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  Feb 10, 2012                  

DSM-5: Kate Kelland vs the American Psychiatric Association

Having considered the plight of the Whittemores and the funding of the WPI in my previous Nederlog of today, I now return to the DSM-5 and comment on an article written by Kate Kelland for Reuters, that can be found on Suzy Chapman's excellent site about the DSM-5:

  • DxRevisionWatch

I quote it as I found it, quote by indentation, and in the order the quotes appear in the original, and write my own remarks without indentation - and please note that Ms Kelland seems to me (who is a psychologist and philosopher, by university degrees) to be quite correct in what she writes:

LONDON, Feb 9 (Reuters) - Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labelled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and mental health experts said its new categories and "tick-box" diagnosis systems were at best "silly" and at worst "worrying and dangerous".

I say! I like it, and it's the first time I see the "tick-box" diagnosis systems criticized, by another than myself, while I also like the moniker.

Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medicalising behaviours most people would consider normal or just mildly eccentric, the experts said.

But then one should be so very proud and thankful of being able to help the noble and ever well-intentioned, so very scientific shrinks and psychobabblers, to have their incomes in the top 2%.

Indeed, I think it probably make sense to put it on that level, in public: This is not about science, this is not about morals: This is about money, and specifically about money for shrinks and psychobabblers. (*)

Those psychiatrists and clinical psychologists who do not protest the DSM-5 are grossly incompetent or in it for the money. The APA is in it for the money, and quite competently so: So far, nearly everyone in medicine and health-care has been swindled into believing they work in the patients' interests. They don't, or if they do because it pays them.

And to be clear here, morally and financially: That people work for money is not bad, in itself, if they are also just, honest and fair, for everybody needs a living. The problem is that the DSM-5 is neither fair, nor honest, nor just, nor scientific, in any real sense, nor is it medical science: it is mostly a sort of theology of the soul, formulated in postmodern terms that are meant and designed to mislead and to obfuscate, and that are intentionally ambiguous, vague and poly-interpretable.

At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like "paraphilic coercive disorder" - and may allow offenders to escape prison by providing what could be seen as an excuse for their behaviour, they added.

Indeed, again: That's another logical consequence, and it is likely to happen if the legal possibility has been created.

In this context: The DSM-5 will be mostly, in effective practice, a legal document, enabling psychiatrists to enrich themselves and put people away under pretext of pseudo-science. For me it is much like handing over the care of the ill to the Catholic Church, whose priests of course also all mean awfully well, especially on top of a choir boy.

The DSM is published by the American Psychiatric Association (APA) and has descriptions, symptoms and other criteria for diagnosing mental disorders. It is used internationally and is seen as the diagnostic "bible" for mental health medicine.

Yes, or perhaps better: It is widely treated as if it has biblical stature, also by people who should not, like judges and bureaucrats, which means that it works as an enabler for psychiatric interventions, and that is what the DSM-5 is all about:

To enable psychiatrists to intervene in almost any illness, for their own financial benefit, on the pretence of doing "evidence-based medical science", while in fact they are doing artfully contrived pseudoscience to enrich themselves.

That's what psychiatry is and ever was, for the most part, in most hands: A pseudoscience designed to enrich psychiatrists and to control and exploit patients, much as is Catholic or Protestant theology. And this is the position the DSM-5 psychiatrists are bidding for: To be The Official Doctors Of The Soul, legally and "medically" and "scientifically".

More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.

This seems - to me - a good result, and also shows that not all psychological health-workers are dishonest or incompetent, which indeed they are not. (Also, the reader should realize that quite a few psychologists and psychiatrists must have found themselves qualifying in a subject they did not really believe in, at the end of their studies.)

My own view, as a psychologist and philosopher, is that the DSM-5 should be trashed, the APA should be trashed, and psychiatry should be trashed: It is pseudoscience, it is fraudulence, it is bogus, it is dishonest, it is dangerous, it has become in the DSM-5 shape much like Soviet-psychiatry, that served the Soviet psychiatrists who served the Soviet authorities, e.g. by driving the opposing dissidents insane.

"The proposed revision to DSM ... will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don't fit nicely into those boxes," said Peter Kinderman, a clinical psychologist and head of Liverpool University's Institute of Psychology at a briefing about widespread concerns over the book in London.

Indeed, but then these boxes will be uses as a Procrustean bed. Besides, another problem with the DSM-5 that should be raised in this context is that it is all intentionally vague and arbitrary, and seems to be designed so as to be most effectively abused, and without ever being refutable by its own criteria.

He said the new edition - known as DSM-5 - "will pathologise a wide range of problems which should never be thought of as mental illnesses".

Yes, and let's be clear WHY this happens, rather self-evidently: To provide shrinks and psychos with money. That's what the APA is about; that's what the DSM-5 is about. And as with Catholicism in Catholic countries, it will be embraced by the authorities, by the bureaucrats and by most medical folks, because of its pretenses to be there in the name of "evidence based science", whereas it is obvious fraudulence, for anyone really qualified in medicine, psychology or philosophy of science, who also is honest.

For nobody but the committee of the DSM-5 ever thought of most of these new forms of supposed "madness" as treatable mental illnesss:

Only the members of the DSM-5 committees and their psychiatric ilk have a financial and personal interest inventing mock diagnoses they can use to diagnose mock "mental diseases", that they can then "treat" for very real money.

The theological doctors of the inquisition needed sinners like the psychiatric doctors of the APA need patients: To improve their own power, status and income, and indeed also to satisfy their perversions, in not a few cases, indeed again as with priests and clergy.

"Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as mentally ill," he said. "It's not humane, it's not scientific, and it won't help decide what help a person needs."

True, and it is also grossly immoral and a Big Lie, and it is there because it promises to give psychiatrists much more power and much better incomes, and it WILL, alas, also help formally to decide what "help" an incompetent or lying shrink is going to have the right to claim from a patient's insurance, indeed whether or not the patients approves, for if the patient doesn't he shows "evidence-based" symptoms of refusing to accept the science of the APA, thereby "proving" - for any psychiatrist or judge who believes them - that the patient "must" be mad.


Simon Wessely of the Institute of Psychiatry, King's College London said a look back at history should make health experts ask themselves: "Do we need all these labels?"

He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognising 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.

As usual, Wessely avoids being tied down to a clear and definite statement or position, and is trading innuendo.

Then again, he is right in his suggestion that this state of affairs is very odd, and would be quite right if he'd conclude that is strong evidence in support of the thesis that psychiatry is not and never was a science, but still is what it is from its inception: (i) A tool to control people on what are claimed to be medical grounds, and (ii) a means to make money for medical folks qualified in this pseudoscience, and (iii) a pseudoscience from bottom to top because NOBODY, and certainly not psychiatrists, have the kind of knowledge and insight into mental processes of people that psychiatrists claim to have, for the necessary knowledge of how the brain produces experience, meaning and motives has not been found so far, whatever dishonest psychiatrists like Wessely publicly pretend about their abilities and their pretended "science of psychiatry".

Allen Frances, Emeritus professor at Duke University and chair of the committee that oversaw the previous DSM revision, said the proposed DSM-5 would "radically and recklessly expand the boundaries of psychiatry" and result in the "medicalisation of normality, individual difference, and criminality".

I agree, but then the question is: What does this teach about psychiatry, psychiatrists and the APA?

In my eyes: That many are dishonest or incompetent, and are in it for the money of themselves and their colleagues - and that these same folks now have an instrument, the DSM-5, that will be irrefutable by its own criterions, and that allows psychiatrists many more grounds to make money or to lock people up.

And that is what it is really about: Money and power for psychiatrists and the APA; and not about help for the mentally ill or the confused or those in need of some medical help.

Health carers tend to be in health care to take care of their own interests, as is also human-all-too-human. (And to work for money is not, by itself, immoral: What is immoral is to pretend to knowledge one knows or should know no one has, with the end of defrauding people from money by such pretenses. Which is what witch-doctors, woo-traffickers and the members of the APA - "36.000 Physician Leaders In Mental Health" do, and very profitably also, for themselves.)

As an unintended consequence, he said an emailed comment, many millions of people will get inappropriate diagnoses and treatments, and already scarce funds would be wasted on giving drugs to people who don't need them and may be harmed by them.

Quite so. Indeed, I am interested in the finances of it all, and believe setting up a model of financial streams, including factual information, would clarify much about what really motivates psychiatrists, on average, in practice. (In Holland there now is - for just one example - a totally fraudulent attempt by ever-lying local psychiatric professors to deny people get sleeping pills prescribed by their GPs (25 eurocents for a night of sleep) so as to give them CBT for the same purpose (175 euroos an hour for their kind shrink), on the pretext that this will be healthier to the patients "because sleeping pills are known to be not healthy": Typical psychiatric fraudulence.

Also typical is the cheek never to mention their own financial motive, or these enormous price-differences between quite effective quite cheap drugs and usually mostly ineffective but quite expensive and profitable "cognitive therapy". (*) Or indeed to mention that CBT - "Cognitive Behavorial Therapy" - is hardly effective, in this as in most applications of it, if investigated honestly and objectively, that is, not by the psychiatrists who stand ready to make money from it. For talk-therapy aka psychobabble is and ever was ineffective for most patients, but is and ever was most profitable for the shrinks and psychos offering them for money.

Nick Craddock of Cardiff University's department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM's broad categories were going wrong.

Probably including the fraudulent gambit I just sketched: If you can't sleep, DSM-5 diagnoses that you need CBT, which will make your kind shrink or psycho richer by 500-1500 euroos. An effective sleeping pill costs 25 eurocents, but then these patient-loving shrinks will assure you, with a very honest face, that taking sleeping pills is very bad for you. Taking 1000 euros - the equivalent of a mere 6 hours of "honest" "evidence-based" CBT - as the median, this means 4000 nights - over 11 years - of good sleep, on pills, that have the grave disadvantage to work and not to be profitable at all to psychiatrists. These folks mean so well when they offer you "to learn to sleep by CBT"!

Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.

Or more precisely, I think: Being set up intentionally so as to enable such abuse, because such abuse forces patients to go to shrinks. It is not necessarily true that the DSM-5 must be abused; it is true it can be abused, and seems to be nicely and cleverly and competently designed for precisely that purpose, including the ever-continuing doubletalk; and so as to be beyond criticism or indeed so as to be beyond rational comprehension, the last because it is irrational as science, and only rational as intentional medical  fraudulence, designed to be that. (And as intentional fraud it is a lot easier to make sense of than as what it pretends to be, viz. "a diagnostic manual for" supposedly but not really "scientific diagnosing".)

And that's what I think it is: Intentional malfeasance designed to further medical and psychiatric fraudulence, at the cost of patients, for the benefit of psychiatrists and those these serve, like state bureaucrats.

Other examples of diagnoses cited by experts as problematic included "gambling disorder", "internet addiction  disorder" and "oppositional defiant disorder" - a condition in which a child "actively refuses to comply with majority's requests" and "performs deliberate actions to annoy others".

Note again that this is very much like the practice of the Church and the Inquisition: Make a sin/certifiable disorder of anything you want to repress, in the name of God/evidence-based science.

"That basically means children who say 'no' to their parents more than a certain number of times," Kinderman said. "On that criteria, many of us would have to say our children are mentally ill." (Reporting by Kate Kelland; Editing by Andrew Heavens.)

See above, on the DSM-5 being set up for abuse, but not necessitating it - which also means that if the doctor or shrink doesn't like the patient or the patient's mother he can declare them both insane using the DSM-5, while if the doctor likes the patient or the patients mother (especially if pretty and willing) he may not do it.

But it is nice to see that Reuters is - still - capable of doing decent reporting, for this is a good and sensible article.

(*) To quote Multatuli, again, in my translation, about medical morality and motives in his day (the days of doctor Semmelweis, who died horribly, trying to do the best he could to bring his medical colleagues to reason, or at least to do sensible experimentation, but to no avail). I added bolding to make even medical morons see the point:

And they burned, incinerated, fried the ill child. And they plastered it. And they made the child sweat and purged it. And they put ice on its head, and mercury in its stomach. And they rubbed the child, and rolled it, and pinched it...

And all these gentlemen had the rank of doctor or professor. The small tortured patient was buried under official science.

And behold, there came fourteen more learned ones equally officially recognized, equally posh, equally dressed up, and told the poor child:

Be glad and joyful! They did rather pester you... that is true, and you might, perhaps, be justified to complain a little, but be happy. Console yourself with the thought that during that illness, you provided bread, status, and enjoyment to all those gentlemen that did not cure you.

And we... we have carefully investigated your father's message, and found that it never was properly understood. We assure you on our honour - as doctor, minister, professor, etc. - that we will understand the message well...

- Oh, groaned the ill one, that's what all the others also said! Since eighteen centuries there were the same assurances. Would you be so kind as to take away that heavy yoke they put around my neck, and the weight that presses my heart? Oh, I long for some air, some light, some freedom... was all this not written in my father's message?

- But my dear boy, what then would happen to us?

That is true! It is impertinent of the ill, to desire to get better, and to forget that his everlasting fever is the benefactor of the doctor's own family.

Therefore: New needs, gentlemen! New diseases, gentlemen! Always something new. Du nouveau, du nouveau toujours, n'en ft-il plus au monde!

That also explains the many new diagnoses Simon Wessely pretended to be puzzled by: New "diseases" are new ways to squeeze money from ill or confused or ignorant people.

Corrections, if any are necessary, have to be made later.


As to ME/CFS (that I prefer to call ME):
1.  Anthony Komaroff Ten discoveries about the biology of CFS (pdf)
3.  Hillary Johnson The Why
4.  Consensus of M.D.s Canadian Consensus Government Report on ME (pdf)
5.  Eleanor Stein Clinical Guidelines for Psychiatrists (pdf)
6.  William Clifford The Ethics of Belief
7.  Paul Lutus

Is Psychology a Science?

8.  Malcolm Hooper Magical Medicine (pdf)
 Maarten Maartensz
ME in Amsterdam - surviving in Amsterdam with ME (Dutch)
 Maarten Maartensz Myalgic Encephalomyelitis

Short descriptions of the above:                

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who understands ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:

7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.
9. I tell my story of surviving (so far) in Amsterdam/ with ME.
10. The directory on my site about ME.

See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.

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