To no one’s great surprise, the American Psychiatric Association has decided to reject Parental Alienation Syndrome/Disorder, for it’s Diagnostic and Statistical Manual V. PAS has been the subject of hot debate within the mental health community for over a decade now, with those against inclusion often sounding more political than scientific. Here’s one article on the APA’s decision (Washington Times, 9/23/12).
The official reason given by the APA for exclusion of PAS is that the disorder is “relational” and therefore doesn’t qualify as a “mental disorder.”
“The bottom line — it is not a disorder within one individual,” said Dr. Darrel Regier, vice chairman of the task force drafting the manual. “It’s a relationship problem — parent-child or parent-parent. Relationship problems per se are not mental disorders.”Hmm. I’m not a mental health professional, but the fact is that many behavioral disorders in children and adults have their origin in parent-child relationships while the child is growing up. I’ve read a good bit on PAS and there are eight discrete behaviors by a child, most of which must be present, in order for a diagnosis of PAS to be made. These are behaviors by the child and they, like others with their roots in parent-child interactions that cause behavioral disorders, are produced by the alienating behavior of one parent. They are also likely to occur due to parent-parent power dynamics that may well have predated the divorce or separation. But, although the parents may be the cause, the disorder is in the child. So I fail to understand Dr. Regier’s theory that the extreme – and extremely destructive – behaviors that characterize PAS children are not mental disorders of the child. In short, he seems to be confusing cause and effect. But I’m a layperson, so I’ll be glad to listen to a more detailed explanation for the APA’s decision.
Meanwhile, whatever the merits or demerits of the APA task force’s decision, we can all take solace in the fact that some things never change. One of those is the shocking intellectual dishonesty of anti-PAS forces. Here’s one of the least persuasive efforts in that direction (PsychCentral, 9/22/12). Dr. John Grohol has nothing to add to the previous arguments made against recognition of PAS as a mental disorder in children of alienating parents. All the usual suspects are there.
First there’s the claim that inclusion of PAS is just a trick by greedy mental health professionals to add to their fees. I guess Grohol doesn’t notice the fact that anyone can say the same about any medical or mental diagnosis. For example, let’s say the patient has small cell carcinoma, but why diagnose and treat it since to do so would only line the oncologist’s pockets? That’s the kind of reasoning that makes sense to Grohol and others who oppose PAS inclusion and have nothing better with which to make their case.
But it gets worse. Here’s Grohol’s entire effort to describe the symptoms of PAS:
Its “symptoms?” When a child’s relationship with one parent is poisoned by the estranged parent.Actually, a child’s relationship with a parent, whether “poisoned” or not, is not a symptom of anything, as Grohol well knows. What he also knows, if he’s read any literature on PAS, is that there are eight symptoms typically required for the diagnosis. For example, an alienated child will deprecate the target parent; his/her rationalization for doing so will lack real-world justification; the child will exhibit no ambivalence about the alienated parent, i.e. his/her attacks will be unquestioning; the child will be just as certain about the complete virtue of the alienating parent; the child will parrot the words of the alienating parent and often use words, phrases and concepts that are not age-appropriate, etc.
Again, those are the symptomatic behaviors of children suffering from PAS. They are “relational” only insofar as they are directed at another person, which is to say, they are individual in exactly the way the DSM requires. Does Grohol truly not know the symptoms of PAS? If not, he has no business opining on the subject or should at least disclose his ignorance before doing so. If so, his pretense regarding PAS symptomology is nothing but intellectual dishonesty.
Finally, Grohol feigns incomprehension about one of the aspects of PAS – that a child rejects the alienated parent without justification.
What the heck is “legitimate justification?” And who determines what’s “legitimate” and what’s not?Again, Grohol knows very well what “legitimate justification” means. If a parent is extremely abusive of a child, perhaps that child may come to want nothing to do with the parent. That could be viewed as a healthy response to a destructive situation. But when a parent has done nothing to justify rejection by the child and where the alienating parent has carried on a campaign of alienation with which the child is complying, the rejection of the parent is not justifiable and can be extremely detrimental to the child’s immediate and long-term emotional well-being. Much PAS research confirms this.
Isn’t it a child’s right to align themselves with whomever they’d like, whenever they’d like, with or without justification?
Has Grohol read anything on PAS? If he has, it’s far from apparent. Worse is his casual disdain for the well-being of children. He writes of children’s “rights” as if whatever a child is legally entitled to do cannot possibly indicate an underlying mental disorder. So for example, children have the right to fail in school, to watch television and play video games all day and night, to smoke cigarettes, to ignore their parent’s rules, to shout epithets at them, to engage in all manner of anti-social behavior, etc. But would Grohol simply ignore all of those behaviors and countless others if a concerned parent brought the child to him for diagnosis and treatment?
Here’s Dr. Amy Baker’s response to the silliness penned by Grohol:
There are quite a few mistakes/misunderstandings presented in this article which I believe should be addressed/corrected. The first is that PAS is a relationship disorder and therefore does not belong in the DSM. There is precedent for relationship disorders being included in the DSM, such as foilie a deux. Moreover, there is a specific place in the DSM for relational disorders and part of the proposal with respect to parental alienation is that it be considered a relational disorder. Second, the author mocks the notion that it is possible to decide what is legitimate justification for a child’s rejection of a parent when this is the kind of clinical judgment that mental health professionals make all of the time. Custody evaluators, for example, are routinely charged with making just this determination. Third, the author writes that certain groups consider PAS to be “an unproven and potentially dangerous concept useful to men trying to deflect attention from their abusive behavior” seemingly supporting this misguided contention. However, within the definition proposed to the APA, this issue is clearly addressed by stating that if there is abuse or neglect on the part of the rejected parent than parental alienation is not applicable. Thus, this criticism is not valid. Further, to suggest that it is “unproven” is also incorrect in that there are numerous peer reviewed studies published in scholarly journals at this point supporting various aspects of the theory (i.e., which behaviors are associated with parental attempts to manipulate children to reject the other parent, which behaviors children will exhibit when they have been manipulated to unjustifiably reject a parent, and the likely long-term negative consequences for children when this occurs. The evidence demonstrates that it is possible for children to be manipulated to reject a parent who has not abused or neglected them, that when they do so they exhibit a set of behavioral manifestations (i.e., symptoms) which can reliably be recognized as part of the clinical picture (syndrome), and that absent intervention and treatment some of these children will suffer over the course of their life. It is time to stop arguing about whether it is real and put our efforts towards effective intervention and treatment for the affected children and families.As usual, PAS deniers have nothing to say. They toss out claim after claim in the vain hope that someone will believe them. Their tactics have nothing to do with science and very much to do with harming children, which will redound to their everlasting disgrace.
The good news is as it’s always been; PAS researchers are daily assembling more and more evidence about the disorder and more and more mental health professionals are seeing it in their own practices. And here are a couple of interesting facts: it took Asberger’s Syndrome 37 years to be included in the DSM; it took Tourette’s Syndrome 98. Eventually, PAS will follow them, to the howls of anti-father extremists everywhere. In the meantime, courts will continue to hear evidence of PAS and issue orders limiting the influence alienating parents can have in their children’s lives. Let the APA struggle with its internal dissension and include PAS in the DSM as it will; mental health professionals of good will and concern for children’s well-being will continue to report PAS to the courts that will rule accordingly.
Thanks to Don for the heads-up.