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  Feb 11, 2012                  

DSM-5: Allen Frances vs the American Psychiatric Association (1/3)


   "It is impossible for someone to lie unless he thinks he knows the truth. Producing bullshit requires no such conviction. A person who lies is thereby responding to the truth, and he is to that extent respectful of it. When an honest man speaks, he says only what he believes to be true; and for the liar, it is correspondingly indispensable that he considers his statements to be false. For the bullshitter, however, all these bets are off: he is neither on the side of the true nor on the side of the false. His eye is not on the facts at all, as the eyes of the honest man and of the liar are, except insofar as they may be pertinent to his interest in getting away with what he says. He does not care whether the things he says describe reality correctly. He just picks them out, or makes them up, to suit his purpose."

   -- professor Harry Frankfurt, on Bullshit (<-Wikipedia)
My bolding and coloring.


        1. Introduction
"Documentation That DSM-5 Publication Must Be Delayed"

1. Introduction

In the previous Nederlog,  I returned to the DSM-5 and commented on an article written by Kate Kelland for Reuters, that can be found on Suzy Chapman's excellent site about the DSM-5:

Here is more information about the DSM-5, that will probably come in a series of three Nederlogs, in which I will consider dr. Allen Frances writing against the American Psychiatric Association and/or the DSM-5, of which this Nederlog is the first.

One reason to do this is that dr. Frances was the chief editor of the DSM-IV, who presently is emeritus professor of psychiatry at Duke University, and is a man who wrote or said quite a lot about the DSM-5, and by implication about the American Psychiatric Association aka APA, that is quite critical of them, that seems to me also justified criticism, made by a man with a lot of relevant knowledge, who also found the courage to stand up for moral reasons, and protest against the DSM-5, though this did not make him popular with the leaderships of these two groups (where it should be noted "the DSM-5" refers to a set of committees and editors that is writing the DSM-5 at the behest and under the aegis of the APA).

By way of introduction to dr. Frances, here are two links, the first to Wired of a little over a year ago, which is an interview with him by Gary Greenberg, who is a psychotherapist:

The second link is to Frances' first public writing on the DSM-5, I think from 2007, in the form of a fairly long essay in pdf:

This is a fairly long essay with quite a few references, and as an essay by a psychiatrist - of which I have read quite a few, just as I have read quite a lot of books by psychiatrists, generally without finding any rational enlightenment or indeed without finding much in the way of clear and plausible rational explanations, while finding much very bad, very pretentious writing, usually without any real scientific foundation, in spite of assurances to that effect - and as such it is quite good, quite clear, and quite daring and moral, which is one reason for me to link it, though I also don't quite agree with it, as I also do not agree with dr. Frances's general position on psychiatry, though I do agree with many of his points (and have done so for decades, being a philosopher of science and a psychologist with few illusions about the soft sciences).

This will show itself in my comments, and as is usual for me in Nederlog, I will quote by indentation, while my comments are without indentation.

The general difference between dr. Frances view of psychiatry and my own may be indicated by saying that he is a believer in it, as a specialism in medicine and medical science, and as a way to help patients, while I am not a believer in psychiatry, having read very few psychiatric books (of which I did read quite a few, being a psychologist and philosopher with wide interests) that made much rational sense to me, or that seemed to be solidly based on good empirical evidence, although I also do believe there is such a thing as mental illness, and people suffering from it need help, and may indeed sometimes find it through psychiatrists.

And my basic problem with all psychiatry I have read is that it presumes or pretends knowledge or insight into the causes of mental, emotional or human malfunctioning that just does not exist, and indeed cannot exist in any rational scientific sense, until considerably more is known about how the human brain generates human experience.

For me, therefore, psychiatry is not a science, namely because it does not have any real scientific foundations, for lack of any empirically founded theory of how the human brain produces human experience, while all that has been offered by psychiatrists in its stead, from Charcot, Freud and Jung onwards, until this day, at the very best was not science but metaphysics (bad but pretentious philosophy), and more usually looked very much like waffle and cant intended to deceive the reader about the fundamental ignorance of the writer about the issues he was pontificating about.

