1. On confusions and misunderstandings concerning the DSM-52
This is the first
Nederlog of June 24 and it is not an ordinary crisis
I have written more
than hundred Nederlogs about
psychiatry, and I have
decided to republish some of the best of them under the comprehensive
titel "On Psychiatry N", where "N" is a number.
This is the second of that series. The first was on June 13, 2014. In this On Psychiatry 2
I explain among other things the
systematic confusion of operational and conceptual definitions that
lies at the root of all of the DSMs and the utter mathematical idiocy of
"defining" "disorders" by means of "you have X if you have at least
n of s and m of t and k of u symptoms".
Here is part of the moral lessons I drew in 2011:
My advice: Give it
up. Give psychiatry up. Use your common sense, and such neurology and medical science as you understand, and insist
that psychiatrists should not be in medical science but in
theology, as doctors of the soul, and as evident frauds and
flimflammers, at least since the DSM-5, if not since the days of the coke-snorting
Freud and the schizoid paranoid Jung.
And I should say the
original was published on August 19,
2011, nearly two years before the DSM-5 was published, while I do
not know anything more than I say about Dayle Jones, who gets quoted
and who meant well.
Besides, there is an appendix I wrote
As to me: I am a psychologist, who got an M.A. of only A's (while ill) and a philosopher, who was removed
briefly before taking my M.A. in philosophy (while ill) because I asked questions and was not
a marxist, nor did I pretend to be one, like almost everybody else who
studied at that time in the University of Amsterdam.
Apart from the
introduction, there is one other reason to make the
series "On Psychiatry": I
have been reading and writing for over a year now about the crisis,
and I need occasional other topics, and this is a good one for me to
reread and assemble into a series (and no: I do not often reread
There will be at least three more items in the series, and
possibly more, and there probably will be a crisis issue in Nederlog
1. On confusions and
misunderstandings concerning the DSM-5
Now to the subject of my
title - various confusions and
misunderstandings concerning the DSM-5 notably of methodological, statistical and
gives quite a few links to
material on this site. If you have read the books under the first link,
and the texts under the second, I must suppose you are rationally
My general background as regards methodology, statistics, science and
philosophy of science is here:
In fact, very few will have read any of the books under the first link,
though all of these can be fairly regarded as classics in their fields
(by many, not just me), and that mostly because few these days, also
when they have an academic degree, have learned much about methodology,
statistics, and philosophy of science, since this got quite widely out
of fashion, since postmodernism became fashionable:
It so happens that I wanted to
write about these confusions and misunderstandings anyway, and the
reason I do so now is that I received a copy of a blog by a Ms K. Dayle
Jones, who is a counselor and an associate professor, and who has been
to some extent involved with the DSM-5 the past year, and who wrote an
interesting blog about the DSM-5, with some good ideas and
recommendations, but also with some confusions and misunderstandings.
As I've implied, I do not blame Ms. Jones for these, for in fact (1)
she shares them with many academics, notably many psychiatrists and (2)
the reason this is so is that few scientists are well educated in
methodology and philosophy of science. Moreover (3) this can be excused
to a considerable extent for scientists who are in fact mostly practicians
of science rather than research scientists - GPs, surgeons,
clinical psychologists, engineers etc.
So let us see - and yes, I will explain myself, and not argue by mere
claims, as the DSM-5 editors do. The original is under the link in the
title and was posted on August 16, and I quote in blue:
Quite so - and that is the whole
point as well: More power and money to the psychiatrist brotherhood.
the last year writing about the DSM-5, which is slated for publication
in May 2013. I admit, the more I’ve read and learned about the proposed
revisions and how they’re being developed, the less optimistic I’ve
become about the final product.
described several of the problematic proposed revisions in previous
blogs and in the DSM-5 Update column in Counseling Today. The most
worrisome proposals involve diagnoses with lowered symptom requirements
and the inclusion of “subthreshold” disorders. For example, the DSM-5
proposals that reduce the symptom requirements in existing disorders –
like Major Depressive Episode, Generalized Anxiety Disorder, Substance
Use Disorder, ADHD, and others – have the potential consequence of
dramatically increasing the prevalence rates of disorders.
