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May 20, 2013
me+ME: About the DSM-5
Sections
Introduction   
1. "How psychiatry went crazy"
2. "German psychiatry murder of mental patients"
3. "We're all mad here"
4. "British psychologists find fault with DSM-V"
5. "Delusions of Progress: Psychiatry's Diagnostic Model"
About ME/CFS


Introduction:

I am still paying back my walk of over three weeks ago, so I am still not feeling very well. But it may be improving some - and "the proof" is that there are today two essays by me, for the previous one of today is "About philosophy"

The present one is about the DSM-5, Actually, I am quite tired with it, but now that the DSM-5 is out, and does not get "a fair press", it may be reported some. This last fact also does me some good, and I'll report five comments (although the second is more historical).

Note that I give the original titles and the links to the originals in my section titles.

1. "How psychiatry went crazy"

This is by Carol Tavris, and it was published on May 17, 2013, with the subtitle "The "bible" of psychiatric diagnoses shapes-and deforms-both treatment and policy". Here are its first two paragraphs, plus two more.

The Diagnostic and Statistical Manual of Mental Disorders is often called the "Bible" of psychiatric diagnosis, and the term is apt. The DSM consists of instructions from on high; readers usually disagree in their interpretations of the text; and believing it is an act of faith.

At least the Bible lists only 10 Commandments; the DSM grows by leaps and bounds with every revision. The first edition, published by the American Psychiatric Association in 1952, was a spiral-bound pamphlet that described 11 categories of mental disorder, including brain syndromes, personality problems and psychotic disorders. (The final category, "Nondiagnostic Terms for the Hospital Record," contained Dead on Admission, the one diagnosis that psychiatrists have ever agreed on.) The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973. In the general excitement about that progressive decision, few noted that voting didn't seem to be the most scientific way of determining mental illness. Narcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years? Doctors don't vote on whether pneumonia is a disease.

(...)

But the DSM has grown too powerful to ignore; it is the linchpin of the pharmaceutical-medical complex. Adding more disorders allows doctors to be compensated for treating any kind of problem, from garden-variety sorrow to incapacitating depression. Drug companies encourage new disorders so that they can create medications or repackage old ones: Prozac, when its patent expired, was renamed Sarafem to treat "Premenstrual Dysphoric Disorder." PMDD had been relegated to the kids' table (that is, an appendix) in the DSM-IV, thanks to protests by women clinicians who wondered why menstrual symptoms constitute a "mental disorder" when, say, Hypertestosterone Hostility Disorder is nowhere to be found. Alas, PMDD has moved to the adults' table in the DSM-5. HHD is still MIA.

(...)

Readers of both "The Book of Woe" and "Saving Normal" will learn why the goal of "precision medicine" in mental health is a mirage. The DSM committees already tried their damnedest to support their diagnoses with neuroscience or biomarkers, but no lab tests yet exist for depression, schizophrenia, bipolar or obsessive-compulsive disorder, or, for that matter, any other mental disorders. Efforts to find explanations in genes, neurotransmitters, "chemical imbalances" or brain circuits have, Dr. Frances writes, "turned out to be naïve and illusory."

2. "German psychiatry murder of mental patients"

Actually, the following is not a review of the DSM-5. This is a 20 years old review by Peter Breggin MD, himself a critical psychiatrisr, who outlines psychiatry's role in organizing concentration camps.

This is a pdf of 4.3 MB, and I merely give the abstract here plus the first paragraph:

"German psychiatrists proposed the exterminati on of mental patients before Hitler came to power. Then in Nazi Germany, organized psychiatry implemented  involuntary eugenical sterilizatio n and euthanasia, ultimately killing up to 100,000 German mental patients. The six psychiatric euthanasia centers utilized medical professionals, fake death certificates, gas chambers disguised as showers, and the mass burning of corpses.
Psychiatrists from the euthanasia program also participated in the first formalized murders in the concentration camps. Inmates were "diagnosed" on euthanasia forms and sent to the psychiatric euthanasia centers. These facilities later provided the training, personnel and technology for the larger extermination camps.
Medical observers from the United States and Germany at the Nuremberg trials concluded that the holocaust might not have taken place without psychiatry. This paper summarizes psychiatric participation in events leading to the holocaust, and analyzes the underlying psychiatric principles that anticipated, encouraged, and paved the way for the Nazi extermination program."

"Psychiatry played a key role in the events that unfolded in Nazi Germany
leading up to the mass murder of the Jews and other groups considered alien to the German state. According to many observe rs at the Nuremberg trials, psychiatry was the "entering wedge" [1] into the holocaust and the tragedy might not have taken place without the profession's active leadership. This paper summarizes psychiatry's role and attempts to answer the question, "What psychiatric principles could have led to these abuses?" "

3. "We're all mad here"

This is by Dr. Allen Frances, published on May 19, 2013, in the New York Post.
I offer you the first two paragraps, plus three more:

Human nature doesn’t change that fast, but the labels used to describe it can follow fickle fashions. The vehicle of today’s fashion shift is the publication yesterday of the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders,” the official compendium of psychiatric diagnoses.

DSM 5 has added many new mental disorders that include many symptoms and behaviors previously accepted as simply part of the human condition. The resulting overdiagnosis of mental disorder will have many harmful unintended consequences — the misuse of medication, unnecessary stigma, high costs, misallocated resources, narrowed expectations, a reduced sense of personal responsibility, and the misapprehension that we are all becoming sick individuals living in an increasingly sick society.

(...)

Why all the these daffy DSM 5 diagnoses reducing the large pool of normal into a small puddle? This is a classic case of psychiatric experts run riot — overvaluing their pet areas of research and making their mark by getting them included in the diagnostic system. Poorly tested research concepts have been given a diagnostic status they simply don’t deserve. And we, the public, are the guinea pigs in what amounts to a public health experiment.

Potential about-to-be patients, beware. Getting a psychiatric diagnosis can be a life changing moment that provides great benefits if it is accurate, great harms when it is not. The care exercised should be equivalent to picking a spouse or buying a house. Instead, 80% of psychiatric diagnoses are made by harried primary care physicians with little training, in seven minutes visits that are brought to a quick end with the provision of a “free” sample of medication courtesy of a kindly drug salesman.

Nothing is free. My advice: Never accept a psychiatric diagnosis or pill offered this casually.

4. "British psychologists find fault with DSM-V"

This is by Alexander Reed Kelly. I found it on truthdig.com and reproduce its first three paragraphs (and record it should be "DSM-5"):

"England’s Division of Clinical Psychology, which represents more than 10,000 practitioners, has criticized the latest edition of the field’s leading diagnostic manual for its categorizing of normal behaviors—such as shyness in children and depression after the death of a loved one—as medical problems treatable with drugs.

The debate centers on whether behaviors that are clinically labeled as disorders have either biological or social sources, or some combination of the two. The fifth edition of the Diagnostic and Statistical Manual, published this month, treats mental health as a biological issue.

The British group is calling for a shift in the way mental health is viewed and treated, saying that practitioners of psychology should look for personal and social causes of perceived aberrations rather than behaving as if they were doctors of physical medicine."

5. "Delusions of Progress: Psychiatry's Diagnostic Model"

This is from a long piece by Andrew Scull, published on May 19, 2013. I will try to quote from it so as to preserve part of it:

Certainly Gary Greenberg (a PhD psychotherapist) and Michael Taylor (who prefers to call himself a neuropsychiatrist) think it is not. Their respective analyses of the DSM project are equally scathing, though they approach the problem of mental illness from opposing points of view. Greenberg is deeply skeptical of psychiatry’s claim “that psychological suffering is best understood as medical illness.” Taylor, on the other hand, regards Freud as a fraud, disdains the notion that mental illness has any meaning, or has its roots in meaning, or could possibly be treated by addressing psychological issues. For him, mental symptoms are so much epiphenomenal noise, the surface manifestations of the disordered brain, which is the sole and singular source of mental troubles. Greenberg, by contrast, views the attempt to reduce human woes to defective brains as what philosophers call a category mistake (he does seem willing to cede a place for biology in the genesis of some kinds of mental disturbance, but insists this remains speculative, not scientific). Taylor minces no words when expressing his disdain for psychotherapeutics, and psychoanalysis in particular. He uses such adjectives as “baseless,” “silly,” “useless,” and “destructive,” and truculently asserts that “if psychodynamic therapies were medications, their support by the U.S. psychiatric establishment would be a scandal.”

