DSM-5: Question 1 of "The six most essential questions in psychiatric diagnosis"

Introduction to this text

This is a long review of the Contributions to the first of the six questions that have been billed as The six most essential questions in psychiatric diagnosis in a series that appears in Philosophy, Ethics, and Humanities in Medicine, that is still in the process of being published, with two parts fully or provisionally published, and two more to come.

I have reviewed the introduction to The six most essential questions in psychiatric diagnosis in the first of the two links in this paragraph. The second link is to the pdf version of part 1 of the series, and there also is a html-file of the same, that I use for the present review of Question #1.

As it happens, this review of the first of the six most essential questions in psychiatric diagnosis is a large html-file (over 500 Kb). The reasons for this are that (i) I think the subject is important and (ii) I am quite learned about several of its main aspects (having degrees in psychology and philosophy, and having recently found people with my real, painful and invalidating disease have been slandered and defamed since 1988 as not physically ill but as mad or malingering, which made it impossible for the last 25 years to get any help people with other illnesses get as a matter of course, while (iiii) I take the matter of psychiatry, its diagnoses, its power, and its public reception quite serious, especially since having learned how dangerous it is, and how it has been used against persons with the same disease as I have, and therefore have taken the quite considerable trouble of quoting all and also of explicitly discussing all arguments by all contributors to the discussion.

This makes my text long, and probably rather complicated, even for persons who are quite informed about psychiatry, philosophy, psychology or logic.

Here is a table of contents that links to all the main sections in this text, that should enable you to pick and choose, rather than read from the beginning till the end - though what's on offer is a thorough, mostly rational if occasionally satirical discussion by a psychologist and philosopher of science of the arguments by a highly trained largish lot of psychiatrists concerning the merits, demerits and foundations of their own supposed science.

What follows is an extended rational discussion of the mostly not very rational prose of the contributors to The six most essential questions in psychiatric diagnosis and specifically, and in this file only, its first question, which is as follows:

Question #1: How do we Choose Among the Five
Umpires of Epistemology?
Are DSM diagnoses more like constructs or more like
diseases? We would like to have the positions of each
of the five epistemological umpires stated as clearly
as possible.
Umpire 1) There are balls and there are strikes and
I call them as they are.
Umpire 2) There are balls and there are strikes and
I call them as I see them.
Umpire 3) There are no balls and there are no
strikes until I call them.
Umpire 4) There are balls and there are strikes and
I call them as I use them.
Umpire 5) Don’t call them at all because the game
is not fair.
Could you please the position of the umpire which
you endorse?

There is an endnote with some of my own conclusions and there are at various places instances of this link: ->Contents that enables you to read the sections in any order you wish.

I am sorry that this is so much text, but I thought it both fair and desirable to discuss all contributions and most arguments, because (i) I do have the requisite expertise about philosophy of science and (ii) much experience of the harm psychiatry does, simply by furthering pseudoscience and misdiagnosis that hugely benefit psychiatrists while much harming millions of patients with real diseases or quite other problems or illnesses than the pseudoscience psychiatry diagnosed them with.

Finally, my text is long because (iii) unfortunately psychiatrists ignore all criticisms of their field, pretensions, methodologies and treatments that do not come from fellow psychiatrists, thus pretending and suggesting in their own publications there is no criticism from other sciences while (iv) other scientists and most philosophers of science are so much disgusted by what they have read from the abundantly nonsensical and hugely pretentious books by psychiatrist that they tend to ignore it because they have far more interesting things to do. Also, (v) as it happens I seem to have talents for both logical argument and satire, and I don't like being slandered, defamed and harmed by what I consider medical frauds abusing the authority of their medical degree in the name of "evidence based medical science".

Therefore it seemed justified to me to write a long and thorough criticism. If you find this too long, as well you might, the ->Contents feature allows you to read those parts that interest you most.

General introduction to the following discussion

The following criticism has been written  with some background, that stands apart from my main motive to write it:

That my explicitly non-psychiatric neurological illness ME/CFS, according to the WHO's classification of diseases, that apply since 1969 to this day, that I have since 1.1.1979, turned out to be a disease that since 1988 has been stigmatized as a non-existing form of suffering, that is due to a psychiatrically diseased "dysfunctional belief system", that can be cured, it is claimed, by paying psychiatrists to give one "cognitive behavioural therapy", to launder one's brain free from the notion that the medical doctors of the WHO are NOT insane and not incompetent: From what these psychiatric frauds have lied about me and millions of ill people with my disease it follows logically that thousands of medical doctors, who are not psychiatrists must be at least as insane as I and these millions of ill people are, if not more, since they have medical degrees and do not claim to be ill.

This form of psychiatric insanity has been introduced by psychiatrists and clinical psychologists, who clearly are groups of professionals who will profit hugely from getting this scam accepted, and do so basically on the ground that any disease that is unexplained by real medical scientists is explained by the pseudoscientists who are psychiatrists, namely as a psychiatric disease, the patients of which are to be exclusively treated and research by psychiatrists, while the patients of this painful and exhausting disease are to be forced to work, without pay, until they have learned work discipline.

As is, these insanities and immoralities in the name of medical science are now the received notions for "treating" people with this disease in Great Britain and in Holland, and have driven many ill patients to suicide.

Apart from the above main motive to force my ill body to produce this text, I write it because

• I have - excellent - degrees in psychology and philosophy, both
  acquired while I and my ex-wife were ill with ME/CFS (after a
  bout of Epstein-Barr in January 1979)
  
• I have a large website about philosophy, logic, computing and
  ME/CFS since 1996
  
• I had hoped to have an academic career in philosophy of science
  or logic, in both of which I am very well-read:
  
• I can do so - unlike most people with ME/CFS - because I am gifted
  and besides nearly 62, and do not risk forced labour and forced
  brainwashing anymore, having succeeded in forcing the City of Amsterdam
  to that extent, with my site, personality and great talents
  
• I have received decades of sickening discrimination on the simple ground
  that I honestly said and believed that I have ME/CFS, as I have also been
  diagnosed with by at least four competent medical doctors, and am
  exceedingly angry about what I see as sick sadism on the part of the
  psychiatrists who manufactured this scam, against the rulings of the WHO,
  against medical morality ("first do no harm"), and against rational biomedical
  science, in the name of a pseudoscience maintained and furthered by liars,
  who play the public, the politicians and the parliament rather than face
  their competent medical colleagues.                          ->Contents

Presuppositions and rational and logical standards

Also, there are, next to my presupposed large knowledge of philosophy of science and logic, that I explicitly assume, having recently read tens of intellectually and morally incompetent and scientifically mostly ignorant psychiatrists and clinical psychologists on the subjects of my disease ("dysfunctional belief system"), character ("malingerer"), reputation ("somatoformer"), integrity ("liar or insane"), and motives ("wimp, laziness"), which I take as personal slander and defamation of myself and millions of others with my disease, a number of further presuppositions and criterions I will assume as known in the following texts in the next five introductory sections, that you can skip - very unwisely - at your own risk, using  ->Contents.

Backgrounds:

A.  Real philosophy of science

Since most that psychiatrists discuss or will discuss in The six most essential questions in psychiatric diagnosis does directly relate to philosophy of science, about which psychiatrists have been lying and misleading people for several generations now and still do so, let me provide the reader with a list of books that give the real thing, that you should know to be able to judge the poses and deceptive writings of psychiatrist on the subject of real science and on the subject of their own pseudoscience:

Psychiatrists, psychologists and others who have not read a good part of the above or can't handle the more formal parts should shut up about philosophy or science or the excellencies of psychiatry: They are posturing in a very immoral dishonest way, for which see my Morningstar shines a bright light on postmodernism.

B. Clifford's and Voltaire's dicta + Philosophical Dictionary

Clifford's dictum, formulated and argued by the English mathematical genius William Kingdon Clifford stems from his "The Ethics of Belief", that is highly relevant for the discussions that follow and reads thus:

" It is wrong always, everywhere, and for anyone,
  to believe anything upon insufficient evidence".

The above is also a link to the full text of "The Ethics of Belief" on my site, that also has my extensive notes on this text.

What happens when one does not abide by Clifford's dictum or is otherwise irrational or unreasonable was very well expressed by Voltaire:

  "If we believe absurdities,         
     we shall commit atrocities."    
     -- Voltaire 

This manages to diagnose the Inquisition, the regimes of Hitler, Stalin, and Mao, and the cruel inanities of psychiatrists (and much more) I have been forced to read because I am physically ill with a disease it is very profitable for them to lie about, and also applies to much of psychiatrists' beliefs and acts at large, though it is true there are some sane and decent psychiatrists as well, even though the psychiatrically received doctrines are far from rational and not reasonable at all. (Patients and their rights, as will also be seen in what follows, by its absence, are the least of the worries of most psychiatrists). Also: I do have excellent degrees since decades: I am not in the dole because I could not earn well if I were healthy.

I also presume my

Philosophical Dictionary

This is on my site, and contains over 600 brief and clear definitions of the meanings of philosophical and logical terms. I include it because, unlike psychiatrists, I am quite clear about the senses of the words I use, and as it happens these matter, if only because (i) one psychiatric peculiarity, as will be amply illustrated below, is the use of impressive sounding terms from philosophy or other sciences than psychiatry in a quite new psychiatric sense, and because (ii) very much of psychiatry is best understood as - intentional or acquired - abuse of words, intentional rhetoric and verbal acrobatics, and as an evident scam to help psychiatrist earn incomes in the highest income brackets by practicing a craft that is mostly bogus, but comes with much authority derived from clever propaganda by psychiatrists and the ignorance of the public, politicians and parliamentarians who believe their pretenses for lack of knowledge.                 ->Contents

C.  Scientific Realism and Postmodernism

What I shall argue, among other things, is that

• Modern psychiatry has all the features of postmodernism,
  none of the features of science.
   
• Psychiatry is an art rather than a science; intellectually
  psychiatry is bad philosophy or secular theology rather than honest medical science.

My reference here is my own brief essay on the subject, that I here partially repeat in a somewhat rewritten form to have my reasons and my reasoning explicit and in one and the same file and text - and the reader should notice, and will find out below, that my own text is very much clearer and more sensible than what psychiatrists offer, when asked to reflect on the intellectual foundations of their "science" - that is not a real science but a pseudoscience, and these days comes in the full regalia of carefully crafted and twisted postmodernism:

Scientific Realism versus Postmodernism

The subject is not only large but also too complex to receive an adequate and complete treatment in these brief essays in Nederlog which are always written fast, in poverty and in some pain.

After a little thinking I have prepared, like a finger pointing to the moon, a table of contrasts and oppositions between the things I call scientific realism and postmodernism:
 

		Scientific  realism	Postmodernism
		Properties
Assumption:		There is an independently existing reality that is best known by means of scientific methods and is best explained by and written in mathematics.	Both inside and outside the academic world careers, position, power and status are reached most easily by pretentious poses, moral delusions and general - cultural - relativism.
End:		Empirically tenable testable rational explanations of natural facts, that may be used to relief human suffering and satisy human desires.	Cant, waffle, purple prose and moral postures that may be used to further a career for the propounders by way of the media, politics or bureacracies.
		Methods
Cognitively:	1	realism	relativism
	2	probabilistic	totalitairian
	3	objective	ideological
Morally:	4	personal emancipation	social levelling
	5	change	freedom/empowerment (soi-disant)
	6	personal and a-political	political en politicised
Practically:	7	technologically oriented	power oriented
	8	scientifically oriented	media oriented
	9	individual thinking	groupthinking

One can draw other constants, stress other oppositions, or make a more refined analysis, but for the moment this should do, though I will give brief clarifications of these 9 contrasts between the methods of real science on the one hand and the modern fraudulence or delusion that is called postmodernism, and start with the two different assumptions on which they are based:

Assumption:

There is an independently existing reality that is best known by means of scientific methods and is best explained by and written in mathematics.

