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July 20, 2011           

me+ME: More about the DSM-5 and psychiatry

 

 

  (A)ccording to Erewhonian law, offenders are treated as if they were ill whilst ill people are looked upon as criminals.
   -- After Samuel Butler
   There was only one catch and that was the DSM-5, which specified that a concern for one's health in the face of illness was the process of an irrational mind. One was ill with ME and could be helped. All one had to do was ask the health-authorities for help; and as soon as one did, one would be called crazy and would not be entitled to help. One would be declared crazy if one said one was ill with ME and needed help, and would be declared sane if one didn't, but if one were declared sane one would get no help while being ill. If one asked for help while ill one was declared crazy; but if one didn't ask for help one was considered sane and denied help for that reason.
   -- After Joseph Heller

Sections

1. Introduction
2. A patient's advocate submission
3. The DSM-5 psychiatric lies and deceptions in book form
4. On the stigma of being mentally ill 
5. The Catch-22 of the DSM-5

1. Introduction

After yesterday on probability and confirmation and learning from experience, here is yet a llittle more on the DSM-5, about which I wrote, at length also, in my own submission to the APA about it:

You can find out much more about the DSM-5 on Suzy Chapman's DSM-5 site:

There you find a list of submissions to the APA about the DSM-5:

2. A patient's advocate submission

July 18 was the last day to submit a comment to the DSM-5 editors. Here is another patients' submission, that addresses some fundamental issues:


Submission by patient advocate, Caroline Davis

J 00 Complex Somatic Symptom Disorder

I would like to express my deep concern about the proposed new category of Complex Somatic Symptom Disorder (CSSD) in DSM-5 scheduled for release in 2013.

CSSD proposes to add a mental health diagnosis to any condition where the sufferer has been ill for more than six months, and has developed ‘excessive’ concern about his or her health.

Since most good employers have a sick leave scheme which pays full or most-of-full pay for six months, this timeframe coincides most unhealthily with:

a) The individual’s realisation that their illness might not resolve, and/or might possibly be a disability and

b) A concerted effort to research their condition and seek more tests and treatments in order to get well and

c) The looming possibility of job loss, financial penury and the imminent need to make insurance or disability claims.

A patient in such a situation is likely to fall slap-bang within the CSSD criteria of:

(2) Disproportionate and persistent concerns about the medical seriousness of one's symptoms and

(3) Excessive time and energy devoted to these symptoms or health concerns

The effect is to automatically deliver a diagnosis for an Axis I psychiatric disorder, simply for finding out what is causing one’s symptoms after such a long time of being ill, and wanting to do the best one can in order to get well and save one’s job and prospects for the future.

There is no empirical data to support the existence of ‘CSSD’. I believe that it is neither clinically safe nor morally right to force through un-researched, untried, untested (and possibly entirely inaccurate) diagnostic criteria for an entirely un-researched, untested (and possibly false) psychiatric condition. As your paper itself says, CSSD is merely ‘a construct’. There is no empirical evidence to support this ‘construct’ but plenty of circumstantial and factual evidence for why this ‘construct’ has been proposed and is being pushed forward with such unseemly speed.

Most patients are sick, but not stupid. We were managers, scientists, teachers, medical people, civil servants and business people in our former lives, and we still have functioning brains. We can see that names on the DSM committee considering CSSD include those in the pay of insurance companies and Governments (including the UK medical establishment). We also know that the implications of DSM-5 will extend to the next version of WHO.

There are those on your committee who wish only to do the bidding of their financial paymasters, and they are doing this by creating diagnoses such as ‘CSSD’ which will allow insurance companies and Government agencies to deny the claims of the genuinely sick and disabled. I urge the rest of the committee members not to allow them to do this, and to remain faithful to the objectives of WHO classifications as an excellent source of unbiased medical knowledge for the guidance of medical practitioners across the world.

Please do not let the DSM – and by implication the WHO classifications – become the vehicle of Governments and insurance companies to get their financial needs met.

