Dr. William Bernet: DSM-5’s Inclusion of PAS Concept ‘a Great Improvement’

June 26, 2013 by Robert Franklin, Esq.

Following up on my post of May 26th, in which I reported the good news that the concept – if not the actual term itself – of Parental Alienation was included in the Fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual, I’d like to report on this article (Psych Central, 6/13). I’s an interview with Dr. William Bernet, Professor Emeritus at Vanderbilt University and perhaps the world’s leading authority on Parental Alienation and Parental Alienation Syndrome. Bernet is the one who led the effort to include PA in the DSM-5.

His effort of course was resisted every step of the way by, among others, lay people who time and again oppose any and every improvement in the relationships between children and fathers. Anything that seeks to expand fathers’ access to- or time with- their children, is met with mule-like resistance from the anti-dad crowd. As I pointed out in my last piece on PAS inclusion, the ironies in that stance by, for example, the National Organization for Women, are almost too many to count.

NOW pretends to be pro-woman and pro-mother, but its white paper on PAS shows that, given a choice, it opts for the anti-male over the pro-female. After all, what are the results if a mother is allowed to alienate a child from its father? Well, Dad is cut out of his child’s life, so that means Mom does, for all practical purposes, all the parenting. Essentially 24 hours a day, seven days a week, she’s on duty as Mom. Is she sick? She doesn’t get a break. Does she want a vacation? Tough. Her alienation of the child from him means that Dad’s not there to take up the slack. That’s what NOW advocates.

Another consequence of being a full-time mother is that it’s much harder to work and earn. That’s probably one reason single mothers in this country earn on average $23,000 according to the U.S. Census Bureau. And of course lower earnings for mothers mean lower savings and a tougher retirement in later years. But NOW doesn’t care. Yes, NOW has for decades advocated for more women in the workplace and for women to work and earn more. But when it comes to fathers having some role in their kids’ lives, NOW would rather sideline women in the home. Hypocrisy doesn’t get much more blatant than that. NOW’s position on PAS is not only an attack on fathers, it’s an attack on mothers too. Quite an accomplishment for a supposedly pro-woman organization.

That said, the inclusion/non-inclusion of PA in the DSM-5 looked to me like a sort of solomonic decision by the APA. From this far remove, it seems like the science on PA and PAS was too convincing to ignore, but the anti-dad crowd was so loud and unpleasant they had to be placated. So the DSM-5 effectively includes the concepts of PA and PAS but, by not actually using those terms, tosses a bone to those opposed to inclusion.

Here’s Dr. Bernet’s description of the DSM-5’s take on the subject:

In DSM-5, the description of parent-child relational problem does allude to PA, but unfortunately does not include those actual words. The discussion explains that cognitive problems in parent-child relational problem “may include negative attributions of the other’s intentions, hostility toward or scapegoating of the other, and unwarranted feelings of estrangement.”

That is a pretty good description of a child’s view of the alienated parent. That is, the child attributes negative intentions to almost everything the alienated parent does; the child scapegoats the alienated parent by persistently blaming him or her for every bad happenstance that occurs; and the child experiences unwarranted negative feelings and attitudes toward the alienated parent.

The authors of DSM-5 clearly were describing PA in the discussion of parent-child relational problem, but they went out of their way to avoid using the actual words, “parental alienation.”

That word “unwarranted” is one of the keys to PA and PAS. Any child can have negative feelings about a parent. Indeed, among teenagers, we’d be surprised if they didn’t. And a younger child who’s been abused or neglected might develop bad feelings about his/her abuser. But those feelings don’t indicate PAS because there’s a reasonable basis for them. The word “unwarranted” points to the notion that if a child has extremely negative feelings toward a fit and loving parent, there’s something else at work.

And that turns out to be one of the many things opponents of PA/PAS inclusion refused to acknowledge. We’ve seen them publish articles claiming that any and all children who dislike a parent are just choosing who they like and with whom they wish to spend time. How a child of, say, five, can exercise such discretion, the anti-inclusion folks never got around to explaining.

But that’s just one definition that encompasses the concept of PA/PAS. There are two more.

The DSM-5 has two important new diagnoses that can also be used by clinical and forensic practitioners in cases involving PA. There is a new diagnosis called child affected by parental relationship distress, which should be used “when the focus of clinical attention is the negative effects of parental relationship discord (e.g., high levels of conflict, distress, or disparagement) on a child in the family, including effects on the child’s mental or other physical disorders.” That is a good description of how PA comes about, in that it describes how children are injured during high-conflict separation and divorce, especially when the parents experience distress and persistently disparage the other parent.

The second new diagnosis in DSM-5 is child psychological abuse, which is defined as “nonaccidental verbal or symbolic acts by a child’s parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child.” In many instances, the behavior of the alienating parent constitutes child psychological abuse. When these three diagnoses are considered, it is clear that DSM-5 is a great improvement over the previous editions of DSM when it comes to identifying, classifying, and diagnosing PA.

In short, the DSM-5 now effectively includes the diagnosis of PA/PAS, just not by those names. True, none of the three possibilities is PA/PAS per se, and the three put together don’t fully encompass an actual PA/PAS diagnosis. But it’s a near thing. Whatever it’s called, any mental health professional that sees a parent engaged in a relentless campaign of disparagement of the other parent, who doesn’t deserve it and a child who’s driven to adopt the attitudes and ideas of the alienator toward the target parent, can make one or more of the three possible diagnoses. As Dr. Bernet said, that’s a “great improvement.” From now on, alienating parents will not be able to hide behind the DSM-5. The science of mental health will no longer permit that behavior.

The benefits are many.

Why does this matter? (1) To improve clinical care of families affected by PA. Most of the textbooks that are used to teach the next generation of mental health professionals are based on the most recent edition of DSM. If PA is present in DSM – either the concept or the actual words – it is much more likely that mental health students and trainees will learn the causes, manifestations, and treatment for PA. (2) To improve research regarding PA. We need to have consistent definitions of PA, which have proven validity and reliability, in order for research personnel to study the causes, manifestations, and treatment for PA. (3) For legal purposes. We need to move past the era of repeatedly debating in court whether PA really exists. If PA is in DSM, it will usually be accepted in court as a real problem that needs to be addressed.  

All of that is a plus. One of the worst things fathers face in custody cases is bias against them on the part of mental health professionals. One reason for that is the training they receive in undergraduate and clinical programs. As Dr. Bernet points out, newly trained professionals will now get that training based on a DSM edition that includes the concept of PA/PAS. That means that gradually, we’ll begin to see custody experts with greater awareness of- and openness to- the idea that parents sometimes intentionally turn their children away from the other parent.

And of course, those professionals will no longer need to convince judges of the validity of a diagnosis that’s nowhere to be found in the DSM. Now it is, whatever its name.

The National Parents Organization is a Shared Parenting Organization

The National Parents Organization is a non-profit organization that is educating the public, families, educators, and legislators about the importance of shared parenting and how it can reduce conflict in children, parents and extended families. If you would like to get involved in our organization, you can do so several ways. First, we would love to have you as an official member of the National Parents Organization team. Second, the National Parents Organization is an organization that believes in the importance of using social media as a means to spread the word about shared parenting and other topics, and you can visit us on our Facebook Page to learn more about our efforts. Last, we hope you will share this article with other families using the many social networking sites so that we can bring about greater awareness of shared parenting. Thank you for your support.

#parent, #Bernet, #PAS, #DSM, #NOW

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