Both inside and outside the academic world careers, position, power and status are reached most easily by pretentious poses, moral delusions and general - cultural - relativism.

This is the fundamental contrast, opposition and distinction, and it is that between honest people trying to find the truth, and conmen and fools who exploit and/or believe in wishful thinking.

This is also what makes postmodernism and its rhetorical techniques among politicians, bureaucrats, and the more stupid run of intellectuals: It requires no talents or knowledge whatsoever, other than knowing how to pose, pretend, deceive and manipulate, and any stance that pleases one's audience is ipso facto valid.

End:

Empirically tenable testable rational explanations of natural facts, that may be used to relief human suffering and satisy human desires.

Cant, waffle, purple prose and moral postures that may be used to further a career for the propounders by way of the media, politics or bureacracies.

This is what is directly implied by the above fundamental contrast, opposition and distinction, and indeed thus it works - where it should be noted that the postmodern target group is that of the vast so called democratic ignorant or untalented majority, who are not interested in truth,  reality, rationality or reason but in what personally pleases and flatters them and in wishful thinking, that unfailingly succeeds in believing what their mediamanipulated prejudices and desires suggest to them.
 

1

realism

relativism

Science is realistic: Statements are true or not, provable or not and are or are not well supported by tested facts and/or repeatable experiments; postmodernism denies the existence of truth and serves as the propaganda of academic, political and bureacratic postmodern impostors and careerists, also strongly concerned with relativizing everything that does not serve their personal careers or incomes.
 

2

probabilistic

totalitairian

Science is fundamentally probabilistic: Theories and beliefs can be rationally estimated as more or less probable on the basis of objective evidence and many things can only be investigated and represented adequately by means of statistics; postmodernism presents totalitairian ideology of freedom/empowerment centered around a so called epistemology that reduces all human beliefs and desires to the same level that can be democratically voted upon and that depends on what The Media say and The People believe, in majority, in their universal equality of all with all.
 

3

objective

ideological

Science is based on knowledge of and interest in objective facts, established by objective observers, and on repeatable experiments, established by honest experimenters; postmodernism calls this an ideology but is itself explicitly ideological and totalitairiar, in a usually phony moral way: Whatever seems to oppose the postmodern rhetorics and propaganda of freedom that are presently in fashion, is postmodernisically decried as out of fashion, as lacking in solidarity, as tending to fascism (racism, sexism, homophobia etc.)

4

personal emancipation

social levelling

A very important motive of the real sciences and of real scientists is the personal emancipation of human individuals in accordance with their talents and the relief of suffering of all human beings; the postmodern freedom consists in the social levelling and equalisation nivellering, gelijkschakeling, en gelijkmaking of all and everyone until each is the equal or equivalent of all (except that postmodern leaders are just a little bit more equal than the rest, for which reason all well-paying jobs morally speaking ought to be reserved for them, for proper postmodernists).

5

change

freedom/empowerment (soi-disant)

Science is concerned with truly understanding reality and with finding the means to change the world in accordance with human desires, needs and interests; postmodernism is concerned with getting the best - most paying and most powerful - jobs to postmodernist academic, bureaucratic, political and journalistic careerist, by making them the most prominent Talking Heads of the day or age, and always does so by pretending To Emancipate, Liberate and/or Empower repressed women, blacks, gays and (after these all have postmodern well cushioned jobs) repressed humans of other fashionable kinds. (And this Emancipation / Empowerment in turn manifests itself -"physical 'reality' ... is at bottom a social and linguistic construct" - in the enforcement of the totalitarian language and terminology that is called Politically Correct.) 

6

personal and a-political

political en politicised

Real science is oriented towards the individual emancipation of all, and is produced by the intellectually most gifted individuals, for whom real knowledge of reality is a personal instrument of civilisation, liberation and emancipation; postmodernism is oriented towards liberating all by reducing everyone - but the leaders - to the same common level of humanity that is open to even the most stupid, the most lazy and the least moral (and especially of professors of postmodern philosophy and literary "science"), in the interest of all, or so it is postmodernistically claimed.

7

technologically oriented

power oriented

Real science - and only real science - leads to real human technology: New artefacts and constructions created by humans, that as really existing things, such as medicines, apparatuses and instruments, that are useful for others also if they lack the knowledge that was necessary to create them, and without having to pray, to have faith or to have to rely on priests, clergy, shamans, or postmodern media-sophists; postmodernism is driven by the lust for power and the desire to level all except the leaders to common folks one should respect, and in the end depends on rhetorics, lies, poses and their eventual democratic success because of the ignorance of the majority and misrepresentations in the media of nearly everything (that is not fit for being understood by ignorant common men and women, who are always in democratic majority).

8

scientifically oriented

media oriented

Real scientists address mostly other real scientists to receive criticism or support ('peer review'); the postmodernists are mostly media oriented because their message is in fact populistic, levelling, canting, and directed at the average (lacks of) qualities of the masses, and is in fact directed at furthering the emancipation, careers, incomes, and media fame of postmodern leaders and their philosophical and journalistic servants.

9

individual thinking

groupthinking

A real scientist is an human individual who has both the courage and the talents to think rationally for himself; the postmodernists, from lack of talent, lack of knowledge or lack of courage reason only in terms groupthinking, and swear by democratic majorities, however much deceived and manipulated, and swear by so called equality and equivalence of all for all, always in the name of human liberation and emancipation, except in the proportionally few individual cases (like me) who oppose the moral pretenses and irrational delusions of the postmodernists, and who generally cannot find any function in postmodern politics, institutions, and universities, other than as whipping boys.

I hope this little list of contrasts and oppositions is of some help, and if you want to know more you can follow the links or go to my site, that from a postmodern point of view is a horror show composed by a kind of fascist freak. (See my 39 questions about the qualities of education and government in the Netherlands for the reasons why I was repeatedly removed from the postmodern University of Amsterdam "because of your outspoken public opinions", something that happened only to me in Holland since World War II ended.)                   ->Contents

---

Finally, I presuppose two lemmas from the Wikipedia, that I will partially quote to have these in the text that contain my criticisms. The first concerns the actual contents and scientific tenability of psychiatry, which is a pseudoscience as defined:

D. Pseudoscience

Quote:

The distance between pseudoscience and science is filled with protoscience (and fringe science) which can be understood from the following table:^{[32][not in citation given]}

				Systematized as scientific definition
		Treated with scientific method
	Presented as science or looks like science
Superstitions	Pseudoscience	Fringe science	Protoscience	Mainstream science

A field, practice, or body of knowledge might reasonably be called pseudoscientific when (1) it is presented as consistent with the norms of scientific research; but (2) it demonstrably fails to meet these norms.^[2]

Karl Popper stated that it is insufficient to distinguish science from pseudoscience, or from metaphysics, by the criterion of rigorous adherence to the empirical method, which is essentially inductive, based on observation or experimentation.^[33] He proposed a method to distinguish between genuine empirical, non-empirical or even pseudo-empirical methods. The latter case was exemplified by astrology which appeals to observation and experimentation. While it had astonishing empirical evidence based on observation, on horoscopes and biographies it crucially failed to adhere to acceptable scientific standards.^[33] Popper proposed falsifiability as an important criterion in distinguishing science from pseudoscience.

To demonstrate this point, Popper^[33] gave two cases of human behavior and typical explanations from Freud and Adler's theories: "that of a man who pushes a child into the water with the intention of drowning it; and that of a man who sacrifices his life in an attempt to save the child."^[33] From Freud's perspective, the first man would have suffered from psychological repression, probably originating from an Oedipus complex whereas the second had attained sublimation. From Adler's perspective, the first and second man suffered from feelings of inferiority and had to prove himself which drove him to commit the crime or, in the second case, rescue the child. Popper was not able to find any counter-examples of human behavior in which the behavior could not be explained in the terms of Adler's or Freud's theory. Popper argued^[33] that it was that the observation always fitted or confirmed the theory which, rather than being its strength, was actually its weakness.

Unquote.

"And thus it was and is until this very day", as far as the contents of psychiatry is concerned, when considered realistically, and without prejudice in favour of psychiatry.

As far as the methods of psychiatry are concerned: While psychiatrists pretend they are medical scientists (they have a medical B.A. and then specialized in their pseudoscience, very probably in most cases without really understanding at first they specialized in a pseudoscience):

It is very much a rhetorical science, full of fallacies and tricks, that cannot be rationally understood in terms of scientific method, since what methods there are that seem scientific are often only there for make-belief, and is best understood as deliberate propaganda or - for its true believers - as intellectually and morally very bad philosophy, that pretends to be informed by scientific methods, but isn't, a few small parts - Parkinson's, Azheimer's, syphilitic insanity excepted (that psychiatrists always pretend can stand as pars pro toto, which is a fallacy):              ->Contents

E. Weasel words, bullshit, propaganda, rhetoric

First weasel words, the preferred method of nearly all psychiatrists I have read (a few of which may have been so unintelligent as to believe them):

-- Quote:

A weasel word (also, anonymous authority) is an informal term^[1] for equivocating words and phrases aimed at creating an impression that something specific and meaningful has been said, when in fact only a vague or ambiguous claim, or even a refutation has been communicated.
(..)
The use of weasel words to avoid making an outright assertion is a synonym to tergiversate.^[2] Weasel words can imply meaning far beyond the claim actually being made.^[3] Some weasel words may also have the effect of softening the force of a potentially loaded or otherwise controversial statement through some form of understatement, for example using detensifiers such as "somewhat" or "in most respects".^[4
(..)
The expression first appeared in Stewart Chaplin's short story "Stained Glass Political Platform" (published in 1900 in The Century Magazine),^[8] in which they were referred to as "words that suck the life out of the words next to them, just as a weasel sucks the egg and leaves the shell". Theodore Roosevelt attributed the term to Dave Sewall, claiming that Sewall used the term in a private conversation in 1879.^[9] Winston Churchill wrote: "The reserve of modern assertions is sometimes pushed to extremes, in which the fear of being contradicted leads the writer to strip himself of almost all sense and meaning." Current examples include governing parties in various countries commenting upon their country's financial state with statements such as "the budget deficits we inherited" rather than specifically blaming their predecessors.

Additionally, the definition of the word 'weasel' includes: n. a sneaky, untrustworthy, or insincere person; v. to manipulate shiftily. ^[10] A weasel word (or phrase) can quite likely be understood to come from a position of intending to manipulate the communication, in a sneaky or underhanded manner.