“subthreshold” disorders – such as Attenuated Psychosis Syndrome (i.e.,
Psychosis Risk Syndrome), Mixed Anxiety Depression, Mild Neurocognitive
Disorder, and Disruptive Mood Dysregulation Disorder (i.e., Temper
Dysregulation Disorder) – have generated more concerns. A subthreshold
disorder is not, by itself, considered a disease or disorder. Instead,
it represents some, but not all, of the symptoms of a mental disorder.
The problem with subthreshold disorders is that they blur the
boundaries between pathology and normal behavior.
Not quite - I mean: I agree "they blur the
boundaries between pathology and normal behavior" , and again I think this
is intentional, but Ms Jones, like most people, seems to mistake operational
definitions and conceptual definitions - a a
confusion of a measuring tool and what it measures, as in the visible symptoms of measles and the disease
this confusion is very widespread:
Originally, at least the DSM-III was meant to offeroperational
definitions, i.e. in the present context: definitions of symptoms in behavioral or
empirical terms, that especially medical doctors could factually
and practically agree on, as a way to have at least agreement
on the terminology used, and on what a disease was supposed to show in
the behaviour of those who had the disease.
That was good science, at least in principle, and it was not
meant that the operational definitions are definitions of the disease,
but only of some behavioural symptoms
that are supposed or known to go with it, typically or always, in theory. (All of that may very well be
mistaken, but then again such mistakes are
only empirically provable or plausible if the operational definitions
are unambiguous and in observational terms.)
What since then happened is that almost everyone,
including - it would seem - all 38,000
leaders of the APA (and I so much like the
megalomania of that: 38,000 leaders, no less:)
Click image for my submission to the APA
mistook and mistake operational definitions and conceptual
definitions - and the latter would attempt to define a disease or
aspect thereof in terms that are not
necessarily limited to terms describing observable behaviours. (E.g.
Alzheimer may be defined, provisionally, as a set of cognitive and
related problems due to a certain type of lesions in the brain
(conceptual definition), manifested behaviorally by lapses of memory
especially in the elderly and old (operational definition) - and I am
giving an example of a distinction, and am not seriously defining
So as far as I can see, almost everybody writing about the
DSM does not understand its purpose, the reason it exists, and believes
or pretends that its operational definitions are conceptual definitions.
One problem is that very few pronouncing on it have much of an idea of
what science is like. Thus, few seem to realize science proceeds by
testing guesses, which needs precise guesses (and no
multi-dimensional vagueness), for only
precise guesses can be falsified and
indeed verified. Imprecise, vague or ambiguous guesses are untestable.
(The DSM-5 will make psychiatry totally untestable and unfalsifiable,
and I think again that is intentional: That's why it is made "multi-dimensional" - to make it
the whole DSM-5 and indeed all
ME-diagnoses, and it seems indeed many medical diagnoses, are based on
the DSM-5 sort of way:
P has ailment A
if P has m1 of n1 symptoms of category A, m2 of n2
symptoms of category B, and m3 of n3 symptoms of category C."
That sort of schema, that's used nearly
everywhere, with its numbers, suggests great scientific precision and
exact mathematical measurement, but in fact is quite otherwise:
Consider - for example - when some ailment is diagnosed across three
dimensions or categories ("physical social
psychiatric", for one example) and is
required to have 4 out of 7, 3 out of 6 and 5 out of 8 to be diagnosed as having that ailment A. Now in mathematical fact these choices can be
made in resp. 35, 20 and 56 ways, namely by
The result is "a diagnosis" which is inherently extremely
imprecise and vague, even though it looks as if it is the
pattern of exactitude.
For in fact, that supposed pattern of exactitude implies in the example
that there are then 35*20*56= 39200
possible different patterns of this ailment thus diagnosed, of which
patient P then manifested 1 of these 39200, all as
"scientifically defined by evidence-based medical science".
If one were to object that I present an extreme case:
Consider "a simple diagnosis" that requires 4 out of 7 symptoms to be present. This can
happen in 35 different ways. Which DSM-wizard has as much as thought
these possibilities through, in any
such case? Or tested
their frequencies in a large enough population? None
It's rather elementary mathematics, but I have never seen this
problem even mentioned, whereas it should be obvious
for anyone who knows elementary combinatorics.
