Feb 11, 2012
DSM-5: Allen Frances vs the American Psychiatric Association (2/3)
In a 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. "The DSM 5 Follies, As Told in Its Own Words"
The following quoted text, that I quote by indentation in the order of appearance, is by dr. Frances, and appeared on February 9 in the Huffington Post as
The above links to the original, and the unindented comments that follow are mine. The article starts as follows, after the title:
Yes - probably much for the worse. And it is a very reprehensible lie and intentional confusion to present a manual for practitioners as if it were a set of scientific hypotheses. What if surgeons would try to palm off the same sort of bullshit on their patients? ("O, we'll try to make it a bit more likely to succeed and less painful for you, once we start practicing this. Trust us! Promise! We might even introduce anesthetics! You see, we do this out of pure love for our patients!")
Actually, I don't think it can, and neither could nor did DSM-IV. But Frances is right that any proposed diagnosis or therapy that is not based on existing good evidence, that also makes it at least more probable than not (!), should not be either a diagnosis or a therapy in any manual for practitioners of any kind: That means intentional playing with the health of patients, without having any good reason to do so, apart from the money it makes for those who do so, of course.
I agree, but I have also noted that psychiatrists are most uneducated - if not very clever liars, of course - as regards what is good evidence, what is good philosophy of science, what is good methodology: Either they have hardly a clue, or else they are very fraudulent. (I admit that in ordinary psychiatrists, that is: Not the writers of the DSM-5, the probability is that they hardly have a clue, as they never got any decent education that way.)
Indeed. For me this sounds actionable, in fact: They say in effect that what they say has no proof, and nevertheless it is in the DSM. In surgeons and in veterinarians this would be clearly most reprehensible.
Query: By whose
standards? As is, the DSM 5 seems to have been composed on the
principle: "If our editors believe it might be true, it's in the
DSM-5", which is probably how it has been composed, in fact, though
quite possibly with one word difference: "If our editors believe it
might be profitable to psychiatrists, it's in the DSM-5".
I agree - but then I believe, unlike Frances, that psychiatry as is and has been the last 100 or more years is not and never was a real science. Indeed, it cannot be: The knowledge of the brain it pretends or should have just does not exist, in quite the same sort of sense as the knowledge of physics that would prove the truth of Catholicism does not exist.
Actually, this is
Sales talk, that also is trying to pass their bullshit
off as if it is biomedical science, which it totally is not:
The necessary brain science for this just doesn't exist. Period. (If it
did, you would have endless series on its revelations on the BBC, and
rightly so. But it doesn't, and neither Freud nor Wessely has anything like a
plausible idea of how people feel, think, mean, desire or what
processes in the brain do this.)
Well... I very much doubt it. First, I do not understand the basis for "more accurate" that Frances underwrites. There are various reasons for this, and one is: Second, IQ, height, weight and blood sugar are not measured as continuous variables. Third, it wouldn't help anyone if they were. Fourth, psychiatrists tend to be very obscure about the - measurable - facts of experience, that never are continuous, for example, and about what might be the - measurable, testable - supposed facts that might explain them. Fifth, I do know a fair bit about continuity and mathematical analysis, and clearly most psychiatrists do not, and couldn't solve a differential equation. Sixth, it is all baloney anyway: What matters is not whether the real facts are or are not continuous in some sense, but whether such theories one has for them, which need not at all be phrased in continuous terms to make accurate predictions, are supported by the facts.
My own cynical
belief - unless I get evidence that dr. Regier's IQ < 115 - is that
this is all on purpose: They want "ad hoc, untested,
and so impossibly time-consuming and unnecessarily complex" tests for
their own psychiatric theories, for they want them to be irrefutable;
they want obscurity and ambiguity. It is in their personal
financial interest, after all.
I wish! But no: What I think will happen is that it will thoroughly confuse nearly everyone in the field and outside the field, and I think that's precisely the reason it was introduced. Namely to make psychiatry irrefutable.
Well... it makes excellent sense if the comparison is made, as I think it is, to mislead the public. It's not exactly the first time psychiatrists have pretended medical knowledge and insight they do not have at all, but pretended to have so as to make money by what is effective fraudulence.
Quite so, which is
also why treatment risks should be discussed rationally and
honestly: What is the risk, in health and health-costs, to patients and
to society, of treatments and diagnoses that are false, mistaken,
improbable? And who should pay it?
(AV) va(T)>0 IFF va(~T)<0
This merely says
that the value of the successful treatment is positive iff the value of
the non-successful treatment is negative. Usually, there is no more
precise quantitative relation between these two, but this is sufficient
for a useful application:
Here is the answer,
worked out step by step:
Yes indeed - and it is also worth noticing how much of the DSM-5 talk is intentional cant: Always everything is for the best in the best of worlds with the best of shrinks doing their best for you: Trust the APA!
But indeed: Why
should rational people care for "should be a living document",
which anyway is an oxymoron? You want probable truth in a
scientific document, and you want to do no harm in a medical
treatment: The APA does not care for probable
truth, and is quite capable of harming the interests of the
patients for the benefit of the psychiatrists. As indeed is
human-all-too-human, but as is not in line with accepted medical
morality since 2500 years: Primum non nocere.
This is also why I
regard the APA as maleficent, and intentionally so, if
only by their willful inclusion of diagnoses only they can profit from.
take very good care of their own personal well-being and interests!
Well... yes and no.
The problem is mostly: Are the experts real experts? My point
is that there is real provable expertise in physics and
engineering and also in medicine - but not in psychiatry,
except for some small parts of it: It provably is ineffective; it
provably is unscientific; it provably is as it is because that benefits
Yes... but then for real scientists this also should count as very strong evidence that folks who do make arbitrary changes and do not wait on scientific foundations for their diagnoses and treatments, as is the case in psychiatry, are not real scientists and/or are real frauds.
As it happens, I was sold that a paper test - a questionnaire - for my mother, who had Alzheimer's, was a diagnostic instrument, or so the medics and shrinks told me, ca. 1994. But Frances probably means that the biological mechanism that leads to Alzheimer is close to being known.
If the DSM-5 folks
are saying this, as it seems they do, they are lying themselves blue in
the face in precisely the same trained manner as politicians do: Accuse
your opponents fallaciously,
to confuse them and muddle the argument. (Here the fallacy is that
of the straw man.)
Kudos to dr. Frances for this, and I agree, though I also believe - unlike him - that, while dr. Szasz is mistaken about the non-existence of madness, he is far more right and far more honest on psychiatry and its theories and ends than most psychiatrists are.
Rejoice, shrinks of the world! Lots of money coming your way, if you play the way the APA wants it! That's what psychiatry is for: Make psychiatrists happy and well-paid!
Ah, but they are very responsible to their own financial interests, and to the financial and career interests of psychiatrists! Dr Frances has the questionable motive of caring for the interests of his patients, and seems to forget that one should only care for patients if the financial advantages of this to the psychiatrist are palpable! (Sound business principles! Approved by the GOP, also! And by Wall Street Bankers!)
Yes, it's a lie, again of the grossest astroturf variety: Tell it like you want the yokels and proles to believe it! Newt Gingrich and Fox News show you how!
Indeed, and if the DSM 5 changes seem or are claimed to be "supported by scientific evidence" this is only so because one does not know what real scientific evidence is or would be, or else because those who claim so lie knowingly. (*)
What they are effectively saying is: Fuck evidence! Fuck morality! Fuck patients interests! We shrinks of the APA put in the DSM-5 what serves our interests and our incomes, and if you don't agree: Fuck you! (And be polite to shrinks, especially from 2013 onwards, or you'll be sectioned! The APA knows who the judges in court cases will most probably trust!)
So why are they
nevertheless included in the DSM-5? Because they are believed to be
beneficial to psychiatrists, who need incomes, in the highest brackets,
for which they need patients, for which they need diagnoses to declare
them fit for psychiatrist care.
Possibly so - but then I am convinced, having wrestled myself through DSM-5 and APA prose, that their style of writing is quite intentional and quite crafty:
They are vague, ambiguous, imprecise and suggestive because they want to be, because they do not want to be found out, and besides ill pretentious ambiguous writing is much easier to produce than honest, realistic and precise writing. The staff of the DSM-5 may not be capable of it, for the most part, but it certainly is very much in their own interests to be vaguely grandiose, imprecise, and full of ambiguities, unclarities and innuendos and suggestions.
More could and should be made of this, indeed as was done of the NASA's failings: You should not expose patients or astronauts to untested flaky "science".
I believe that the chiefs of the DSM 5 can write much clearer than they do in the DSM 5, and indeed that to do so requires no great intellect or special abilities to write on their parts: They want confusion, they don't want clarity, for they don't want to be found out.
Well, my own guess about dear doc Regier is that he is a major fraud, whose mission is to see a DSM 5 to the press that is as ambiguous, pretentious, confused, and unclear as he could make it.
He is not casual
about time: He is casual about science and morality, and that because
he knows the DSM-5 is not scientific and not moral. But he firmly
trusts he can get away with it, namely by writing intentionally in an
obscure and ambiguous fashion, while insisting all the time he and the
APA mean o so very well.
Why should one accept the self-advertising of anyone, including shrinks, as if that is the last or the most rational words on the subject?! And why do so few people discuss the obvious major financial interests that psychiatrists have, in their profession?
My own conclusion is that the DSM 5 shows that the APA and psychiatry do not belong in - real, rational - medical science: They belong in pseudoscience, medical fraudulence, and woo. They should simply be terminated, as the cheapest, most rational and most moral decision, given the facts of the matter and the ends of medicine.
O you lying
bullshitters! ANY two, three
or four capable philosophers of science or methodologists can make
total mincemeat of the whole DSM-5 on purely methodological
grounds! And WHY be so mightily offensive about - for one example -
Psychological Society?! Since when is a bunch of ill-trained very
pretentious very ill writing US shrinks more capable or more expert
than a select committee of the BPS?
One interesting possibility is to hand over the DSM-5 to philosophers of science, or to professor Frankfurt, the philosophical writer of "Bullshit", or to psychologists, or to physicists, and ask what they think of it. Well, for my money, as a psychologist and philosopher, it is plain bullshit that exists to help make psychiatrists defraud ill people with pseudoscience.
Besides, firstly, for one thing almost all psychiatrists I have read (all, except for McCulloch, Ashby, and Arieti) had a lousy or absent understanding and knowledge of real science and good methodology, so in my eyes the probability that most of the editors of the DSM-5 are unqualified to do their own "scientific review process" is much larger than 1/2; secondly, no one is a good judge of matters his own interests and livelihood depend on; and thirdly, there are vastly more capable real scientists than the psychiatrists who wrote the DSM-5: Ask professor Frankfurt; read the late professors Feynman and McCulloch; or ask the BPS, who wrote a good criticism of the DSM-5.
I never heard of them, and a brief search suggests they are a commercial and legal international firm. Maybe they are qualified, in my eyes, maybe not. But for what it is worth: Both the British Psychological Society and part of the American Psychological Association (not: "Psychiatric") have criticized the DSM-5 in no uncertain and what must be quite well-informed ways.
Personally, I don't think so, and for the same sort of reason I believe this about Catholic cardinals: Their public statements serve to confuse the public, to help the faithful, and to defend the Church, rather than to speak the truth or than to say what conforms to real science.
My own guess is that the APA and the editors of the DSM-5 proceed in a planned way, and know quite well what they are doing:
They want more power and more money, and the way to get these is through unclear, flawed, immoral, but very pretentious texts and teachings, and that's not only so in psychiatry, but in almost any business for money - though psychiatry is the only supposed science where this can happen.
I agree, and dr. Frances is to be strongly commended and much thanked for having the courage to stand up and criticize his own colleagues, on admirable moral and good intellectual grounds.
Whether it will
help I personally doubt, but then it should be clear to many from his
writings about the issues that much IS flawed AND immoral about the
Then again, there is an intelligent and benevolent minority in most groups - in case you might be somewhat disappointed in humankind, or at least in psychiatrists.
These are very human weaknesses, and one of the other very human weaknesses is the avoidance of as much as openly and rationally discussing the possibility that their own leaders may be lying to enrich themselves.
In my eyes, politics, religion and psychiatry are three fields of human endeavour where there is very much lying, usually but not solely for the purpose of personal benefit, and indeed very much more than there is in the real sciences, which is one major reason for me to like real science, and to avoid participating in politics, religion or psychobabble of any kind.
As to ME/CFS (that I prefer to call ME):
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.
See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.
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