In the political sphere, this type of language is used to "spin" or alter the public's perception of an issue. In 1916, Theodore Roosevelt argued that "one of our defects as a nation is a tendency to use ...'weasel words'; when one 'weasel word' is used ... after another there is nothing left".^[11]

-- Unquote

Next, there is bullshit, a favourite psychiatric game, often played, as we shall see, by pretending a scientific subject is best discussed by metaphors and words sung apart from their meanings in the real sciences (see Sokal for other examples:

--Quote:

-- Unquote

Of course the purpose of pseudoscience is to make money, as in quackery, which is what psychiatry is, as pseudoscience and carefully crafted bullshit ever since Freud showed how to get famous and rich with psychiatric bullshit. (See also my: More on Freud and psychiatry.)

And then there are two other favourite ploys of psychiatrists to get their views prevailed, which are techniques at which they are much better than real scientists, who tend to speak the truth, or at least do not lie. For psychiatrists as for postmodernists, there is not truth, if not sanctioned by their professional organizations, and so there are no lies, at least not by psychiatrists: See how clever they prevent being refuted!

-- Quote:

Propaganda is a form of communication that is aimed at influencing the attitude of a community toward some cause or position. Propaganda is usually repeated and dispersed over a wide variety of media in order to create the desired result in audience attitudes.

As opposed to impartially providing information, propaganda, in its most basic sense, presents information primarily to influence an audience. Propaganda often presents facts selectively (thus possibly lying by omission) to encourage a particular synthesis, or uses loaded messages to produce an emotional rather than rational response to the information presented. The desired result is a change of the attitude toward the subject in the target audience to further a political agenda.

--Unquote

And the "political agenda" may as well be a psychiatric one, for psychiatrists are much interested in power and control over their patients and over the ways psychiatry is publicly discussed.

Finally, psychiatrists, from Freud and Jung onwards, tend to excel in rhetoric, quite possibly not because they closely studied it, but because they are fundamentally at heart and in outlook postmodernistic bullshitters who just don't believe in "truth", and who are convinced a well-composed "narrative" is far more effective, socially and for one's career, than honest real science (which unfortunately is true if one tries to gain one's end by convincing the public of one's baloney, as has been the way of psychiatry ever since Freud got famous by provoking his contemporaries, and then soothing them by the tale that "empirical medical science" had "discovered" his fictions).

-- Quote:

Rhetoric is the art of discourse, an art that aims to improve the facility of speakers or writers who attempt to inform, persuade, or motivate particular audiences in specific situations.^{[1] (..)} Its best known definition comes from Aristotle, who considers it a counterpart of both logic and politics, and calls it "the faculty of
observing in any given case the available means of persuasion."^[

-- Unquote.                   ->Contents

Please note - whatever your beliefs about psychiatry are - that to understand most of my criticism you need to have some knowledge of the above sections

A. Real philosophy of science
B. Clifford's and Voltaire's dicta + Philosophical
     Dictionary
C. Scientific Realism and Postmodernism
   Tabular exposition
D. Pseudoscience
E. Weasel words, bullshit, propaganda, rhetoric

Besides: This should be helpful to you in also judging many other subjects than psychiatry in a rational way: There is much bullshit, deception and delusion in the human world, and there is little better than real philosophy of science to help you see through it and explain why such and such is bullshit, fraud or delusion.

Indeed, for a full appreciation of how psychiatry works in practice, you really need to consider these two references:

-   The Rosenhan-experiment - illustrating psychiatric abuse
-   Donald Ewen Cameron - ex chief of the Canadian, American and World Psychiatric Associations, and clearly a truly monstrous man, with a morally depraved mentality. (See my Corporate psychopaths - part A for what I have in mind - and incidentally, the talented Mr. Fuld you'll find portrayed there is a colleague of the very talented o so "pragmatic" dr. Pincus below.)

The discussion

Introduction

Question #1 involves both ontological and epistemological issues: what are psychiatric disorders, and how do we know them?

Let me just note three points here that I will return to in the rest of my text at various places:

• This is not at all as in real sciences: These generally have fairly
  sophisticated and worked out methodologies and epistemologies:
  See good readings in philosophy of science above.
• What seems pretty immoral and dishonest to me, with the exception
  of dr. Szasz and possibly two others in this text: Nearly all psychiatrists
  choose not to mention the fact that psychiatry is different from other
  sciences as regards the freedoms and rights of its patients:
  
  Of all scientists only psychiatrists can have people locked up without
  these people having done anything illegal, while only psychiatrists can
  force people to take medicines.
  
  These are anyway great differences - practically, legally, morally - and to know that the "science" that is allowed to do so is for the most part bullshit or delusion does not make it more palatable that its purported "scientists" decline to discuss the special legal privileges and powers they have.
• The five many dicta to judge practices like psychiatry and the Catholic Inquisition by (also folks who public claimed to be specialists who meant it all very well) should be these:
  
  - Hippocrates: "First do no harm."
  - Clifford: "It is wrong always, everywhere, and for anyone, to
                    believe anything upon insufficient evidence."
  - Voltaire: "If we believe absurdities, we shall commit
                    atrocities." 
  - Chambers/Dr Johnson: "We never hurt each other but by error
                    or by malice." 
  - Rev. Sidney Smith: "As long as the patient will suffer, the cruel
                    will kick."

More dr. Phillips:

Framing these questions with the metaphor of umpires and balls and strikes comes from Allen Frances’s response to commentaries in Bulletin 1, “DSM in Philosophyland: Curiouser and Curiouser.” That response offered the positions of three umpires: the realist first umpire, the nominalist second umpire, and the constructionist third umpire.

It's a simplification anyway, that is not adequate, and also quite pomo-ish. Then again this sort of question, to the effect of what are the basic assumptions on which psychiatry is founded and how one knows this, is a fair one, if also a very curious one for a discipline that is supposed to be a science: Where is the description of its subject matter and its methodology? (Answer: The psychiatrists - after 100 years of locking people up and misdiagnosing them "in the name of science" - still do not know what their subject is or how to define "mental illness" or "mental disorder", and do not have any rational idea or indeed often: do not have real knowledge, of what sort of methods they should use, for studying a subject they do not know how to define, and that many of them declare to not exist or at least not exist as claimed in their profession the last 100 years.)

And the names are somewhat misleading, to say the least:

A brief visit to the excellent and free Stanford Encyclopedia of Philosophy should have provided dr. Frances and the others with the standard meanings of philosophical terminology they bandy around as if they understand it. (I suppose not, and if they do, so much the worse for their consciences.)

The author sided with Umpire 2, espousing a nominalist stance to the effect that he knows that there is real psychopathology out there but has no guarantee that his diagnostic constructs sort it out correctly.

"Nominalism" is a mistaken term in this context, and the whole false opposition between the first two alternatives could have been avoided by a formulation on the lines of "There are psychiatric disorders or diseases and I believe they probably are as I say they are, for else I wouldn't be doing science but would be engaging in fiction or deception".

Besides, in a science or supposed science like psychology the received methodological wisdom is that one's theories are hypotheses that involve hypothetical terms - say: 'intelligence', 'personality', 'judgment' - that are fairly called constructs, because they involve empirical and theoretical parts in their definitions, and often also are operationalized for doing empirical research, where the operationalization refers to assumptions and methods - say: standardized tests in standardized conditions - to make the terms and theories testable.

He wrote: “This brings us to me a (call’um as I see’um) second umpire. In preparing DSMIV, I had no grand illusions of seeing reality straight on or of reconstructing it whole cloth from my own pet theories. I just wanted to get the job done - produce a useful document that would make the fewest possible mistakes, and create the fewest problems for patients” (Bulletin 1, p. 22).

That sounds well, but is a bit of a pose, it seems to me: No scientists in any science can do better than proposing hypotheses. Also, it presumes answers it does not give:

A. Is there at all a useful DSM possible and are "fewest possible mistakes" and "fewest possible problems"
(1) intellectual consistent and
(2) morally fair for patients?! And

B. Where is a recognition of the unique position psychiatry has with regards to its patients, and the admissions that
(1) many persons have been misdiagnosed and mistreated in the past 100 years or so of applied psychiatry and
(2) at least part of the reason for the fact stated in (1) is that so much of psychiatry was quite unscientific, except that lip-services were paid to science and medicine, because psychiatry got admitted as a science as a branch of medicine, as are neurology, urology etc. - always
(3) with the difficulty Question I addresses, if in a fanciful somewhat bantering way, namely that other parts of medicine have clear subjects that clearly empirically exist psychiatry does not have a clear subject that empirically exists, nor agreed upon truly scientific methods of studying that possibly non-existing subject.

More dr. Phillips:

For this article we have added two more umpires: a pragmatist fourth umpire and a fifth umpire who rejects the entire exercise. We were motivated to add these umpires by the fact that some of the responses required them.

This is a bit unfortunate for at least two reasons. First, it suggests that there is a fourth position that somehow is practical/pragmatical, which seems to confuse several things, such as practice and theory, and truth and value. I'll come to these later. Second, it suggests that the fifth alternative is singular, whereas it clearly isn't, as one may reject psychiatry as a science or as a practice for theoretical reasons (such as: there is not enough knowledge to base it on, either as science or as a practice) or for moral reasons (such as: a medical doctor should not engage in policing or forcing persons or consort with authorities to lock them up) or indeed for both kinds of reasons.

I'll turn to this later also, though of all contributors to this Question 1 only a minority - most clearly and unambiguously: Dr. Szasz - seems to be aware of any moral problems involved in practising "a science" they can't define the subject or methods of, that in its practice may be very dangerous to its "patients": One may be locked up, misdiagnosed or forced to use medicines because a psychiatrist said so, merely on the basis of his supposed authority as a claimed "medical scientist".

Further, we recognize that in asking respondents to choose one position and defend it, we have made an unreasonable demand. Why should an individual not say, I’m a combination of these two umpires, or, I’m a lot of this umpire and a little of that, or finally, I’m a first umpire if we’re talking about Huntington’s disease, but a second umpire if we’re talking about schizoaffective disorder. So, quite understandably, in some our responses we witness the same problem we have with our diagnoses: comorbidity - in this case epistemological (or ontologic) comorbidity rather than diagnostic comorbidity.

As I said, I think the distinctions were not clear enough and not well phrased. And clearly in any halfway tenable science of something there will be various theories with various probabilities or plausibilities, depending on the subject and the state of research.

The problems with psychiatry are rather that

(1) it is so far and has been based for some hundred years on the presumption that there are "mental illnesses" (rather than: deviant opinions of abnormal acting that is not illegal) that

(2) have turned out psychiatrists cannot even agree about amongst themselves how to define, recognize, establish the existence of, treat, or cure "mental illnesses", that they also, unlike somatic illnesses that have been researched deep and long enough,  have no biological markers for, except for some rare cases, while

(3) the whole practice of psychiatry is about people who often have no clear somatic ill health whatsoever, but whose behaviour is considered somehow strange, improper, immoral, dangerous, or based on delusions, who "therefore"

(4) risk being locked up (as used to happen to heretics) in what are called "mental hospitals" but effectively are much like prisons not because they committed a crime but because they have been declared mad by some doctor with a B.A. in basic medicine, while finally

(5) not only can psychiatrists not clearly define, describe, recognize or classify many of the mental illnesses they attribute to patients, and that they claim - falsely, seen in historical terms - to be able to give paid professional help for; they also widely disagree amongst themselves about most or all aspects of their supposed "science":

(6) There also have been very many admitted false diagnoses on the basis of false psychiatric theories, e.g. about the causes of peptic ulcers, multiple sclerosis, and homosexuality, that destroyed the lives and chances of untold many millions, though their psychiatrists generally flourished economically and socially.