And I also should say that, as one who has widely read for over 40 years in quite a few branches of science and supposed science, that in modern science there is nothing that sounds less than real science, and that sounds more like - a very amateurish mixture of - metaphysics, theology and parapsychology, in brief: like science fiction, than psychiatric text-books, that also tend to be very high in ill-defined pretentious jargon and cant, and very low in empirical certifiable fact.

2. "Documentation That DSM-5 Publication Must Be Delayed"

The following quoted text, from which I quote in the order of appearance, is by dr. Frances, and appeared as

dated February 7, and was published in both the Psychiatric Times and Psychology Today. I provide the link to the latter, and not the former because - significant detail: Fraudian slip - the Psychiatric Times wants money from you; Psychology Today doesn't.

Anyway, to dr. Frances' text:

Last week, I wrote that DSM-5 is so far behind schedule it can’t possibly produce a usable document in time for its planned publication date in May 2013.1 My blog stimulated 2 interesting responses that illustrate the stark contrast between DSM-5 fantasy and DSM-5 reality. Together they document why publication must be delayed if DSM-5 is to be set right.

I don't think it can be and I don't think it is intended to be. I think the main people behind the DSM-5 know quite well that what they are doing is neither science nor based on real good credible evidence, and is in fact a coup d'état. It's bullshit (*) (check out that footnote!) and they know it and want it this way.

Alternatively, they are like cardinals of the Catholic Church: Conceivably sincere in their beliefs, even if that requires, presuming their intelligence, a complete ignorance of any real modern science, but certainly sincere in their conformism to their own priesthood and its interests.

The first email came from Suzy Chapman of Dx Revision Watch http://dxrevisionwatch.wordpress.com

Re DSM-5 delays, here is a telling statement made by Dr Darrel Regier, its Vice Chair, on March 9, 2010: “We have just released draft criteria on a website on February 10th at dsm5.org. And we’ll be having a field trial starting in July of this year. We’ll then have another revision based on field trial results going into a second revision or second field trial in July of 2011. As a result, we will not have our final recommendations for the DSM-V probably until early 2011.” She continues,

Please note the dates. Dr Regier’s promised timetable has been missed by more than a year—we still don’t have final recommendations.

This is very well seen by Ms Chapman, whose site I strongly recommend because it is clear and rational and by and large the best single source of information about things twisted the DSM-5 way.

Here is a similar point by someone else:

Dayle Jones, PhD, is head of the Task Force of the American Counseling Association that monitors DSM-5. She sent in a timeline comparing DSM-5 promised deadlines with actual delivery dates:

The DSM-5 academic/large clinic field trials were designed to have two phases. Phase 1 was first scheduled to begin in June 2009, but had to be postponed for a year because the criteria sets were not ready. The timetable for field trial completion was unrealistic from the start and not surprisingly the end dates have been repeatedly postponed from early 2010 to early 2011, and we’re now already into 2012 with no end in sight. Phase 2, originally scheduled for September 2011 to February 2012, was to re-test those diagnoses that did poorly in Phase 1 and had to be revised. The phase 2 trials were quietly canceled. We still don’t have results from the phase 1 field trials, but the APA leadership has warned us that we must accept reliabilities that are barely better than chance. Without the second stage, uncorrected problem diagnoses will be included in DSM-5.

My own - admittedly - cynical view (which is that of a psychologist and philosopher, not of a therapist of any kind: I do not profit from the acceptance of my opinions) is that this was the point. The good people of the APA want to change medical science (all of it, if it were up to them, which happily it isn't) into a sort of theology, where the soul is biopsychosocially (**) involved in everything, by another name, and so must they be, as ministers to and of the - biopsychosocial - soul, just like the priesthood in the Middle Ages, and with similar powers to mistreat and lock up people.

Alternatively, they all have IQs not higher than 115, if they are sincere in what they profess. (And while I believe being a genius and being a psychiatrist is very close to an oxymoron, I don't believe the top brass of the DSM-5 or the APA is as stupid as that.)

The separate clinician field trial has been an even worse disaster. Clinicians were originally scheduled to be trained by August 2010, enrolling patients no later than late November 2010, and ending by February, 2011. Training was finally completed 18 months late in December 2011, which means the earliest these trials could possibly end is June 2012—well after most DSM-5 final decisions will have been made. Furthermore, of the over 5000 clinicians who registered to participate, only 70 (1.4%) have begun enrolling patients for the field trial. My guess is that like academic/large clinic Phase 2 field trial, poor planning and disorganization will force cancellation.

