Basic Facts About The Parental Alienation Syndrome
This document may be freely duplicated or linked to, provided it is
not altered in any way.



By Richard A Gardner, M.D.
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DEFINITION OF THE PARENTAL ALIENATION SYNDROME

In association with this burgeoning of child-custody litigation, we
have witnessed a dramatic increase in the frequency of a disorder
rarely seen previously, a disorder that I refer to as the parental
alienation syndrome (PAS). In this disorder we see not only
programming ("brainwashing") of the child by one parent to denigrate
the other parent, but self-created contributions by the child in
support of the alienating parent's campaign of denigration against
the alienated parent. Because of the child's contribution I did not
consider the terms brainwashing, programming, or other equivalent
words to be sufficient. Furthermore, I observed a cluster of symptoms
that typically appear together, a cluster that warranted the
designation syndrome. Accordingly, I introduced the term parental
alienation syndrome to encompass the combination of these two
contributing factors that contributed to the development of the
syndrome (Gardner, 1985). In accordance with this use of the term I
suggest this definition of the parental alienation syndrome:

The parental alienation syndrome (PAS) is a childhood disorder that
arises almost exclusively in the context of child-custody disputes.
Its primary manifestation is the child's campaign of denigration
against a parent, a campaign that has no justification. It results
from the combination of a programming (brainwashing) parent's
indoctrinations and the child's own contributions to the vilification
of the target parent. When true parental abuse and/or neglect is
present, the child's animosity may be justified and so the parental
alienation syndrome explanation for the child's hostility is not
applicable.

In the PAS, the alienating parent programs into the child's brain
circuitry ideas and attitudes that are directly at variance with the
child's previous experiences. In addition, PAS children frequently
add their own scenarios to the campaign of denigration, from the
recognition that their complementary contributions are desired by the
programmer. The child's contributions are welcomed and reinforced by
the programmer, resulting in even further contributions by the child.
The result is an upwardly spiraling campaign of denigration. In mild
cases the child is taught to disrespect, disagree with, and even act
out antagonistically against the targeted parent. As the disorder
progresses from mild to moderate to severe, this antagonism becomes
converted and expanded into a campaign of denigration. The PAS
diagnosis is based on the symptoms of the child, but the problem is
clearly a family problem in that in each case there is one parent who
is a programmer, another parent who is the alienated parent, and one
or more children who exhibit the symptomatology. PAS children respond
to the programming in such a way that it appears that they have
become completely amnesic for any and all positive and loving
experiences they may have had previously with the targeted parent.

The term PAS is applicable only when the target parent has not
exhibited anything close to the degree of alienating behavior that
might warrant the campaign of vilification exhibited by the children.
Rather, in typical cases the victimized parent would be considered by
most examiners to have provided normal, loving parenting or, at
worst, exhibited minimal impairments in parental capacity. It is the
exaggeration of minor weaknesses and deficiencies that is the
hallmark of the PAS. When bona fide abuse does exist, then the
child's responding alienation is warranted and the PAS diagnosis is
not applicable. The term parental alienation would be applicable in
such cases and justifiably so. However, without specifying the
particular cause of the alienation the term is not particularly
informative.

PARENTAL ALIENATION

Parental Alienation (PA) refers to the wide variety of symptoms that
may result from or be associated with a child's alienation from a
parent. Children may become alienated from a parent because of
physical abuse, with or without sexual abuse. Children's alienation
may be the result of parental emotional abuse, which may be overt in
the form of verbal abuse or more covert in the form of neglect. (As
will be described below PAS, as a form of emotional abuse, is also a
type of parental alienation.) Children may become alienated as the
result of parental abandonment. Ongoing parental acrimony, especially
when associated with physical violence, may cause children to become
alienated. Children may become alienated because of behavior
exhibited by a parent that would be alienating to most people, e.g.,
narcissism, alcoholism, and antisocial behavior. Impaired parenting
can also bring about children's alienation. A child may be angry at
the parent who initiated the divorce, believing that that parent is
solely to blame for the separation. These and many other parental
behaviors can produce children's alienation, but none of them can
justifiably be considered PAS.

IS PAS A TRUE SYNDROME ?

Some who prefer to use the term parental alienation (PA) claim that
the PAS is not really a syndrome. This position is especially seen in
courts of law in the context of child-custody disputes. A syndrome,
by medical definition, is a cluster of symptoms, occurring together,
that characterize a specific disease. The symptoms, although
seemingly disparate, warrant being grouped together because of a
common etiology or basic underlying cause. Furthermore, there is a
consistency with regard to such a cluster in that most (if not all)
of the symptoms appear together. The term syndrome is more specific
than the related term disease. A disease is usually a more general
term because there can be many causes of a particular disease. For
example, pneumonia is a disease, but there are many types of
pneumonia—e.g., pneumococcal pneumonia and bronchopneumonia—each of
which has more specific symptoms, and each of which could reasonably
be considered a syndrome (although common usage may not utilize the
term).

The syndrome has a purity because most (if not all) of the symptoms
in the cluster predictably manifest themselves together as a group.
Often, the symptoms appear to be unrelated, but they actually are
because they usually have a common etiology. An example would be
Down's Syndrome, which includes a host of seemingly disparate
symptoms that do not appear to have a common link. These include
mental retardation, mongoloid facies, drooping lips, slanting eyes,
short fifth finger, and atypical creases in the palms of the hands.
Down's Syndrome patients often look very much alike and most
typically exhibit all these symptoms. The common etiology of these
disparate symptoms relates to a specific chromosomal abnormality. It
is this genetic factor that is responsible for linking together these
seemingly disparate symptoms. There is then a primary, basic cause of
Down's Syndrome: a genetic abnormality.

Similarly, the PAS is characterized by a cluster of symptoms that
usually appear together in the child, especially in the moderate and
severe types. These include:

1. A campaign of denigration

2. Weak, absurd, or frivolous rationalizations for the deprecation

3. Lack of ambivalence

4. The "independent-thinker" phenomenon

5. Reflexive support of the alienating parent in the parental
conflict

6. Absence of guilt over cruelty to and/or exploitation of the
alienated parent

7. The presence of borrowed scenarios

8. Spread of the animosity to the friends and/or extended family of
the alienated parent

Typically, children who suffer with PAS will exhibit most (if not
all) of these symptoms. However, in the mild cases one might not see
all eight symptoms. When mild cases progress to moderate or severe,
it is highly likely that most (if not all) of the symptoms will be
present. This consistency results in PAS children resembling one
another. It is because of these considerations that the PAS is a
relatively "pure" diagnosis that can easily be made. Because of this
purity, the PAS lends itself well to research studies because the
population to be studied can usually be easily identified.
Furthermore, I am confident that this purity will be verified by
future interrater reliability studies. In contrast, children subsumed
under the rubric PA are not likely to lend themselves well to
research studies because of the wide variety of disorders to which it
can refer, e.g., physical abuse, sexual abuse, neglect, and defective
parenting. As is true of other syndromes, there is in the PAS a
specific underlying cause: programming by an alienating parent in
conjunction with additional contributions by the programmed child. It
is for these reasons that PAS is indeed a syndrome, and it is a
syndrome by the best medical definition of the term.

In contrast, PA is not a syndrome, has no specific underlying cause,
and the proponents of the term do not claim it is. Actually, PA can
be viewed as a group of syndromes, which share in common the
phenomenon of the child's alienation from a parent. To refer to PA as
a group of syndromes would, by necessity, lead to the conclusion that
the PAS is one of the syndromes subsumed under the PA rubric and
would thereby weaken the argument of those who claim that PAS is not
a syndrome.

THE PARENTAL ALIENATION SYNDROME AND "PARENTAL ALIENATION"

There are some who use the term parental alienation instead of
parental alienation syndrome. Generally, these are individuals who
know of the existence of the parental alienation syndrome but want to
avoid using it because it may be considered in some circles to
be "politically incorrect." But they are basically describing the
same clinical entity. There are others who will use the term parental
alienation syndrome but strictly avoid mentioning my name in
association with it, lest they be somehow tainted. Unfortunately, the
substitution of the term parental alienation for parental alienation
syndrome can only result in confusion. Parental alienation is a more
general term, whereas the parental alienation syndrome is a very
specific subtype of parental alienation. Parental alienation has many
causes, e.g., parental neglect, abuse (physical, emotional, and
sexual), abandonment, and other alienating parental behaviors. All of
these behaviors on the part of a parent can produce alienation in the
children. The parental alienation syndrome is a specific subcategory
of parental alienation that results from a combination of parental
programming and the child's own contributions, and it is almost
exclusively seen in the context of child-custody disputes. It is this
particular combination that warrants the designation parental
alienation syndrome. Changing the name of an entity because of
political and other unreasonable considerations generally does more
harm than good.

THE PARENTAL ALIENATION SYNDROME IS NOT THE SAME AS PROGRAMMING
BRAINWASHING

It has come as a surprise to me from reports in both the legal and
mental health literature that the definition of the PAS is often
misinterpreted. Specifically, there are many who use the term as
synonymous with parental brainwashing or programming. No reference is
made to the child's own contributions to the victimization of the
targeted parent. Those who do this have missed an extremely important
point regarding the etiology, manifestations, and even the treatment
of the PAS. The term PAS refers only to the situation in which the
parental programming is combined with the child's own scenarios of
disparagement of the vilified parent. Were we to be dealing here
simply with parental indoctrination, I would have simply retained and
utilized the terms brainwashing and/or programming. Because the
campaign of denigration involves the aforementioned combination, I
decided a new term was warranted, a term that would encompass both
contributory factors. Furthermore, it was the child's contribution
that led me to my concept of the etiology and pathogenesis of this
disorder. The understanding of the child's contribution is of
importance in implementing the therapeutic guidelines described in
this book.

THE RELATIONSHIP BETWEEN THE PARENTAL ALIENATION SYNDROME AND BONA
FIDE ABUSE AND/OR NEGLECT

Unfortunately, the term parental alienation syndrome is often used to
refer to the animosity that a child may harbor against a parent who
has actually abused the child, especially over an extended period.
The term has been used to apply to the major categories of parental
abuse: physical, sexual, and emotional. Such application indicates a
misunderstanding of the PAS. The term PAS is applicable only when the
target parent has not exhibited anything close to the degree of
alienating behavior that might warrant the campaign of vilification
exhibited by the child. Rather, in typical cases the victimized
parent would be considered by most examiners to have provided normal,
loving parenting or, at worst, exhibited minimal impairments in
parental capacity. It is the exaggeration of minor weaknesses and
deficiencies that is the hallmark of the PAS. When bona fide abuse
does exist, then the child's responding alienation is warranted and
the PAS diagnosis is not applicable.

Programming parents who are accused of inducing a PAS in their
children will sometimes claim that the children's campaign of
denigration is warranted because of bona fide abuse and/or neglect
perpetrated by the denigrated parent. Such indoctrinating parents may
claim that the counteraccusation by the target parent of PAS
induction by the programming parent is merely a "cover-up," a
diversionary maneuver, and indicates attempts by the vilified parent
to throw a smoke screen over the abuses and/or neglect that have
justified the children's acrimony. There are some genuinely abusing
and/or neglectful parents who will indeed deny their abuses and
rationalize the children's animosity as simply programming by the
other parent. This does not preclude the existence of truly innocent
parents who are indeed being victimized by an unjustifiable PAS
campaign of denigration. When such cross-accusations occur—namely,
bona fide abuse and/or neglect versus a true PAS—it behooves the
examiner to conduct a detailed inquiry in order to ascertain the
category in which the children's accusations lie, i.e., true PAS or
true abuse and/or neglect. In some situations, this differentiation
may not be easy, especially when there has been some abuse and/or
neglect and the PAS has been superimposed upon it, resulting thereby
in much more deprecation than would be justified in this situation.
It is for this reason that detailed inquiry is often crucial if one
is to make a proper diagnosis. Joint interviews, with all parties in
all possible combinations, will generally help uncover "The Truth" in
such situations.