I urge the committee to see past the claim that: a ‘diagnosis of CSSD could be applied to any patient with any diagnosis’. In clinical practice, as well as in your own discussions, it is already clear that this ‘diagnosis’ would be applied far more readily to patients already vilified for having conditions for which there is no objective medical test, eg: IBS, ME/CFS, FM, Gulf War Syndrome, interstitial cystitis, long-term pain and others. I urge the committee to examine the level of medical research funding dedicated to these conditions: they will find that funding for biomedical research has been restricted to bare, minimal levels for the past thirty years, which goes a long way toward explaining why there are no differential medical tests for these conditions yet. The solution is more and better biomedical research, not to create a new ‘bucket’ classification to financially manage-away these conditions.

I urge the committee to consider the consequences of moving too fast to approve a classification which is likely to be immediately pejorative to patients. The inclusion of ‘CSSD’ as a possibility for diagnosis will tap into the already hysterical media and ‘biopsychosocial’ research claims and pronouncements about these misunderstood and underestimated conditions.

The consequences – unintended by those whose moral conscience on DSM-5 is clear, and jauntily dismissed by those for whom recognition of these conditions would be financially and politically injurious – are likely to be catastrophic. They include: sceptical medical practitioners who will increasingly believe that it is OK not to test and treat, nor to provide appropriate care, nor to support disability benefit claims; and insurance companies who continue to charge huge premiums and would (with CSSD in place) be free to dismiss valid claims for some of the sickest people they serve.

Not only is this not an appropriate route to management or cure for such patients, but the consequences will quickly spiral into poverty, physical distress and in some cases preventable death.

Even if a patient should subsequently recover, the stigma of a mental health diagnosis is likely to legislate against the possibility of future employment and full reconstruction of a career at pre-illness levels. Thus it would have a direct economic effect on both the individual and the economy.

How much is CSSD really about the management of sickness and disability in patients by doctors and health service professionals, and how much is it the product of financial machinations by insurance companies and Governments seeking to minimise liability for medical care and disability?

While there is such a dearth of properly-conducted research (by non-partisan medical scientists) into the medical validity, applicability and usefulness of CSSD as a diagnosis; and while the likelihood of rushing into including it is likely to have such potentially dire consequences for patients (and, through effects on reputation and liability, also for medical practitioners) I request and appeal for CSSD to be omitted from the DSM-5.

Yours sincerely

Caroline Davis

Patient, advocate


Indeed, and Ms. Davis asks some quite good questions. And while I do not believe that the editors of the DSM-5 are going to be moved by her arguments or questions, or anyone else not of their own group - since in fact I guess there has been a take-over by a group in which Sharpe, White and Wessely are three main characters, who also have been intrigueing this take-over for a long time, with co-ordinated 'evidence-based medical science' in 'medical journals' edited by their own group (*) - it is important to note that

There is no empirical data to support the existence of ‘CSSD’. I believe that it is neither clinically safe nor morally right to force through un-researched, untried, untested (and possibly entirely inaccurate) diagnostic criteria for an entirely un-researched, untested (and possibly false) psychiatric condition. As your paper itself says, CSSD is merely ‘a construct’. There is no empirical evidence to support this ‘construct’ but plenty of circumstantial and factual evidence for why this ‘construct’ has been proposed and is being pushed forward with such unseemly speed.

As Ms. Davis notes, the main reason seems to be this:

There are those on your committee who wish only to do the bidding of their financial paymasters, and they are doing this by creating diagnoses such as ‘CSSD’ which will allow insurance companies and Government agencies to deny the claims of the genuinely sick and disabled.

In fact, this is what persons like Sharpe, Creed and Dimsdale, who are main players in the DSM-5 editing are and have been saying for years: "Our proposals to have psychiatrists manage ill people by telling them they are making it up are ... less expensive having ill people helped in a moral and medical way by medical people."

The quotes + lack of indentation in the previous paragraph are meant to be signs that I paraphrased. But I am not making it up at all:

3. The DSM-5 psychiatric lies and deceptions in book form

On July 14, Francis Creed and two of his cronies published a book,

Medically Unexplained Symptoms, Somatisation and Bodily Distress:
Developing Better Clinical Services.

Creed, Francis; Henningsen, Peter; Fink, Per

in which most of the group of fifteen to thirty shrinks and "professors in psychosomatic medicine", who seem to have taken over the DSM-5 for their own nefarious ends, all get their personal pages to advertise, in effect, their very own personal willingness to destroy ill people, to politicians and bureaucrats, and namely in such terms as follow quoted in black - and I comment in blue, with indentation:

"They [unexplained bodily symptoms] form one of the most expensive categories of health care expenditure in Europe. This book makes the case for shifting some of this expenditure away from numerous investigations for organic disease and towards effective treatment of bodily distress." (Preface vi)

This is what it is all about: Stigmatize ill people as "somatoformers", and simultaneously palm off the Catch-22 that somatoformers do not deserve any medical research. Besides they lie both about 'numerous investigations for organic disease' and about 'effective treatment of bodily distress' by which they mean their own psychiatric bullshit imposed on ill people, as if there are no moral or medical alternatives to psychiatric lying, deceiving and defrauding of genuinely ill people.

And if these immoral unmedical practices - primum non nocere, which in the hands and minds of freaks like Creed, Sharpe and White is turned by fraudulent argumentation and lies to their personal rights, qua shrinks of their brand, and quite like the Dominican fathers of the inquisition, of primum nocere, and namely in the name of their fraudulent 'evidence based medical' pseudo-science - now count as moral and medical means the APA supports, then why not honestly and forthright ad straight away propose to gas the undeserving ill? Or at least, if they were honest, simply to propose to deny ill people any dole or social support, and while perhaps - in a fit of untypical humaneness - offering them suicide pills so they don't have to suffer in cardboard boxes in the streets?

"Since the traditional labels 'medically unexplained symptoms' or 'somatisation' are so unhelpful, we propose the term 'bodily distress' as a more useful term for these disorders..." (Preface vi)

Typical DSM-5 style: While not saying in which ways the terms are unhelpful, all of this pseudo-science is on the level of relabelling what real science cannot explain, in such a way that those who suffer any unknown disease will not be helped, get no research, and no social support in the form of health-benefits.

That is the game of Creed, Dimsdale, Fink, White, Wessely, Sharpe, Kroenke, and some twenty more psychiatric moral rotters:

It's all as in Butler's Erewhon, the ill are guilty of their own illness, especially if the illness is unknown, and deserve discrimination and denial of human rights because they are ill. I quote from Wikipedia: "For example, according to Erewhonian law, offenders are treated as if they were ill whilst ill people are looked upon as criminals."

That is the science and medical morality as proposed by the DSM-5. As also witnessed by this:

"ICD-10 included neurasthenia (chronic fatigue), as one of the somatoform disorders. This is considered here as chronic fatigue syndrome under the heading of functional somatic syndromes." (Page 8)

This is once more of breath-taking sadistic impertinence (and check out the US psychiatric Lavrenti Beria like freak who was called Donald Ewen Cameron: surely the fit mascottes for the DSM-5, as Lavrenti Beria also looked like Simon Wessely): The effective equations neurasthenia = chronic fatigue = somatoform disorder = functional somatic syndromes, also by falsely suggesting that the ICD-10 did so.

And this is again the skillful bullshit lying of the present editors of the DSM-5 and their group of intriguers.

You perhaps think I am mistaken? I am a psychologist and a philosopher of science, ill for over 30 years almost without any help whatsoever, and that always on the grounds these folks have been intrigueing for more than 20 years now: Whoever has the ill luck of having a disease that's not yet capable of being causally explained by medical science, will be accused of making it up, simply because this is cheaper:

"They [unexplained bodily symptoms] form one of the most expensive categories of health care expenditure in Europe. This book makes the case for shifting some of this expenditure away (..)"

I call this medical sadism, since that is the only cogent rational explanation why people who studied medicine would want to so grossly mistreat people they admit feel ill and that they do not want to treat morally and medically, specifically on the totally insane ground that since their illness cannot be found in an existing medical handbook, it cannot and does not exist, and "therefore" the patients who suffer from it may and must be medically accused of malingering, making it up, or being insane.

You can not rationally infer that a person whose miseries cannot be explained by current medical science "therefore" has miseries that can be explained by current psychiatic science. That's just plain unlogical madness, indeed on a par with Tertullian's "credo quia absurdum".

But the current APA, the editors of the DSM-5, and evident moral rotters like Creed, Dimsdale, White, Wessely and Sharpe do so, and in part have done so since decades.

It is sadism in the name of medical science - and I can't make it sound more kind without misrepresenting the truth. Besides, I much resent being denied medical help and health benefits, in the end because a bunch of medical sadists have succeeded in having people with unexplained diseases branded as mentally ill, and are being offended by such moral rotters as a matter of course, merely because they have academic degrees, and choose to make a living by lies and misrepresentations of others' sufferings and of their own incompetence and total lack of moral or medical integrity or humaneness.

Check out Donald Ewen Cameron (Wikipedia) to see to what very frightening sadistical depths a very prominent US psychiatrist has fallen to, very recently, who based his career on the combination of personal sadism and his degree as psychiatrist - and indeed also to see how the career of this sadist in the name of the science of psychiatry may have inspired others with the same perversion and education to go the same way: If Cameron could get away with it, any psychiatrist in the US can get away with virtually anything. (See also  It's malevolence, stupid!, On medical sadism - 1 and On medical sadism - 2. Especially the last contains stunning evidence on medical sadism by Cameron and many others.)

Again, if you think I am mistaken, consider some evidence by professors of psychiatry who happen to be not sadists, as indeed I hope and trust most psychiatrists are not, even if they believe many things I don't believe (**), because I happen to know so much more of real science, of psychology, of philosophy and philosophy of science than psychiatrists do:

4. On the stigma of being mentally ill

Finally, here is a link to an interesting site that considers psychiatry as it is depicted in the media and indeed as psychiatrists have wanted to be depicted in the media, and have tried to depict "the mentally ill" in the media:

It is an extensive site, that seems to exist for more than ten years, with a lot of material, including some interesting videos.

Here are some quotations from its opening page:

PsychoMedia was coined to expose how the media fosters prejudice and discrimination against anyone who has fallen into the mental health system. It is an in-depth look at the way people who receive, or have received, psychological counseling and/or mental health services are labeled mentally-ill and are identified as being potentially dangerous psychotics.

In fact, mental patients are the only group of people in the entire United States against whom it is legally permissible to espouse containment, isolation, and even revocation of their most basic constitutional rights. You need not have ever committed a crime in order to forfeit all of your constitutional rights. All that is necessary is the threat of violence and a doctor's expert opinion that you are a danger to yourself or others. (It is not at all uncommon for anyone who has been labeled "mentally-ill" to be considered a threat of violence.) Contrary to popular belief, having a prior history of violence is not the determining factor in these decisions. Against any other group of people this would be considered a clear-cut violation of constitutional law. "People with psychiatric disabilities are the only Americans who can have their freedom taken away and be institutionalized or incarcerated without being convicted of a crime and with minimal or no respect for their due process rights." (Excerpt from a National Council on Disability Report, January 20th, 2000)

I have been successful in maintaining the vision of Mental Health Stigma.com as a vehicle for independent advocacy by absorbing all expenses out-of-pocket, including all the research materials, books, posters and movies. Of course I've had to sacrifice my own needs and wants as I receive no funding of any kind from any governmental or philanthropic agency, and so I live just above the poverty level. Unfortunately, the belief that people labeled "mentally-ill" are entitled to the same basic human rights that all other human beings are entitled to is a very unpopular cause. Hopefully my sacrifice will not be in vain... The resource materials posted on MentalHealthStigma.com are archived items. They are a veritable history of the stereotyping, emasculating and the legal genocide of society's most vulnerable people. I've been very humbled to learn how naive it is to stand up for the American ideals of freedom, justice, and equality for all. This is indeed the "madman's dilemma." The ideals we profess to live by are not what we actually practice. It is difficult, at best, to remain optimistic under such circumstances. Our history books tell of a similar era less than two generations ago, when "the mentally-ill" were the first group of people to lose their rights in Nazi Germany, and within a decade everyone else had lost their rights. I can only hope and pray that Americans will eventually awaken from their slumber as the rights they naively take for granted are gradually being seized and forfeited. A contemporary Christian author of the time shamefully acknowledged his indifference to the plight of his fellow countrymen by writing: "In Germany first they came for the Communists, but I never said anything because I wasn't a Communist. Then they came for the Jews and I never said anything because I wasn't Jewish. Then they came for the trade unionists and I never said anything because I wasn't a unionist. Then they came for the Catholics and I never said anything because I was a Protestant. Then they came for me, but by that time there was no one left to say anything!"

