come about."
That was twenty-five years ago. Surely the billions of dollars poured into psychiatric “research” in those years have resulted in final proof after all this time. No. Despite the decades and billions, not one single, objective scientific marker can be shown for even one so-called "mental illness." The disorders are ASSUMED to be genetic or related to a chemical imbalance in the brain yet not one scientific paper have clearly delineated a responsible gene and no one has even been able to identify what a normal chemical “balance” would be. From the New York Times, June 14, 2005, "Psychiatrists have been searching for more than a century for some biological marker for mental disease, to little avail." –” Benedict Carey
In the future, we can look forward to even more pseudo-science from psychiatry. The lead psychiatrist in charge of formulating the new DSM V openly admits to the lack of "scientific research" done to back up DSM diagnoses, "A primary purpose of this group then, was to determine why progress has been so limited and to offer strategic insights that may lead to a more etiologically-based diagnostic system. The group ultimately concluded that given the current state of technological limitations, the field is years, and possibly decades, away from having a fully explicated etiology- and pathophysiology-based classification system for psychiatry." –”Michael B. First, M.D. A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers, May 2002.
Psychiatric journals have reported studies into potential “disorders” that could be voted into the next iteration of the DSM. Arachibutyrophobia – the fear of peanut butter sticking to the roof of your mouth, Post Election Selection Trauma – your candidate loses, and Automatonophobia – the fear of ventriloquists’ dummies have been created and seriously studied. Paul McHugh, Professor of psychiatry at Johns Hopkins University, understands how comical his profession has become, “Pretty soon, we’ll have a syndrome for short, fat Irish guys with a Boston accent, and I’ll be mentally ill." –” New York Times, June 7, 2005
The DSM has no scientific basis, therefore TeenScreen has no scientific basis. Psychiatrists themselves criticize its validity. This could all be an interesting discussion, scintillating parlor conversation, except for the simple, brutal, shocking fact that mental health screening programs like TeenScreen are busy right now infiltrating schools all over the USA in order to apply this pseudo-science to our children. This is not an academic discussion; this is a matter of life and death for America’s children. Do you want to trust your children to the very same group that cannot quite agree on their “science”, while boldly going forward with drugging millions of children with mind-altering, deadly drugs? If you are a parent, teacher, school administrator, elected official or anyone who cares about the future of this country, you need to find out if TeenScreen is operating in your local schools. Demand that TeenScreen is stopped and that children are allowed to grow up as the beautiful, normal children they are and not as lifelong drug addicts and mental patients.