That's another reason why I can't take any DSM I have seen serious as
empirical rational science:
Testing theories is best
done by binary tests: it is so, or it is not so, and
thus definitely confirmed or undermined given one of these. Theories
which do not logically imply such tests are less testable or hardly testable, while something that is
diagnosed as "X" and can be "X" in 39200 possible different ways is an
"X" in an almost totally useless mass of vagueness and
ambiguity, as indeed it also is next to useless if it were 35 or 18: Having "X" is then too ambiguous and imprecise,
for its method of diagnosing logically implies the term "X" will cover
too many distinct possibilities of having the ailment with that one
name "X" - that also will make it much more difficult to test
any therapies or treatments for "X".
case of an empirically well-established kind of entities with real and
known empirical properties (!!), it may be possible to research
this - but in the DSM-5, where this procedure, with m1
of n1 symptoms of category A, m2
of n2 symptoms of category B, etc.
being used to "define", "describe", or "diagnose" "mental ailments"
that are mere labels or suppose very strong almost wholly untested -
and indeed by the DSM-5-way wholly untestable - theories, this
procedure is mere arbitrary doubletalk: A study in arbitrary
vagueness presented as if it were a precise way of diagnosing, which it
is not at all.
for the extreme terminological vagueness with which these new mental
ailments or theories thereof get introduced in the DSM-5, see:
for those who like to contemplate this manner of
things: For most of the DSM-5 the following table
suffices with instances of in how many ways x things can be taken out
of y things, with 1 <= x <= y, and 1 of x always in x ways and x
of x in 1 way (calculated in Squeak):
|2 of 3=3
||2 of 4=6
||2 of 5=10
||2 of 6=15
||2 of 7=21
||2 of 8=28
||3 of 4=4
||3 of 5=10
||3 of 6=20
||3 of 7=35
||3 of 8=56
||4 of 5=5
||4 of 6=15
||4 of 7=35
||4 of 8=70
||5 of 6=6
||5 of 7=21
||5 of 8=56
||6 of 7=7
||6 of 8=28
||7 of 8=8
a hopefully instructive aside, as to the number of distinct ways in
which one can have an ailment "X" on the diagnostic schema the DSM-5
Back to Ms
I agree - but add that almost no
one seems to understand what the DSM was intended for, and seems to
believe that its operational definitions,
that were originally framed to test psychiatric theories
by having clear behavioural symptoms, are in fact the core and essence
of modern psychiatry.
main fears about the inclusion of diagnoses with lowered symptom
requirements and subthreshold disorders are
a. the potential for drastically increased prevalence rates;
b. the medicalization of normal behavior;
c. increased stigma; and
d. unnecessary treatment that frequently includes medications that
sometimes cause harmful side effects and complications.
This is like mistaking behaviorism and psychology, and like insisting the
visible outside is all there is to a thing, or like
mistaking hell with Jeroen Bosch's pictures of it. (*)
The whole set of ideas most of
its users have about its purpose and content is fundamentally
mistaken, and indeed unscientific: A science does not
consist of its operational definitions - these are only
introduced to test its theories.
wouldn’t have a problem with any of the DSM-5 proposed revisions if I
was assured that they were supported by strong scientific evidence.