But apart from dr. Szasz's contribution none of the contributors, including dr. Frances, seems willing to discuss these serious moral and intellectual problems in a serious way: Instead, much of the discussion is conducted in terms of vague and misleading moral talk, while abusing standard philosophical and scientific terms, and spinning metaphorical tales about the supposed ends of fictional umpires in baseball.

In this debate over the nature of psychiatric disorders we experience a tension among the umpires that reflects the status of nosologic science. 

No, I don't think so - rather, as is also the case with most psychiatric terms and concepts, the real logical and empirical problems arise out of their bad definitions and unclear theoretical presuppositions to start with, as in the present case a clear ad hoc metaphor, that now is boldly but quite misleadingly declared to "reflect(..) the status of nosologic science": Sorry, that is bullshit or delusion.

On the one hand our patients suffer greatly from psychiatric symptoms, and it seems wildly foolish to theorize away their suffering. On the other hand our efforts to organize and classify their suffering can seem arbitrary and confusing. 

This also is quite misleading, in leaving the personal interests of the psychiatrists completely out of consideration: What about their making up supposed diseases only their unique kind of medical science can sell the cure or treatment for? They are in their business not as warranted holy men without blame or dishonesty, but simply as professionals who are in it for the money, aren't they? Doesn't that invite distrust about their motives, practices and theories if in the end these are about their personal incomes and social status, and about the special kinds of power they have to incarcate person they accuse of being "mentally ill"

?

Also, the second statement seems to presume - "can seem", without further clarification - a competence in psychiatrists that many other scientists, including medical doctors with other specialisms, have seen little or no evidence of.

We organize or categorize a symptom cluster and give it  a diagnostic name, and it overlaps with another cluster.  Or a patient simply has symptoms of both. 

Let's set the patients with symptoms in two diagnostic categories apart as a red herring: The problem is that the whole notion of "symptom cluster" as used in psychiatry is obscurantistic and seems set up as if it is meant to confuse:

The totally mistaken and misguided idea that the "5 out of 9 of the following attributes" style of "definition" is a clear diagnosis (apparently because it looks "mathematical") I criticized in my On confusions and misunderstandings concerning the DSM-5, and I here repeat the main mathematical part

The following table suffices with instances of in how many ways x things can be taken out of y things, with x <= y, and 1 of x always in x ways and x of x in 1 way :

But this is merely a hopefully instructive aside, as to the number of distinct ways in which one can have an ailment "X" on any diagnostic schema that is written around the "x out of y" attributes: 5 out of 9 (a common couple of figures in the DSM) in fact defines 126 different ways of having that ?same? "ailment" defined by 5 out of 9 attributes.

Suppose you show symptoms 1 to 5, and your neighbour symptoms 5 to 9: Do you both have the "same" "disease"?!

And since all there is in psychiatry for diagnosing people, in virtually all cases, are collections of symptoms, you have not the least assurance of any rational kind that any of these 126 different ways of having that "ailment" are not specific "diseases" that differ from each other depending one one, two ... or possible 126 of the different ways in which 5 symptoms can be selected from 9.

This seems and is presented as if it is "a mathematically precise way of diagnosing".

To me it appears as either a cleverly contrived way to infuse enormous amount of vagueness and ambiguities in psychiatric diagnoses - or indeed seems sheer incompetence and ignorance of elementary combinatorics and mathematics.

Back to dr. Phillips:

We start off with the expectation that there will be a match-up between therapeutic agent and diagnostic cluster, and we discover that, at the extreme, most of our pharmacologic agents seem to treat most of our disorders. 

If so, the honest rational conclusion must be: Therefore psychiatrists did not know what they were talking about. (Then what is the point or content or competence of this supposed "science"?!)

Finally, we somehow want to resolve this confusion by getting at the underpinnings of the identified disorders, and we discover that the genetics and neuroscience don’t support our groupings.

Again: If so, the honest rational conclusion must be: Therefore psychiatrists did not know what they were talking about.

In view of this confusion it’s not surprising that opinion divides itself in various ways. Focus on the real suffering out there, along with a conviction that the diagnostic clusters reflect distinct, real conditions, and you end up as a first umpire. Focus on that suffering with uncertainty about the isomorphism between label and disorder, and you become a second umpire. Switch your focus onto the arbitrariness of the labeling, and you end up questioning whether there is anything but the labeling and become a third umpire. Or switch away from the issues of these umpires onto the effects of one label versus another, and you are now a fourth umpire. Finally, decide that it’s all nonsense, and you are our fifth umpire.

By now I find this sounds rather like an exercise in trivialization, where the real problems are avoided by misleading and trivializing terminological oppositions that have no real foundation in philosophy of science or in the subject of psychiatry: It's like discussing the theology of Catholicism with the help of fairytales only.

This gets well illustrated by the first contribution. Readers who want rational clarity rather that a playful cleverness better move to contribution 1.               ->Contents

Messrs Zachar and Lobello jump into playing the game with a boys' scout eagerness:

One might think that a philosophical pragmatist should identify with either the pragmatist or the nominalist position in Allen Frances's clever analogy, but that isn't the case. From a pragmatist perspective, philosophical -isms such as realism, pragmatism, nominalism, and constructionism are conceptual distinctions that we make for certain purposes. The question is what information or response options are gained from making these distinctions that would not be gained were other distinctions made. 

For example, let's take the pragmatist's view that I call balls and strikes as I use them. If taken too literally this is a recipe for a shallow utilitarianism.

So there you are: "Psychiatry lacks fixed gold standards" so sometimes "spit balls" ("Nudge, nudge. Know what I mean?") "(e.g., pedophilia)" ("Know what I mean? Say no more!") must be thrown according to "official" "umpires" but don't we shrinks all know that in ancient Greek times ("Nudge, nudge. Know what I mean?") the "umpires" had other "official" rules, more "platonic" ("Know what I mean? Say no more!").

See? Concentration camps, waterboarding, Mao's Cultural Revolution and Pol Pot's prisons also are "social constructions", you see, and also each and all  "a real thing". And "Vaseline helps you throw good spit balls" ("Nudge, nudge. Know what I mean?"). How to judge them all depends on "umpires", you must understand: Everything is one if not a plurality of  "social constructions", that is, presumably, as long as the monthly psychiatric tenure is promptly and correctly paid each month.

The two securely tenured gentlemen continue with their kind of wit and wisdom:

So what information do we gain from the constructionist analysis? Rather than saying There are no balls and strikes until "I" call them, it is more accurate to say that social construction is a historical and community activity.

As were the Gulags - and don't you believe for one moment Messrs Zachar and Lobello's "umpire" will hold them personally responsible or accountable for anything (except cashing pay  checks: Even pomo shrinks need income to be able to spout their wisdom). No, no! Precisely as during Stalin's purges all that happens is "a historical and community activity", and how one calls it depends on one's "umpire".

You see - and there is more waffle to follow:

Baseball proper did not exist in 1800 and a pretty good story can be told about the social and economic factors that helped shape the game we have today. A similar narrative could be developed for psychiatry, for example, there is a good story to be told about how degeneration theory in the 19^th century and pharmaceutical marketing practices in the 20^th century both shaped the classification system. Social constructionists would also point out that something like the introduction of the designated hitter was not a deductive consequence of the rules of the game. Its legitimacy has to be understood with respect to the baseball community and its chosen authorities. Something similar is true of the scientific community and its designated authorities, including the process by which the DSM and the ICD is developed. The pragmatists consider this useful information.

By which these tenured gentlemen mean that "Anything goes!", in baseball and shrinkery, as long as the salaries are duly paid. And if so, they call'um as their own state's umpire sees'um, and they will not be to blame: It's all in the game, doncha see?

Having thus disposed of everything in psychiatry, epistemology, philosophy and ethics, our brave authors turn to dispose of Satan himself:

Finally we come to the Szasian. It is a category mistake to lump a political and ethical position such as I refuse to play because the game is not fair with realism, pragmatism, nominalism and constructionism.

Thus dr. Szasz is hoisted with the petard that dr. Frances forged: He is a living category mistake, according to these two clowns, and not even an "umpire" - but yes, I do agree, for the nonce, that those who deny psychiatry is a legitimate form of baseball and think it throws spitballs all the time, except that it doesn't call'um thus (but then all name calling is a "social construction", doncha see?), do have some sort of point, modulo terminology and psychiatric posturing and liberal if non-admitted using of "vaseline" to grease their own balls.

And dr. Szasz is put next to the garbage thus, by these two psychiatric clowns, who love to pretend that psychiatry did not make millions of nonsensical harmful diagnoses that were pretended to be "medical science":

Anti-psychiatry is better considered a behavioral option available to a disillusioned realist.

He needs some cognitive behavioral therapy to learn to cope with the problems of old age, or so I decode the psychiatric duo's prose. Then again, the gentlemen turn to their favourite mode of talk:

In terms of baseball, the claim would be that in the rest of sports, things like field goals and holes-in-one are objectively fixed, but there is so much variation between umpires in terms of the strike zone, that any rational person would see that the so-called objectivity of the game is a myth. Other like-minded critics would point out that there seems to be statistical evidence that the strike zone gets wider when the count is full - which keeps the game exciting. It is also economically convenient for the sport as a whole if pitchers are allowed some leeway when being close to throwing perfect games and batters allowed leeway when being close to breaking hitting records. Field goals and holes-in-one do not work like that, say the critics, yet baseball wants its consumers to think it is like those other sports.

So there: That's what real psychiatry and real philosophy is in the hands of psychiatric academic clowns with secure tenure: Playing baseball. 

But then they have a moral-of-the-story, in the "Vade retro me" tradition:

Perhaps the best argument against the Szaszian view is to point out that if they studied football and golf more closely, they might see that things are not as always as objective over there as they assume. Baseball should not be evaluated with respect to an idealized image of other sports just as psychiatry should not be evaluated with respect to an idealized image of other medical specialties.

These Satan's followers didn't even do their homework well, doncha see?! They confuse baseball with football, while messrs Zachar and Lobello are certain-sure concentration camps and Gulags "should not be evaluated with respect to an idealized image of" reality or morality!" O no! What matters is who is the "umpire" who signs the pay check!

And that was the contribution of two gentlemen who also may be clinical psychologists (apparently being no M.D.s) who may be praised for playing the game as pros, and having the patter and the postures pat.    ->Contents

I turn to a vastly more rational contribution.

This is by dr. Pouncey, whose contribution has the considerable merit of being a clear explanation of the terminology dr. Frances introduced in a sort of jest or else a sort of postmodernist move to relativize all rational discussion to reflections on texts and terms rather than on realistic theories and real things.

I reproduce her text with hardly a note:

Actually, so far all of this is a fallacy, that means to suggest - but does no way prove or even argue - that psychiatry is a science like astronomy, wherefore - presumably - the lessons learned by astronomers should apply to psychiatry... whereas in fact the learned Pierre has not even given a single ground to believe that psychiatry is a real science rather than a mock one, nor a single ground why this particular example is at all appropriate to discussing the very ill laid grounds of the purported "science" of psychiatry.

But we get a little information about how dr. Pierre sees himself:

The belief that this dynamic process is both acceptable and necessary for the Diagnostic and Statistical Manual of Mental Disorders (DSM) would seem to place myself in the category of Allen Frances' "Umpire #2," where I suspect the vast majority of clinicians reside.

Let me suggest to the dear dr. Pierre that this is an artefact of how the alternatives were presented by dr. Frances, something psychiatrists seem to be well-trained in: Treating something in borrowed ill-used terms as if these are appropriate, scientific and rational.

And let me note this whole discussion is about this "belief" - and not whether dr. Pierre or dr. Frances have this belief, but whether that belief is true or plausible in any rationally defensible sense.

Then again, dr. Pierre has seen some problems with his presentation as well:

Still, since I have just suggested that reality often defies simple classification, allow me to state my position more clearly. I believe that psychiatric disorders do exist and that they are brain-mediated diseases (leaving aside for the moment the challenge of defining "disease") with genetic, biologic, and environmental etiologies and influences.

I am sorry, but this another mocking gem from the psychiatric kitchen: They do not quantify their terms (nor do they clearly define them, nor do they use them as they are in other sciences): What one wants to know is not whether some tame tenured psychiatrist has the "belief" "that psychiatric disorders do exist", though I note in passing the learned dr.  is so strategically clever in a lawyers' way that he does not even call them "illnesses", but this: how many or what percentage of the "psychiatric disorders" in the psychiatric handbooks are real, as defined or described in those handbooks, according to dr. Pierre.

Furthermore, I should remark that making these hypothetical entities (of which many definitions and descriptions may be safely assumed to be as pseudoscientific as so much of psychiatry has been these last 100 years) may conceivably be "brain-mediated", if that is not a tautology or pleonasm, to say that these hypothetical entities also have "genetic, biologic, and environmental etiologies and influences" - like angels, ghosts or zombies, perhaps? - is a rather bold hypothesis, that also introduces lots of leeway and possibilities for more terminological obfuscations.

How does dr. Pierre know this? He doesn't tell, and if he honestly would, then he would be bound to say that all he has are his imprecise guesses, and that not about all or most hypothetical "psychiatric disorders ("leaving aside for the moment the challenge of defining "disease"") but only about a few he knows about.

Meanwhile he has been confusing his non-psychiatric readers, but also has managed to suggest that psychiatry is a science like astronomy is (no, it is not); that it uses the scientific method as astronomy does (no, it does not); that psychiatrists have knowledge to the effect "that psychiatric disorders do exist and that they are brain-mediated diseases (..) with genetic, biologic, and environmental etiologies and influences" (no, they do not have such knowledge: they claim they have it).

I conclude that dr. Pierre must be a clever man with most of the trappings and tricks that make a psychiatrist these days, it seems. Here follows some more to make at least that worthy of belief, even if what the clever Pierre says is not:

The disorders (not diseases) cataloged in the DSM represent our best attempts at achieving consensus definitions of these conditions, seriously limited as we are by diagnosis that is based almost exclusively on describing manifest symptoms.

First note that dr. Pierre, in a trained psychiatric way (it meanwhile seems from my readings in psychiatry) has shifted what were in his previous paragraph "diseases" to "disorders" - as usual, for psychiatrists, without offering any rational explanation.

Next, note how clever he is at innuendo and suggestion: It is precisely at issue whether the hypothetical entities "cataloged in the DSM" "represent" anything real at all - but the clever dr. Pierre knows how to twist this verbally around to their doing so, and not only do these hypothetical entities exist, by dr. Pierre's hidden fiat: they also are his and your and perhaps even my ("our") "best attempts at achieving consensus definitions".

No, they are not. They are most definitely not. Something far better, far more rational, far more honest, far more moral, far more scientific could have been made from the DSMs than has been made in their stead, which is part of the sorry lot of rot that I have come to see looms up its ugly head as soon as one starts to do some serious reading in psychiatric handbooks, armed with some relevant knowledge of real science, of methodology, and of psychology.

Then again, presumably the clever dr. Pierre is a lot younger than I am and dr. Frances is, and he surely knows - even without psychiatric training - how effective flattery of the leaders of one's own chosen field of career is.

We are not done yet, for dr. Pierre has yet another bit of clever trickery, that turns around his phrase "seriously limited as we are by diagnosis that is based almost exclusively on describing manifest symptoms":

Because of this limitation, it is unavoidable that psychiatric diagnosis is overly simplistic, just as many medical diagnoses would still be if not for technology-driven discoveries about pathophysiology. As such, DSM diagnoses are constructs, and DSM-IV's chief utility is as a "good enough rough guide for clinical work [38]."

Again a clever - false - suggestion that the problems psychiatry are in are due to its diagnoses being "based almost exclusively on describing manifest symptoms". Not so!

The reason that I find this a pretty sickening piece of trickery is that psychiatrists have known this for hundred years, and should have been far more humble in their pretensions about what they could "deduce" from behavioural symptoms - which turned out to be anything whatsoever, from the wishes of dr. Pierre to sleep with his mother, to the uncertainties and dishonesties of dr. Pierre in the face of authorities, to his tendencies towards polymorphic perversities (and I could make many more inferences about the character of dr. Pierre, based on my extensive reading in "our best attempts at achieving consensus definitions of these conditions").

And there is another clever suggestion the clever dr. Pierre foists on his readers, while simultaneously flattering dr. Frances, viz. that "DSM-IV's chief utility is as a "good enough rough guide for clinical work [38]".

Not so: This is what dr. Frances may have thought or hoped for originally, but since he has found that the DSM-IV has been abused to prescribe anti-psychotic medicines to young children by the millions ("ADHD, doncha know? It's in the DSM-IV, so it must be true, for psychiatrists should work according to "first do no harm", doncha see?") and has also created a true epidemic of "autism" and "Asperger's".

I am not quite done with dr. Pierre. Here is his last paragraph, again cleverly phrased in - what might be - the best mocking traditions of psychiatry, that might be a science, if we may rely on dr. Pierre and his clever ways of phrasing:

As an imperfect work in progress, the DSM-IV contains diagnostic constructs of variable validity. In the tradition of Umpire #1, I believe that many of the disorders in DSM do a good job of describing the essential symptomatic features of what are probably "real diseases" (e.g. obsessive-compulsive disorder). However, I can also acknowledge the concerns of Umpire #3, including that some DSM disorders may tread dangerously close to pathological labeling of socially unacceptable behaviors (e.g. paraphilias) [39], while others might be better understood as "culture-bound syndromes" (e.g. anorexia) [40].

Again, he cleverly tries to twist around things: The issue is not whether the DSM-IV is "perfect", nor is the issue whether it contains "diagnostic constructs of variable validity":

The questions are whether it was good enough for the purposes it was designed for (I say no, and I think dr. Frances cannot in consistency do otherwise, but then dr. Frances is a clever psychiatrist with a way with words as well); whether it was anything in the way of a scientific diagnostic manual (I say no: psychiatry does not have sufficient knowledge of the brain to be a real science about mental illnesses that cannot be shown by some empirical pathology in the brain); and whether there are not too many "diagnostic constructs of variable validity" in it (and I say yes, and think dr. Frances should agree, having seen his worries about prescribing anti-psychotics to rowdy small children in the name of the science or "science" he is a professor in).

But the clever dr. Pierre has more: He has a belief! It is this: "I believe that many of the disorders in DSM do a good job of describing the essential symptomatic features of what are probably "real diseases" ". Now a man may believe what he pleases, but being rather rational myself I am at a total loss at seeing how dr. Pierre could come to this belief: How "many"? Why? "Disorders" not "diseases"? Since when is a psychiatrist a policeman dealing with "disorders" that are not due to "diseases"?! And "essential" in just what refined sense? And what are "features" of "symptoms"? And how does one measure - quantify, judge, attribute infer - "probably", especially if what is "probably" so is embedded in scare quotes that makes its whole existence questionable, let alone its capacity of being measured by probability?

Finally, the clever dr. Pierre may be a psychiatric guru of great potential, for he has really mastered the game with "may" and "might" that is so essential in all psychiatric writing, and which comes to this:

If you know that what you write must strike anyone intelligent who is not hopelessly in love with you as difficult to keep apart from being bogus, bullshit, pretense, mockery, game playing, verbal acrobatics, plain dishonesty, salestalk, propaganda, prejudice or general loonyness or delusions, you insert at all proper places "may" or "might" for "is", and you keep insisting that your personal kind of baloney is - kneel down, laymen! - "evidence based medicine".

The basic trick of the psychiatric "may" and "might" is to plant an innuendo in the reader's mind, without being logically being committed to it, and so always being capable of pleading innocence. Thus, paraphilias may be no diseases, but a man as clever as dr. Pierre may be won't say they are not: he wants to innuendo they may not be, but wants to keep being able to say that he did not say they are not, or indeed that they are.

In the same way, one may wish to suggest that there may have been no concentration camps in Germany under Hitler, or that they may in fact have been asylums for the ill or may have been genuine humanitarian efforts of dealing with the problem of foreigners. You see? Be as clever as psychiatrists may be, and you may get away with suggesting almost anything you want your hearers to believe, while not really saying it, because all you're saying has been that what you're saying may be true - which it logically may be, however insane, unfair, or crazy, for anything that is not an explicit logical contradiction may be true.

Let's see how the clever dr. Pierre does it:

He says "some" ("forgetting" to mention what proportion, as if patients have no right to know how often they have been had by bogus and bullshit) "DSM disorders may tread dangerously close" to taking the place of the reverend minister and policeman in one, this time in the name of  - kneel down, laymen! - "evidence based medicine".

Next, to top this, the clever doctor says (after having carefully and cleverly "forgotten", in an appropriate Freudian way, just how many of "some DSM disorders" this amounts to) that "others" (of those "disorders" that may be "diseases", or may be not, that you may have been diagnosed with by him) "might be better understood as "culture-bound syndromes" - but again he has the careerist wit not to say this explicitly or indeed to deny this explicitly: To be always on the safe side, he said merely that things "might" be so (or not, but being so clever, he omits that).

In brief, I feel again rather mocked, by what may be an intentionally mocking psychiatrists, who just might have been engaging in a bit of careerist prose that he may very well know to be mostly ambiguous if carefully phrased bogosity, that suggests much, but says almost nothing, and makes no contribution of any cognitive kind to the Question 1 it may have been trying to answer.

I have arrived at the next contributor:                   ->Contents

Of dr. Greenberg I know a little more than I do from most contributors (whose existence escaped my notice, till very recently) because I read an interview he did with dr. Frances. You find it here:

     Inside the Battle to Define Mental Illness

Also, he is a psychotherapist whose degree is in psychology: He is not a psychiatrist, and maybe for that reason his take is somewhat different from the ones we have seen so far. He starts as follows:

"There are no balls or strikes until I call them" is not the postmodern fantasia that it sounds, nor is it a throwback to the idealism that Samuel Johnson refuted so thoroughly by kicking Bishop Berkeley in the knee. Or, to put it another way, it is neither the death knell of psychiatry nor a straw man for psychiatrists to use to refute their critics.

I will not attempt to tease out the references and word play, or whatever it is (dr. Johnson did not kick Bishop Berkeley, for example, in case you believe this), and merely observe that it seems to me that dr. Greenberg has been considerably misled by the terms and phrasings of dr. Frances' question.

I may be mistaken, so let's see. Dr. Greenberg continues thus:

No, what dr. Frances was pleased to call - quite misleadingly - "constructivism" is definitely not "plain common sense": In fact, it is one of the more corrupt forms of postmodernistic posturing. Then again, it is my firm guess dr. Greenberg wasn't aware of this, and really means what he either is or seems to be saying, which I would express as follows:

MM: While there is little that is real science in psychiatry, and much that is false or bogus, psychiatry as an attempt to help people with life problems is a worthy enterprise. But given the lack of real science of the brain, much of psychiatry must be discarded, and their practice must be based on common sense rather than mockery or pretenses that one is doing real science. Moreover, this can be done quite well in common sense terms, for all one needs to help people with life problems are intelligence, kindness, empathy, some knowledge of psychology, some information about the person's situation, and the possibilities of society for a person thus situated. One does not need science, or indeed psychiatric "science", to help people with problems: All that is needed next to what has been said is common sense and good will.

Then again, this is my guess, and what I would say were I a psychotherapist like dr. Greenberg (which I am not and never was). What he wrote is this:

Consider this question. What is the difference, from nature's point of view, between the snapping of a branch of an old oak tree and the snapping of a femur of an old man? We rightly recoil from the suggestion that there is no difference, and yet to assume that there is in nature a difference is to assume that nature cares about us enough to provide us with categories of broken hips. There is ample evidence, most stunningly Darwinian theory, that this is not true. Nature is indifferent. Unlike Major League Baseball, nature doesn't provide the rules by which the world can be divided into balls and strikes.

If there is a difference between the hip and the branch, it is surely to be found in the difference between the man and the tree, which is that the man is capable of caring about his femur, as are the people that love him. The only reason to distinguish one break from the other is to create a category--intracapsular transcervical fracture, Stage II, let's say. Naming the suffering, we bring it into the human realm. (It is not a coincidence that the authors of Genesis tell us that the first task given to Adam and Eve in Eden was to name the creatures of the earth; naming is how we put our stamp on the world.) By inventing categories like this one, we give ourselves a way to get hold of it, which in medicine means among other things a way to talk to other professionals about it, a way to determine treatment options, and a way to provide a prognosis to the patient and family. What we don't do is to discover that nature intends hips to break in certain ways, that there exist in nature intracapsular transcervical fractures and trochanteric fractures, any more than nature provides a branch with different ways to snap off a tree.

This much is uncontroversial, largely because whether you buy the argument or not, you are still going to treat the problem more or less the same way. The difference between fracture as a man made and a natural category is trivial, unless you're in a philosophical argument. But when it comes to psychiatry, something changes. To call a snapped femur an illness is to make only the broadest assumptions about human nature--that it is in our nature to walk and to be out of pain. To call fear generalized anxiety disorder or sadness accompanied by anhedonia, disturbances in sleep and appetite, and fatigue depression requires us to make much tighter, and more decisive, assumptions about who we are, about how we are supposed to feel, about what life is for. How much anxiety is a creature cognizant of its inevitable death supposed to feel? How sad should we be about the human condition? How do you know that?

I would not have made or phrased the argument like dr. Greenberg does, but his last paragraph makes sense, that I will try to restate in my terms:

MM: Most of the attributions psychiatrists make about the causes and forms of human problems of life are much infected by obscure jargon and cant ordinary people are not at all helped with and that in real fact are probably - like the majority of the concepts that were introduced by psychiatrists - fictional or mostly fictional. Moreover, most of the attributions psychiatrists make about the causes and forms of human problems of life are useless for effective treatments of these problems, as the history of psychiatry shows, since that is full of misdiagnoses of untold and uncounted millions of human beings. Finally, almost none of that ballast is helpful for a practicing psychotherapist who means well, is informed, and helps people through being humane, rational, kind and commonsensical.

Again, I must say this is my guess, and what I would say if I were a psychotherapist like dr. Greenberg (which I am not and never was).

In any case, in my formulation I agree. Dr. Greenberg may also agree, for his last paragraph starts as follows:

To create these categories is to take a position on the most basic, and unanswerable, questions we face: what is the good life, and what makes it good? It's the epitome of hubris to claim that you have determined scientifically how to answer those questions, and yet to insist that you have found mental illnesses in nature is to do exactly that.

I mostly agree, and like to add that much of what psychiatrists in fact do or say has very little to do with science or research of any kind, but is the kind of work and admonishments priests, clergy or policemen used to do, or else falls in the category of preaching or of adult education.

Whether that is "the epitome of hubris" I do not know; what I do know is that one does not at all need to study psychiatry nor speak in the manner and jargon of psychiatrists to do this kind of work well - and indeed if one does not talk or think like a psychiatrists, chances are one is more effective and helpful than if one does.

And now we have arrived at dr. Greenberg's plea for more common sense and less quasi-scientific posturing and talk:

But that's not to say that you can't determine scientifically patterns of psychic suffering as they are discerned by people who spend a lot of time observing and interacting with sufferers. The people who detect and name those patterns cannot help but organize what they observe according to their lived experience. The categories they invent then allow them to call those diseases into being. They don't make the categories up out of thin air, but neither do they find them under microscopes, or under rocks for that matter. That's what it means to say that the diseases don't exist until the doctors say they do. Which doesn't mean the diseases don't exist at all, just that they are human creations, and, at their best, fashioned out of love.

Again I would have formulated this quite differently - and rather than abide by dr. Frances' umpires I would have cast them away and would have insisted I prefer the road of common sense and ordinary psychology much rather than the normal psychiatric road of pretentious jargon in obscure grammar.

Also, I might have added a point to the effect that, for somebody engaged in the practice of psychotherapy, there is little use for digging through the academic and besides quite vague, uncertain and often pretty useless categories and classifications of supposed "diseases" one finds in psychiatric handbooks: Not all is nonsense, not all is false, but there is far too much uncertainty and ignorance about the causes and etiologies of most supposed psychiatric diseases to be useful for a practician.

But then I am interpreting again, and agree with dr. Greenberg's concluding words:

If psychiatry were to officially recognize this fundamental uncertainty, then it would become a much more honest profession--and, to my way of thinking, a more noble one. For it would not be able to lose sight of the basic mystery of who we are and how we are supposed to live.

Or to rephrase the last bit in my terms: For it would not need to pretend to know and understand where it only guesses, with little evidential support, and thus leave much more room for real science and for a humane practice.

We have arrived at the next commentator:           ->Contents

Doctor Pincus has been credited by dr. Frances as being responsible for the fourth umpire, the one called "pragmatic" by both, although they really mean "practical" - but then it seems the psychiatric habit, or professional disease, to always use the longest Latinate terms, also or especially if not used in their received senses, and do verbal acrobatics with these, as if psychiatrists always know what they are talking about.

Let us see. Dr. Pincus starts thus:

The fourth umpire has a very pragmatic perspective and understands that a classification of diagnostic categories is used for many different purposes by many different groups and individuals. Umpire 4 also understands that these various "user groups" approach their tasks with varying empirical, philosophical and historical backgrounds and, and with this proliferation of users and backgrounds, there needs to be a balance between (to mix metaphors) letting "a thousand flowers bloom" - creating a Tower of Babel with little ability to effectively communicate among these groups - and a single approach that cannot be tailored to particular needs.

I call'um as I sees'um (sorry), and I sees this as relativism disguised as if it makes sense - which it does if (and presumably only if) one wants to defend one's profession, business and colleagues against aspersions and doubts articulated by whoever is not blessed with the profession of psychiatrist.

As happens so often with psychiatrists, the first statement is in fact a truism: "different folks like different strokes". As also happens so often with psychiatrists, the conclusions derived from truisms are not true or are misleading and not what they seem, and I read the contorted second sentence of dr. Pincus as being contorted and full of varying claims just because dr. Pincus wants to hide the fact that he has kicked truth out of the window, and replaced her by - what I suppose he would call - "pragmatism", and what he would defend by its "utility", its "usefulness".

And rather than attempting to take apart the innuendos, references, vagueness, ambiguities, and unfoundedness of dr. Pincus second statement, I'll explain why this psychiatric concern with "pragmatism", "utility" and "usefulness" is fallacious.

The main reason is that "utility" (Ve reelly neet deh concentration camps, mine Führer! Zey aar so ferry useful!) presupposes, for its rational and non-manipulative use, two conditions or frameworks: An ethical one that considers the question whether such and such really is as useful and practical as it is claimed to be by its proponents; and a logical-empirical one that considers the question whether such and such a useful end can really (probably) be reached with such means as are proposed or available.

I do not believe dr. Pincus is not aware of this; I do believe he is intentionally bullshitting his readers - unless (I graciously concede) one can get these days to be a professor at Columbia with a very low IQ, and even then I think dr. Pincus is not as stupid as the things he writes.

For consider how he continues the above:

From this perspective, there is a recognition that the world has changed and the management of information has become the pre-eminent task of a classification system, overshadowing (but also enhancing), the clinical, research and educational goals of a classification. As such, the ICD/DSM should serve a critical translation function to anchor communications among multiple user groups that apply psychiatric classification in their day to day functions.

I must assume the "perspective" is that of "a pragmatist", in psychiatric terms, which are not those of people who know what "pragmatism" means - but OK: These most enlightened psychiatric folks have made a discovery that yet again finds a new role for what they falsely insist is "the science" of psychiatry:

Since "the world has changed" these days, dr. Pincus pontificates, the task of psychiatry, that most pragmatic of "sciences", or at least that of  its "classification system", that once pronounced so confidently on the causes and etiology of multiple sclerosis, homosexuality, and peptic ulcers (all due to "dysfunctional belief systems" of those who had them), these days the "goals of" that "classification system" have been changed, possibly by some ukase from the department of psychiatry at Columbia, to that of... "the management of information"!

Yea verily, forsooth! Psychiatry as public relations: All classification system suddenly should further the - "pragmatic"?! - end of serving "a critical translation function to anchor communications among multiple user groups".

Of course, for a "pragmatic" mind like dr. Pincus, this discovery of his, that classification systems exist "to anchor communications among multiple user groups" (rather than help one find one's way to a complex territory that is for the most part in the dark) probably went together with the joyful realization that such non-"pragmatic" notions as "truth" can be completely ditched. As long as the "multiple user groups" can "anchor communications" in such a communicating classification system!

And dr. Pincus - who hasn't even mention truth or patients or "first do no harm", or a hundred years of pretended but false, phoney and dishonest pretended psychiatric insights into the minds of non-psychiatrists - immediately proceeds to dream like a utopian:

This information management goal intersects with multiple user groups in terms of:

-health policy
-clinical decision making
-quality measurement
-epidemiology
-educational certification/accreditation
-multiple areas of research from genetics to psychopharmacology to cognitive science, etc.

Why ever not?! There is after 100 years not even a proof in sight that psychiatry is a real science, rather than a set of delusions or a con game by doctors without talents for neurosurgery or unable to cope with ordinary patients, but the "pragmatic" psychiatric dr. Pincus sees utopia around the corner!

To what end, as one may ask of a "pragmatist", who in its psychiatric incarnation is one to be able to get around all demands of proofs that it works, is true, makes empirical sense, is not a delusion or fraudulence - none of that matters to the pomo psychiatric pragmatist: He just pretends that all that matters is "utility". O, and "communication between user groups".

But to what end? World hegemony, I must infer from the almost transcendentally clear Pincusian prose:

The way this would work is that the ICD/DSM classification would remain relatively stable, serving as a kind of "Rosetta Stone" to facilitate communication among the various user groups. Each individual user "tribe" (or individual scientist) would be free to identify various alternative classifications. However, all journals or other public reporting mechanisms would require that any clinical population also be described in the ICD/DSM classification in addition to whatever tribal criteria for the "Syndrome XYZ", 70% met ICD/DSM criteria for GAD, 40% OCD, and 30% Anxiety Disorder, NOS).

Note dr. Pincus's rhetorically trained assurance that his utopia "would work". True believers, including the "pragmatic" ones always believe so, but they rarely are as brazen:

First, the existing system, that is full of bullshit, obscure terminology, untested theorizing, non-existing constructs, and ill-supported classifications, must remain - and no less as a glorified puzzle piece, namely "a kind of "Rosetta Stone"".

Second, this obscure mostly mistaken system is blandly asserted, in the most confident if not really honest psychiatric way, to "facilitate communication".

Third, it must, in dr. Pincus fond conception, become much like the Vatican office of censors used to be: "all journals or other public reporting mechanisms would require that any clinical population also be described in the ICD/DSM classification".

There is that desire for world hegemony of dr. Pincus: He wants to see to it that "all journals or other public reporting mechanisms" conform to his pet "pragmatic" notions already - one must suppose: dr. Pincus is conservative - contained in the DSM.

And then he has fond dreams about percentages of required accordance with his favourite - "pragmatic", don't you see?! - classification system, it seems.

I wonder why he not just turns Catholic, since that "pragmatic" system has already much in place that moves him to such enthusiasm.

For consider his ideals:

Changes in future (descriptive) classifications should be infrequent and guided by a highly conservative process that would only incorporate changes with strong evidence that they:

Conservatism is built in as core value: "Changes" (..) "should be infrequent". Indeed, if truth is not relevant to this most "pragmatic" of psychiatric belief systems, I don't see why there would be changes at all.

And indeed truth is not relevant: What Pincusian psychiatry is for is to "enhance" the communications of ""tribes""; of what I must assume are the ""tribes"" of decision-makers; and of patients' ... lives? problems? well-being? health? incomes? chances? happiness?... All wrong: "patient outcomes". (God knows what it means, except that patients should definitely not expect anything they might want from a most "pragmatic" professional like dr. Pincus.)

I am not done yet with the doctor from Columbia University (also, I noticed a colleague of that great leader Dick Fuld): He keeps on dreaming fond dreams of hegemony by mediating communications between what he styles, very humbly or humorously, as ""tribes"":

However, ICD/DSM would have a section describing the relationships among the various tribal concepts that could be updated on a more frequent basis.

It's again the wet dream of a Vatican head of censorship, but then "it takes all kinds to make a world".

If at this point you think I have been misrepresenting dr. Pincus: Not so! I have not, and he does not believe in such boring non-"pragmatic" psychiatric layman's notions as "truth":

Note that this approach gives up the ideal (or even a focus) on validity, per se.

See? A Pincusian Psychiatric "Pragmatist" has no need for such old-school pre-postmodern useless notions as "truth": That should emphatically not be "the ideal (or even a focus)" of Pincusian Psychiatry, at least as long as dr. Pincus monthly pay-check arrives without fail, and as long as no joker in Columbia has struck out a few zeroes in the amount to be paid on the ground that this would be so pragmatically useful for the university's finances.

You see, dr. Pincus has decided that in fact psychiatry and psychiatrist are a cross between journalists and whores:

Maintaining effective communication (most notably, effective use, reliability and understandability) and client satisfaction clinical utility (either the more limited improvement of sexual clinical and organizational decision-making processes or the ideal of outcomes improvement) become the principal goals of the whorehouse classification

I am sorry: My strikethroughs are justified "pragmatically". And did I mention world hegemony? I did, and here is the dear doctor, fondly dreaming on:

In other words, while a psychiatric classification must be useful for a variety of purposes, it cannot be expected to be simultaneously at the forefront of, for example, neurobiology and genetics, psychoanalysis, and the education of mental health counselors, primary care providers and psychologists.

See? In the dear doctor's delusional dreams it is pragmatic psychiatry that leads, circumscribes, defines, and controls ("pragmatically", of course) "neurobiology and genetics" and also "mental health counselors, primary care providers and psychologists".

I don't see why the "pragmatic" doctor does not extend his kindness and guidance ("pragmatically", of course) to physics, chemistry, mathematics and logic.

However - dr. Pincus loves starting sentences with "However": check it out ("pragmatically", of course) - our "pragmatic" doctor has already divided and approved the workloads:

However, multiple groups can continue their work on epistemic iteration using genetic approaches and others can develop ways to better measure quality or costs of care and yet others can study dimensional ratings of personality.

Isn't he merciful?! There is even "epistemic iteration", although the "pragmatic" doctor himself insisted that his "approach gives up the ideal (or even a focus) on validity".

However, as dr. Pincus loves starting sentences with "However", and as he's an inspiring communicator:

However, each tribal group would need to be able to communicate across the commons using the "Rosetta Stone".

How is that for "effective communication" (most notably, effective use, reliability and clarity)?! 

Here is the "pragmatic" doctor last statement, if you can believe it:

Thus, we would not be wobbling toward the asymptote of true validity, but, instead, be very slowly, but continually, rising toward the goal of better outcomes for patients.

From which you can learn - "pragmatically", to be sure - that truth and validity are not good for patients, who instead ought to believe - perhaps: if they want to avoid "pragmatic" incarceration, of course in their "own very best interests" - that "very slowly, but continually", and also very mysteriously, the Pincusian "Pragmatic" Psychiatry for ""Tribes"" will, eventually, who knows before 3000 AD, arrive at what will be "pragmatically" presented as "better outcomes for patients".

On this most happy thought it ends. As the reader may have surmised, somehow, it strikes me as total bullshit, but then I know more of physics than of psychiatry.              ->Contents

I have arrived at the next contributor, who I welcome with gladness:

Dr. Szasz (<- Wikipedia) just got 92 and is still going strong, quite possibly - having just survived dangerous doses of psychiatric "pragmatism" - because he has spoken and written the truth as he sees it during his long life, instead of playing games of "let's pretend".

He starts thus:

I thank Dr. James Phillips for inviting me to comment on this debate. I am pleased but hesitant to accept, lest by engaging in a discussion of the DSM (the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders) I legitimize the conceptual validity of "mental disorders" as medical diseases, and of psychiatry as a medical specialty.

I agree and also thank Dr. Phillips. Dr. Szasz' concern also seems justified to me, but I don't think it holds in the context in which his contribution stands, though that is not something he could know when he wrote this.

And I quite agree that "mental disorders" are not at all the same, either in meaning extensionally or intensionally, as "medical diseases", and that I too have come to conclude that psychiatry should be terminated as a medical psychiatry, or changed altogether, namely into something that is more like counseling or social work; that is not coercive nor punitive; that does not function as an extension of the law or the police; and that is based on terms, concepts and hypotheses that are consistent with real science and its methods, and written in clear English, and supported by objective and repeatable evidence.

More of dr. Szasz, who is one of the most, quite possibly THE most, effective critics of psychiatry the last half century:

Psychiatrists and others who engage in this and similar discussions accept psychiatry as a science and medical discipline, the American Psychiatric Association (APA) as a medical-scientific organization, and the DSM as a list of "disorders," a weasel word for "diagnoses" and "diseases," which are different phenomena, not merely different words for the same phenomenon.

I have added the link to weasel word of which Wikpedia's definition follows, because it explains so - awfully - much of the prose I am working through:

an informal term^[1] for equivocating words and phrases aimed at creating an impression that something specific and meaningful has been said, when in fact only a vague or ambiguous claim, or even a refutation has been communicated.

And I quite agree with dr. Szasz: Psychiatry is not a real science and cannot be one as long as there is so little knowledge of how the brain produces conscious experience, rather like there was no real science of colour or heat or paints until rather a lot of physics and chemistry had been discovered, in spite of the fact that there were colours, heat and paints long before the reasons for their being as they are were known.

In short: Psychiatry at present and the last 100 years, in spite of the large choirs of psychiatric voices who claimed otherwise, for financial reasons mostly, is much more like alchemy or astrology than like a real science such as chemistry or astronomy, and the most disappointing fact about the rather large "tribe" - I quote the pragmatically learned eminence dr. Pincus - of its professional exploiters is that they pose as if they are scientists, but they write and talk as if they are politicians, priests, salesmen or conmen. And I find this this both dishonest and reprehensible, as they could help patients with problems in a better way if they were more honest and less pretentious.

Further with dr. Szasz - after remarking that he has the great merit of writing far more clearly than any other psychiatrist I could name:

In law, the APA is a legitimating organization and the DSM a legitimating document. In practice, it is the APA and the DSM that provide medical, legal and ethical justification for physicians to diagnose and treat, judges to incarcerate and excuse, insurance companies to pay, and a myriad other social exchanges to be transacted. Implicitly, if not explicitly, the debaters's task is to improve the "accuracy" of the DSM as a "diagnostic instrument" and increase its power as a document of legitimation.

Quite so, and as has been amply illustrated by the commentators before dr. Szasz. And it is a considerable relief to have, at long last, a clear if brief mentioning of what psychiatrists do in fact, rather than endless elaborations of vain metaphorical distinctions that seem to have been designed to talk trash or flummox readers.

Long ago, having become convinced of the fictitious character of mental disorders, the immorality of psychiatric coercions and excuses, and the frequent injuriousness of psychiatric treatments, I set myself a very different task: namely, to delegitimize the legitimating authorities and agencies and their vast powers, enforced by psychiatrists and other mental health professionals, mental health laws, mental health courts, and mental health sentences.

This was and is a very noble end, precisely because psychiatry is for the most part not a science, and because so many of its diagnoses are false, dangerous and unjust.

In Psychiatry: The Science of Lies, I cite the warning of John Selden, the celebrated seventeenth-century English jurist and scholar: "The reason of a thing is not to be inquired after, till you are sure the thing itself be so. We commonly are at, what's the reason for it? before we are sure of the thing." In psychiatry it is usually impossible to be sure of "'what a thing itself really is," because "the thing itself" is prejudged by social convention couched in ordinary language and then translated into pseudo-medical jargon.

As it happens, I have read only one book of dr. Szasz, so far: "The myth of mental illness", which I read some 40 years ago, and found quite convincing, except for some reservations to the effect that there may well be mental illnesses, although Szasz was quite correct, I thought then and think now, in claiming there was far too little evidence that there are, except in a few cases (Alzheimer's, Parkinson's, madness associated with syphilis), and even these are very ill understood till this very day.

Then again, in case the reader is interested: I did write a long review of the presentation of dr. Szasz's ideas on Wikipedia: DSM-5: Thomas Szasz's ideas about psychiatry.

More dr. Szasz:

Seventy-five years ago, in my teens, I suspected that mental illness was a bogus entity and kept my mouth shut. Twenty-five years later, more secure in my identity, I said so in print. Fifty years later, in the tenth decade of my life, I am pleased to read Dr. Allen Frances candidly acknowledging: "Alas, I have read dozens of definitions of mental disorder (and helped to write one) and I can't say that any have the slightest value whatever. Historically, conditions have become mental disorders by accretion and practical necessity, not because they met some independent set of operationalized definitional criteria. Indeed, the concept of mental disorder is so amorphous, protean, and heterogeneous that it inherently defies definition. This is a hole at the center of psychiatric classification." This is as good as saying, "Mental illness, there ain't no such thing," and still remain loyal to one's profession.

Quite so - and I for my part am probably a bit amazed by it, as is dr. Szasz, though most psychiatrists clearly are not. Most psychiatrists verbally trick around it, but the position seems to be as dr. Szasz says: Psychiatrists are like priests who lost their faith in God, but who remain in the business of being priests.

In fact, there are some in Holland, and one - in this case, a Protestant minister who turned atheist - just recently won a courtcase that his flock has to keep paying him till his pension, in spite of his writing books to the effect that their religion, the one he gets paid for preaching to them, is nonsense.

So I should briefly state my response to psychiatrists who are willing to agree with me (or dr. Szasz) for the most part, but insist that they should be in business, because they are specialists in alleviating human suffering of a certain kind.

My response is that they may be right, but they can't be right in doling out the psychiatric teachings they learned ("You've such major personal problems because you want to fuck your mother | kill your father | are a repressed homosexual | have an inferiority complex | didn't sort your archetypes properly" etc.) because these are fictions, attributions or accusations without any good evidence.

More dr. Szasz:

The fallacy intrinsic to the concept of mental illness - call it mistake, mendacity, metaphor, myth, oxymoron, or what you will - constitutes a vastly larger "problem" than the phrase "a hole at the center of psychiatric classification" suggests. The "hole" - "mental illness" as medical problem - affects medicine, law, education, economics, politics, psychiatry, the mental health professions, everyday language - indeed the very fabric of contemporary Western, especially American, society. The concept of "psychiatric diagnosis," enshrined in the DSM and treated by the discussants as a "problem," is challenging because it is also a solution, albeit a false one.

Quite so - and this is precisely why I have become increasingly more irritated as I am reading through this collection of psychiatric reflections on the shortcomings of their craft: Most are not honest, it appears to me, but are playing verbal games they should have the intelligence to know are games, and are fallacious as rational scientific communication, for this is what they are decidedly not, with some - unfortunately rare exceptions, of which dr. Szasz is one.

Also, the above key paragraph mentions the real problems that should have been discussed, in clear non-metaphorical English, and without very confusing abused terminology from other sciences or disciplines, like philosophy, and with a clear awareness of the very many social and personal problems modern psychiatry has created by misdiagnosing them and/or by recommending or enforcing treatments and medicines that are harmful rather than helpful, except for those selling them: psychiatrists and pharmaceutical companies.

More dr. Szasz:

Medicalization, epitomized by psychiatry, is the foundation stone of our modern, secular-statist ideology, manifested by the Therapeutic State. The DSM, though patently absurd, has become an utterly indispensable legal-social tool.

Dr. Szasz is a libertarian, which is a political stance that probably has informed his wording here. I am not a libertarian - though I probably agree with a part of Dr. Szasz's convictions, since I describe myself politically as a classical liberal (think: Jefferson, Tocqueville, Mill) - and I don't fear the "Therapeutic State" so much as an authoritarian state.

Then again, the "legal-social" use that is being made of psychiatry, with psychiatrists as "willing executioners" of state policies is frightening, and should stop, if only because psychiatry isn't a science and medicine isn't a legal profession.

Here is dr. Szasz's last paragraph:

Ideologies - supported by common consent, church, state, and tradition - are social facts/"truths." As such, they are virtually impervious to criticism and possess very long lives. The DSM is here to stay and so is the intellectual and moral morass in which psychiatry has entwined itself and the modern mind.

Here he seems to me to be quite right again: As long as policies are decided on ideological grounds, as they usually are, rather than on real (as opposed to pseudo or quasi) scientific grounds and scientific knowledge, they will be far more often mistaken or misdirected, if sincere, for a reason Voltaire gave: "If we believe absurdities, we shall commit atrocities", or at least do harm where we could do good.

I arrive at the last contribution, that is a little strange, in that it again fondly engages on metaphorical talk about baseball, but this time not so much to defend psychiatry and its practices, but to make a valid point, albeit in a partially obscure and metaphorical way.               ->Contents 

Commentary: On Inviting the Gorilla to the Epistemological Party
Elliott Martin, M.D.
Yale University Department of Psychiatry.

What makes the epistemological umpire analogy so enticing is its capacity for adaptation, the fact that the strike zone must be different for every batter. If I call 'em as I see 'em, then of course what is a ball thrown to one batter may be a strike thrown to another.

Quite so, as one probably - if one has read all or most of the above, with some rational understanding - has also has come to realize: This is at best a mock serious way to discuss the intellectual scientific foundations of psychiatry, and not a really rational and responsible attitude, indeed not more so than one would object to a collection of Catholic cardinals who insist on discussing the intellectual basis of Catholicism in terms of analogies and terms from soccer, while using all manner of philosophical terms with new meanings, that generally also are not explicitly given, but shown in use: "philosophical", "pragmatist", "nominalist", "realism", "pragmatism", "nominalism", and "constructionism"  (see above) all come with uses that suggest the users do not know how these terms are use in serious philosophy, or else know but insist on confusing their readers.

And I do believe this was done on purpose: If dr. Frances had wanted a serious discussion he would and should have phrased his question differently. I will return to this below, when I consider his answers to the contributors. Here and now I continue with dr. Martin's prose:

As applied to the broadly descriptive nosology of DSM IV there is hardly an argument to be made against this.

Perhaps dr. Martin is speaking mock-seriously (an attitude that seems as common in psychiatrists as in Catholic apologists, that simply is not honest, as it is neither rational not polite). In any case, I have given above a series of arguments against this manner of discussing fundamental and serious questions.

But let's add a missing piece to the scenario. Let's cast the eight hundred pound gorilla in the analogy, the insurers, as 'the owner'. More specifically, let's call the beast 'the hometown owner'. And then let's say the umpire's salary is paid by the owner.

What dr. Martin really is concerned with, forgetting about baseball for a moment, is the role of the pharmaceutical corporations, and their relations with the so called "medical scientists" who are psychiatrists, who in the US alone help move billions of dollars each year from the pockets of patients or insurance companies to the bank accounts of psychiatrists and pharmaceutical corporations.

This is highly commendable of dr. Martin, for it surely is an important fact about psychiatry and psychiatrists: Unlike all other sciences in their abilities to lock people up and drug them against their will, psychiatrists and psychiatry also are unlike all other sciences in being the willing collaborators of both the law in practice as of the selling of medicine in practice - and the last, since they are rewarded for this by the pharmaceutical corporations, gives their "science" and their persons and activities a decidedly corruptible position, though I concede gladly that this is quite profitable for psychiatrists and also psychiatry, as it seems e.g. the American Psychiatric Association also gets funded by the corporations whose medicines they help sell for a percentage.

I return to dr. Martin, who in fact starts singing the praises of the past, of baseball to be sure:

With the game yet played on rural fields, before the advent of electronic pitch-tracking devices, before the price of every pitch was calculated, before the global media contracts, the strike zone was a sacred space, the tiny, arbitrary, marked off piece of ether from which intimacy the entire game was decided. Before the 'owners' blew the entire field up to stadium-size the game was about conceptualization and process; before psychiatry was snatched up by the insurers the pathologies were sought in subjectivity over objectivity. Artfulness existed alongside science. What, after all, did psychiatrists care for nosology before the rise of private insurance over the past several decades? Disordered thinking, as opposed to ordered thinking, was just that. Slapping a name on it did little to change the fact. One man's depression is another man's 'blues', and what does the patient care for the label?

This patient does, since he knows that being diagnosed in any way by any psychiatrist makes him liable to receiving legally very harmful "diagnoses", as we have seen from the above discussions, normally without rational or empirical scientific foundation.

My advice to anyone with "psychological problems" must be to avoid psychiatrists, since these have far too much power and authority, and hardly any rational knowledge of what they confidently judge, and instead rely on their GP or - if they feel they must - a psychologist.

Having wrestled through the above, my brief justification of my advice is: If you read psychiatrists, with some intelligence and education, you will find that most of them lie most of the time, and do so very trickily and with much dishonesty, for they also want to be seen as medical saviours and benevolent persons, which at best only a small proportion of them is: Most have a very well-paying job with few really exactable personal responsibilities and are protected by a powerful professional brotherhood of likeminded similarly motivated colleagues, who all feel that their first loyalties are to themselves and their colleagues, and not to their patients or rational science.

More dr. Martin:

'Carving nature' does require a measure of reliability, true, but the only conversations I have had in which I have coughed up the full DSM criteria have been those over the telephone, most often in the emergency room, with insurance reviewers 'objectively' determining, from up to thousands of miles away, whether a particular patient warrants two days or three days in which to be cured. And at that, for the benefit and safety of my patients, my strike zone widens tremendously after five minutes, and my diagnoses tend to reduce to the very non-DSM, if at times heavily punctuated, 'imminently suicidal!' or 'imminently homicidal!'. The arguments tend to end there, and it is apparent that what is missing in the epistemological umpire analogy is the hard baseball rule against arguing balls and strikes.

In other words, dr. Martin suggests that much of the DSM is in the everyday practice of psychiatrists mostly hogwash - it looks impressive in court and on one's coffee table, but it is not really serious, and those who hide behind it as their professional Bible don't really take it serious either (in spite of assurances like those of dr. Pincus, dr. Pierre, dr. Corullo etc.)

As a former academic, however, I simply have to believe that there is an inherent value in the pursuit of knowledge for knowledge's sake, that all sciences, veiled or not, are interwoven, regardless of the current paradigms, and the loss of even one is somehow crippling to the others.

While I believe in "the pursuit of knowledge for knowledge's sake" I have in the last two years learned that psychiatry is not a science and is very dangerous to literally millions of genuinely ill and suffering patients in my own position:

With an unexplained medical disease, admitted as real and non-psychiatric, that droves of psychiatrists nevertheless feed on as vultures by declaring all these millions, and thousands of medical doctors who are not psychiatrists and insist these people are really ill, to be insane albeit it normally in weasel words: These medical doctors who believe me, like myself, must suffer from "dysfunctional belief systems" and must be subjected to verbal and physical therapy by the authorities, to learn them to think well, that is according to what psychiatrists claim, and to learn to work, by being forced to do so without pay.

By what hair's breadth is this different from undiluted fascism and terrorism? Those who want to protest this question or suggestion are advised to consider my family background, my degrees, my age (nearly 62), and my 'career' as a 'student leader' who protested the postmodern relativization of all standards and all morals. Also, potential protestors should take a close look at the Action T4:

This poster (from around 1938) reads: "60,000 Reichsmarks is what this person suffering from a hereditary defect costs the People's community during his lifetime. Fellow citizen, that is your money too. Read '[A] New People', the monthly magazine of the Bureau for Race Politics of the NSDAP."

P.S. Corrections, if any are necessary, have to be made later.
-- April 29, 2012: Meanwhile I've corrected quite a few typos and unclarities
and added quite a few internal and external links. The file is almost 540 Kb, and will probably not be corrected further. Later today - I expect - there will be a P.S. with a few additions and clarifications.
-- November 4. 2012: This long text seems to be quite popular, and I have reformatted some: A few parts had fonts of too large a size.

Short descriptions of the above: