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  May 7, 2012                  

DSM-5: PsychoSpeak II (Epic Fail of DSM-5 "field trials")

"Thus those who have defined original sin as "the lack of the original righteousness, which ought to reside in us," although they comprehend in this definition the whole meaning of the term, have still not expressed effectively enough its power and energy. For our nature is not only destitute and empty of good, but so fertile and fruitful of every evil that it cannot be idle. Those who have said that original sin is 'greed' have used an appropriate word, if only it be added - something that most men will by no means concede - that whatever is in man, from the understanding to the will, from the soul even to the flesh, has been defiled and crammed with this greed. Or to put it more briefly, the whole of man is of himself nothing but greed." (The Many Faces of Evil - Historical Perspectives, p. 121, John Calvin, Human Corruption) (*

I turned to "The Many Faces of Evil - Historical Perspectives" - edited by Amélie Oksenberg Rorty, Routledge, 2001 - to shed some light in on the making and makers of the DSM-5, because this provides a far better light on their motives and humanity than do their own completely dishonest, flagrantly unscientific, fundamentally deceptive and quite sadistic and manipulative texts - although the definition of "Antisocial Personality Disorder" from the DSM-IV that concludes the cited work does seem to be a frighteningly close projected self-portrait of what really moves many, quite possibly most, postmodern psychiatrists.

Here is some quite interesting quite frightening news I picked up yesterday from the 1 boring old man site (who is in fact a pensioned psychiatrist, who sounds sensible) that today also was picked up by Dr Frances. I quote the latter to start with

...bad news has just been reported from the annual meeting of the American Psychiatric Association in Philadelphia. The hard won credibility of psychiatric diagnosis is compromised by the abysmal results reported by the DSM 5 Field Trials.

These were supposed to test - as it happens: in a special context that contributes a lot to obtain support for the DSM-5 - the "reliability" of psychiatric diagnoses.

Let me first briefly explain what "reliability" means here, and why I flanked it with square-quotes: It has nothing to do with truth of the diagnosis, and also not with predictive validity of the diagnosis (which is what rational and moral people want from medical diagnoses and psychological tests: A fair chance that the test or diagnosis correctly predicts what will happen if one has the diagnosis): It has only to do with the rate of agreement between different diagnosticians of the same subject.

Clearly, if the diagnosticians have fair empirical knowledge and a similar education there judgements on the same subjects must be mostly the same: Either they know what they are speaking about, and come to the same conclusion; or they don't know, and still come mostly to the same conclusion since they share the same sort of education.

The real sciences tend to have great reliability and indeed also consistent predictive validity, especially on technologies that were based on the real sciences, and this is why houses and bridges do not suddenly collapse, and why airplanes do not randomly fall down.

In a not-so-real science as psychology predictive validity is an important subject, because one wants one's psychological tests to be useful, and considers them to be not useful if there is no predictive validity (no correlation between predicted outcomes and factual outcomes) or a negative one (the predicted outcomes are more often false than true). Also, psychologists tend to be uninterested in reliability, since this mostly is a measure of similarity of education and outlook, and doesn't say much about the supposed facts.

NOT so in the pseudoscience par excellence, postmodern psychiatry:

First, the judgments reached in psychiatry have no predictive validity - and indeed real diseases like MS and peptic ulcers, and natural relative abnormalities like homosexuality have for many decades been falsely stated by psychiatrists to be psychiatric diseases that only mad people (with "dysfunctional belief systems") have.

Second, it now has turned out that the judgments reached in psychiatry have not even reliability: The wording of and total lack of realistic theory for the diagnosis are so obscure, so useless, so misleading, so arbitrary, so much subject to personal interpretation that more than half of the judgments psychiatrists reached in the field trials of the DSM have a reliability less than half - which means that it is more probable than not that any two psychiatrists will disagree on the diagnosis of the same patient with the same problems.

Here is the probable source of this fact, an article by Ferris Jabr in the Scientific American, dated May 6, 2012. It's a fine and courageous article, that I recommend you read in full:


This weekend I attended the APA’s annual meeting here in Philadelphia to hear some of these researchers speak in person and to learn more about the DSM-5. I was particularly excited about results from the “field trials”—dry runs of the new DSM-5 diagnoses at universities and clinics around the country. The field trials are primarily concerned with one question: do different psychiatrists using the revised DSM-5 diagnoses reach the same conclusion about the same patient? If they do, the updated lists of symptoms have high “reliability”—a good thing in medicine. If not, the new diagnoses are unreliable and the revisions are a failure.

The APA has not yet published the results of the field trials, but at the annual meeting in Philly the association gave a preview of the findings during a Saturday symposium. It was a first glimpse at extremely important data that many people have been waiting a long time to see.

Some of the results—and the way in which the speakers presented them—frustrated and concerned me.

To understand why, it’s helpful to first discuss some statistics. I’ll keep it simple. The APA uses a statistic called kappa to measure the reliability of different diagnoses. The higher the value of kappa, the more reliable the diagnosis, with 1.0 representing perfect reliability.
The kappa for generalized anxiety disorder was about 0.2 and the kappa for major depressive disorder was about 0.3.