Both men, though, see the DSM as a disaster — a psychiatry built upon such foundations as a rickety, unsafe, unscientific enterprise that faces looming catastrophe. And as weird as it is to see two such narcissistic know-it-alls (see DSM IV TR diagnosis 301.81, Narcissistic Personality Disorder) agreeing on anything, in view of their completely divergent starting points and competing grandiose senses of self-importance, they may well be right.

OK... and note that both Greenberg and Taylor attack the DSM-5, but from opposite directions. Here is Scull on the previous two DSMs, that in my opinion are almost as bad as the DSM-5

This shift to a psychiatric world dominated by a book — or rather, to an anti-intellectual collection of categories jammed between two covers — can be dated quite precisely. The publication of DSM III in 1980 ushered in our so-called neo-Kraepelinian world (an era named after the fin-de-siècle German psychiatrist who first distinguished between dementia praecox — later renamed schizophrenia — and manic-depressive psychosis). Each of the ensuing revisions of psychiatry’s manual has codified its own fundamental approach to the universe of mental disorder, and that approach has come to dominate our understanding of mental illness. Not entirely by coincidence, a few years after the appearance of DSM III, the psychoanalytic hegemony in American psychiatry collapsed, to be replaced by an emphasis on biology, neuroscience, and drugs.

Actually, this seems a bit over the top, although simultaneously it is quite fair in fact, for a reason Mr Scull indicates himself:

But if validity was to be set aside, reliability was not to be jettisoned. Reliability is the statistically demonstrable ability of any two clinicians confronted with the same patient to assign him or her the same diagnostic category. This was where Spitzer and his team concentrated their efforts.To accomplish their ends, the DSM III task force adopted a “tick the boxes” approach to assigning illness labels. Find any six from a list of 10 symptoms, and voilà, a schizophrenic. Why six? Well, as Spitzer later put it, that felt about right. How many categories of illness to accept, and which ones? Here, too, there was much politicking at work

Note how totally insane psychiatry has gotten here - or has always been: There is no validity to almost any of their diagnoses - and even the reliability that the same diagnosis is made is very arbitrary and tenuous.

Also, note as to these "any six from a list of 10 symptoms": There are e.g. these elementary combinations, quoted from my own DSM-5: Question 1 of "The six most essential questions in psychiatric diagnosis, from a year ago:

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:

The dangerous nonsense of the x out of y diagnostic schema


2 of 3=3 2 of 4=6 2 of 5=10 2 of 6=15 2 of 7=21 2 of 8=28 2 of 9=36 2 of 10 = 45
  3 of 4=4 3 of 5=10 3 of 6=20 3 of 7=35 3 of 8=56 3 of 9=84 3 of 10  =120
    4 of 5=5 4 of 6=15 4 of 7=35 4 of 8=70 4 of 9=126 4 of 10 =210
      5 of 6=6 5 of 7=21 5 of 8=56 5 of 9=126 5 of 10 =252
        6 of 7=7 6 of 8=28 6 of 9=84 6 of 10 =210
          7 of 8=8 7 of 9=36 7 of 10 =120
            8 of 9=9 8 of 10 =45







9 of 10 =10

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: 6 out of 10 (a common couple of figures in the DSM) in fact defines 210 different ways of having that ?same? "ailment" defined by 6 out of 10 attributes.

And there is nothing else but this kind of schema: Only the numbers differ.

Then again psychiatrists just do not care, by and large, and probably also, in vast majority, do not understand - and no, you cannot trust liars to speak the truth in public:

The architects of DSM III and DSM IV, men who had built their careers on this very approach, launched an increasingly fierce attack on the work of their successors. Robert Spitzer began the assault, but he was ailing with a bad case of Parkinson’s disease. Soon Allen Frances, who had retired to Southern California to take care of his wife, took up the cause. (..) For orthodox psychiatrists, it was a deeply embarrassing spectacle. It is one thing to be attacked by Tom Cruise and the Scientologists, quite another to come under withering assault from one’s own. Wounded, the leaders of American psychiatry struck back with ad hominem attacks, alleging that Spitzer and Frances were clinging to past glories, and going so far as to suggest that the latter, by far the more energetic of the two, was motivated by the potential loss of $10,000 a year in royalties he still collected from DSM IV. (Left unmentioned was how dependent their professional association had become on the multimillions in royalties a new edition promised to provide.)

In fact, those who accused Frances profited themselves far more, as Mr Scully also makes clear later, but did not say so, of course. We have arrived at one of Mr. Scully's - very safe - conclusions:

All this suggests a profession in crisis.

Here Mr. Scully is discussing Dr. Taylor's opinions:

It is hard, however, to know quite where to locate the missing Age of Gold. Certainly it did not exist when Taylor joined the profession in the 1960s, the last decade of a psychoanalytic dominance he deplores. Nor can it be found, as he is at pains to make clear, in the years since.

[A] political rather than a scientific document […] [T]he process was and is very much like congress writing legislation. The procedure is messy and the results are wanting. Instead of “earmarks” we have new never validated labels and distinctions, such as shared psychotic disorder, identity disorder, schizophreniform disorder, bipolar I, II, III as separate diseases, and many other “bridges to nowhere.”

Diagnoses have proliferated, but not because of any advances in the profession’s scientific understanding of mental illness.

“The explosion of diagnoses […] is a fabrication of the political process […] The pharmaceutical industry adores the explosion of conditions, because as ‘medical diagnoses’ the DSM categories provide the rationale for prescribing drugs.”

Apart from locating an unfindable place when psychiatry was a science, the quotations are OK. Now I'll cut some quotes, to go to the end of Scully's piece:

If all these shenanigans

.. that I have mostly left out ..

provide ample support for Taylor’s claim that his profession is in crisis, the rot does not stop there.

Here is the main secret:

Antipsychotic and antidepressant drugs routinely rank among the top five most profitable classes of prescription drugs on the planet, and, as always, the great bulk of those profits are earned in the United States. In pursuit of them, the multinational drug industry has been ruthless and unscrupulous. There has been much talk in recent years about evidence-based medicine, but for such an approach to work, the evidence has to be what it seems.

Or worse - and correctly: "evidence based "science"" = "pseudoscience". Here is a part of the reason why (and see dr. Healy's website for much more on this):

And it is not. The drug companies own the double-blind controlled trials on which we rely to assess the worth of new medications lock, stock, and barrel. They own the data. They manipulate the data. They conceal the data they don’t like and that are at odds with their self-interest. Their public relations flacks ghostwrite scientific papers that then appear in even the most prestigious medical journals  Journal of the American Medical Association, New England Journal of Medicine, The Lancet — with the names of the most prominent academic researchers appended. Data about side effects, even fatal side effects, are suppressed and hidden, and then see the light of day only through the discovery process provided by class-action lawsuits. Meanwhile, direct-to-consumer advertising increasingly drives drug sales, and neither physicians nor their patients seem to grasp or act upon the difference between statistical significance and clinical significance.

I'll end with quoting Greenberg:

Greenberg reports of the APA:

[Its] income from the drug industry, which amounted to more than $19 million in 2006, had shrunk to $11 million by 2009, and was projected to fall even more [….] [In addition] journal advertising by the drug companies was off by 50 percent from its 2006 high.

     (...)

What would happen if [psychiatrists] told you that they don’t know what illness (if any) is causing your anxiety or depression, or agitation, and then, if they thought it was warranted, told you that there are drugs that might help (although they don’t really know why or at what cost to your brain, or whether you will be able to stop taking them if you want to; nor can they guarantee that you (or your child) won’t become obese or diabetic, or die early), and offer you a prescription [for these substances].

That is: What would happen if psychiatrists and medical doctors started to speak the truth about psychiatry and its mad diagnostic schemes?!

Well... that will very probably not happen, except for a few old, pensioned psychiatrists and idem psychologists. For there is far too much to lose.

My advice for those who may run into trouble with psychiatry is to get a good lawyer, and to reject having anything to do with psychiatrists: They are not scientists, but pseudoscientists, and they may be quite dangerous.

Meanwhile, the only "optimistic" thing to be told about them is that there are only relatively few of the millions with diseases that are not wholly explained by present medicine - most diseases, in fact - who will be committed.
---------------------------------

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)

2. Malcolm Hooper THE MENTAL HEALTH MOVEMENT:  
PERSECUTION OF PATIENTS?
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)
9.
Maarten Maartensz
Resources about ME/CFS
(more resources, by many)


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