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  Feb 11, 2012                  

DSM-5: Allen Frances vs the American Psychiatric Association (2/3)


   "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
        2. "The DSM 5 Follies, As Told in Its Own Words"

This continues the first part of this series, and has the same introduction as the first part, so if you've read that you can skip it and jump straight to section 2.

1. Introduction

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:

Nothing can illustrate how far DSM 5 has gone off track better than the words spoken in its defense by DSM 5 leadership. Dayle Jones and Suzy Chapman have assembled (from among many others) the 10 most wrong-headed quotations, and I have annotated them with my own thoughts.

1. "And that's what the DSM is -- a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn't found to support them."

No! DSM 5 is most decidedly not "a set of scientific hypotheses"; it is an official manual that will influence people's lives for better (and sometimes for worse) in enormously consequential ways.

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!")

DSM 5 is not a research agenda "intended to be tested" after its publication; it must hit the ground safe and scientifically sound.

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.

Any DSM 5 proposal for change that lacks strong evidence should be considered "disproved" right now, without further ado before publication, not after. Our patients are not guinea pigs for reckless DSM 5 experimentation.

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.

Allow entrance into DSM 5 only for changes that have already passed muster.

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".

"It's the economy, stupid!": "We are only in it for the money!" (And almost completely uncontrollable! "Only We are experts on Our business! Trust Us!")

Exclude everything that "has not been tested as well as we would like." DSM 5 is not a place for the untried speculations and the pet theories of the assembled experts. Add new suggestions only if they are well studied and of proven worth and safety.

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 bloody cant: 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.)
Besides, psychiatrists - that I have read, with hardly any exception, and the exceptions odd ones, among psychiatrists, like W.S. McCulloch and W.R. Ashby - do not have any adequate notion of methodology or real science, that is, if they are not very clever liars.

Furthermore, nearly all psychiatry I read was much flawed by logical, methodological and epistemological fallacies of the grossest kinds, while "making up" for this by the most pretentious claims about what it would and could explain and do for one.

DSM 5 is introducing a variety of dimensional measures. Dimensions are more accurate than categories in describing continuous variables (e.g., IQ, height, weight, blood sugar).

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.

Providing dimensions could have been a useful advance if done well. But the measures suggested by DSM 5 are ad hoc, untested, and so impossibly time-consuming and unnecessarily complex that they will never be used in clinical practice.

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.

Incidentally: "clinical practice" is a false or misleading notion in this context, and indeed is so in the way psychiatrists and medical folks tend to confuse these: What is the practice in clinics is not and should not be what is the practice in research, simply because clinics exist - if moral and rational - to apply the findings, theories and treatments approved by - moral and rational - research.

A premature and poorly done dimensional system will have no result other than to give dimensional diagnosis an undeserved bad name.

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.

And it makes no sense to compare assessing mental disorders to assessing cholesterol or blood pressure so long as psychiatry has no objective biological tests.

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.

Our diagnoses are now, and will remain for some time, necessarily far less precise than those in the rest of medicine.

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?

As it is, the patients have to pay for the mistakes the psychiatrists and doctors make, who also - in my experience - NEVER provide a clear risk analysis, of the form "The probability my diagnosis is correct is d; the costs of my diagnosis being incorrect is c". So let me do it, briefly: 

In mathematical terms, I'll use T for successful treatment, D for diagnosis, pr(X|Y) for the conditional probability of X on Y and va(X) for the value of X, for which we assume this axiom (AV):

(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:

Consider pr(T|D)=P and

The last is the expectation of the diagnosis (on average, in the population): The value of a successful treatment times its probability on the diagnosis plus the value of a non-successful treatment times its probability on the diagnosis.

So when is exp(T|D) not less than zero? That is: When is the sum of the outcomes with the given values and probabilities at least zero? Which is a result that suggests that it might be worth trying, while it is not when less than zero?

Here is the answer, worked out step by step:
                           va(T)*pr(T|D)+va(~T)*pr(~T|D) >= 0  IFF    

introducing convenient abbreviations: V = va(~T), P=pr(T|D) etc.:
                           V*P+ V*(1-P) >= 0 IFF    

and gathering terms:

                            P*(V-V) >= -V      IFF    

while using (AV) to get only non-negative terms and |x| for positives (and if V is negative, as assumed, -V = |V| must be positive by (AV)):

                           P*(V+|V|) >= |V|  IFF    
So dividing both sides, using (AV) while assuming it is V that is positive:

                           P>= |V| : (V+|V|)

So on this approach a diagnosis and treatment make sense only if the probability that the treatment is successful on the diagnosis is at least as large as the absolute value of a non-successful treatment divided by the sum of the absolute values of a successful and an non-successful treatment. (V assumed positive, hence without sidebars to indicate it.)

This implies that if |V| - the harm done by a non-successful treatment, in absolute terms - is much larger than V i.e. the good done by a successful one, then pr(P|D) should be close to 1 to make exp(T|D) greater than 0. It also implies that if |V| is small, the pr(P|D) need not be large to make exp(T|D) greater than 0.

I suggest that by this criterion many - I think: Very probably most - psychiatric treatments should NOT take place: Their expectation (in terms of reasonable values of the treatment to the patients, and not in terms of the financial expectations to the therapists!) is less than 0, usually because the cost of an unsuccessful treatment is too high.

This also applies to prescribing exercises to people who are ill, especially with ME/CFS.

4. "The revision should be a living document. That's so we can convene expert panels more frequently in the future."

Please spare us a future filled with frequently convened expert panels; their fickle suggestions will likely do far more harm than good.

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.

To illustrate from Wikipedia:

Primum non nocere is a Latin phrase that means "First, do no harm". The phrase is sometimes recorded as primum nil nocere.

Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

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.

And since psychiatry is about money, for psychiatrists: Let me note in passing that the APA's "expert panels" seem to be taken care of very liberally, financially speaking, in the best hotels also. At least from what I have read about the making of the DSM-5: Clearly, these "36.000 physican leaders in mental health", to quote them:

 take very good care of their own personal well-being and interests!

Expert panels are largely responsible for the mess DSM 5 is in now. Why so? Experts live in an ivory tower world and don't appreciate how suggestions that may work for them can be so badly misused in the real world.

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 the psychiatrists.

Therefore - I conclude - psychiatry should be removed from medical science, as a legitimate medical specialization, and GPs should take over, and receive some more education for it (because I do think people may get mad, and the mad deserve help, and also society deserves protection, but I also think that if you don't have the relevant empirical facts you can't construct a scientific theory that requires knowledge of such facts. Therefore: Exit psychiatry, as a medical specialization, for there is no rational basis for it, and indeed historically most psychiatry was evident baloney that mostly benefited the psychiatrists.)

We should avoid making changes arbitrarily and instead wait until scientific discovery makes it clear that change is necessary.

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.

There are no prospects for quick breakthroughs in psychiatric diagnosis in the near future except for Alzheimer's, where diagnostic tests may be available in several years.

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.)

I have hardly seen else of the leading DSM-5 folks, like Regier and Creed. Besides, the fallacy used also wholly avoids the issue whether the medicalization that the DSM-5 offers is based on sound fact, which it is not at all: It is based on psychiatric greed for money and power.

The fear that DSM 5 is conducting a "wholesale imperial medicalization of normality" originated with me, and I am a great defender of psychiatric diagnosis and treatment -- but only when it is done well and within its proper sphere. Most of the widespread criticism of DSM 5 is not directed toward psychiatric diagnosis in general, but toward the careless way DSM 5 has been prepared, and toward its disregard for the harmful unintended consequences it will most certainly cause.

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.

6. "Our intent is not to increase or decrease prevalence, but to make something that is more accurate and scientifically based."

DSM 5 will dramatically increase prevalence by adding five new, very common "disorders" that together will mislabel many millions of people now considered normal.

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!

Also, DSM 5 plans to lower thresholds for many of the existing disorders, turning normal grief into depression and dramatically increasing rates for attention-deficit disorder and generalized anxiety disorder. It is simply irresponsible not to be concerned about or measure the major impact this will have on the over-use of medication, on stigma, and on the misallocation of scarce resources.

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!

DSM 5 literature reviews are remarkably variable in quality; often one sided, incomplete, and unsystematic; and sometimes giving undue weight to unpublished papers or papers authored by DSM 5 work-group members. The DSM 5 changes are mostly unsupported by scientific evidence.

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. (*)

8. "A kappa for a DSM-5 diagnosis above 0.8 would be almost miraculous; to see a kappa between 0.6 and 0.8 would be cause for celebration. A realistic goal is kappa between 0.4 and 0.6, while a kappa between 0.2 and 0.4 would be acceptable."

DSM 5 is not-so-subtly warning us that the reliability results from its field trial came in so low that we should accept a level of diagnostic agreement far below the universally accepted minimum standards.

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!)

It wants to include some definitions whose diagnostic agreements are barely better than chance -- which means they are useless.

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.

That is: They are included because they are useful - for psychiatrists. As to the patients: The APA wants you to believe all they do is in the patients' interests. I think they plainly lie, plainly are immoral and unscientific, and plainly ought to be terminated as a "scientific discipline" or as a "scientific specialism" in medicine: It is pretentious fraud, designed to benefit psychiatrists at the costs of the ill.

The unacceptably low reliability is caused by the remarkably imprecise DSM 5 writing.

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.

This was supposed to be corrected in a second stage of field testing, but DSM 5 so badly missed its deadlines for the first stage that Phase 2 had to be stealthily cancelled.

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".

Low reliability is unacceptable; DSM 5 should rewrite and retest its poorly performing criteria to ensure that they do not cause great confusion.

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.

9. "When asked if he thinks the APA can adjust revisions by the end of this year, Regier says 'there is plenty of time.'"

Perhaps this casual attitude toward time explains why every DSM 5 deadline has been missed -- some by a whopping 18 months.

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?

The poor planning and execution of DSM 5 have already forced a postponement from its original publication in 2012 to 2013, and yet another postponement is now necessary if it is to meet even minimal standards of quality.

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 - the British 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?

This whole phrasing is Catholic in its brazenness and gross fallaciousness: As if anybody not having the proper faith is not qualified to judge it.

Indeed, anybody with a sound mind and some understanding of what real science is really like can easily and rationally conclude that the DSM-5 is not real science, and is not by a LARGE measure: The writing is horribly ambiguous and unclear, and nearly all that is put forward has no good rational empirical evidence of any kind, as anybody can know who knows how little is known about how the brain works and malfunctions. (Indeed, for my money, the great writers have a far better understanding of human nature and human experience than any psychiatry I have read.)

This statement is in response to the request for independent scientific review contained in a petition endorsed by 47 mental health professional associations.

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.

Because it is internal, secret, and porous, DSM 5's own scientific review process has no credibility.

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.

But contrary to the quote, there is a very clear and highly desirable alternative. The Cochrane group is expert in conducting independent, evidence-based scientific reviews to guide medical decision making. Cochrane should be contracted by APA to review the most contentious diagnoses. There is no other way DSM 5 can possibly gain the public trust.

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.

                                      * * * * *
This is just a select sample from among any number of equally self-incriminating quotations that consistently hoist DSM 5 on its own petard. The public statements of the DSM 5 leadership consistently reveal just how insulated they are -- far out of touch with the proper purpose of their task and unable to see serious risks that seem perfectly apparent to everyone else.

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.

DSM 5 is probably stuck on its disastrous course unless it can finally be restrained by outside forces --some combination of press shaming, public and professional opposition, and/or governmental intervention. Time is running out.

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 DSM-5.

Anyway... dr. Frances did his best, and I like the article. I gave my disagreements, but then I am not a psychiatrist, and I also never made any money by being a psychologist, and have no illusions to loose about either kind of psy or their claimed "science" or their real motives, nor any loyalties to preserve with either kind: Most of psy is pseudoscience or fringe science, not real science (illustration from last link, in Wikipedia):

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.

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(*) Maybe I should make a general remark on lying, egoism and greed:

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.

See also: The myth of mental illness, by Paul Lutus (not a psychologist or psychiatrist but a space scientist and computer programmer).



Corrections, if any are necessary, have to be made later.
-- Feb 14, 2012: Corrected some unclarities and typos, and added some links.
-- Feb 22, 2012: Renamed the file to NL120211aa.html



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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