June 11, 2013
Varia: On Sex, Snowden, and Angell 
“Psychiatry is to medicine as
 astrology is to astronomy.”
– Leonard Roy Frank

1. Sex and its annoyance
2. Three links about Snowden
3. Marcia Angell and the DSMs
About ME/CFS


I believe I have paid back most of the harm my walk of over six weeks ago, but  sleeping remains quite difficult for me.

By now I am convinced it is mostly the supplements I am taking, but then these also do help with my ME-problems, and that is part of the difficulty for me: To find the right doses. I certainly have not done so right now, and it also is quite difficult to do, mainly because there are so many factors that are or may be relevant.

So I'll probably write about that later. For now I provide some links to Snowden; I do some about the DSMs and Dr. Marcia Angell; and I start with sex, because that's getting a bit annoying, although it probably is a fluke.

1. Sex and its annoyance

It may be my audience is shifting, but here is the beginning of the latest search strings:

30 of 438 from SearchStrings
# Hits % Search String
1 176 14.07 women naked
2 116 9.27 naked men and women
3 94 7.51 &esrc=s
4 45 3.60 importance of philosophy
5 36 2.88 naked women and men
6 25 2.00 female naked
7 22 1.76 importance of studying philosophy
8 20 1.60 why is philosophy important
9 19 1.52 naked soccer players
10 17 1.36 naked spanish women
11 15 1.20 (Google Cache)
12 14 1.12 why philosophy is important
13 12 0.96 naked female
14 12 0.96 naked men with women
15 11 0.88 spanish women naked

The next 15 are just the same: 4 about the importance of philosophy, 11 about naked women. This is rather different from how it used to be, that was much more variegated.

It may be - probably is - a fluke, and I do not know much about my audience, but hey, young dudes:

My site is not about sex. You are at the wrong address. I like sex; I very occassionally write about it; and there is an image, from an ordinary paper, that I published long ago, as a joke about something else. (And no, there is very little to be seen there, sexually speaking.)

But that's it. You are at the wrong address. And I put this first, so that you may  know it, and go somewhere else to get satisfied: I do wish you the best, and lots of satisfactions, but once more: This site is not about sex or nudity.

So there. (I am not much annoyed, but this is just to set the records straight: If  you are really interested in sex or nudity - and there is nothing wrong with that -  then you should very probably look elsewhere. And indeed: one of my reasons to be reticent about it, is that there are extremely many other sites that are dedicated to it.)

. Three links about Snowden

I have meanwhile looked at more about Edward Snowden than I like, though that is not his fault, and have seen all manner of opinions about him, mostly not really interesting, and also not really worth reading.

So I'll save on this for the moment, except for three items
The first is a video from The Young Turks aka TYT, which has the merit of asking "What would you do - if you were 29, got $ 200.000 a year, lived in Hawaii with a hot girl friend?", which is all true of Edward Snowden, with Uygur answering that he probably would not have done it - which is fair enough, as this answer applies to almost everyone.

The second is a good piece by Daniel Ellsberg - the man of the Pentagon Papers (<- Wikipedia) - who explains why he thinks this is good, important and brave.

Here are Ellsberg's first three paragraphs:

In my estimation, there has not been in American history a more important leak than Edward Snowden’s release of NSA material – and that definitely includes the Pentagon Papers 40 years ago. Snowden’s whistleblowing gives us the possibility to roll back a key part of what has amounted to an “executive coup” against the US constitution.

Since 9/11, there has been, at first secretly but increasingly openly, a revocation of the bill of rights for which this country fought over 200 years ago. In particular, the fourth and fifth amendments of the US constitution, which safeguard citizens from unwarranted intrusion by the government into their private lives, have been virtually suspended.

The government claims it has a court warrant under Fisa – but that unconstitutionally sweeping warrant is from a secret court, shielded from effective oversight, almost totally deferential to executive requests. As Russell Tice, a former National Security Agency analyst, put it: “It is a kangaroo court with a rubber stamp.”

The third is a link to the nakedcapitalism site, where there is a link to the interview Potrias and Greenwald made with him in Hong Kong on June 6, 2013. My reason to provide that link is that it seems a reasonable site, and it does not require JavaScript to watch, which I find a relief. [1]

I do intend to return to the subject, but not while it is the most important thing on the internet.

3. Marcia Angell and the DSMs

I mentioned Marcia Angell (<- Wikipedia) before, in the context of the DSM-5, and do so again today.

The reason she is important is that she is a smart and prominent medical doctor (and also is some other things: read the Wikipedia on her), and she wrote sensibly about quite a few things, notably about medicine in the US.

In the context of the DSMs, she wrote two quite important pieces, in June and July 2011, both in the New York Review of Books, both fairly long and very well researched, and both presented as reviews of sets of books:
I strongly recommend that you read both pieces if you are at all interested in psychiatry. (And please note that the first in the series comes in a series of three, with links at the end to the other two parts, and the second in the series has two  different bits.)

Now I am going to quote and comment some, with a proviso, which is this: I presuppose at least some knowledge of my dsm-5 series, for I'll mostly though not only quote to support my views that are in that series. (Here it should be noted that I am a psychologist and a philosopher, who is ill.)

First as to all of the "pure hearts" dr. Allen Frances - the chief editor of the DSM-IV - repeatedly wrote about. Here is dr. Maria Angell:
Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.
And I note that - very probably - this is by their official statements only, which are probably partial.

Next, one of the books Angell reviewed is Whitaker's "Anatonomy of an Epidemic" and quotes him i.a. as follows:
Whitaker summarizes the growth of industry influence after the publication of the DSM-III as follows:
In short, a powerful quartet of voices came together during the 1980’s eager to inform the public that mental disorders were brain diseases. Pharmaceutical companies provided the financial muscle. The APA and psychiatrists at top medical schools conferred intellectual legitimacy upon the enterprise. The NIMH [National Institute of Mental Health] put the government’s stamp of approval on the story. NAMI provided a moral authority.
Yes. That's also one of the reasons I was enthusiastic about Dr Insel's retraction of his support for the DSM, that he in turn retracted (partially).

In any case, my own point of view is that psychiatry is not a real science, but is a
pseudoscience that is all about money, that for over 30 years have been mostly made by prescribing drugs to patients, that mostly have no real factual foundation.

The two fundamental points most men entirely miss about psychiatry are that
    (1) there is extremely little known about how the brain works, and
    (2) there is a lot known about how people can be deceived.

And that is what you get, in most cases you get to see a psychiatrist: A deceiver, who is in it for the money he makes, and who these days makes money by prescribing pills of extremely dubious efficacy to the patients, where also hardly anything is known about their long term effects, that are prescribed for currently 400 diagnosed "disorders", that are only "defined" by lists of symptoms, that are only "known" to be partially consistently applied, but to be of totally unknown validity.

The one thing that is absolutely certain is that it is extremely remunerative for psychiatrists and for Big Pharma to sell pills to naive patients.

Back to the review. One of the books dr. Angell reviews is Carlat's "Unhinged: The Trouble with Psychiatry" who is, in my opinion, someone who wants to be all things to all men, which is impossible.

In any case, here he is about the great advantages of not being a Freudian and not doing talk therapy:
Like most other psychiatrists, Carlat treats his patients only with drugs, not talk therapy, and he is candid about the advantages of doing so. If he sees three patients an hour for psychopharmacology, he calculates, he earns about $180 per hour from insurers. In contrast, he would be able to see only one patient an hour for talk therapy, for which insurers would pay him less than $100.
Note that in fact the real dollars seem to be higher, these days. Also, the work is a lot easier. But - being all things to all men - he is sometimes fairly honest:
And he [Carlat - MM] sums up:
Such is modern psychopharmacology. Guided purely by symptoms, we try different drugs, with no real conception of what we are trying to fix, or of how the drugs are working. I am perpetually astonished that we are so effective for so many patients.
Then again, that astonishment needs some astonishment: It seems to be not so, for very many patients. Besides, one main reason is that you do not know what you are trying to cure to start with. (And he doesn't say he cures them, either: he says something much vaguer.)

Next, here is dr. Angell on dr. Frances - and note the first word:

Even Allen Frances, chairman of the DSM-IV task force, is highly critical of the expansion of diagnoses in the DSM-V. In the June 26, 2009, issue of Psychiatric Times, he wrote that the DSM-V will be a “bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net.” As if to underscore that judgment, Kupfer and Regier wrote in a recent article in the Journal of the American Medical Association (JAMA), entitled “Why All of Medicine Should Care About DSM-5,” that “in primary care settings, approximately 30 percent to 50 percent of patients have prominent mental health symptoms or identifiable mental disorders, which have significant adverse consequences if left untreated.” It looks as though it will be harder and harder to be normal.

And as to this last named couple of fraudian shrinks:

At the end of the article by Kupfer and Regier is a small-print “financial disclosure” that reads in part:

Prior to being appointed as chair, DSM-5 Task Force, Dr. Kupfer reports having served on advisory boards for Eli Lilly & Co, Forest Pharmaceuticals Inc, Solvay/Wyeth Pharmaceuticals, and Johnson & Johnson; and consulting for Servier and Lundbeck.
As I said: I have harvested quotations mostly with a view to supporting my own opinions, and not with the intention of giving a fair summary of dr. Angell's articles, which I do think are very fine (but which are hard to adequately summarize).

Then again, it is not likely she was much pleased by them, for there appeared the next month three letters, to which she replied:
Again, I am not going to to quote with any view to give the writers their dues. All I am saying is that they were by Drs. Oldham, Carlat and Friedman & Nierenberg, and are, for the most part, quite dishonest, in my opinion - it's about their incomes, after all.

But I will quote two bits. First, from Carlat:
There is no question that among the medical professions, psychiatry is the most scientifically primitive. We have no more than the most rudimentary understanding of the pathophysiology of mental illness and we have resorted to tenuous and ever-shifting theories of how our treatments work.
Quite so - except that in my opinion "scientifically primitive" is too optimistic, indeed in view of "the most rudimentary understanding": There is hardly any real science there: it's almost all pseudoscience.

The second bit I'll quote is this total rot by Friedman & Nierenberg:
To start, psychiatric illnesses are diagnosed on the basis of signs and symptoms. With the exception of substance-induced disorders, we do not know the cause of most mental disorders. But medicine is no different; aside from infectious diseases, the cause of diseases like cancer, hypertension, and arthritis is unknown.
No, you liars: Cancer, hypertension and arthritis are clearly existing medical conditions, unlike something like 390 of your 400 utterly contrived "disorders".

Finally, Marcia Angell did reply, quite well also, but probably not quite happily. I'll quote two bits. First the beginning:
Marcia Angell replies:

All three of these letters simply assume that psychoactive drugs are highly beneficial, but none of them provides references that would substantiate that belief. Our differences stem from the fact that I make no such assumption. Any treatment should be regarded with skepticism until its benefits, both short-term and long-term, have been proven in well-designed clinical trials, and those benefits have been shown to outweigh its harms. I question whether that is so for many psychoactive drugs now in widespread use. I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry.

Quite so. It is as if dr. Angell had been discussing theology with theologians - which indeed is where it is at, for the greatest part, but with the exception that the "theologians" who are shrinks pretend to be scientific.

Finally, here is Dr. Angell on Dr. Oldham, who wrote a very fraudulent letter:
Contrary to Dr. Oldham, I did not say that mental disorders were invented in order to create a market for psychotropic drugs. What I did say is that the boundaries of mental illness are being stretched for a variety of reasons—to increase drug company sales, to enhance the income and status of the psychiatry profession, and to get insurance coverage or disability benefits for troubled families. It may be that, as Oldham says, the disorders that these medications treat have been around for all of recorded history, but they weren’t necessarily considered “disorders,” rather, simply emotional states or personality traits. Just as a cigar is sometimes only a cigar, unhappiness might have been considered just that, not a medical condition.
Quite so.

[1] That is: You are being conned when a site says that to see a video on it JavaScript is needed. No: the owner wants to track or trace you. (That may be justified, quite rarely, but I do not like being lied to, and I do not like JavaScript's applications.)

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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