The leas the link will show you is how things have been, are and probably will be manipulated wherever the interests of psychiatrists, the media and state bureaucracies overlap or meet.

5. The Catch-22 of the DSM-5

Finally, here are a link to the Wikipedia entry for Catch-22; a quotation of Heller on the meaning of the phrase as (supposedly) used in the US Army; and a restatement by me of the meaning of the phrase as (really) used in US and British psychiatry since ca. 1988:

Heller and the Catch-22:

There was only one catch and that was Catch-22, which specified that a concern for one's safety in the face of dangers that were real and immediate was the process of a rational mind. Orr was crazy and could be grounded. All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions. Orr would be crazy to fly more missions and sane if he didn't, but if he were sane he had to fly them. If he flew them he was crazy and didn't have to; but if he didn't want to he was sane and had to.

ME and the DSM-5

There was only one catch and that was the DSM-5, which specified that a concern for one's health in the face of illness was the process of an irrational mind. One was ill with ME and could be helped. All one had to do was ask the health-authorities for help; and as soon as one did, one would be called crazy and would not be entitled to help. One would be declared crazy if one said one was ill with ME and needed help, and would be declared sane if one didn't, but if one were declared sane one would get no help while being ill. If one asked for help while ill one was declared crazy; but if one didn't ask for help one was considered sane and denied help for that reason.
   -- After Joseph Heller

As the DSM-5 worthies themselves claim, here is the Erewhonian reason for this perverse game:

"They [unexplained bodily symptoms] form one of the most expensive categories of health care expenditure in Europe. This book makes the case for shifting some of this expenditure away (..)"

Soon, and unless you are very rich, you'll be declared insane if you are ill, if this happens to be cheaper to the state or the insurance companies.


(*) This seems to me the best explanation. My evidence is mainly that I've been seeing the same pseudoscientific rot, all written along the same lines, all using the same techniques of innuendo, suggestion,  and vagueness - "Evidence exists that suggests that it may be that ..." with on the dots any bullshit claim - by the same group of 15-30 psychiatrists and clinical psychologists again and again. You find again that the same group edited or wrote the above mentioned volume:

Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services.

None of it is science; all of it is false; most who perpetrate do it knowingly.

(**) There is a good analogy with what I believe about resp. Roman Catholics, Catholic priests, and Catholic inquisitioners, and what I believe about medical doctors, psychiatrists, and psychiatrists like Wessely, Creed, White, and Sharpe. The one major difference I see is one that makes me less forgiving of fraudulent psychiatrists: They  pretend to be medical scientists, and they practice their perversions in the name of science, and while medical science is far from omniscience, it is a legitimate science, which outside of psychiatry has managed to establish rather a lot about the functioning and malfunctioning of the human body.

The psychiatric APA and DSM-5 lie and policy that persons who are ill with a disease medical science can't explain (but psychiatrists - supermen all - can, so they dysfunctionally believe or lie) must be malingering or deluded, except that the APA and DSM-5 call it "somatoform disorder", is just sadism if not a proof of total incompetence to be trusted in any medical or care function, where the health and well-being of others depend on one's intellectual competence and moral integrity.


P.S. Corrections, if any are necessary, have to be made later.
.




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


1.  Anthony Komaroff Ten discoveries about the biology of CFS (pdf)
2.  Malcolm Hooper THE MENTAL HEALTH MOVEMENT: 
PERSECUTION OF PATIENTS?
3.  Hillary Johnson The Why
4.  Consensus of 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)
9.
 Maarten Maartensz
ME in Amsterdam - surviving in Amsterdam with ME (Dutch)
10.
 Maarten Maartensz Myalgic Encephalomyelitis

Short descriptions of the above:                

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:

7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.
9. I tell my story of surviving (so far) in Amsterdam with ME.
10. The directory on my site about ME.



See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.
 


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