by David Kupfer, MD
I am still paying back my walk of over a week ago, so I am still not
feeling very well.
Yesterday, my subject was poetry, by the learned and witty John
Wilmot. Today, I am not very well and merely deal with the
by David Kupfer, MD"
The reason for this
"statement", that was made on May 6, is the earlier statement of Thomas
Insel MD, who is the head of the NIMH, who decided to reject
As usual with David Kupfer, the so called "Chair of DSM-5 Task
Force", he is very
dishonest, as I will illustrate
now by taking his piece apart.
David Kupfer, MD
Chair of DSM-5 Task
Force Discusses Future of Mental Health Research
The promise of the science of mental disorders is great.
- except that you do not have a science of mental disorders: You can't even define
"mental disorder" in a rational way!!
In the future, we hope to be able to identify disorders
using biological and genetic markers that provide precise diagnoses
that can be delivered with complete reliability and validity.
the present, all you can do is "identify" "disorders" - hundreds
them! in spite of your not having any theory of any
kind what it is
that you are identifying - with quite incomplete reliability
validity at all.
is not science: that is pseudoscience,
and you know it.
why should these non-existent "markers" be necessarily "biological and
genetic"? And how is it possible your crazy house of cards, the
DSM-5, can "identify" hundreds of "disorders"?
That is over 40 years of
remaining "disappointingly distant"!
Yet this promise, which we have anticipated since the 1970s,
remains disappointingly distant.
We’ve been telling patients for several decades that we are
waiting for biomarkers.
me: After more than 40 years, the game is over: You have been lying.
And you have been lying not because there are no biomarkers - although
there is no reason to believe there are, so far. and since 40 years -
but because you have
based three successive thick DSMs on the basis of nothing at all.
We’re still waiting. In the absence of such major
discoveries, it is clinical experience and evidence, as well as growing
empirical research, that have advanced our understanding of disorders
such as autism spectrum disorder, bipolar disorder, and schizophrenia.
What you have been doing is pushing dangerous drugs, that you knew you
did not know to be not dangerous, into patients based on the pretension
of knowledge you did not have.
This progress will soon be recognized in the fifth edition
of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
no! Dr Insel, who is the head of your own National Institute of Mental
Health has rejected your DSM, and the only "recognition" you may hope
for is "recognition" from the ignorant.
The new manual, due for release later this month, represents
the strongest system currently available for classifying disorders.
it does not: Dr Insel, who is the head of your own National
Institute of Mental Health has rejected your DSM: He does not
think that it is "the strongest system currently available".
It reflects the progress that we have made in several
• A revised chapter organization signals
how disorders may relate to each other based on underlying
vulnerabilities or symptom characteristics.
"may relate". Which is the same as saying: "may not
are framed in the context of
age, gender, and cultural expectations, in addition to being organized
along a valuable developmental lifespan within each chapter.
what is the point of that if you say you want and expect and have been
hoping for over 40 years on - I quote you - "biological and genetic
- Key disorders were
reorganized because the relationships among categories clearly placed
them along a single continuum, such as substance use disorder and
autism spectrum disorder
Lord! The "categories" are based on nothing; the "relationships" are
based on nothing - and you dare to suggest that there is something that
"clearly placed them"?!
• A new section introduces emerging
measures, models and cultural guidance to assist clinicians in their
evaluation of patients. For the first time, self-assessment tools are
included to directly engage patients in their diagnosis and care.
there is "a new section"! All for a mere $ 199!
DSM, at its core, is a guidebook to help clinicians describe
and diagnose the behaviors and symptoms of their patients.
but let me repeat your noble self: "Yet this promise, which we
have anticipated since the 1970s, remains
disappointingly distant. "
It provides clinicians with a common language to deliver the
best patient care possible.
no! What it provides
is the pretext to prescribe and push
dangerous drugs into ignorant patients. Your art is not
and it is not for patients: your art is to get psychiatrists
And through content such as the new Section III, the next
manual also aims to encourage future directions in research.
the rest is useless, right?
Efforts like the National Institute of Mental Health’s
Research Domain Criteria (RDoC) are vital to the continued progress of
our collective understanding of mental disorders.
that is not the point! Let me reiterate it for the third
time: The director of your own National Institute of Mental Health has rejected
your whole DSM.
But they cannot serve us in the here and now, and they
cannot supplant DSM-5.
did they claim so! For that is not the point!
RDoC is a complementary endeavor to move us forward, and its
results may someday culminate in the genetic and neuroscience
breakthroughs that will revolutionize our field.
position of dr Insel is different from what you claim it
is: He did not say that he sees his RDoV as "a complementary
endeavor": He presents it as a competive system - and I quote him, with
NIMH will be re-orienting its research away from DSM
forward, we will be supporting research projects that look across
current categories – or sub-divide current categories – to begin to
develop a better system.
In the meantime, should we merely hand patients another
promissory note that something may happen sometime?
you have started this with saying so: "The
promise of the science of mental disorders is great." It's just that
for over 40 years - at least - you have not been able
to keep it.
Every day, we are dealing with impairment or tangible
suffering, and we must respond. Our patients deserve no less.
you must not: What your patients deserve is valid
diagnoses. As long as you cannot do that, all your pretense of "dealing
with impairment or tangible suffering" is just that: Pretense without
foundations, serving as pretext to prescribe dangerous
drugs to them.
The American Psychiatric Association is a national medical
specialty society whose physician members specialize in the diagnosis,
treatment, prevention and research of mental illnesses, including
substance use disorders.
What is the point of
adding "including substance use
disorders" is totally obscure to me, but it is not at all obscure to me
that (1) your DSM has no valid foundation, nor
is it obscure to me that (2) to
prescribe dangerous drugs on the basis of no valid
foundation at all is simply criminal, in my judgment, and not alone
in my judgement.
Visit the APA at www.psychiatry.org
was the statement by David Kupfer MD, with my comments.
Holmes said it, in the 19th Century:
believe that if the whole materia medica could be sunk to the
bottom of the sea, it would be all the better for mankind and all the
worse for the fishes."
This is no
longer true for ordinary medicine, which is a real science, for the
most part, but does seem to me to be true of psychiatry, that is not a
I am sorry in
case you expected something else, but I had to say the above.
ME/CFS (that I prefer
to call M.E.: The "/CFS" is added to facilitate search
is a disease I have since 1.1.1979: