January 22, 2011


More on the APA and the DSM-5


Yesterday I wrote about a piece in the Washington Examiner about the DSM-5:

I then also mentioned ME agenda's - aka Suzy Chapman - fine site about the DSM-5 and indeed also the ICD-11:

which in fact is such a fine site - among other reasons - because she has the documents or links thereto and provides clear explanations of it all.

Today Suzy Chapman has a fine comment in the Washington Examiner. She also mentions a previous comment, also good, that I copy too. And no - Skeeter is not me, neither known to me:


Good article, that says things that need to be said, long and loud.

Both the APA, and the broader psychiatric profession, are currently indulging in a seriously unjustified power grab, and they and their claims are in desperate need of much closer and tougher (and ongoing) external scrutiny then they have been subject to date.

Generally speaking, I would have to agree that the profession is becoming much too closely aligned with and mutually reliant on both state and corporate interests, as opposed to the interests of the patient and the science on which they base their claims to authority.

One small point: I would not invoke British psychiatry as any counterbalance to the excesses of their American colleagues. The Brits have their own serious problems. Not least of which is that they are mired deep in the methodological and ethical swamp of somatoform disorders (aka conversion or psychosomatic disorders, and their related 'treatments'), and a lot of patients are paying a very heavy price indeed for this obsession by certain influential members of the British psych establishment.

Suzy Chapman (with my bolding of the title):

Erasing the interface between psychiatry and medicine

The previous commenter cautions against invoking members of the "British psych establishment". Two very influential members of the British psychiatry and psychosomatics establishment, Professors Michael Sharpe and Francis Creed, have seats on the DSM-5 "Somatic Symptom Disorders" Work Group.

While many column inches by rightly perturbed journalists and a stream of often acerbic critiques from former DSM Task Force chairs, Allen Frances and Robert Spitzer, have focussed on the implications for introducing new additions into the DSM and broadening the definitions of existing diagnostic criteria, the DSM-5 "Somatic Symptom Disorders" Work Group (Chair, Joel E Dimsdale) has been quietly redefining DSM's “Somatoform Disorders” categories with proposals that if approved would legitimise the application of an additional diagnosis of “Somatic Symptom Disorder” to all medical diseases and disorders.

Radical proposals for renaming the “Somatoform Disorders" category “Somatic Symptom Disorders” and combining a number of existing categories under a new umbrella, "Complex Somatic Symptom Disorder (CSSD)" and a more recently suggested "Simple Somatic Symptom Disorder (SSSD)", have the potential for bringing millions more patients under a mental health banner and expanding markets for psychiatric services, antidepressants, antipsychotics and behavioural therapies such as Cognitive Behavioural Therapy (CBT) for all patients with somatic symptoms, irrespective of cause.

Professor Creed is co-editor of The Journal of Psychosomatic Research. In a June '09 Editorial, titled "The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV - a preliminary report", which expanded on a brief DSM-5 Work Group progress report published on the DSM-5 Development website that April, Joel E Dimsdale and fellow DSM-5 Work Group member, Francis Creed, reported that by doing away with the "controversial concept of medically unexplained symptoms", their proposed classification might diminish the "dichotomy, inherent in the 'Somatoform' section of DSM IV, between disorders based on medically unexplained symptoms and patients with organic disease."

If the most recent "Somatic Symptom Disorders" Work Group proposals gain DSM Task Force approval, all medical conditions, whether "established general medical conditions or disorders" like diabetes or conditions presenting with “somatic symptoms of unclear etiology” will have the potential for a bolt-on diagnosis of "somatic symptom disorder".

Under the guise of "eliminating stigma" and eradicating "terminology [that] enforces a dualism between psychiatric and medical conditions" the American Psychiatric Association (APA) appears hell bent on colonising the entire medical field by licensing the application of a mental health diagnosis to all medical diseases and disorders.

Quite so - and note Ms Chapman's nicely fielding the fallacious rhetorical trickery the APA likes to indulge in, these postmodernistic days: Witchdoctors, quacks, homeopaths, chiropractors and acupuncturists also would very much want to be ' "eliminating stigma" and eradicating "terminology [that] enforces a dualism between" their very own supposed "medical" arts and real medicine.

But then sometimes borders, dualisms, distinctions and distance are quite justified, and indeed that was one of the reasons real science came to be: Patients and real scientists want the quacks, psychobabblers and shrinking pseudoscientists OUTSIDE rather than INSIDE science.

And the APA has placed itself with the DSM-5 firmly in the camp of the quacks, the  psychobabblers and the fraudian shrinks, who are not doing medicine to help ill people but to enrich themselves, and OUTSIDE real science.

Personally, I would be much pleased if the US psychiatrists who disagree with the DSM-5 or who would want to see much more biomedical psychiatry rather than so called 'evidence based' psychobabble, abandon the APA and start a new and more scientific professional psychiatric organization: There is an urgent need for good psychiatry, and an even more urgent need to remove quackery from the domain of real medical science, and maintain the boundaries between psychiatric quackery and real science.

Finally, for the more sensitive minds, who may not like my mockery of Freud yesterday:

Earlier today I provided a copy from yesterday's More on the APA's mockery of medicine and morality without the picture with Freud and his Freudian cigar, that I like (having read too much about and around the Viennese fraud), but that may not be to everyone's tastes: Minus Freud, fit for family-viewing, but with all the arguments in place.

Enjoy! Good clean fun, that's even well argued! ()

As to ME/CFS (that I prefer to call ME):

1. Anthony Komaroff

Ten discoveries about the biology of CFS (pdf)

3. Hillary Johnson

The Why

4. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf)
5. Eleanor Stein

Clinical Guidelines for Psychiatrists (pdf)

6. William Clifford The Ethics of Belief
7. Paul Lutus

Is Psychology a Science?

8. Malcolm Hooper Magical Medicine (pdf)

Short descriptions:

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who understands ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:
   "it is wrong always, everywhere, and for anyone, to believe anything upon
     insufficient evidence
7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.

    "Ah me! alas, pain, pain ever, forever!

No change, no pause, no hope! Yet I endure.
I ask the Earth, have not the mountains felt?
I ask yon Heaven, the all-beholding Sun,
Has it not seen? The Sea, in storm or calm,
Heaven's ever-changing Shadow, spread below,
Have its deaf waves not heard my agony?
Ah me! alas, pain, pain ever, forever!
     - (Shelley, "Prometheus Unbound") 

    "It was from this time that I developed my way of judging the Chinese by dividing them into two kinds: one humane and one not. "
     - (Jung Chang)


See also: ME -Documentation and ME - Resources

Maarten Maartensz (M.A. psy, B.A. phi)

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