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  Apr 24, 2012                  
     

DSM-5: There is at least one sane psychiatrist (it seems)


If you have been following Nederlog for a while, or have looked in the indexes (Nederlog is in its nineth year, my site in its sixteenth), you may have noticed that since late 2009 I have written rather a lot about psychiatry and the DSM-5 - which I did not do before that date, as you can find out yourself. I explained the reasons for this four days ago, in my DSM-5: The six most essential questions in psychiatric diagnosis - 0 as follows:

my reasons to write about the DSM-5 and psychiatry are not, in the first place, my strong interests in science, philosophy and ethics, but the fact that I have found that the fact that I am ill with ME/CFS has been a reason for psychiatrists and clinical psychologists to slander and defame myself and millions of others with my disease:

According to psychiatric frauds like professors Wessely, Sharpe (also active in the DSM-5), White, Reeves, Bleijenberg (a clinical psychologist), both the World Health Organizations and thousands of medical researchers who are not psychiatrists, who have argued, in medical journals, on the basis of much research and evidence, that people afflicted like I am have a serious neurological disease, that is explicitly not psychiatric, must all, like me, be mad with "dysfunctional belief systems"... for which reasons I and many others with my disease have not received any help ill people do get for 34 years now, while scientific research - such as does not support the lies of the abovementioned frauds and medical malpracticians - into my disease also has been made impossible or very difficult where I live, because of what these frauds claim, and because politicians and bureaucrats want to save money, and do so preferably from folks who cannot defend themselves. [1]

My father survived almost 4 years of German concentration-camps - the link contains the text of his description of that - because he was a member of the Dutch resistance against Nazism. He could raise a family. I could not: I get no help; I have been consistently discriminated and slandered for saying I am ill; and I am denied the right on both help and research; in my country (Holland) at least tens of persons - according to a medical specialist in the disease - have committed suicide for this reason.

I must chalk this up to the claimed "sciences" of psychiatry and clinical psychology, that are hardly real sciences in the sense physics, chemistry and pharmacology are sciences, but instead are for the most part pseudosciences, that enable fraudulence, medical malfeasance, and the spread of bullshit in the name of "psychiatric science", and also to the depravity of some of its practitioners, that I see in the same light as the activities of the former president of the American Psychiatric Association Donald Ewen Cameron and the human-all-too-human motives that enabled the Action T4

So I have been empirically forced to see that psychiatry as practised and indeed as propagandized theoretically works as a strong force for evil: To harm ill people; to destroy their human rights; to save money by stultifying real scientific research into real diseases; to force GPs to abide by the opinions of the state's tame psychiatrists as to who is ill in what sense; and to abuse ill people.

And while not all psychiatrists or all psychiatry are bad or mad, most of its theories are bogus, deluded, pseudoscientific, or at the very best guesses in the dark with little empirical support, the facts about and around psychiatry, and its bureaucratic and governmental abuse have force me to conclude that a considerable part of is

"Malice is pleasure derived from another's evil which brings no advantage to oneself." (Cicero) 

which has been made possible by the sorry state of psychiatry as a science; the ease with with the majority of the public can be flummoxed; the - partially intentional - obscurity, untestability, and pretentiousness of its doctrines and prose; and the great financial advantages its abuse brings to psychiatrists, bureaucrats, governments and pharmaceutical companies.

And I am quite serious about this, for I am having pain constantly now for nearly 25 years, in which I have also been systematically denied any help whatsoever - help, moreover, that people living around me with far less serious diseases than I have (to judge by the hail and hearty ways they wash their cars that they got because they are supposedly ill) receive as a matter of course; help that almost certainly would have enabled me to live a less miserable life with less pain.

But I am not entitled to any kind of help whatsoever, because a bunch of psychiatrists have decided it is more convenient for their and the Dutch state's interests if the likes of me are driven to suicide and kept in abject poverty: That saves millions of my fellow Dutchmen some eurocents; that saves the Dutch state many millions they can instead pay out in pensions or perks to parliamentarians, bureaucrats or bank managers; and that helps psychiatrists and clinical psychologists to some eighty thousand ill Dutchmen they can then freely - with governmental blessing and proctection - abuse, slander, defame and drive to suicide for excellent pay and to satisfy their deepest personal needs, as self-proclaimed specialists in the (pseudo)sciences of psychiatry and clinical psychology, who may as yet only own up to their private selves and their brother therapists that, really, they're only in the game for money or for  personal satisfaction.

Having written rather a lot that is quite critical of psychiatry and clinical psychology I am glad to find there are some psychiatrists who agree with me, probably without knowing of my existence and writing, just as I did not know of their existence and writing till very recently.

Indeed, I do not systematically search for things relating to psychiatry or psychology on the internet, although I am, in terms of academic degrees, a psychologist (and a philosopher), mostly because I have long ago decided neither is a real science, and neither will teach me much except more reasons to believe most men are not very rational, nor very intelligent, nor especially honest.

Then again, I have a correspondent who is much more informed about the sorry state of modern psychiatry, and who sends me materials, including the stuff relating to The six most essential questions in psychiatric diagnosis that I have been reviewing, who the other day send me more of the discussions about and around this in the Bulletin of the Association for the Advancement of Philosophy and Psychiatry of the year 2010.

This is entitled - see how humble psychiatrists are, naturally and by education, and check the next link if you don't understand my sarcasm - "Symposium on DSM-5", and in this "Symposium"'s part 1, dated 2010, I found what may be evidence for what - conceivably, possibly - may be an actual psychiatrist with academic tenure who (the mind boggles) may be sane, or more so than not.

As the reader may have noticed, I may have picked up some of the rhetorical devices that may come with being a psychiatrist or clinical psychologist, since there may be evidence that suggests that persons thus afflicted may use the words "may" and "suggest" and "evidence" in ways appropriate in and peculiar to their "education" and mind set, which is such that they cannot stand - quite possibly on grounds outlined by their fellow Alfred Adler - being found out, contradicted, doubted, or - God forbid! - satirized.

I am therefore glad to have discovered what may be evidence for what may be a - partially: we all know there may be evidence that psychiatrists may like to qualify - sane tenured academic psychiatrist.

The gentleman's name and qualification is G. Scott Waterman M.D.; the text on which I base my diagnosis is on p. 19-20 of Volume 17, Number 1 of what reached me as the Bulletin of the Association of the Advancement of Philosophy and Psychiatry, and it has been co-written by David P. Curley, Ph.D., who also risks being unbeloved by Dr Regier and other DSM-5 worthies. [1]

Here is the text from that Bulletin:

Quote:


Doing No Harm: The Case Against Conservatism

G. Scott Waterman, M.D.
David P. Curley, Ph.D.

Department of Psychiatry
University of Vermont College of Medicine

We agree fully with the proposition that the diagnostic system used in psychiatry – and proposed changes to it – must “first do no harm.” And although we believe that the publication in 1980 of the DSM-III marked a monumental advance for our discipline, we are convinced that continued progress in psychiatry necessitates that our system of diagnostic classification undergoes radical revision.

Allen Francis is entirely correct that the current state of sciences relevant to psychiatry makes formulation of a nosology based on etiopathogenesis grossly premature. He is also on target with his admonition regarding the potential of change to carry with it unintended negative consequences.

What he does not address, however, are the negative consequences of leaving largely unchanged a taxonomy we know to be inadequate at best and simply wrong at worst. The progress-retarding effects of the current system on all areas of psychiatric endeavor – clinical, educational, and scientific – must be recognized and remedied.

Our appraisal of the DSM system begins with its overall structure – namely, the “axes.” Despite its authors’ explicit wishes to the contrary, the spurious separation of “mental disorders” from “general medical conditions” is reified by the multiaxial system, contributing to (among many other important fallacies) the false conviction that there is actual substantive content to disputes over whether illnesses such as fibromyalgia or irritable bowel syndrome are “really” mental disorders or “physical” disorders. Similarly, the distinction between “clinical disorders” (Axis I) and “personality disorders” (Axis II), which masquerades as one of the deep and fundamental branch points of psychiatric diagnosis, serves as a nidus for some of the least productive and least meaningful exchanges in all of clinical psychiatry and psychiatric education.

Moving from the multiaxial structure of the taxonomy to the contents of its diagnostic categories, the first assumption we must challenge is that DSM diagnoses are “descriptive.”

Even if it were true that all of its categories were defined in such terms, it is questionable whether or not the current system has identified what we need it to describe. The conviction of most clinicians, which seems borne out by recent data (see below), appears to be that it has not. Moreover, the assertion that DSM diagnostic categories are in principle defined descriptively is belied by the definitions of somatoform disorders, adjustment disorders, and disorders “due to a general medical condition". Somatoform disorders are said not to be “fully explained by a general medical condition.” Since few (if any) entities in medicine are “fully explained” in any sense, that construct is problematic to say the least. In addition, the definitions of some of the somatoform disorders demand that they be associated with “psychological factors,” a diagnostic requirement that is as flexible as it is vacuous. The etiological assumption implicit in the category of adjustment disorders is obvious, but unfortunately leads many consumers of the diagnostic system to the spurious conclusion that, in contrast to adjustment disorders, more significant psychopathology must come “out of the blue,” a common misconception that flies in the face of what we know about the etiological contributions to many forms of psychopathology of adversity in the social environment. And the disorders “due to a general medical condition” – in addition to being another example of an etiological as opposed to descriptive organizing principle in the DSM – simply add an unnecessary layer of psychiatric/medical dualism onto the already-familiar primary versus secondary distinction used in all other medical contexts. Related to this reification of dualism is the effect that this diagnostic category has in fostering the fallacious view that the etiopathogenetic mechanisms by which psychiatric syndromes occur come in two distinct flavors: “medical” (e.g., thyroid dysfunction, stroke) and “psychiatric” (e.g., inherited vulnerability, social environmental adversity).

While the above-described problems with the multiaxial framework of, and the etiologically defined categories in, the DSM are considerable, our most fundamental objection – and main justification for advocating a radical overhaul – relates to what is turning out to be the error of the neo-Kraepelinian assumption of the DSM-III/IV/IV-TR enterprise: that psychiatric diseases are discrete entities, as defined in the DSM, with which humans either are or are not afflicted. Accumulating evidence renders such a conceptualization antiquated, and the necessity of freeing psychiatric research, education, and practice from its adverse effects urgent.

The powerful statistical tools of latent variable modeling have suggested that the phenotypic structure of clinical psychopathology as it exists in actual people differs considerably from the definitions established by DSM committees.

Such findings call into question the validity of DSM subtypes of attention-deficit/hyperactivity disorder (ADHD) (1,2), depression (3), and anorexia nervosa (4); distinctions among ADHD, oppositional defiant disorder, and conduct disorder (5); the distinction between juvenile bipolar disorder and post-traumatic stress disorder (6); the distinction between depressive and anxiety disorders (7); and distinctions among psychotic disorders (8). Further evidence that the initial stab of DSM committees at formulating valid diagnostic boundaries missed the mark is provided by the near ubiquity of “comorbidity” among psychiatric patients.

Thus, it appears that in many important instances DSM diagnostic categories neither encompass within them nor distinguish between them those clusters of cognitive, emotional, and behavioral abnormalities that comprise the phenotypes of actual patients.

That recognition doubtless explains why attempts to link specific genes, environments, and their interactions to the etiopathogeneses of particular psychiatric disorders have largely been disappointing, and why psychiatric geneticists must frequently rely on other taxonomies to identify phenotypes to study. It likely also underlies the fact that effective treatments for psychopathology have very little diagnostic specificity, nor do the criteria for most DSM diagnostic categories demarcate syndromes that even approach homogeneity with respect to treatment responses.

Dr. Frances has again provided psychiatry a great service, this time by stimulating widespread thought and debate on the question of whether in the next edition of the DSM the diagnostic system of the past three decades should remain largely intact.

Our answer is no. The validity problems associated with both the structure of the taxonomy and many of its specific elements are burdensome to the discipline as it is currently practiced and taught, and impede its ability to make needed progress. Criteria to be used in determining its replacement should emphasize consistency with currently available evidence regarding clinical presentations of psychopathology. Also of tremendous importance are usefulness in the clinical arenas of prognosis and treatment response, in the investigation of the genetic and environmental contributors to etiopathogenesis, and in the education and training of students and residents, where cessation of teaching and learning DSM diagnostic rules could make room in curricula for actual science. Determining the form of our next nosology is a formidable but exciting project that we must undertake for the wellbeing of our discipline and of our patients.


Unquote.

In case you missed it: Here are some of the points that risk Dr Regier's ire while earning my praise - and I quote by multiple copy/paste from the above, but I have added some bracketed notes to clarify my own take:

        • We agree fully with the proposition that the diagnostic system used
          in psychiatry – and proposed changes to it – must “first do no harm.”
        • we are convinced that continued progress in psychiatry necessitates
          that our system of diagnostic classification undergoes radical revision.
        • The progress-retarding effects of the current system on all areas of
          psychiatric endeavor – clinical, educational, and scientific – must be
          recognized and remedied. [2]
        • Our appraisal of the DSM system begins with its overall structure –
          namely, the “axes.” Despite its authors’ explicit wishes to the contrary,
          the spurious separation of “mental disorders” from “general medical
          conditions” is reified by the multiaxial system, contributing to (among
          many other important fallacies) the false conviction that there is actual substantive content to disputes over whether illnesses such as
          fibromyalgia or irritable bowel syndrome are “really” mental disorders or
          “physical” disorders. [3]
        • Somatoform disorders are said not to be “fully explained by a general
          medical condition.” Since few (if any) entities in medicine are “fully
          explained” in any sense, that construct is problematic to say the least. [4]
        • In addition, the definitions of some of the somatoform disorders demand
          that they be associated with “psychological factors,” a diagnostic
          requirement that is as flexible as it is vacuous. [5]
        • And the disorders “due to a general medical condition” – in addition to
          being another example of an etiological as opposed to descriptive
          organizing principle in the DSM – simply add an unnecessary layer of psychiatric/medical dualism onto the already-familiar primary versus
          secondary distinction used in all other medical contexts. [6]
        • Further evidence that the initial stab of DSM committees at formulating
          valid diagnostic boundaries missed the mark is provided by the near
          ubiquity of “comorbidity” among psychiatric patients. [7]
        • The validity problems associated with both the structure of the taxonomy
          and many of its specific elements are burdensome to the discipline as it is currently practiced and taught, and impede its ability to make needed
          progress. [8]
        • (..) cessation of teaching and learning DSM diagnostic rules could make
          room in curricula for actual science. [9]

Incidentally: While I mostly agree with doctors Waterman and Curley, it is quite possible I don't agree with them on the finer point of psychiatric diagnosing - but even so: It is nice to see a psychiatrist who makes sense.

It's true I know it happened before, but even so, it is nearly miraculous enough to agree with Madame du Deffand that "Il n'y a que le premier pas qui coûte", and to hope that the next step is the total ditching of the DSM-5 and its replacement by something that - at long last! - makes rational and scientific and moral and legal sense - and that indeed factually abides by the medical and moral rule that it is a doctor's duty to see to it that his practice must first do no harm”, instead of breaking that rule as a matter of course and ordinary psychiatric practice in many cases.


                                                      Notes

[1] Actually, I don't know messrs. Waterman and Curley from Adam, and they very probably are as informed about me as I am about them - which I remark to plead resp. myself and them free from any responsibility for the opinions of resp. them and me.

[2] Quite - and being a patient I mention the somewhat easily forgotten fact that medical science, which psychiatrists claim to be involved in, does not exist to help medical scientists gain a well-paid livelihood (I agree there is nothing bad about this, if the medical scientist is a real and moral scientist), but to help patients who are ill or suffer a lot, and I also like to suggest that the best remedy for the many ills and abuses implicit in the DSM-5 is to stop and/or replace it by something much better - which cannot be difficult given how thoroughly irrational, unscientific and immoral it is.

[3] I quite agree with the suggestion that these are illnesses and not psychiatric disorders - and add that those who have introduced this gambit in psychiatry (to the effect of: Unexplained illnesses are psychiatric disorders, until proved otherwise) should be prosecuted for gross medical incompetence or malfeasance, and for slander, defamation and character assassination  of millions of people who are ill according to the WHO and according to many more medical doctors who are not psychiatrists than there are psychiatrists.

[4] Quite: Another excellent point, especially made by psychiatrists - and I like to add that the whole concept of "somatoform disorder" is pseudoscience and has been extremely harmful for people like me: I cannot use my talents and degrees because I am forced to clean up my own house and do shopping as best as I can, which is not very well at all. This has cost me almost 25 years of constant pain now, without any help, and with sadistic denials by bureaucrats or Dutch medical doctors if I raise the possibility (!) that it may (!) not be quite moral to deny help to someone who has a serious neurological disease to this day according to the medical diagnostic system of the World Health Organization.

[5] Yet another excellent point, especially made by psychiatrists - and I like to add everything I have read by other psychiatrists about "somatoform disorders" struck me as bullshit and baloney that may very well be motivated by either the perversions of those making the diagnosis or the payments handed out by health insurances for doing so. Either is sick, immoral and medical malfeasance in my judgment.

[6] Quite: Either there is good and objective evidence for a diagnosis or making the diagnosis is medical malfeasance, especially if one knows that, as a consequence, health insurances or bureaucrats will proceed to abuse those having the diagnosis (e.g. of "somatoformer").

[7] Quite - though I suspect, also because of the large proportion of psychiastrists who have based their careers on the pseudoscientific concept of "psychosomatic illness" that this may be intentional, to help precisely this manner pseudoscientist claim more patients as his or her due or diagnose the ill as psychosomatic ill, thereby - o frabjous day for a medical sadist - denying them all forms of help other ill people are entitled to.

[8] I should like to kindly suggest that this is not only "burdensome to the discipline as it is currently practiced and taught" but extremely burdensome to what may be several tens of millions of people who have been misdiagnosed as being "somatoformers" by psychiatric frauds while having a real disease, such as M.E., Lyme Disease, F.M. or M.S. according to the World Health Organization.

There must be something very rotten in the states of medicine and psychiatry if - as is the case - for decades now psychiatrists are completely free to wipe their asses with diagnoses of ill people according to the criterions of the World Health Organization, and instead diagnose them as "somatoformers", thereby knowingly driving many to suicide because of lack of any medical help combined with much bureaucratic and medical discrimination.

These days it is forbidden in law to discriminate homosexuals or women or blacks for being homosexual, female or dark skinned - but it is applauded by psychiatrists, bureaucrats and politicians if an ill person is diagnosed with a practically, socially and legally very harmful diagnosis - to the effect that one is not really ill but either insane or a malingerer, and thus should be forced to learn to work, with graduated exercise therapy, and forced to learn to think, with cognitive behavorial therapy - all because psychiatrists have been inventing fictions and sold them to the public and to politicians as if these injurious fictions were "medical science". In fact these are not only pseudoscience but are in plain contradiction with the rulings and classifications of the World Health Organization and the moral duties of anyone with a medical degree to "first do no harm": Psychiatrists apparently first may do harm, and then may plead their innocence because they do it, verbally and falsely and dishonestly, in the name of "evidence-based medical science".

What manner of criminal negligence and raving incompetence is this? Why is this allowed against defenseless ill people and forbidden against - say - black people: You are effectively a sub-human without civic and human rights such as a bit of help when you are ill, and namely and specifically because you are black pardon: ill with a disease the WHO admits as a serious neurological disease (since 1969) and insists explicitly is not a psychiatric disease (since 1994)  but that fraudulent and/or plainly sadistic shrinks who have the ears of the government, just like slave ship owners used to have the ears of the government, declare to be a form of madness that also is the fault of the patients' dysfunctional belief systems, for which reason these patients are not entitled to any help and instead forced to work and forced to undergo cognitive behavorial therapy, to the great financial benefit of psychiatrists?!

What degree of plain sick sadism by nominal "medical colleagues" is required to bring about that those who do this ought to be sanctioned and removed from any medicine based on moral norms like "first do no harm"?!

[9] Quite: You can't do real science on the basis of real nonsense, however profitable that nonsense is for psychiatrists, pharmaceutical corporations and governmental bureaucrats. But I do like the sarcastic phrasing: "cessation of teaching and learning DSM diagnostic rules could make  room in curricula for actual science".


P.S.
Corrections, if any are necessary, have to be made later.
-- Apr 25, 2012: Corrected some 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)
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 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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