Moreover, it now seems as if DSM-III, and more
specifically DSM-IV and DSM-5 have been dreamt up quite
intentionally and on purpose to satisfy the
financial interests of psychiatrists (for: the more mentally ill, the
rosier the financial future of the Physician Leaders Of Mental Health
of the APA) by the committees of its editors, all operating secluded from the public and other
psychiatrists, and also operating without
any input from any real science, and even, it would seem, since
DSM-IV at least, without any input from any one who knows philosophy of
science or is at least aware what operational definitions are and why
Yes, and I think it is rationally
quite safe to conclude it happened all on purpose. I do not
know how much the DSM-5 wizards of the APA
know about philosophy of science and methodology - not as much as I, I
am sure, but I doubt they are totally
clueless - but I feel quite certain in assuming they know and welcomed
the opportunity to redefine psychiatry so as to fit their own interests and prejudices, and in assuming they know,
for the most part, it is all quite irrational and ad hoc, as
indeed were DSM-III and DSM-IV, from what I have meanwhile read about how these came about, though perhaps these
were at least considerably less dishonest, if
not decidedly more rational. (**)
Renowned researchers and experts in
diagnosis have publicly expressed many concerns about the DSM-5, such as
a. lack of an
independent, systematic, transparent, and evidence-based method for
reviewing the empirical support for changes;
b. inadequate field
trial research design; and
c. proposals to
include untested dimensional assessments that lack information about
scale development procedures or psychometrics
interesting to get some numbers, and in fact
strikes me as fairly crazy, given
what the DSM is: NOT a book of definitions,
NOT a handbook of psychiatry - but merely a list of lists of
operationalized symptoms, put together to be able to agree at
least on the empirical terms used to describe symptoms and then use
that for the testing of real theories and unoperationalized concepts that are part of these theories
(for any theory that is
testable and worth its minimal salt must go beyond the known facts, if
only to be testable, and if tested and not refuted, to be of some use).
over 500,000 mental health professionals in the U.S. that use the
manual (197,000 social workers; 115,000 mental health counselors;
54,000 marriage & family therapists; 93,000 psychologists; 75,000
psychiatric nurses; 38,000 psychiatrists), the DSM greatly impacts
counselors’ work in assessing, diagnosing, and treating clients.
Another major scandal is that these, as with the DSM-III, were never
properly validated by any research: They were dreamed up by committees, essentially without
rational evidence, for that requires the framing of conceptual
definitions and theories to explain the operational definitions used to
This seems not
clearly expressed: In fact the DSM-5
is the work of editorial committees and sub-committees, altogether of some 150 or so who do it, and fundamentally by making it up from thin
air, with lots of innuendo and vague bullshit, on the pattern
"Evidence-based science has been found that suggests that it may be "
a.s.o. (In fact, that they use this manner of verbal bullshit suggests strongly to me
they know they are lying and imagining things.)
fact, the American Psychiatric Association (APA) is the sole group that
revises the DSM, despite representing only 7% of all mental health
My advice: Give it up. Give
psychiatry up. Use your common sense, and such neurology and medical science as you understand, and insist
that psychiatrists should not be in medical science but in
theology, as doctors of the soul, and as evident frauds and
flimflammers, at least since the DSM-5, if not since the days of the coke-snorting
Freud and the schizoid paranoid Jung.
counselors and other mental health professionals have relied on APA and
the DSM for guidance in the diagnosis process. Yet, the DSM-5’s
questionable research methodology leaves me wondering if we should
what can counselors do if we don’t like the DSM-5 final product?
Use the DSM-III? Use some
good handbooks of yore, like the books of Silvano Arieti,
dean of the APA ca. 1970, who wrote good books on general psychiatry,
schizophrenia, and creativity? (***) Use some Luria and Vygotsky, who at
least were sensible psychologists? Rely on James's
"Principles of Psychology" as basic text, supplemented by any of
the far less clear and sensible but more up to date modern texts, used
at Harvard or Stanford?
recently been writing about the International Classification of
Diseases (ICD-10-CM). My purpose has been to educate counselors that
DSM is not mandatory for most clinicians unless specifically required
by their institutional settings.
And even there pseudoscience
cannot be made mandatory except by abuse.