That's also well caught, and I agree with the guess. My own cynical view is that it is more likely to be contrived this way than not: They want a DSM-5 filled to the brim with diagnoses the psychiatric brotherhood can use for their own interests, and they are quite capable of ushering these diagnoses in on pretext that (i) "DSM-5 is very good for you, trust us" and (ii) "all will be repaired, eventually, in an evidence-based scientific way, of course: trust us".

They are like lawyers or revolutionaries who want to revise the laws by themselves, without any real control, in their own interests and of their clients (which are, for psychiatrists, especially: The state and its bureaucrats, which willingly they serve - rightly or wrongly - by giving reasons to lock people up, to force medicines into them, or to diagnose them as the state's bureaucrats desire), and with nobody interfering till the new law-book is in place to be let loose to control everyone - after which it will be too late, more or less like was the case in the Soviet Union, after Stalin grabbed power in 1927.

Dr Jones concludes,

In my opinion, there is no process and not enough time left to ensure that DSM-5 will attain high enough quality to be used by counselors. Fortunately, we can always bypass it by using ICD-10-CM.

Sobering stuff. Its constant procrastination has at last caught up with DSM-5. Having fallen so far behind schedule, DSM-5 abruptly dropped the second stage of field-testing—without public comment or justification or discussion of what would be the effects on quality and reliability.

They probably could produce a spin - and maybe have - about "evidence-based science", "clinical trials", "unpublished evidence", and "trust us". In fact, that's the card they normally play: The fallacy of being authorities. (While in fact they are authorities in the same way as theologians are authorities: About a matter of faith that rational people can't believe and look upon as non-existent and without any good evidence of any kind.)

In fact, the second stage of the field trials was perhaps the most crucial step in the entire DSM-5 process—a last chance for sorely needed quality control to bring a lagging DSM-5 up to acceptable standards. The DSM-5 proposals that were weak performers in the first stage were supposed to be rewritten and retested in the second to ensure that they deserved to be included in the manual.

The American Psychiatric Association (APA) is now stuck with the most unpalatable of choices—protecting the quality of DSM-5 versus protecting the publishing profits to be gained by premature publication. Given all the delays, it can’t possibly do both—a quality DSM-5 cannot be delivered in May 2013.

Nor in 2014, 2015, .... 2020, by the present folks or the present APA. But monetary interests will probably prevail and they will publish in 2013, but then "as a 0-version", which again will serve their agenda, since then they will be able to play the song: "We TOLD you it's not perfect, but we are doing "evidence-based science", "clinical trials" and we have sensational "unpublished evidence" ("Trust Us!"), and besides we live "in these days of the internet", where we can produce version after version. So you better "trust us", that is, if you want to avoid arrest and forced tranquillizers or tasering for being a Von Münchhausen by proxy. (***)

All along, it was predictable (and predicted), that DSM-5 disorganization would lead to a mad, careless dash at the end. The DSM’s have become far too important to be done in this slapdash way—the high cost to users and the public of this rush to print is unacceptable. Unless publication is delayed, APA will be offering us official DSM-5 criteria that are poorly written, inadequately tested, and of low reliability.

That also will give psychiatrists and any medical doctors willing to play along with their colleagues greater power than ever, and which will be irrefutable by its own criteria, and therefore will not be real empirical science but faith based promises, or deceptions.

But dr. Frances doesn't see it this way at all, so far as I can see, at least, though it seems he claims to have read and to admire Szasz, I think. Then again, he is a psychiatrist, so one shouldn't expect him to think like a real scientist. (****) Indeed, most medical doctors don't, and indeed shouldn't: Theirs is a practical rather than a theoretical field, at least when they are practicing medicine and are not much concerned with research.

The proper alternative is clear: APA should delay publication of DSM-5 until it can get the job done right. Public trust should always trump publishing profits.

Maybe that has a right ring, but I disagree for various reasons, one of which is that I don't trust the public either: Psychobabble is the dominant mode of talking about matters of psychology or psychiatry for most. And clearly, the American Mathematical Society - for example, speaking about real science - is, quite rightly, unconcerned with what "the public" might feel or believe. Then again, they have far less power, far fewer pretenses, and far fewer false promises or real interests in deceiving the public than the American Psychiatric Association. (And almost certainly a considerably higher average intelligence than the members of the APA have.)

