unacceptable - insufficient - tolerable - fair - good
Excursus on the
badness of modern
The latest DSM-5
an update of the
series on the DSM-5, that
got started in Nederlog, in 2010, and that
you can find summarized here
and diagnosed here.
1. Excursus on the badness of
brief of it is that,
considered as science, psychiatry is not a science but a pseudoscience,
as it has been from its very inception, by Charcot and Freud, as argued
very well by the late Richard Webster, summarized by me here (whose excellent
site is being
kept going: Thank you, whoever is responsible for that!)
Note that in itself this is not very bad: I consider large
psychology, sociology, political sciences aka politicology, some
branches of medical science, and even some parts of physics as little
better than pseudoscience or as protosciences of some kind, that
eventually may pan out.
Also, there are considerable grey margins, and it may depend on
authors, subjects, and treatments, as the mathematically inclined who
have looked into cybernetics,
systems theory, or chaos theory
may have found for themselves: These fields are based on mathematical
notions, that are themselves hard to find fault with, but the way they
are applied may be wacky, pretentious or just nonsensical.
In any case, none of this strikes me as very bad, even if I
it nonsense, because these would be sciences, whether
pseudoscience, or wacky science, are generally limited to the field of
ideas, a few universities, and a handful believers, as indeed is the
case with most new scientific theories.
If you haven't read Martin Gardner's
"Fads and fallacies in the name of
science" and "Science: Good, bad and bogus", and are in any
interested in science at all, you should: He was a very
with lots of relevant knowledge, who wrote a very clear style.
Things start to get very bad only when pretended science
agency or justification of social repression, as happened to the
science Karl Marx
believed himself to have discovered or when it
becomes a justification for fraud and abuse on a large scale, as is the
case with modern psychiatry, especially since that teamed up with large
pharmaceutical companies, and started to prescribe all manner of
dangerous drugs to all manner of people, without any good
rational justification whatsoever.
That is ... apart from greed, to be sure: The basic reason psychiatry
Pharma teamed up is that psychiatrists are legally entitled to
prescribe drugs, and Big Pharma makes drugs.
And here again a proviso or two have to be made: Many medicinal drugs
that pharmacologists design do work - indeed to an extent, with
variations, and often with unpleasant side-effects, but on the whole
better than having no drugs.
Also, it is not uncommon that a drug works, as just stated, while there
is no good medical or bio-chemical explanation why it does. If the
potential risks and benefits have been charted in an honest, empirical
and rational fashion, at least there is a choice, that can be made on
the basis of some relevant evidence.
With psychiatric drugs, it is different: Whether they really
they are claimed to do, in the general population, and whether they
really have no dangerous side-effects, is often unknown, for three
First, psychiatry - unlike most of the rest of
medicine! - is NOT a
science but a pseudoscience, ever since it was invented as
to make money for medical folks with little or no conscience.
Second, the trials and tests of psychiatric drugs
often are not
properly done, for various reasons, that include the first point and
the next, besides simple financial reasons (i.e.: shoddy testing costs
less and reveals no failures) and not so simple
methodological and statistical reasons.
Third, because there is an unholy alliance between the
prescribing the drugs, that is here: the psychiatrists, in their role
as "medical doctors", and the pharmaceutical companies, for there have
been made many arrangements by which the psychiatrists profit in
person, financially or otherwise, if they prescribe specific drugs.
In these circumstances, you have the wherewithal for a racket, a scam,
a schema of fraudulence, where a pseudoscience becomes the
justification for prescribing each year billions of dollars of
dangerous drugs to unsuspecting patients, not because these
drugs are known to work, but because those making and
prescribing them know they
are profitable, and work for profit rather than for patients'
or sound, honest and moral science.
They have turned themselves into sellers of snake oil, because
snake oil is profitable, and hardly anyone knows enough biochemistry,
medical science, or about psychiatry - the pseudo-science of snake oil
selling, effectively a subset of Public Relations
aka the art and
science of conmanship
- to stop them on legal, scientific or moral
Having reached this stage, which is the stage psychiatry reached
already in 1980, with the DSM-III, the stage of very bad -
pseudoscience has been reached.
For more on this topic - in part also related to ME/CFS, in part
to philosophy of science
and methodology - see the
series I wrote on the
DSM-5 and How to write like a psychiatrist (psychologist, psychotherapist).
latest DSM-5 bullshit
There now are the latest PR-bids by the designers of the
DSM-5 and the APA. You'll find the details on Ms Chapman's excellent
site, including many links - though I should warn you that, since
APA is into pretended medical science, served with large doses
PR-sauce, only for the money, you'll have to pay a lot of money
acces - for 24 hours, for $35, for each file of PR-crafted bullshit
- to their baloney.
Then again, some real specialists did, such as dr. Allan Frances, who
has the considerable merits of being the chief editor (sorry: I don't
believe in animated chairs) of the DSM-IV, who for moral and scientific
reasons objects to the DSM-5, and 1boringoldman, who is in fact a
psychiatrist with a good mind and moral courage, who feels flummoxed by
quite a few of his colleagues in the DSM-5, and rightly so, and
arguably so, as he does himself, quite well, here.
So I'll go through some of their latest posts, and start with Dr
Frances, whose latest in his series DSM-5 in distress in Psychology
Today can be found here.
I'll quote parts of it, in blue, and give my comments in black.
To start with, I like his opening quote:
can't turn a sow's ear
into a silk purse."
Put otherwise: Bullshit is bullshit whatever form, shape or sauce you
present it in.
Next, I am afraid I must disagree with his
"Second problem- the design of the DSM 5 field trial
had a byzantine
complexity that could be dreamed up only by people with no experience
in real life field testing."
My reason is
that I think they know what they are doing.
Not all of them, but the top. The public, including Dr Frances and me,
are being skilfully flimflammed,
Phil Parker style,
but by smarter
folks than PP. (Then again, I do know it may be risky for Dr Frances to
say so, seeing the scurvy way Ms Chapman was treated by the APA - see: Is the American Psychiatric
terrorist organization? - while speaking for myself, I don't
care, since I
have nothing to
loose, a very sharp mind, and sites in countries where it is difficult
to take sites down for expressing opinions distasteful to frauds.)
I agree with Dr Frances about this:
"According to the authors, 14 of the 23 disorders had
“very good” or
“good” reliability; 6 had questionable, but 'acceptable' levels; and
just three had “unacceptable” rates. Sounds okay until you look at the
actual data and discover that the cheerful words used by the DSM 5
leaders simply don't fit their extremely disappointing results. The
paper is a classic example of orwellian 'newspeak'."
Thus it seems
to me, and
indeed the APA and DSM-5 have done so before,
and effectively it comes to this:
rules - unacceptable -
good - excellent
shift the standards, while pretending everything is the same.
The reason Dr Frances gives is also good:
" In fact, only the 5 of
the 23 DSM 5 diagnoses that
levels of agreement between 0.60–0.79 would have been considered 'good'
in the past. DSM 5 cheapens the coinage of reliability by hyping these
merely okay levels as 'very good'. Then it gets much worse. The 9 DSM 5
disorders in the kappa range of 0.40–0.59 previously would have been
considered just plain poor, but DSM 5 puffs these up as 'good'. Then
DSM 5 has the chutzpah to call acceptable the 6 disorders that achieved
lousy, absolutely unacceptable reliabilities with kappas of 0.20–0.39. "
I agree, though
there is a BUT...: I am not much interested in
"reliability" - which after all is merely some sort of consensus on labels,
that are not based on anything clear or coherent. (As it
happens, I am re-reading "Gulag" by Anne Applebaum
and noticed that the
reports of inspectors of Gulags also worked that way, as did the CCCP:
They invented (made up from thin air) whole categories of
just for the purpose of terrorizing the Soviet population and filling
the Gulags with cheap labour. No doubt they mostly agreed on the
labels - but the labels classified a chimaera,
not reality, and
classified it for political profit, not for descriptive accuracy. Not
surprisingly, they also used the shifty trick I illustrated above.)
Next, I supose I agree with Dr Frances'
"It is sad that the American Journal Of Psychiatry
agreed to publish
this sleight of hand interpretation of the remarkably poor DSM 5 field
trial results. Clearly, AJP has been forced into the role of a
cheerleading house organ, not an independent scientific journal. AJP is
promoting APA product instead of critically evaluating it."
As it happens,
much less than he does about them, but I'd guess
they are not so much "forced" as - from their perspective -
"collaborating". (Yes, that can be read in two tones.)
I also agree with his conclusion:
"A diagnostic system that affects so many crucial
decisions in our
society cannot be left to a small professional association whose work
is profit driven, lacking in scientific integrity, and insensitive to
Then to 1boringoldman (who in fact is a
psychiatrist I could name,
which I do not do because he writes pseudonymously): He names
partially quotes what looks like a very good article by Marcia
in the New York Times, The
Illusions of Psychiatry, and I will see if I can find more.
As to 1boringoldman's comments: I like his
" that psychiatry rapidly became a medication specialty
rather than a
medical specialty. The whole industry scenario described in Angell’s
piece above from Robert Whitaker’s book was not apparent at the time –
at least to me."
though I also
find it a
bit odd, especially because he knows statistics
and seems to be a smart man. (I mean: There clearly was something
rotten there. Then again, I am willing to suppose he was working hard
and had little time - and as I have
remarked before: While I don't
believe psychiatry is a science, this does not mean
that there are no
psychiatrists who help people, indeed rather like religion: I
disbelieve all religions, but some religious people have done fine
things, perhaps indeed because of what I think are
reasons not founded
on facts or science.)
As to 1boringoldman's next paragraph:
"Now, it’s very easy to cast blame. Fibiger sees the
last three decades
as a massively failed experiment in which no new psychiatric drugs of
note arrived because the academic scientists didn’t give industry
enough to work with. It’s hard to even read that without laughing
aloud. Organized and academic psychiatry has talked of little other
than new drugs and advances in neuroscience for this whole period. The
most lucrative pharmaceuticals for all time have been new psychiatric
drugs. He makes no mention of the staggering profits, the ubiquitous
corruption, or the fact that industry has owned a lot of the very
people he’s blaming – academic psychiatrists. And all of those ads in
our journals or on television didn’t mention that it was all just one
great big experiment. His point is, however, correct in that "a massive
experiment has failed: despite decades of research and billions of
dollars invested, not a single mechanistically novel drug has reached
the psychiatric market in more than 30 years.""
As it happens,
I take a
different - somewhat more cynical, some might
argue: more realistic - perspective:
It is not "a failed experiment" of
30 years: It was a huge success, financially speaking, that is,
also as pseudoscience: almost everyone, except Dr Szasz and a few
lawyers, were effectively flimflammed, and enormous profits
for 30 solid years.
Next, I sort of agree with 1boringoldman's
" The experiment that we
didn’t know was an experiment
failed. The experimenters that we didn’t know were experimenting have
fled the scene. And psychiatry proper is left in dubious straits, a
position we earned by collusion. The gambles made by Dr. Sabshin’s
medicalization, Drs. Robins’ and Guze’s neoKraepelinian Tenets, and Dr.
Robert Spitzer’s DSM-III revision combined to solve a problem in 1980,
but contributed to the one we have now in the process. "
However... as I
the fight is not against poor science or
against honest but spineless medicos, but against intentional fraud
perpetrated by PR, in the name of "evidence based medical science",
which is utter bullshit.
And that has been going on ever since Spitzer invented the DSM-III,
from thin air, though he may have been just someone who found himself
by chance in a position he couldn't responsibly fill, and who started
making up things to save himself and his colleagues, having seen the
incredible mess psychiatry had gotten in by the 1960ies and 1970ies
Freud Wars"? Remember Grünbaum?)
and its effective refutation of almost every claim except
that some did help some, for mostly obscure reasons?
Then there arrived the DSM-III,
propelled with PR, advertisements and
fanfares by many naive journalists, almost none with any qualification
to rationally judge that book of biblical proportions and pretentions -
and suddenly psychiatry was without any theoretical foundation, which
made it both unfalsifiable
and a pseudoscience, but with an impressive
seeming categorial set of labels, that - it seems - mostly were
by Bob Spitzer himself.
Finally, I do agree with 1boringoldman's conclusion:
"How can psychopharmacology be in crisis?
Psychopharmacology is in the
same place it has been for much of its history. Psychopharmacologists
may feel like they are in a state of crisis because industry has
abandoned them to their own devices. But Psychiatry itself is what is
in a real crisis, but not the one Dr. Fibiger is talking about. It’s
the one Dr. Angell and Robert Whitaker write about – a crisis of
conflicts of interest and ultimately medical ethics. And while we’re at
it, we might just throw in a genuine crisis in leadership. Too many
leaders are part of the problem…"
neither 1boringoldman nor Dr Frances
would agree with my own
view, which is that psychiatry should be cast out of science: It
30 years of systematic abuse, and has no real scientific foundations of
any kind. But then I do agree that is a quite radical proposal and
I am not a psychiatrist - but somebody has to propose radical
and I am a psychologist and philosopher of science, severely discriminated for
decades because of psychiaytric fraudulence, so I do believe I have
a right to speak, and a right to insist on the maintenance rather than
the obfuscation of scientific norms and medical morality.
For backgrounds, see my "How
to write and think like a real psychiatrist (psychologist,
psychotherapist) - aka how to become rich, famous and admired with
a degree in a pseudoscience, and if you did not do so yet: The least it
is is good informed satire.
P.S. My eye
necessary corrections have to be made later.