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June 2, 2013
DSM-5: Some DSM-related varia
Sections
Introduction
1. Some DSM-related varia - new stuff
2. Some DSM-related varia - a bit older stuff
About ME/CFS


Introduction:

I believe I am still somewhat paying back my walk of over 5 weeks ago, but I also seem to be getting out of it.

Then again, I keep sleeping too little, and last night I did 6 1/4 hours, which is too little for me. Even so, it is better than it was in the months I had seriously sore eyes, and I tend to conclude now it is not because of my eyes (that are improving, though it may take another year to have them back to where they were in the beginning of May 2012 - yes: it was all quite serious).


So today I am taking it easy and link in some stuff I should have known earlier - although it is supportive of my position, and it has been around, in part, since the summer of 2010.

1.
Some DSM-related varia - new stuff

I referred my readers yesterday to the 500 Kb of my - I admit: too long, but apart from that quite good:

and do so again today, in part because the only two psychiatrists I treated there that I could be enthusiastic about were drs. Szasz and Ghaemi. The first was a generation older than I am, and the second is a generation younger tham I am, and while I think I know Szasz well enough - see:
- it would have been nice to know more about Dr. Ghaemi, whom I mostly found out about today. [1]

So I'll start with the new stuff, which are two fairly recent columns by, firstly,  Christopher Lane, Ph.D., who teaches "literature and intellectual history at Northwestern University", and has a column "Side Effects - From quirky to serious, trends in psychology and psychiatry" in Psychology Today, that got repied to ny Nassir Ghaemi, M.D. Ph.D., who teaches "Psychiatry at Tufts University School of Medicine", and also has a column "Mood Swings - A psychiatrist surveys the mind and the wider world", also in Psychology Today.

So after these details, here goes - and this got published in 2013:
The second is an answer to the first, and billed explicitly as such - and it should be noted that the two have been writing about it since, at least, the summer of 2010.

Most that Dr. Lane says has been said by me (without knowing about him- and I merely give one post, and not 128 others on the subject), but this is to say I - broadly speaking - agree, notably with the ending (and I removed the stupid reference to Psychology Today's "data base"):
The manual's authority won't end overnight, but, given the implications of the NIMH's decision, it also can't and won't stay as it has.

Nevertheless, the alternatives, at least those that the NIMH is presenting, may turn out to be equally problematic and unworkable. As Gary Greenberg noted recently in the New Yorker, “doctors in most medical specialties have only gotten better at sorting our suffering according to its biochemical causes … [but] psychiatrists still cannot meet this demand. A detailed understanding of the brain, with its hundred billion neurons and trillions of synapses, remains elusive, leaving psychiatry dependent on outward manifestations for its taxonomy of mental illnesses.”

Now before going on, it should be said both gentlemen wrote before Dr Insel's - partial - retraction became known, which reached me on May 16.

Having said that, I quote the first three paragraphs of Dr Ghaemi (again removing the stupid links to the "data base"):

It is the beginning of the end. Just weeks before the publication of the fifth revision, the NIMH leadership has spoken out against the APA leadership, and the reign of DSM-III to 5 will end sooner rather than later. At the same time, the NIMH approach rejects, as it should, those critics of DSM who are anti-biology critics.

Finally, some sense between two extremes of nonsense.

For the past three years, I’ve been writing about how DSM-IV has been a major obstacle to the advance of science in psychiatry, often in direct debate with the leader of DSM-IV, who also has a blog on Psychology Today. I’ve also been debating other bloggers who oppose biology in psychiatry under any circumstance.

Actually, I found this a lot more interesting than Dr. Lane's. I'll skip his comments about the ages of his opponents, although I think they are very likely to be true, but do like to quote this (again the same "database" remark):
And yet the defenders of DSM-5 have been simplistically extreme as well. How can anyone defend each of 400 “disorders” as being biological diseases? Even those non-biological psychiatrists, the psychoanalytic camp, who love borderline personality “disorder”, defend the DSM approach because it allows their “disorders” to try to be equal to other “disorders” in diagnostic and therapeutic attention.
For more on those "400 “disorders”" see below. And finally there is this, which is nearly the end:

Now, the postmodern critics of science, like the psychologist above and the leader of DSM-IV and many PT bloggers, see science as being about scientists trying to push their agendas, not finding out the truth.  But the NIMH leadership has weighed in, finally. Science matters; it is science that will improve patients’ treatments, nothing else.

“Patients deserve better…. A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories….”

That’s it; the battle is won. The past DSM leaders’ "pragmatism" is shown to be the cynicism that it is. The current DSM’s tinkering with a false model is shown to be more of the same.

Unfortunately, Dr. Insel - partially - retracted, and also I do not hold high hopes of his program.

2. Some DSM-related varia - a bit older stuff

Originally, I wanted to go back to July and August of 2010, with Dr. Lane and Dr. Ghaemi discussing the DSM-5 about around the time I originally heard of it, but you can do so yourself if you are interested.

Instead, I give four other posts of this year, and indeed December last year, for the first, and this time the contenders are Dr. Frances and Dr. Ghaemi, both from their blogs on Psychology Today:
Well... it's an interesting debate, and I side mostly with Dr Ghaemi. Here is why, from his last contribution, from which I quote the beginning (again with the "data basis" quotes removed):

When Leon Trotsky opposed Josef Stalin, it was a disagreement among believers.  One believed in more Communism of a certain kind, another in more Communism of another kind. So it is with Dr Frances and his opponents: they are all pragmatists of various stripes criticizing each other. They all fail to value science sufficiently, as any credible medical profession should. 

Dr Frances explicitly supports "pragmatism" over science as a basis for defining psychiatric diagnoses.  He criticizes DSM-5 for valuing science somewhat more than DSM-IV, under his leadership, did, because of the presumed "practical" harms of overdiagnosis, mislabeling, overtreatment, and other baleful practics of our presumably incompetent profession.

This has two merits: First, it clearly locates the debate where it is in fact: Between several groups of believers in a pseudoscience. Second, it gives part of my reason why I said "mostly": I do not believe Dr. Ghaemi is quite fair to Dr. Frances, and notably not as regards DSM-5 being "somewhat more" "valuing science". For they do it as little as did the DSM-IV and the DSM-III, against both of which Dr. Ghaemi indeed is also opposed, and rightly so.

Finally, here are three paragraphs from near the end, which gives some of my reasons to support Dr Ghaemi, and also comes back to the number of diagnoses that I promised I would return to:

Trotsky and Stalin were both wrong because Communism was wrong, presumably.  My colleague's loud attacks on DSM-5 impress me as much as Trotskyism: pragmatism is harmful whether there is a huge amount of it (as in DSM-IV) or a whole lot of it (as in DSM-5).

I agree completely with the goal of reducing the number of psychiatric diagnoses: I would take them down from the hundreds in DSM-5 or DSM-IV to just about a dozen; making diagnoses dependent on good scientific evidence would be the best way to make this change, not an idiosyncratic "pragmatism" that depends on the opinions of the pragmatizers. 

If one really wants to help patients and the public health, making science the most important criterion in any medical profession would seem to be an obvious necessity.  The DSM revisions have failed us all and produced many harmful outcomes because of this denigration of science.

Almost quite so - and my "almost" is due to an (indeed) earlier post of Dr Ghaemi's, when he seemed to be in favour of something between 20 and 50 psychiatric diagnoses.

I don't know myself how many there are that are reasonably beyond doubt, but surely 50 is too much, and 10 may be a safe guess. Then again, I'm at least as much pro - real - science as is Dr Ghaemi, and I do not have any interest in preserving any of the DSMs whether III, IV or 5.

The sooner this bullshit is laughed out of court, the better - and that especially because of the patients, who have been massively frauded [2] at least since 1980, and quite purposively [3] so.

And since I put it quite well on May 16, I'll end on that note:
But then that is the normal behavior for psychiatrists: They do not know what the self is; they do not know how the brain manufactures conscious experience; they do not have any valid theory that is provably relevant to going insane or neurotic; and in fact they do hardly know anything about how the human mind works, for nobody does, and so they lie, for they do want to make a very well-paid living.
---------------------------------
Notes

[1] The main reason is that either no one finds it worth his or her while to write me, or else I just don't receive almost anything people write - and since I have well over 3000 hits a day on the least popular of my (two identical) sites, and I always answer the few who write me politely, I have to submit it may be the latter, though I can't provide any proof for that surmise.

[2] I give the reference to the Wikipedia because psychiatry clearly and obviously satisfies the full definition of
fraud - and I quote (only minus two references to notes):

In the United States, common law recognizes nine elements constituting fraud:

  1. a representation of an existing fact;
  2. its materiality;
  3. its falsity;
  4. the speaker's knowledge of its falsity;
  5. the speaker's intent that it shall be acted upon by the plaintiff;
  6. the plaintiff's ignorance of its falsity;
  7. the plaintiff's reliance on the truth of the representation;
  8. the plaintiff's right to rely upon it; and
  9. consequent damages suffered by the plaintiff.
To establish a claim of fraud, most jurisdictions in the United States require that each element be pled with particularity and be proved with clear, cogent, and convincing evidence (very probable evidence).
[3] Regardless of what either Dr Frances or Dr Lieberman say to the public: Their purported "science" is not a science, it is clearly and evidently a pseudoscience (apart from around 10 diagnoses, that is: 2.5% out of 400, of which at least some 300 were compiled for bullshit reasons).

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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