THE PARENTAL ALIENATION SYNDROME AS A FORM OF CHILD ABUSE

It is important for examiners to appreciate that a parent who
inculcates a PAS in a child is indeed perpetrating a form of
emotional abuse in that such programming may not only produce
lifelong alienation from a loving parent, but lifelong psychiatric
disturbance in the child. A parent who systematically programs a
child into a state of ongoing denigration and rejection of a loving
and devoted parent is exhibiting complete disregard of the alienated
parent's role in the child's upbringing. Such an alienating parent is
bringing about a disruption of a psychological bond that could, in
the vast majority of cases, prove of great value to the child—the
separated and divorced status of the parents notwithstanding. Such
alienating parents exhibit a serious parenting deficit, a deficit
that should be given serious consideration by courts when deciding
primary custodial status. Physical and/or sexual abuse of a child
would quickly be viewed by the court as a reason for assigning
primary custody to the nonabusing parent. Emotional abuse is much
more difficult to assess objectively, especially because many forms
of emotional abuse are subtle and difficult to verify in a court of
law. The PAS, however, is most often readily identified, and courts
would do well to consider its presence a manifestation of emotional
abuse by the programming parent.

Accordingly, courts do well to consider the PAS programming parent to
be exhibiting a serious parental deficit when weighing the pros and
cons of custodial transfer. I am not suggesting that a PAS-inducing
parent should automatically be deprived of primary custody, only that
such induction should be considered a serious deficit in parenting
capacity—a form of emotional abuse—and that it be given serious
consideration when weighing the custody decision. In this book, I
provide specific guidelines regarding the situations when such
transfer is not only desirable, but even crucial, if the children are
to be protected from lifelong alienation from the targeted parent.

"THE PARENTAL ALIENATION SYNDROME DOES NOT EXIST BECAUSE IT IS NOT IN
DSM-IV"

There are some, especially adversaries in child-custody disputes, who
claim that there is no such entity as the PAS, that it is only a
theory, or that it is "Gardner's theory." Some claim that I invented
the PAS, with the implication that it is merely a figment of my
imagination. The main argument given to justify this position is that
it does not appear in DSM-IV. The DSM committees justifiably are
quite conservative with regard to the inclusion of newly described
clinical phenomena and require many years of research and
publications before considering inclusion of a disorder, and this is
as it should be. The PAS exists! Any lawyer involved in child-custody
disputes will attest to that fact. Mental health and legal
professionals involved in such disputes must be observing it. They
may not wish to recognize it. They may give it another name
(like "parental alienation"). But that does not preclude its
existence. A tree exists as a tree regardless of the reactions of
those looking at it. A tree still exists even though some might give
it another name. If a dictionary selectively decides to omit the word
tree from its compilation of words, that does not mean that the tree
does not exist. It only means that the people who wrote that book
decided not to include that particular word. Similarly, for someone
to look at a tree and say that the tree does not exist does not cause
the tree to evaporate. It only indicates that the viewer, for
whatever reason, does not wish to see what is right in front of him
(her). To refer to the PAS as "a theory" or "Gardner's theory"
implies the nonexistence of the disorder. It implies that it is a
figment of my imagination and has no basis in reality. To say that
PAS does not exist because it is not listed in DSM-IV is like saying
in 1980 that AIDS does not exist because it is not listed in standard
diagnostic medical textbooks. The PAS is not a theory, it is a fact.
My ideas about its etiology and psychodynamics might very well be
called theory. The crucial question then is whether my theory
regarding the etiology and psychodynamics of the PAS is reasonable,
and whether my ideas fit in with the facts. This is something for the
readers of this book to decide.

But why this controversy in the first place? With regard to whether
PAS exists, we generally do not see such controversy regarding most
other clinical entities in psychiatry. Examiners may have different
opinions regarding the etiology and treatment of a particular
psychiatric disorder, but there is usually some consensus about its
existence. And this should especially be the case for a
relatively "pure" disorder such as the PAS, a disorder that is easily
diagnosable because of the similarity of the children's symptoms when
one compares one family with another. Over the years, I have received
many letters from people who have essentially said: "Your PAS book is
uncanny. You don't know me and yet I felt that I was reading my own
family's biography. You wrote your book before all this trouble
started in my family. It's almost like you predicted what would
happen." Why, then, should there be such controversy over whether or
not PAS exists?

One explanation lies in the situation in which the PAS emerges and in
which the diagnosis is made: vicious child-custody litigation. Once
an issue is brought before a court of law—in the context of
adversarial proceedings—it behooves one side to take just the
opposite position from the other, if one is to prevail in that forum.
A parent accused of inducing a PAS in a child is likely to engage the
services of a lawyer who may invoke the argument that there is no
such thing as a PAS. And if this lawyer can demonstrate that the PAS
is not listed in DSM-IV, then the position is considered "proven."
The only thing this proves to me is that DSM-IV has not yet listed
the PAS. It also proves the low levels to which members of the legal
profession will stoop in order to zealously support their client's
position, no matter how ludicrous their arguments and how destructive
they are to the children.

An important factor operative in the PAS not being listed in DSM-IV
relates to political issues. Things that are "hot"
and "controversial" are not likely to get the consensus that more
neutral issues enjoy. As I will elaborate upon below, the PAS has
been dragged into the political-sexual arena, and those who would
support its inclusion in DSM-IV are likely to find themselves
embroiled in vicious controversy and the object of scorn, rejection,
and derision. The easier path, then, is to avoid involving oneself in
such inflammatory conflicts, even if it means omitting from DSM one
of the more common childhood disorders.

The PAS is a relatively discrete disorder and is more easily
diagnosed than many of the other disorders in DSM-IV. At this point,
articles are coming forth and it is being increasingly cited in court
rulings. Articles about PAS in the scientific literature will be
cited throughout the course of this book. Court rulings in which the
PAS is cited are also appearing with increasing frequency. I continue
to list these on my website as they appear
(http://www.rgardner.com/refs). My hope is that by the time
committees are formed for the preparation of DSM-V, the committee(s)
evaluating for inclusion will see fit to include the PAS and have the
courage to withstand those holdouts who, for whatever reason, need to
deny the reality of the world. It may interest the reader to note
that if PAS is ultimately included in the DSM, its name will be
changed to include the term disorder, the current label utilized for
psychiatric illnesses that warrant inclusion. It might very well have
its name changed to parental alienation disorder.

"PEOPLE WHO DIAGNOSE PARENTAL ALIENATION SYNDROME ARE SEXIST"

Another reason for the controversy regarding the existence of the PAS
relates to the fact that in the vast majority of families it is the
mother who is likely to be the primary programmer and the father the
victim of the children's campaign of denigration. My own observations
since the early 1980s, when I first began to see this disorder, has
been that in 85–90 percent of all the cases in which I have been
involved, the mother has been the alienating parent and the father
has been the alienated parent. For simplicity of presentation, then,
I have often used the term mother to refer to the alienator, and the
term father to refer to the alienated parent. I recently conducted an
informal survey among approximately 50 mental health and legal
professionals whom I knew were aware of the PAS and deal with such
families in the course of their work. I asked one simple question:
What is the ratio of mothers to fathers who are successful
programmers of a PAS? The responses ranged from mothers being the
primary alienators in 60 percent of the cases to mothers as primary
alienators in 90 percent of the cases. Only one person claimed it was
50/50, and no one claimed it was 100 percent mothers. In the 1998
edition of my book The Parental Alienation Syndrome (especially
Chapter Five) I discuss this gender difference in greater detail and
provide references in the scientific literature confirming the
preponderance of mothers over fathers in inducing successfully a PAS
in their children.

In recent years it has become "politically risky" and
even "politically incorrect" to describe gender differences. Such
differentiations are acceptable for such disorders as breast cancer
and diseases of the uterus and ovaries. But once one moves into the
realm of personality patterns and psychiatric disturbances, one is
likely to be quickly branded a "sexist" (regardless of one's sex).
And this is especially the case if it is a man who is claiming that a
specific psychiatric disorder is more likely to be prevalent in
women. My observations that PAS inducers are much more likely to be
women than men has subjected me to this criticism. The fact that most
other professionals involved in child-custody disputes have had the
same observation still does not protect me from the criticism that
this is a sexist observation. The fact that I recommend that most
mothers who are inducing a PAS should still be designated the primary
custodial parent does not seem to protect me from this criticism.

My basic position regarding custodial preference has always been that
the primary consideration in making a custodial recommendation is
that the children should be preferentially assigned to that parent
with whom they have the stronger, healthier psychological bond.
Because the mother has most often been the primary caretaker, and
because the mother is more often available to the children than the
father (I am making no comments as to whether this is good or bad,
only that this is what is), she is most often designated the
preferable primary custodial parent by courts of law. Somehow this
position has been converted by some critics into sexism against
women.

THE PARENTAL ALIENATION SYNDROME AND SEX-ABUSE ACCUSATIONS

A false sex-abuse accusation is sometimes seen as a derivative or
spin-off of the PAS. Such an accusation may serve as an extremely
effective weapon in a child-custody dispute. Obviously, the presence
of such false accusations does not preclude the existence of bona
fide sex abuse, even in the context of a PAS.

In recent years, some examiners have been using the term PAS to refer
to a false sex-abuse accusation in the context of a child-custody
dispute. In some cases the terms are used synonymously. This is a
significant misperception of the PAS. In the majority of cases in
which a PAS is present, the sex-abuse accusation is not promulgated.
In some cases, however, especially after other exclusionary maneuvers
have failed, the sex-abuse accusation will emerge. The sex-abuse
accusation, then, is often a spin-off, or derivative, of the PAS but
is certainly not synonymous with it. Furthermore, there are divorce
situations in which the sex-abuse accusation may arise without a
preexisting PAS. Under such circumstances, of course, one must give
serious consideration to the possibility that true sex abuse has
occurred, especially if the accusation antedated the marital
separation.

Another factor operative in the need to deny the existence of the
PAS, and relegate it to the level of being only a "theory," is its
relationship to sex-abuse accusations. I mention frequently
throughout the course of this book that a sex-abuse accusation is a
possible spin-off or derivative of the PAS. My experience has been
that the sex-abuse accusation does not appear in the vast majority of
PAS cases. There are some, however, who equate the PAS with a sex-
abuse accusation, or a false sex-abuse accusation. My experience has
been that when a sex-abuse accusation emerges in the context of a PAS—
especially after the failure of a series of exclusionary maneuvers—
the accusation is far more likely to be false than true. Claiming
that a sex-abuse accusation may be false also has potentially been
politically risky in recent years and not "politically correct."
Those of us who have stood up and made such claims, both within and
outside of the realm of the PAS, have subjected ourselves to enormous
criticism—often impassioned and irrational. My experience has been
that sex-abuse accusations that arise within the context of PAS
situations are more likely to be directed toward men than women.
Accordingly, in sex-abuse cases in the context of custody disputes I
am more likely to testify in support of the man. This somehow proves
me "sexist." The fact that I have most often testified in support of
women to be designated the primary custodial parent—even when there
has been a sex-abuse accusation—does not seem to dispel this myth.



RECOGNITION OF PAS IN COURTS OF LAW

Some who hesitate to use the term PAS claim that it has not been
accepted in courts of law. This is not so. Although there are
certainly judges who have not recognized the PAS, there is no
question that courts of law with increasing rapidity are recognizing
the disorder. My website (www.rgardner.com/refs) currently cites 51
cases in which the PAS has been recognized. By the time this article
is published, the number of citations will certainly be greater.
Furthermore, I am certain that there are other citations that have
not been brought to my attention.

It is important to note that on January 30, 2001, after a two-day
hearing devoted to whether the PAS satisfied Frye Test criteria for
admissibility in a court of law, a Tampa, Florida court ruled that
the PAS had gained enough acceptance in the scientific community to
be admissible in a court of law (Kilgore v. Boyd, 2001). This ruling
was subsequently affirmed by the District Court of Appeals (February
6, 2001). In the course of those two days of testimony, I brought to
the court's attention the more than 100 peer-reviewed articles (there
are 106 at the time of this writing) by approximately 100 other
authors and over 40 court rulings (there are 50 at the time of this
writing) in which the PAS had been recognized
(www.rgardner.com/refs). I am certain that these publications played
an important role in the judge's decision. This case will clearly
serve as a precedent and facilitate the admission of the PAS in other
cases—not only in Florida, but elsewhere.

Whereas there are some courts of law that have not recognized PAS,
there are far fewer courts that have not recognized PA. This is one
of the important arguments given by those who prefer the term PA.
They do not risk an opposing attorney claiming that PA does not exist
or that courts of law have not recognized it. There are some
evaluators who recognize that children are indeed suffering with a
PAS, but studiously avoid using the term in their reports and
courtroom, because they fear that their testimony will not be
admissible. Accordingly, they use PA, which is much safer, because
they are protected from the criticisms so commonly directed at those
who use PAS. Later in this article I will detail the reasons why I
consider this position injudicious.

Many of those who espouse PA claim not to be concerned with the fact
that their more general construct will be less useful in courts of
law. Their primary interest, they profess, is the expansion of
knowledge about children's alienation from parents. Considering the
fact that the PAS is primarily (if not exclusively) a product of the
adversary system, and considering the fact that PAS symptoms are
directly proportionate to the intensity of the parental litigation,
and considering the fact that it is the court that has more power
than the therapist to alleviate and even cure the disorder, PA
proponents who claim unconcern for the long-term legal implications
of their position is injudicious and, I suspect, specious.

WHICH TERM TO USE IN THE COURTROOM: PA OR PAS?

Many examiners, then, even those who recognize the existence of the
PAS, may consciously and deliberately choose to use the term parental
alienation in the courtroom. Their argument may go along these
lines: "I fully recognize that there is such a disease as the PAS. I
have seen many such cases and it is a widespread phenomenon. However,
if I mention PAS in my report, I expose myself to criticism in the
courtroom such as, 'It doesn't exist,' 'It's not in DSM-IV' etc.
Therefore, I just use PA, and no one denies that." I can recognize
the attractiveness of this argument, but I have serious reservations
about this way of dealing with the controversy-especially in a court
of law.

As mentioned earlier, there are many causes of parental alienation,
e.g., physical abuse, emotional abuse, sexual abuse, neglect, and a
wide variety of other parental behaviors that will justifiably
alienate children. But there is another reason why children can
become alienated from a parent, namely, being programmed into a
campaign of denigration by an alienating parent. The disorder so
produced, parental alienation syndrome, is also a form of parental
alienation. In short, the PAS is one subtype of parental alienation.
To call PAS PA cannot but produce confusion because it equates a pure
clinical entity (PAS) with a generic term (PA) under which is
subsumed a wide variety of clinical entities. One reason why medicine
has progressed is that we have become ever more discriminating
regarding the various subtypes that exist for any particular disease.
One of the reasons why Hippocrates is known as "The Father of
Medicine" is that he was one of the first to make such
differentiations. Prior to his time people suffered with "fits." It
was he who recognized that there were different kinds of fits, each
requiring a different form of treatment. One form of fits he referred
to as epilepsy. Another he referred to as hysteria. His group was
astute enough to recognize the differences between these different
kinds of fits and provided different kinds of treatment. Three
hundred years ago people suffered with "heart disease." Now, we know
that there are many different kinds of heart disease, each requiring
its own form of treatment. One would not want to go to a doctor today
who makes the diagnosis of fits and heart disease and does not go any
further. We want specifics. Similarly, saying that a child
has "parental alienation" gives very little information. Anyone can
observe that-the clients, the mother, the father, both lawyers, the
guardian ad litem, and the judge. We want to define specifically the
type of the alienation, and PAS is just one possible type. We are
then in a far better position to provide specific treatment. Those
who eschew the term PAS, for whatever reason, but embrace the term
PA, are equivalent to those who would diagnose fits and heart disease
without identifying the specific subtype with which the patient is
suffering. Accordingly, using PA does not represent progression, it
represents regression.

Using the term PAS identifies a specific programmer. In contrast,
using PA clearly indicates that the children are alienated and that
either parent could have exhibited behavior that could have resulted
in the alienation. The term, then, removes the court's focus away
from the alienator and redirects attention to what might be only
minor parental deficiencies exhibited by the alienated parent.
Substituting PA for PAS is, therefore, a disservice to the targeted
parent. If the examiner is a mental health professional (most often
the case), then the utilization of PA under these circumstances is an
abrogation of one's professional responsibilities to do what is best
for the patient or client. Using PA is basically a terrible
disservice to the PAS family because the cause of the children's
alienation is not properly identified. It is also a compromise in
one's obligation to the court, which is to provide accurate and
useful information so that the court will be in the best position to
make a proper ruling. Using PA is an abrogation of this
responsibility; using PAS is in the service of fulfilling this
obligation.

Furthermore, evaluators who use PA instead of PAS are losing sight of
the fact that they are impeding the general acceptance of the term in
the courtroom. This is a disservice to the legal system, because it
deprives the legal network of the more specific PAS diagnosis that
could be more helpful to courts for dealing with such families.
Moreover, using the PA term is shortsighted because it lessens the
likelihood that some future edition of DSM will recognize the subtype
of PA that we call PAS. This not only has diagnostic implications,
but even more importantly, therapeutic implications. The diagnoses
included in the DSM serve as a foundation for treatment. The symptoms
listed therein serve as guidelines for therapeutic interventions and
goals. Insurance companies (who are always quick to look for reasons
to deny coverage) strictly refrain from providing coverage for any
disorder not listed in the DSM. Accordingly, PAS families cannot
expect to be covered for treatment. Elsewhere (Gardner, 1998) I
describe additional diagnoses that are applicable to the PAS,
diagnoses that justify requests for insurance coverage. Examiners in
both the mental health and legal professions who genuinely recognize
the PAS, but who refrain from using the term until it appears in DSM,
are lessening the likelihood that it will ultimately be included
because widespread utilization is one of the criteria that DSM
committees consider. Such restraint, therefore, is an abrogation of
their responsibility to contribute to the enhancement of knowledge in
their professions. The PAS manifests the kind of specificity that is
one of the hallmarks of the expansion of knowledge and progression.
PA clouds specificity, which is one of the hallmarks of intellectual
stagnation and even regression.

There is, however, a compromise. I use PAS in all those reports in
which I consider the diagnosis justified. I also use the PAS term
throughout my testimony. However, I sometimes make comments along
these lines, both in my reports and in my testimony:

"Although I have used the term PAS, the important questions for the
court are: Are these children alienated? What is the cause of the
alienation? and What can we then do about it? So if one wants to just
use the term PA, one has learned something. But we haven't really
learned very much, because everyone involved in this case knows well
that the children have been alienated. The question is what is the
cause of the children's alienation? In this case the alienation is
caused by the mother's (father's) programming and something must be
done about protecting the children from the programming. That is the
central issue for this court in this case, and it is more important
than whether one is going to call the disorder PA or PAS, even though
I strongly prefer the PAS term for the reasons already given."

I wish to emphasize that I do not routinely include this compromise,
because whenever I do so I recognize that I am providing support for
those who are injudiciously eschewing the term and compromising
thereby their professional obligations to their clients and the court.

Richard A. Gardner, M.D.
May 31, 2001