Feb 16, 2012
DSM-5: Alzheimer's Disease
he does address a point I raised five days ago. Here it is, with both dr. Frances' text and then my remark:
Indeed he did. Here is his first paragraph:
As it happens, I treat this here with the prefix "DSM-5:" and with a link to dr. Frances' article, but my main reason to write about it in Nederlog is that it is of concern to me:
Both my mother and her father died rather miserably and awfully in the clutches of Alzheimer's Disease, and it would be very nice if there was a good diagnosis and indeed also an effective treatment for it.
So this is hopeful news, though dr. Frances also has a DSM-5 related point: The editors of that manual decided to include something they call Minor Neurocognitive Disorder, and Frances is rightly worried:
I quite agree, especially with "obviously premature and unnecessary". And there are two related points, one of medical morality and one of terminology.
First, medical morality. While dr. Frances rightly raises the question why one would want to include a test that, at least initially, will have many false positives, I do have a cynical answer: Because diagnosable diseases generally come with some sort of treatment plan, that is a source of income for medical people.
Overall, as medical science is today, that is not bad and indeed a sine qua non, since medical folks must make a living too, but as I have argued in my earlier texts on dr. Frances on the DSM-5, that is not bad only on the condition that the medical science involved is real science, and the diagnosis provided has a well-founded statistical probability that it is, at the very least, more likely to be true than false. If this is not the case, the diagnosis must certainly not be part of a diagnostic manual, for then on that issue the manual is bound to have it more often wrong than right, which simply is not ethical, and is medical malfeasance. (**)
Second, I have a terminological point, that illustrates the general wackiness in the terminology the editors of the DSM-5 use: What is the sense - the meaning, the point, the definition, the rationale - of a term like "Minor Neurocognitive Disorder"?
Are there perhaps cognitions that do not have a neural base? Possibly - what do I know of the DSM-5 worthies - from so exalted a realm as the immortal soul of dr. Regier? I don't have one, I think, and I am an atheist philosopher, but apart from that: In real science there are no "cognitions" that are not produced by a brain, so at best the "Neuro"-prefix is a pleonasm.
And what does "Minor" mean in a phrase like this? Is it a moral judgment? Is it a factual judgment? Is it perhaps - as one must suspect with the dialectics of the DSM-5 - both and neither, just as it is most handy for the psychiatrist making the judgment, with an honest and intelligent facial expression?
Finally, what is the rationale for antiseptic terms like "Disorder"? Is it because - as the editors of the DSM-5 and indeed other psychiatrists - have been very fond of suggesting "to save the feelings of the patients, who do not like to be told they are mad", which indeed is often served to the public as if this is beneficial, on the part of psychiatrists, whereas in fact it is hypocritical and dishonest: Whether you are locked up or by force injected with psychiatric drugs because you are said to be "disordered" or because you are said to be "a paranoid schizophrenic" (or whatever) does not matter to what is being done to you in fact - except that an antiseptic terminology makes it appear that you shouldn't complain and be thankful that you are not locked up because you are "mad" but because you are "disorderly", in some sense. To me, that sounds like the preferred terminology of Soviet-style psychiatry, and with the same danger or purpose: To loosen the boundaries between deviance and madness; to increase the possibilities for incarcerating dissidents on the pretext that they are "disorderly" and making people "disordered".
Is it perhaps that the editors of the DSM-5 want to classify lots of things that are not precisely ailments, diseases, or clear forms of insanity, but much rather moral or legal judgements disguised as "psychiatric evidence-based science"? Because that gives them very much more power over others; or because that will be very helpful to authoritarian states; or because it makes psychiatry-in-DSM-5 form applicable to far more than medical diseases?
My own guess: Probably all of these, but neither the editors of the DSM-5 nor the leadership of the American Psychiatric Association will deign to clarify: As ever, their main message to "the public" is that only they themselves are capable to judge rationally about their manual (not even dr. Frances is, the APA and the DSM-5 have told the public!) and that one should trust the goodness, the intellects and the honesty of the DSM-5 and the APA: "Trust us!"
Well... here is again a link to what I call the DSM-5's mascot, an erstwhile leader of the APA also, to serve as a counterweight to the illusion that US psychiatrists must mean well:
Behold the face of US psychiatry:
My own guess is that he would have loved the DSM-5. And his type of psychiatrist does deserve more renown, especially with the general public, and not because all psychiatrists are like Cameron - they aren't - but because psychiatry, in any shape or form, is and has been very apt to be abused, for many reasons also, in very many contexts, for very many ends.
As to ME/CFS (that I prefer to call ME):
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 understa, but nds 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.
See also: ME -Documentation and ME - Resources
The last has many files, all on my site to keep them accessible.
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