I suppose this is so, but have no
definite knowledge. FWIW, I've only seen and read some in the DSM-III,
somewhere in the 1980ies, as a student of psychology, and note that (1)
this was not part of any of the courses I took (since I am not
a clinical psychologist, it may have been used there, but I doubt it -
see (3) and (4) below); (2)
the book was owed by a professorial friend of mine, and that's why I
saw it: He had it in his bookcase; and (3) all the psychologists I
know, including many professors, did not take it serious, mostly for
the reasons I have given: It's not a summary of the science of
psychiatry in any way, but only - in so far as it is used properly and
written properly - a book to make for uniform diagnosing of possibly
ill people in terms of the same behavioural criterions. Besides (4)
psychologists generally have
a fairly to very low opinion of psychiatry, because they know psychiatry is not a real science, for lack of the
requisite knowledge of how the brain produces conscious experience,
and because they know most of psychiatry since Freud has been shown to
have been bullshit, many
times, and about many things, while psychiatry has harmed many persons,
if not personally and medically, then at least financially, by pseudo-cures and nonsense-therapies and loads of
fact, the ICD is the only classification system approved by HIPAA – not
the DSM. As such, ICD codes meet all insurer-mandated and HIPAA coding
requirements. The reason why mental health professionals can use the
DSM-IV for diagnosis is because the DSM derives its code numbers from
I hope so. But if the
understanding of what the DSM is for and contains is as lousy as it
seems to be, I will not be amazed if they are made to agree in the mean
while, simply because this is much in the financial interest of
psychiatrists, probably much in the interest of powerful
health-insurance and pharmaceutical companies, and also may be of great
interest to governmental institutions, at least such as like to have a
Soviet type of psychiatry: Whoever does not conform to the average, is
eo ipso a nut case and a danger to society.
the DSM-IV code numbers reflect the ICD-9-CM codes. However, the DSM-5
codes will have to reflect those from the ICD-10-CM because use of the
ICD-10-CM becomes mandatory by all health professionals in October 2013.
publicizing the use of ICD as an alternative to DSM so that counselors
know they are not confined to using the DSM-5 – especially if they find
that the DSM-5 lacks credibility.
That's not really the point: It is not "lack of credibility"
that matters, it is lack of scientific foundation that matters.
(Whether that is "credible" to psychiatrists or counselors is of no
concern to me, just as I am not concerned with the beliefs of devout uneducated Roman Catholics about Darwin.)
See above for my recommendations.
However, Ms Jones has a point, namely that counselors
would have a need to speak the accepted officialese lingo, crazy as it
is, for several reasons, and this is a way to do it.
And, to use ICD-10-CM, counselors do
not have to learn a whole new classification system. In fact,
counselors can continue to use their DSM-IV and simply look up and use
the new ICD-10-CM codes numbers (available free online).
Forget it, is
my advice. It was, is and will
be pseudo-scientific bullshit. And most of that is so by design.
And no one ever could trust any DSM for diagnosis: It's end was not
to facilitate diagnosing, but to facilitate the testing
of conceptual diagnoses, arrived at by a real knowledge of the patient
and of science.
I want the DSM-5 to be a quality product that I can trust for diagnosis.
Not to me. It is either intentionally designed
bullshit, or bullshit based on extensive ignorance of science and
the DSM during my entire career as a counselor, and I feel some
allegiance to this classification system. But the inclusion of
potentially dangerous, scientifically unfounded diagnoses scares me
enough to possibly abandon the DSM.
have some recommendations for APA and the DSM-5 Task Force that would
assure the credibility of the DSM-5.
This is fair enough, but it is
clear as daylight that the APA and the editors of DSM-5 do not want
this and never wanted it. What they wanted was the chance to make a
supposed diagnostic manual in camera, by a small committee, dreaming up
its nonsense without any real responsibility
to anyone but the other members of the committee.
that for mental health professionals to endorse and purchase the DSM-5,
that APA should take the following actions:
1. All evidence from the DSM-5 Task Force should be (a) immediately
made public and (b) submitted for independent review. The DSM-5’s
credibility will remain questionable unless it is subjected to
systematic, comprehensive, independent, and multidisciplinary external
review. As such, all evidence and data needs to be reviewed by experts
in evidenced-based decision-making who are completely independent of
the DSM-5 process. This includes all evidence and data from (a) the
DSM-5 Scientific Review Group, (b) the work groups, (c) the field trial
data, and (d) the dimensional assessments development procedures. The
Cochrane Collaboration, an international network recognized for its
high quality reviews of health care research, would be the ideal group
for conducting this independent review.
Again fair enough in principle,
but it may be safely assumed that one of the major ends of the
DSM-5 is to make psychiatry untestable. Anybody who knows anything
about statistics and methodology cannot conclude anything else given
the craziness of what they call "multi-dimensional classifications",
which in fact amounts to "anything an
APA-member asserts must be accepted as gospel, unless he
or she has been thrown out of the APA or lost
the medical license".
2. Any suggested DSM-5 revisions
deemed to lack strong empirical evidence by independent review should
not be approved for DSM-5.
Knowing statistics, my informed
highly probable guess is that is there by design to make
psychiatry a mock "evidence based science", where the prejudices of its
psychiatric priesthood are "evidence based science" because that's what
they chose to call it, and few had the wit or courage to cry "This is
evident dangerous bullshit! This is not science: this is flimflam!".
3. Eliminate the untested dimensional
assessments from DSM-5 and publish them as a separate document.
the volumes in item 9 there explain all the fundamentals of
mathematical logic, statistics, probability theory and methodology,
also in clear and informed terms, and with many useful references and
explanations of points rarely discussed in ordinary handbooks (that
tend to be for practicians, and to be inexact and unreliable as to
Again fair enough in principle,
but I do no see it happen, though I'd love to be refuted here. Also, no
external review by methodological or statistically or logically knowledgeable persons will leave it standing, for
it's bullshit, and at least some of its editors should know enough of
methodology and statistics to add that they must be mala fides.
publication of DSM-5. If having external review means that DSM-5 cannot
be completed on schedule, the DSM-5 publication date will have to be
In summa: Ms
Jones clearly means well, and also has some good
recommendations, although I do fear it is very unlikely they will be
followed. But unfortunately, like most pronouncing on the (de-)merits of the DSM-5, she
does not know enough of methodology and statistics to know how much she
and others have been flimflammed and hoodwinked by the APA, but then, as I said above, she shares this lack of
knowledge with most.
I believe these recommendations are critical
to producing a credible and safe DSM-5 that all mental health
professionals can use and support.
also is an important reason that fraudulent flimflam such as the DSM-5
gets accepted and receives credit: Very few are able to judge its
pretensions rationally, and on the basis of a good knowledge of
philosophy of science, methodology, and statistics.
Appendix of 2014: Why none of the DSMs is
a diagnostic manual
appendix is intended to undo some confusions some readers may have, and
gives my answer to the question in the title.
mostly concerned with making a few inferences from the parts on operational definitions and the DSM-5 way (shared with the other
DSMs) to arrive at what is claimed to be "a diagnosis". Here are the
A1: "Operational" "definitions"
A2: The DSM way of "diagnosing"
A3: None of the DSMs is in any rational way "a
A4: What the DSMs are good for
A1: First, the operational definitions:
As I explained, what are called "diagnoses" that are reached when using
any DSM are in fact based on what are for the most part operational
These operational definitions refer to particular
observable facts, about which there is not supposed to be much
possible difference in trained observers. Indeed, all of this is, at
least in principle, good basic science: One needs to test one's
theories, all of which go always far beyond any empirical evidence,
namely by testing that they do square with such empirical evidence as
But for psychiatry-DSM-style, here the difficulties immediately start:
They have no explicit theories of any kind. This does not
mean they have no theories, but these are not in any DSM:
consists only of what are pretended to be operational
definitions. This itself means that psychiatry is not an
empirical science, because every real empirical science does
have - explicit, if well carefully formulated and tested
and confirmed - theories, and it
is these theories that are tested. But not in psychiatry-DSM-style: That
has, very explicitly also, no theories - which seems to be an
innovation by Robert Spitzer, which he introduced to avoid making
psychiatry falsifiable - which had very plentifully happened (on both
good and bad grounds, in the 1960ies and 1970ies).
of course, the operational definitions of mental disorders that the
DSMs deliver are often not really operational definitions,
which is why there has been developed a test that measures the extent
to which the proposed operational definitions do work. This is
called a lambda (a Greek letter used to name the test - that's all),
and what it tests is not - not at all - the theoretical
validity of any operational definition, let alone any theoretical
validity of a theory: both are impossible for lack of any
theories. No, what it tests is the degree of observational
agreements different doctors have when applying the operational
- normally lousy statisticians, who also are not acquainted with
philosophy of science - make a whole lot of fuss about lambdas, and
tend to pretend these measure the theoretical validity of the DSM,
which is either stupid or fraudulent: All it measures is the degrees of
agreement several doctors have in applying the operational definitions.
