The competition to get your favorite disease recognized in the bible of mental health, the Diagnostic and Statistical Manual of Mental Disorders, can be as fierce as the talent contest in the Little Miss St. Paul Contest. The American Psychiatric Association is contemplating adding something called "parental alienation syndrome" (PAS) to the new edition of the DSM, scheduled to be published in May 2013, and the question has launched a national lobbying and letter-writing campaign on both sides. That angry letters and editorials might play any part in a debate about mental health and custody disputes probably tells you most of what you need to know about the validity of PAS.
What is parental alienation syndrome? William Bernet, a professor of psychiatry at the Vanderbilt University School of Medicine and an advocate for its inclusion in the DSM-5, describes it as "a mental condition in which a child, usually one whose parents are engaged in a high conflict divorce, allies himself or herself strongly with one parent, and rejects a relationship with the other parent, without legitimate justification."* There is no doubt that an ugly divorce can affect kids' relationship with their parents or cause children to choose sides, often in anger. In fact, that probably happens more often than not. But Bernet and others who argue for adding PAS to the Sears, Roebuck catalogue of mental health want to see it recognized as a legitimate mental health disorder in order to "spur insurance coverage, stimulate more systematic research, lend credence to [the] charge of parental alienation in court, and raise the odds that children would get timely treatment."
They want, in other words, to affix a name, some blame, and also a price tag on a broad range of child responses to a custody fight—some perfectly justified and some not—in the hopes of expanding its use in court.
And what's the downside to including PAS in the DSM? Well, for one thing, with a minimum of three participants needed to diagnose it, PAS starts to look less like a mental health disorder than an epidemic. It assumes that one crazy person (the mother) brainwashes a second crazy person (the child) into telling lies about a third person (the father). Just because a lot of parents have experienced blocked visitation and unreturned phone calls doesn't make every instance of that conduct the result of a medical "syndrome." Joan S. Meier, a professor of clinical law at George Washington University School of Law, has explained it this way: "PAS is a label that offers a particular explanation for a breach in relationship between a child and parent, but insofar as that breach could be explained in other ways, it is not in itself a medical or psychological diagnosis so much as a particular legal hypothesis."
The most worrisome aspect of the legal fight over parental alienation syndrome may be that it divides supporters and opponents along strict gender lines: As a rule, this is classed as a women's sickness alleged by men. Fathers' rights groups are not solely to blame for the fact that an entire "disease" is predicated on the notion that women are lying liars; the inventor of the syndrome can take responsibility for that. But no hypothesis so rooted in gender bias should be credited by medical science. And because evidence of PAS is so frequently offered to counter maternal allegations of abuse, the experts testifying about PAS can be aiding and abetting a system that takes children from abused mothers and hands them right back to abusive fathers. Once again, this doesn't mean that some parents don't alienate their children in a divorce. It means that PAS is now used to discredit women whenever they claim abuse.
Much of the blame for the biased history of PAS can be laid at the feet of its originator, Dr. Richard Gardner, who developed the theory—from his own practice and without clinical studies—of mothers who foster hatred for their children's father as a ''powerful weapon'' to grab custody for themselves. This wasn't a theory born of objective empirical observation. It was a campaign against mothers rooted in the idea that they regularly lie and then "brainwash" their children into lying about paternal abuse. Because of Gardner's gender-freighted conclusions, it was probably inevitable that men, in the form of fathers' rights groups, would seize upon the battle to legitimize PAS. One of its most famous spokesmen became Alec Baldwin, who wrote practically a whole book on the subject in 2008, arguing paradoxically that corrupt judges and the courts have too much power over custody disputes and that by recognizing PAS, the courts could make the whole child-custody process more fair. (Here is Baldwin describing PAS as something women mainly do to men.)
Supporters of PAS argue largely from personal experience, and their stories are often compelling. But the theory of PAS is not recognized as valid by the American Psychological Association, the American Psychiatric Association, or the American Medical Association. And the National Council of Juvenile and Family Court Judges has published guidelines for custody courts clarifying that "the theory positing the existence of 'PAS' has been discredited by the scientific community. Any testimony that a party to a custody case suffers from the syndrome or 'parental alienation' should therefore be ruled inadmissible and/or stricken from the evaluation report."
Gardner's long-term scientific credibility was not helped by some of his kookier pronouncements about incest ("intrafamilial pedophilia … is widespread and ... is probably an ancient tradition"), or pedophilia ("It is of interest that of all the ancient peoples it may very well be that the Jews were the only ones who were punitive toward pedophiles."). But he still managed to become the David Barton of child-custody law, having written more than 250 books and articles, cassettes, and videotapes (often self-published) and testified as an expert in approximately 400 cases in more than 25 states.
There are a lot of websites, experts, and emotion invested in this debate. But there aren't two empirical sides. There is science, and then there is passionate non-science. As Paul Fink, a professor of psychiatry at Temple University School of Medicine and a past president of the American Psychiatric Association in Arlington, Va., once said of Gardner, "He invented a concept and talked as if it were proven science. It's not."
That's what makes the current debate over inserting PAS into the DSM-5, which has been going on for years, something of a red herring. It almost doesn't matter. Nobody really believes it's a scientific theory anymore, and Gardner has been all but discredited where it counts. That's what worries Meier most of all: "Courts and experts have stopped talking about parental alienation syndrome and started talking about parental alienation," she says. "By dropping the word 'syndrome' they purport to just be describing a behavior; and that's harder to challenge as inadmissible, even though Parental Alienation is used virtually identically to PAS, with virtually identical quasi-scientific claims and prescriptions." Back when it was a matter of science, opponents of PAS could advance arguments about admissibility and scientific legitimacy. Now it's a conclusory legal term that can barely be refuted.
Even without a scientific basis, parental alienation, like climate denialism, has its own language, passions, and saliency. Right or wrong, recognized or not, most family courts now take PAS extremely seriously. Experts testify, court-appointed advocates offer diagnoses, and family-court judges regularly adopt alienation explanations as a way of rejecting abuse allegations. As Meier wrote in a 2009 article: "Despite the palpably extreme and unbalanced quality of both the PAS theory and the thinking of its author, as well as the lack of scientific basis, the theory has for over a decade become virtually ubiquitous in family courts."
The science just doesn't matter now. Even though no appellate court has found evidence of PAS to meet the scientific standards for legal admissibility, courts admit evidence of precisely the same phenomenon all the time, and by calling it "parental alienation," they achieve the same effect: overlooking allegations of abuse by one parent in order to blame the other for "alienating" the child. In other words, whether science supports them or the DSM-5 ultimately validates them, the supporters of Richard Gardner and parental alienation may have already won. While nobody was looking, a mythical legal argument known as parental alienation may have already taken over family courts.
Correction, May 18, 2011: This article originally misidentified William Bernet as Richard. (Return to the corrected sentence.)