Let’s close with a worrying and all too illustrative quote from Dr Regier, just posted by Scientific American.2 When asked if revisions to criteria in DSM-5 could be completed by the end of this year, he said “there is plenty of time.” I beg to differ—there is not nearly enough time if the changes are to be done based on a much needed independent scientific review and are to be tested adequately in Phase 2 of the field trial. Without these necessary steps DSM-5 will be flying blind toward the land of unintended consequences.

No. I think Regier knows what he is doing: He wants a bullshit DSM-5. He does not want real science, or only where it supports psychiatry - which it mostly does not. But he won't admit so without waterboarding, or until one could get him blind drunk and freely talking, for he wants the credit and authority of being medical scientists for his psychiatric brotherhood: That's their meal ticket, after all, and also a ticket for the richest sort of meal nominal "scientists" can "earn".

1. Frances A. APA should delay publication of DSM-5. January 31, 2012. Psychiatr Times. 2. Jabr F. Redefining autism: will new DSM-5 Criteria for ASD exclude some people? January 30, 2012. Sci Am.
. Accessed February 7, 2012.

Anyway... the above is what I think. And I suppose one main difference between dr. Frances and me is that I just can't take psychiatry serious as a science: It isn't a science and it never was, even if there are sincere psychiatrists who are mostly honest.

Effectively, I am in a fair position to survey some 100 years of this "science", with my knowledge and experience, which is why I do say it is pseudoscience. But I do understand why dr. Frances cannot see this, and probably never saw it this way either. Then again, I have never seen it differently, except that the DSM-5 has taught me how corrupt it all really is, and how dangerous too, now that after 100 years of fraudulence in the name of science a band of frauds from several crazy woo-tribes is trying to overtake medicine in the name of Psychiatric Evidence-Bases Multi-dimensional Medical Science, with pretenses like the Church, another institution that covers all of "biopsychosocial" being (or be-ing, for the dickheads).

Also, my own view seems - to me - to be more practical and more rational, though I also don't see it happen soon or easily:

Kick psychiatry out of science, and give GPs half a year or a year more time in their studies to pick up some about treating patients (sorely needed, I can assure you: most behave as if they are witch-doctors, and the patients better kneel, believe and obey, as they have no effective right on hearing a clear diagnosis with a rational foundation) and about madness, mad people, neuroses, and what to do about these. That's bound to work out as a lot cheaper to the patients, very probably also is much more helpful to them, as it is very likely to deliver a lot less pretentious baloney, next to better and more honest treatment for patients.

And I plead guilty to the charge of wanting to abolish psychiatry, at least as a science:

It has no more scientific foundation than does Catholicism, and is as totalitarian, dogmatic and dishonest as the leaders of that church tended to be, for easy to understand human-all-too-human reasons, that also apply to the APA: Unwillingness to reason rationally; personal greed and corruption; dishonesty; unlimited pretenses and promises; and carefully manufactured irrefutability of the teachings, all because people buy into it, in search of health, reassurance or safety from divine or psychiatric wrath, and it therefore produces the means for a good living based on pretension or deception about one's true knowledge, true abilities and true motives.

There is a place for psychiatry as that specialism of medical science that treats patients who suffer from mental illness, for people may get mad and deserve to be helped, but there does not presently exist the requisite knowledge of the brain to put the practice of this on a real scientific foundation.

Next Next

(*) From: Bullshit - Wikipedia, minus some links and with my bolds:

Bullshit is commonly used to describe statements made by people more concerned with the response of the audience than in truth and accuracy, such as goal-oriented statements made in the field of politics or advertising.
"Bullshit" does not necessarily have to be a complete fabrication; with only basic knowledge about a topic, bullshit is often used to make the audience believe that one knows far more about the topic by feigning total certainty or making probable predictions. It may also merely be "filler" or nonsense that, by virtue of its style or wording, gives the impression that it actually means something.

In his essay On Bullshit (originally written in 1986, and published as a monograph in 2005), philosopher Harry Frankfurt of Princeton University characterizes bullshit as a form of falsehood distinct from lying. The liar, Frankfurt holds, knows and cares about the truth, but deliberately sets out to mislead instead of telling the truth. The "bullshitter", on the other hand, does not care about the truth and is only seeking to impress:

It is impossible for someone to lie unless he thinks he knows the truth. Producing bullshit requires no such conviction. A person who lies is thereby responding to the truth, and he is to that extent respectful of it. When an honest man speaks, he says only what he believes to be true; and for the liar, it is correspondingly indispensable that he considers his statements to be false. For the bullshitter, however, all these bets are off: he is neither on the side of the true nor on the side of the false. His eye is not on the facts at all, as the eyes of the honest man and of the liar are, except insofar as they may be pertinent to his interest in getting away with what he says. He does not care whether the things he says describe reality correctly. He just picks them out, or makes them up, to suit his purpose.

(**) "Biopsychosocial" is a contrived APA and psychiatric term that is designed to confuse, obfuscate and befuddle:

The APA and indeed psychiatry at present has no sound theory about the human mind, about human language, about human thinking, about human selfs, about human motives, about human dreams, about human ideals, or about human nature, so they set up their terminology that it seems as if they are always right: They don't even have clear definitions, nor clear theories, nor interesting revealing experiments, nor any good ideas about how the brain manufactures experience.

Much of psychiatry is pretense or illusion, though I am willing to agree there are some sensible psychiatrists, and there certainly is a moral necessity to take care of the ill, the insane, the young and the old.

There is no good theory of human experience, madness, motives, reasoning, selfs or what have you - and for this reason even the best of well-intentioned psychiatrists must be mostly an artist, for lack of systematic real knowledge of what he is about.

Underneath most psychiatry, however it may be presented in fashionable language, there is the good old Christian soul ("psyche", experience), clothed in and flanked by "bio" and "social" to allow psychiatrists to claim, quite falsely by the way, that they are covering these aspects as well.

Incidentally, I have no major problem with there being no good explanation of human experience (if it existed I'd known, at least in the realms of science, philosophy and mathematics):

What I do have major problems with are folks, whether frauds or fools, who insist that they have scientific explanations of human experience, and who want to be paid to exercise their pretended knowledge on you or on me, for money, to cure you or me from what they claim they can see are your problems: That is bullshit. There is no such knowledge; there are no such theories; and to pretend there are is not to act as a scientist but as a priest or theologian, and fundamentally dishonest and unscientific and also quite immoral for medical men and women.

(***) This is a very realistic consideration: The APA wants the power to lock people up because they care for others ("too much", the APA will say, and insist they, and they alone, are the ones who can tell "scientifically" what is "too much"). Thus, for example, mothers who believe their child may have ME/CFS, which according to psychiatrists is not a biomedical disease risk being locked up. And so it may happen, and to some extent has happened, that people who care for their ill family get locked up as insane, because they do care for them, and because the APA or some shrink insists they shouldn't, namely because the APA or the shrink pretend to know which diseases are real, and which are not, and considers all diseases, and especially but not only unexplained ones, as their very own territory.

In fact, the APA - some of the mighty "physician leaders" (I quote their own grandiose moniker, for their own kind), at least - may want to do to people like dr. Frances what their colleagues did earlier to people like dr. Semmelweis, who believed in an unexplained cause of disease - the germ theory of disease, in fact) that his colleagues did not believe in and did not want to investigate and considered superstition. So they locked him up in a madhouse, had him put in a straightjacket, and had him thus beaten up by their wardens, which killed him.

"Not in this day or century!" you replied, perhaps? Consider the following gentleman's career and opinions and methods of treatment: I suggest he is the proper mascot for the DSM-5 also in view of the fact that he led the APA for quite a while. Behold the face of US psychiatry:

(****) I'm sorry for dr. Frances, who does mean well, but the only psychiatrists that I read who did think like the real scientists I also read, were doctors McCulloch and Ashby, who both gave up psychiatry and were major contributors to cybernetics.


Corrections, if any are necessary, have to be made later.
-- Feb 14, 2012: Corrected some unclarities and typos, and added some links.


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 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)
 Maarten Maartensz
ME in Amsterdam - surviving in Amsterdam with ME (Dutch)
 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 understa, but nds 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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