Well... it turns out they rather often cannot even agree in any
significant manner on how their terms are to be applied (and note: this
is all completely regardless of whether these terms are theoretically
significant or mistaken - for there are no theories in the DSMs).
A2: Second, the DSM
way of "diagnosing mental disorder": Psychiatrists diagnose their
patients as having "a mental disorder X" if the patient has k of s
symptoms X1, l of t symptoms X2, and m of u symptoms X3. That is the
schema. The symptoms are supposed to be operational definitions, though
as I explained they often are not really (which explains the variances
in the lambdas).
combinatorics shows - see above -
that this manner of diagnosing very easily leads to
patient A as having X in one of 39000 ways, patient B as having X in
another of 39000 ways, and patient C as having X in yet another of
39000 ways, and quite possibly A, B and C have no symptom in
common, though all are psychiatrically diagnosed as "having X".
"having X" means no more than having at least k, l and m symptoms: It
is itself no theoretical evidence of any kind, for
there are no theories. Also, the - say - 39000 or perhaps merely 35
different possible diagnoses for having X were never thought
through by any psychiatrist - and indeed "having X" these days
normally merely means "getting prescribed the very expensive patented
and highly profitable and probably also quite dangerous and addictive
A3: Third, why none of the DSMs is a diagnostic
manual: Let me contrast this with real medicine, which is a
science (if we abstract from the many corruptions introduced by the
are theories: Every disease in medicine is based on a real theory about
the causes, mechanisms and course the disease is taking or capable of
taking (that usually are only known in part); the real theory goes very
much beyond the facts, because it mostly consists of theoretical
terms; but the real theory is testable because it does also
logically entail a number of particular facts, that generally can be
tested operationally, e.g. by a blood test.
is more than theories in any well-established real disease:
There are many books, many journals, many courses of treatments and
many tests about any well-established real disease, and this is the reason why
medical people can confidently predict outcomes and possibilities, once
you have tested positively for having a certain real disease. (This is
generally quite easy, for known diseases: They use real operational
definitions and real tests, often of the blood.)
of this is the case in psychiatry, that indeed generally - with a few
exceptions - does not deal with nor cures diseases: it
deals with, it says, "disorders". But nearly all of these
"disorders" are established by the above process: "Disorder X" consists
of having at least k of s symptoms X1, at least l of t symptoms X2, and at
least m of u symptoms X3. (Why this is supposed to be so, also is
rarely rationally explained.)
"disorder X" may be anything, including being aversive to or
not kind or not trustful to one's psychiatrists, or of being an unruly
small child (which "therefore" is - psychiatrically - fit to be treated
with amphetamines "to cure" "ADHD") or reading too much about
psychiatry or griefing longer than two weeks after the death of one's
partner ... or etc. etc. etc.
None of the
DSMs is "a diagnostic manual" in any rational sense: The
"tests" are not real tests of theories or of real knowledge of
real diseases: the "tests" merely score whether one has a certain
number of symptoms; the "disorders" that are diagnosed are - nearly all
- not diseases nor are they explained; the "disorders" are
completely arbitrary; the diagnosing is of "disorders" one can normally
have in any of 35 to 40,000 possible distinct ways, none
of which has been seriously considered by anyone, as opposed to real
medical science, where the tests generally are specific and binary:
one has the symptom of the disease or one has not.
it is all baloney and bullshit. What
is it good for?
A4: What the DSMs are good for: It turned out to be excellent
for generating many billions of dollars of profits.
Psychiatrists may pretend they are MDs, though generally all they got
was a few years of medical studies that provided them a BA in medicine,
and this in turn gives them the right to prescribe pills of kinds only
medical doctors may prescribe.
is what the DSMs are good for: To enable psychiatrists to prescribe
expensive - and often dangerous or addictive - "medicines" against all
manner of "disorders" they "diagnose" with the help of their DSMs.
only in the US, yearly billions of dollars for a few
pharmaceutical corporations and for the psychiatrists prescribing these
"medicines". And this is what the DSMs are for: To make big money, from
people who are too ill or too disturbed to fend for themselves, and who
generally know nothing of real medicine nor of psychiatry.
nearly all complete and utter baloney and bullshit, for there are now over
400 "disorders", while there are at best some 10 mental diseases
(Alzheimer, schizophrenia, depression, some pathologies - and no: these
also are far from clear, but they do exist since well over a
100 years, unlike hundreds of the "disorders" introduced by the
successive DSMs, and are valid complaints - but note that these days it
is more likely you will get into a jail in the US because of your
mental problems than of getting any good treatment, especially if you
are not rich).
general public is naive, and is easily taking in by a plausible
"medical" liar who anyway talks mostly what sounds like medical
gobbledeegook, and "therefore" is trusted. But modern psychiatry, since
the DSM-III, is fraudulent and false, and more so than the also
pseudoscientific psychiatry it replaced.
not mean that all psychiatrists are frauds, for one can be a
fairly good helper of people with psychological problems without much
real knowledge, but they are if they insist on their knowledge, wisdom
or science: they have very little real knowledge, hardly any wisdom,
and psychiatry just never was a real science, and always was a pseudoscience.
It also cannot
be a real science, at the present stage of ignorance, for the simple
reason that no one understands the brain well enough, or
understands well how society and culture and education mould and make
personalities and characters.
(*) Psychiatrists like Wessely are sure to want to
insist at this point that their Cognitive Behavioural Therapy is the
way to proceed with a biosocialphysical approach. I reply they are
systematically and on purpose confusing matters terminologically,
logically and empirically, by inventing bullshit theories that promise
to be all things to all, whereas what they in fact offer is mostly lies
and nonsense to help psychiatrists make money without being found out.
(**) Again and again what people without extensive
knowledge of psychology and psychiatry fail to realize is how
awfully LITTLE is known about how the brain produces experience -
for which reason all theories explaining human experience must be mere
guesses, almost certainly bound to be refuted by later research, as
indeed has happened for much of psychiatry.
the honest well-intentioned ones, that also exist, really have no
special knowledge about human experiencing, thinking and feeling, for
there is hardly any such real knowledge. They pretend to knowledge they
do not really have to get paying patients, as men dealing in medicine
seem to have always done, through at least 25 centuries, in which only
the last 150 years or so saw anything in the way of a rational science
of medicine based on real physics and bio-chemistry.
(***) I have read four of his books, and
unfortunately there is little about him on the internet. "The
Intrapsychic Self" is his general introduction to psychiatry, and
was published by Basic Books. It is available second hand on the net,
and I like it, since Arieti undertook to do what Freud and other
psychiatrists failed to do: Propose a theory of thinking and feeling
(that goes beyond mere empty verbosities).
To quote professor
Frankfurt on the subject, and to clarify why I use the very
appropriate term bullshit for postmodern psychiatry and the DSM-5:
In his essay On Bullshit
(originally written in 1986, and published as a monograph in 2005),
philosopher Harry Frankfurt
University characterizes bullshit as a form of falsehood distinct
from lying. The liar, Frankfurt holds, knows and cares about the truth,
but deliberately sets out to mislead instead of telling the truth. The
"bullshitter", on the other hand, does not care about the truth and is
only seeking to impress:
It is impossible for someone to lie unless he
thinks he knows the truth. Producing bullshit requires no such
conviction. A person who lies is thereby responding to the truth,
and he is to that extent respectful of it. When an honest man
speaks, he says only what he believes to be true; and for the liar, it
is correspondingly indispensable that he considers his statements to be
false. For the bullshitter, however, all these bets are off: he is
neither on the side of the true nor on the side of the false. His eye is not on the facts at all, as the eyes of
the honest man and of the liar are, except insofar as they may be
pertinent to his interest in getting away with what he says.
He does not care whether the things he says describe
reality correctly. He just picks them out, or makes them up, to suit
4. Afterword: In fact, everything between the
two occurences of double lines was copied from August 19, 2011. I think most of the
links work. As I've said, this is the second of a series of
of some of my best Nederlogs about psychiatry.
(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: