May 7, 2013
me+ME:  On a statement by David Kupfer, MD
1.   Statement by David Kupfer, MD
About ME/CFS


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 following:

1. A "Statement 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 the DSM-5.

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.

Statement by 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.

True - 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.

In the present, all you can do is "identify" "disorders" - hundreds of them! in spite of your not having any theory of any kind what it is that you are identifying - with quite incomplete reliability and no validity at all.

That is not science: that is pseudoscience, and you know it.

Besides, 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"?

Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. 

That is over 40 years of remaining "disappointingly distant"!

We’ve been telling patients for several decades that we are waiting for biomarkers.

Excuse 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.

No. 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).

O 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.

Certainly 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 important areas.

A revised chapter organization signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics.

Sure: "may relate". Which is the same as saying: "may not relate".

  • Disorders are framed in the context of age, gender, and cultural expectations, in addition to being organized along a valuable developmental lifespan within each chapter.

But 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 markers"?

  • Key disorders were combined or reorganized because the relationships among categories clearly placed them along a single continuum, such as substance use disorder and autism spectrum disorder

O 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.

And 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.

Sure... 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. 

O no! What it provides is the pretext to prescribe and push dangerous drugs into ignorant patients. Your art is not about patients and it is not for patients: your art is to get psychiatrists rich.

And through content such as the new Section III, the next manual also aims to encourage future directions in research.

So 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.

But 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.

Neither 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. 

The 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 stresses added:

That is why NIMH will be re-orienting its research away from DSM categories. Going 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?

Well, 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.

No, 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

Well... that was the statement by David Kupfer MD, with my comments.

As dr. Holmes said it, in the 19th Century:

"I firmly 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 real science.

I am sorry in case you expected something else, but I had to say the above.


About ME/CFS (that I prefer to call M.E.: The "/CFS" is added to facilitate search machines) which is a disease I have since 1.1.1979:
1. Anthony Komaroff

Ten discoveries about the biology of CFS(pdf)

3. Hillary Johnson

The Why  (currently not available)

4. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2003)
5. Consensus (many M.D.s) Canadian Consensus Government Report on ME (pdf - version 2011)
6. Eleanor Stein

Clinical Guidelines for Psychiatrists (pdf)

7. William Clifford The Ethics of Belief
8. Malcolm Hooper Magical Medicine (pdf)
Maarten Maartensz
Resources about ME/CFS
(more resources, by many)

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