These numbers are way too low according to the APA’s own scales—and they are much lower than kappas for the disorders in previous versions of the DSM. Regier and other members of the APA emphasized that field trial methodology for the latest edition is far more rigorous than in the past and that kappas for many diagnoses in earlier editions of the DSM were likely inflated. But that doesn’t change the fact that the APA has a problem on its hands: its own data suggests that some of the updated definitions are so flawed that only a minority of psychiatrists reach the same conclusions when using them on the same patient. And the APA has limited time to do something about it.


To make an analogy, consider a baker who spends months developing a recipe for the ultimate chocolate cake in his head and—a day before he has to deliver the cake—finally tries out the recipe only to discover that the cake tastes awful. He has one day to come up with something else. The APA has placed itself in a similarly desperate position. The final drafts of the new manual are due December of this year, which means the APA has less than 8 months to implement what it has learned from the field trials if it wants to publish on schedule. New field trials would take years to arrange and at least one additional year to conduct. Either the association delays publication of the DSM-5 severeral more years, revises the diagnoses yet again and conducts new field trials—or it goes forward with the current schedule and publishes a significantly flawed DSM-5.

This was picked up before the last weekend by 1 boring old man, it seems, who wrote a fine article about it:


I also recommend reading that (perhaps skipping some formulas for the math challenged) but what interests me here is to show the solution of those two most honest, most rational gentlemen who head the DSM-5, doctors Regier and Kupfer who meanwhile have - very dialectically - changed the PsychoSpeak meanings for interpreting kappas in the way Orwell described

And here are the two versions of the interpretation of Kappa from Dr. Kraemer’s [et alii, including both doctors Regier and Kupfer, which is to say it is on the mightiest and highest initiative, as far as APA and DSM-5 are concerned - MM] and Dr. Frances’ articles in January of this year [above]…

The row "Kraemer et al" (including DSM-5 supremos Regier and Kupfer lists the Revised PsychoSpeak interpretations of "Kappa" values; the row "Frances" the readings DSM-IV supremo Frances used, which he says are similar to those used by DSM-III alpha-male Spitzer:


    <0.20   >0.20 & <0.40   >0.40 & <0.60   >0.60 & <0.80   >0.80
Kraemer et al   negative   acceptable   realistic   celebration   miraculous
Frances   negative   ~ no agreement   poor   fair   good

What this table depicts, is the psychiatric equivalent of Stalinist retouching (images and text from Wikipedia lemma on Joseph Stalin) and also completely supports my argument that the DSM-5 is not science nor medicine, but is pseudoscience crafted by conmen for the purpose of much extending their own power and influence by bullshit crafted according to the Stalinist rhetoric as outlined by George Orwell in his appendix to "1984" about Newspeak:

Nikolai Yezhov, walking with Stalin in the top photo from the 1930s, was kil/led in 1940. Following his execution, Yezhov was edited out of the photo by Soviet censors.[38] Such retouching was a common occurrence during Stalin's rule

I rest my case. (And here is its predecessor: DSM-5+ME: PyschoSpeak - version 0.0 (JavaScript needed.


(*) This is quoted from the given source (and can be found elsewhere also) with one word differently translated: I have put "greed" where Calvin's translators used "concupiscence", which in English has two meanings, according to my Shorter Oxford English Dictionary: "1. Vehement desire; in Theol. use, desire for 'things of the world'. 2. esp. Libidinous, sexual appetite, lust ME." Since Calvin was a theologian, I have chosen "greed". Here is its SOED definition: "Inordinate or insatiate longing, especially for wealth; covetous desire."

The reason I quoted it, apart from its correct diagnosis of man as a flawed, often dangerous and grossly immoral species, that excels at transgressing its own publicly claimed moral norms, that mostly are flags of conformism and tools to deceive rather than honest statements of intent, and that very often seems driven by greed or malice, is that I live in a country, Holland, that is still and has been for centuries a Calvinist country, most inhabitants of which, while still describing themselves as "religious" if "not Church-going" have totally forgotten the religious teaching they nominally adhere to, indeed especially as regards their own flawed nature.

I am myself an atheist and never was religious in any sense, nor was I religiously educated, and I provided the quote as a good clue about the persons and motives of the editors and contributors to the DSM-5.

Corrections, if any are necessary, have to be made later.


As to ME/CFS (that I prefer to call ME):
1.  Anthony Komaroff Ten discoveries about the biology of CFS (pdf)
3.  Hillary Johnson Th Why
4.  Consensus of M.D.s Canadian Consensus Government Report on ME (pdf)
5.  Eleanor Stein Clinical Guidelines for Psychiatrists (pdf)
6.  William Clifford The Ethics of Belief
7.  Paul Lutus

Is Psychology a Science?

8.  Malcolm Hooper Magical Medicine (pdf)
 Maarten Maartensz
ME in Amsterdam - surviving in Amsterdam with ME (Dutch)
 Maarten Maartensz Myalgic Encephalomyelitis

Short descriptions of the above:                

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who understa, but nds ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:

7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.
9. I tell my story of surviving (so far) in Amsterdam/ with ME.
10. The directory on my site about ME.

See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.

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