On Suzy Chapman's excellent site that documents the DSM-5 so very much better than the APA does it
Dx Revision Watch
I was very pleased to find quite a number of sensible ideas about the DSM-5, that Ms Chapman says originate thus:
Science Media Centre has very kindly given permission to publish, in full, the comments provided by research and clinical professionals for use by the press
and so I will be so kind as to comment on them, also to outline and clarify my own position.
In any case, these "comments provided by research and clinical professionals" are quire heartening, and to my surprise even professor Simon Wessely said - or should one say: appears to have said? - something rational.
So I'll quote and comment, and quote by indentation - and I should remark to start with that the Science Media Centre is British and it is not unlikely that the fine point-by-point criticism of the DSM-5 that was published last year by the British Psychological Society (BPS) has provided a climate of reception for the DSM-5 among British researchers and academics that differs from the US one.
In any case, that was some relevant context. Now to the texts - and in case you want to skip, there also is an endnote, in which I summarize a number of sensible ideas about the DSM-5, in 50 points.
As the SMC seems to have collated it, it comes under the following general title, which is both apt and justified (the link that follows in the title is to Ms Chapman's site, where you'll find it all without my comments):
DSM5: New psychiatry bible broadens definitions of mental illness to include normal quirks of personality
Tim Carey, Associate Professor at the Centre for Remote Health and Central Australian Mental Health Service, said:
“The DSM does not assist in understanding psychological distress nor in treating it effectively. It does not “carve nature at its joints” as it were. It is a collection of symptom patterns that have no underlying form or structure. It is akin to an anthology of the constellations in the night sky.
Yes, that seems mostly true, though it is also true that a schema of classification need not carve nature at its joints to be useful, and that there are various symptomatic descriptions of various forms of what I shall call for the moment "mental illness" that have some predictive validity and help distinguish them from other ailments.
But it is mostly classification without sound theoretical basis, rather akin to alchemy before real chemistry arrived, with Dalton and especially Mendeleev's Periodic Table of Elements which indeed does carve nature at its joints.
The DSM-5 and psychiatry in general lack the required knowledge of how the brain generates experiences, and the required knowledge of how human personalities, selves, meanings, capacities and problems arise from a mixture of genetic, organic, social and environmental causes.
What they have to offer, like the alchemists, is terminology without real empirical foundation.
While it does not assist in understanding or treating psychological distress, it has generated phenomenal revenues for the APA, expanded the market for pharmaceutical companies, assisted in promulgating and maintaining a disease and illness model of psychological suffering, and constrained the focus of research activity. Are these the activities a humane and scientific society should seek to promote?
No, they are not, but then psychiatrists and folks working in pharmaceutical industries have to eat as well.
Then again, there seems to be an enormous mix-up about ends and means in medicines, where often the profits of the pharmaceutical companies and the incomes of psychiatrists and medical doctors have become the end, or at least the motor, of many more health-care activities than is compatible with the end these persons are supposed to serve: The interests of ill people; the care of the ill; the rational understanding of illness and the creation of effective and safe treatments.
“The authors of the DSM themselves acknowledge the inadequacy of the DSM diagnostic system.
“On page xxxi of the latest edition of the DSM it states: ‘there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways’.
In my own understanding of DSM-5 prose, I read this rather differently: Rather than acknowledging the inadequacy of the DSM, they mean to defend it by what they pretend are recent insights of theirs. This is also why they pretend it so trickily, indeed by creating two straw men, that then are rejected as if that is very reasonable argumentation, and would justify there being twice "no assumption".
“So, according to the DSM authors, the boundaries demarcating ‘schizophrenia’ (for example) don’t separate ‘schizophrenia’ from ‘depression’ (or social phobia or intermittent explosive disorder or post-traumatic stress disorder or …) or (perhaps most importantly) the boundaries don’t separate ‘schizophrenia’ from ‘no schizophrenia’.
This is correct - but then in my reading of the DSM-5 that's precisely the point and the end: They want to introduce areas of vagueness of extension and ambiguity of terminology (intension) that allows them to get away with anything, leaving themselves the only experts on the validity of their judgments.
That also seems the point of their dimensional analyses: Make psychiatry irrefutable by making all its claims inherently vague in fact and vague in terminology, leaving the psychiatrists free and uncontrollable in their judgments, and unfalsifiable by their own manual's standards.
“One would have to ask: if the function of creating particular categories is not to separate these categories from each other or from their absence, what exactly are they for?”
To make it easier for psychiatrists appealing to the DSM-5 get away with almost anything.
David Pilgrim, Professor of Mental Health Policy, University of Central Lancashire, said:
“It’s hard to avoid the conclusion that DSM-5 will help the interests of the drug companies and the wrong-headed belief of some mental health professionals (mainly most psychiatrists, but sadly all too often others as well).
Quite so - and that's putting it mildly and politely.
Some patients and many relatives also gain some advantages from diagnosis some of the time because it reduces the reality of the complexity of their experiences and their responsibilities within those existential struggles.
That seems a bit odd to me: What good does a topography of fictional disorders do for people with real disorders? Especially if the topography of fictional disorders is the basis for deciding on their real treatments?
Then again, the writer may have been thinking of the many euphemisms the DSM-5's editors seem to want to introduce, which indeed serves to deceive the patient about the legal import of their diagnoses, and might indeed help somewhat in making them feel less offended, than they should be, and would be if they had been told what the euphemisms hide.
“Madness and misery exist but they come in many shapes and sizes and so they need to be appreciated in their very particular biographical and social contexts.
Yes and no: Yes, in case of serious problems or serious distress, no or not necessarily so in case of minor problems, that have reliable remedies, such as sleeping pills. (Both much cheaper and much more effective than psychiatric help to learn one to sleep, that in turn is so much better for the psychiatrists' incomes.)
At the individual level this should mean replacing diagnoses with tailored formulations, and for research purposes we should be either looking at single symptoms or shared predicaments of those with mental health problems and their significant others. I worry that we risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorised in rigid boxes – in my opinion that would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise.”
Indeed, that is also what the DSM-5 appears to me, in a friendly reading: "a form of collective madness for all those complicit in the continuing pseudo-scientific exercise." Less friendly, what may look like collective madness from a rational scientific point of view, looks like intentional obfuscation and pseudo-science to enable psychiatrists get a better grip and more power over a larger part of the health-market, and also over patients.
Dr Felicity Callard, Senior Research Fellow, Service User Research Enterprise, Institute of Psychiatry, King’s College London, said:
“The ongoing chaos surrounding the development of DSM-5 has intensified rather than lessened fears that this project is ill-conceived and founded on a weak evidence base.
Quite so - and to me it seems as if these editorial committees are simply making it up, most of it, possibly even honestly, at times, if always hampered by a very unscientific set of prejudices and a great lack of knowledge of philosophy of science, methodology, logic and analytic philosophy.
People’s lives can be altered profoundly – and, we should bear in mind, sometimes ruinously – by being given a psychiatric diagnosis.
In my opinion, that the architects of DSM-5 are pressing on with such a flawed framework undermines their claim that they wish to produce a DSM that is ‘useful to all health professionals, researchers and patients’.”
Quite so, again - and indeed my own conclusion is that they do not wish to do so: They wish to produce a DSM that is useful to the interests of psychiatrists, and that does so by pseudoscience.
Dr Paul Keedwell, Honorary Consultant Psychiatrist and Clinical Lecturer in the Neurobiology of Mood Disorders, Cardiff University, said:
“New findings arising from genetics and brain imaging studies hint at biological mechanisms, and challenge the way we classify disorders: syndromes (like bipolar and unipolar depression) might merge, while others (like “the schizophrenias”) might diverge. However a few more decades will pass before we radically change our existing classifications.
This may well be so, and indeed my own view is that psychiatry will have to be radically overhauled as more becomes known about how the brain generates human experience.
“Where the proposed DSMV is particularly controversial is in its addition of more disorders, like “Apathy Syndrome” and “Disruptive Mood Dysregulation Disorder”, which suggest a worrying trend toward medicalising normal variation in behaviour.
Opinions may differ here, but this is the specialism of the writer. And indeed "medicalising normal variation in behaviour" is one of the worrying things the DSM-5 does - or perhaps "psychiatrizing" is the descriptively more correct term.
“Every new diagnosis implies a new treatment, suiting vested interests in the health industry. Nothing should enter the final version of DSMV without sound research evidence of the need for professionals to intervene.
Quite so, with the addition that such interventions serves the interests of patients, and are of proven and reliable effectiveness, and wherever possible do no harm, or do so only with prior consent of the patient, based on real knowledge.
“Also, every mental health professional should remember that classification systems are a guide to diagnosis only: they do not necessarily map on to the complex needs of an individual in real practice, and they are definitely not a guide to treatment.”
All true, but the for me most worrying thing about the DSM-5 is that it does not "map on to" real fact: It's mostly a terminological slicing up of a territory that is for considerable part fiction, and that the DSM-5 consistently describes in ambiguous and vague terms.
Allen Frances, Emeritus Professor at Duke University and Chair of the DSM-4 Steering Committee, said:
“DSM 5 will radically and recklessly expand the boundaries of psychiatry by introducing many new diagnoses and lowering the thresholds for existing ones. As an unintended consequence, many millions of people will receive inaccurate diagnosis and inappropriate treatment. Costs include: the side effects and complications of unnecessary medication; the perverse misallocation of scarce mental health resources toward those who don’t really need them (and may actually be harmed) and away from those who do most desperately require help; stigma; a medicalization of normality, individual difference, and criminality; and a reduced sense of personal responsibility.
This is an excellent sum-up by a man in a position to know, and with considerable moral courage and decency.
The publication of DSM 5 should be delayed until it can be subjected to a rigorous and independent review, using the methods of evidence based medicine, and meant to ensure that it is both safe and scientifically sound.
If there is to be a DSM-5 I'd like it to be "both safe and scientifically sound", but then my own view is that it is better to ditch the DSM-5: It is too much nonsense, in too bad prose, with too many supposed disorders, with too little factual support, produced by committees that now for years have proven to be not amenable to reason and not willing to fairly, rationally and publicly argue with qualified critics, such as dr. Frances.
New diagnoses can be as dangerous as new drugs and require a much more careful and inclusive vetting than has been provided by the American Psychiatric Association. Future revisions of psychiatric diagnosis can no longer be left to the sole responsibility of just one professional organization.”
Quite so - which for me is an additional reason to ditch the DSM-5, and indeed to try to do better, in a public wiki like Wikipedia, but with only academically qualified contributors, like the Stanford Encyclopaedia of Philosophy, and with contributors from many more fields than psychiatry alone, to arrive at a rational, clear and factually tenable classification of mental illnesses.
This would be public, it could be steered like the Stanford Encyclopaedia, and it could have the contributions of psychiatrists, psychologists, lawyers (the edition of the US law I read in the 1970-ies had a quite sensible terminological system of classification), medical doctors of all kinds, social workers and counsellors, yes perhaps even politicians and philosophers!
David Elkins, Professor Emeritus of Psychology, Pepperdine University, Los Angeles, and Chair of the Division 32 Task Force for DSM-5 Reform, said:
“My committee and I remain very concerned the DSM-5, as currently proposed, could result in the widespread misdiagnosis of hundreds of thousands of individuals whose behaviour is within the continuum of normal variation.
Quite so - and the estimate seems optimistically low, and I also know from experience and historical reading that all power tends to be abused, especially if uncontrolled.
And besides misdiagnosing many of those who just are not close to middle of the road as mad, the whole classificatory and terminological system of verbiage that is the DSM-5 is just is too vague, too imprecise, too little founded on fact, and embodying too much fiction to admit as a diagnostic manual of mental illness.
It just is not good enough intellectually and stylistically to be taken serious as rational empirical science: It is a mostly non-rational, non-empirical classification of fictions and vague hypotheses, mixed up with some morsels of fact or rational hypothesis.
If this occurs, it means these individuals will be labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs that can have dangerous side effects.
Indeed. As far as I understand the game of the editors of the DSM-5 and the APA here is that they - pretend to - complain bitterly about the unfairness of "the public": "Trust Us, We Are Authorities - 36.000 Leader Physicians Of Mental Health: That's Who We Are! - And We Mean Well!"
Power and income of psychiatrists, also, are things far from the public discussions of the APA or the DSM-5, that tends to present itself as benevolent workers for health, as free of human interests in power and money as priests once were assumed to be free of sexual interests, by God's grace.
“We are also alarmed that the DSM-5 Task Force seems unresponsive to the concerns of thousands of mental health professionals and dozens of mental health associations from around the world.
Quite so: The general message of the APA and the DSM-5, while pretending to be interested in public discussion of the DSM-5, - in so far as I understood it, at various places, from various such spokespersons - is that anybody who does not belong to the leadership of the one or the other is incompetent to judge it well, including dr. Frances and the BPS.
“My committee recently asked the DSM-5 Task Force to submit the controversial proposals for review by an outside, independent group of scientists and scholars. Our request was denied.
Because only the competent APA and the competent DSM-5 are competent - as can be deduced from the DSM-5, that allows deduction of anything that benefit the APA - to decide who is competent to judge their work.
According to the APA only bakers can decide whether their bread is rotten.
“My committee launched the Open Letter/Petition Website which has now gathered more than 11,000 individual signatures and endorsements from more than 40 from mental health associations including 13 other Divisions of the American Psychological Association.”
Alas, they all are incompetent and not fit to be discussed rationally with, in public, one must infer from the APA's neglecting to take up the offer.
Or perhaps the APA knows it is rather hard to defend a product like the DSM-5 in a rational - moderated - open, honest discussion with qualified persons from various professions such as psychology, medicine, law, philosophy of science and logic.
Dr Kevin Morgan, Senior Lecturer, Department of Psychology, University of Westminster, said:
“The proposed revisions to the diagnosis of schizophrenia i.e. the elimination of subtypes and the use instead of symptom dimensions, is an example of how DSM5 may prove to be more clinically beneficial than the current version of the manual. I wait with great interest to see the final agreed set of changes.”
That's DSM-5 style "English" that may be styled "Psylish": "an example" of how something "may prove" to be "more beneficial" than something. Hardly anything whatsoever is not, but then DSM-5 prose is meant to deceive one into believing something innuendoed to be "more beneficial" with the help of "may" and "could" and "might" and "example".
I may prove to be an example of a person who could prove to be more benefited by less of this manner of prose (but Further Research is desirable).
Til Wykes, Professor of Clinical Psychology and Rehabilitation, Institute of Psychiatry, Kings College London, said:
“The proposals in DSM 5 are likely to shrink the pool of normality to a puddle with more and more people being given a diagnosis of mental illness.
Quite so. See my Brit. Jn. Psychiatry: 78% of the British are not sane
And in a system where it is normal to be mad one must be mad if one is not mad - and here I quote my adaptation of a well-known quandary that in fact arises in many (bureaucratized) institutions and that I have been running into now for over 33 years, though I suppose I should be very thankful how much money must have been saved for the benefit of many bureaucratic pensions:
"There was only one catch and that was the DSM-5, which specified that a concern for one's health in the face of illness was the process of an irrational mind. One was ill with ME and could be helped. All one had to do was ask the health-authorities for help; and as soon as one did, one would be called crazy and would not be entitled to help. One would be declared crazy if one said one was ill with ME and needed help, and would be declared sane if one didn't, but if one were declared sane one would get no help while being ill. If one asked for help while ill one was declared crazy; but if one didn't ask for help one was considered sane and denied help for that reason."
-- After Joseph Heller
(For more: On the DSM-5 + DSM-5 in distress.)
To return to the text of Till Wykes:
This may be driven by a health care system that reimburses only if the individual being treated has a recognised diagnosis – one in the DS manual. Luckily in the UK we have the NHS which treats people on the basis of need, not if they fit a diagnostic system.
I am not British, but I would not be amazed if the NHS will disappear or considerably change, but that's mostly an aside, as is my remark that from such evidence as I have how people with ME/CFS are treated by the NHS it does not emerge that it "treats people on the basis of need", which again is not to say that it cannot or that another system, of Tory design, would.
“It isn’t just a health care system that is subverted by the spreading of diagnostic labels into normality, research will also be changed. Most research studies that reach the widest readership get published in US journals which will expect these diagnostic labels to have been used.
Yes, and this is in fact - or touches upon - a very fundamental point about the DSM-5: It is a form of Psychiatric Newspeak, designed to mean what the psychiatrist wishes it to mean, and to be flexible enough to always allow him to do so. (See Orwell's "Politics and the English Language.")
“We shouldn’t use labels unless we are clear they have some benefit.
As I just remarked, in implication: The labels, terms and style of language the DSM-5 uses, where quantifying terms like "every", "some", "90 procent" seem actively repressed as too precise or too easily open to empirical refutation, does have considerable benefit, if one's end is to make psychiatric diagnoses multi-interpretable and irrefutable.
Saying someone is at risk of a mental illness (in some categories of DSM5) puts a lot of pressure on the individual and their family. When we do not have a good enough prediction mechanism, this is too high a burden.”
But then one should pity the poor psychiatrist, his wife, and his children! What if their incomes derives from saying someone is at risk of a mental illness (and they have A Therapy, Evidence Based, no less, at market competitive price level, overseen by an APA-board)?
Dr David Harper, Reader in Clinical Psychology, University of East London, said:
“The American Psychiatric Association’s revisions of the DSM have become as regular as updates for Microsoft Windows and about as much use.
This writer doesn't like MS Windows, it must be presumed. I sympathize, and he has a point, and MS Windows also exists to make its designers and owners lots of money, and is quite flaky and much less well-designed than it could be.
It has facilitated an increasing medicalisation of life (the number of disorders the DSM covers has increased exponentially from its first edition in 1952 to 357 in 2000)
Indeed, and that is an odd fact, that needs explanation.
and is hugely costly (the text revision of DSM IV made $44m in revenue between 2000 and 2006).
It is a nice bit of income for the APA, which is also why they will not want to give it up, even - or especially - if that meant a much better system of classification, with many more specialists than psychiatrists, such as psychologists, lawyers, social workers, and philosophers of science.
The problem is not simply the revisions proposed in DSM 5 but the idea that psychological distress matches its diagnostic categories – people’s experiences of distress cluster in an entirely different manner.
As I prefer phrasing it: The language of the DSM-5 is a kind of Psychiatric Newspeak.
This is why most people end up with more than one diagnosis, why the ‘not otherwise specified’ category is massively over-used and why ratings of agreement between psychiatrists continue to be poor.
This last statement is quite interesting, and suggests that the DSM fails in one of its primary ends: To make diagnosing at least more or less consistent - the same symptoms leading to the same diagnosis. Then again, if the language designed to arrive at the diagnosis is deliberately vague or multi-interpretable then lack of consistency follows and is explained.
The DSM represents a massive failure of imagination: most clinicians and researchers know the system is flawed but try to convince themselves, despite the evidence, that it aids communication, research and treatment. It does not.
I suppose that may be so and is so, respectively, but as with the statement on poor ratings of agreement would like to get some background.
The frustrating thing is that there are other viable alternatives – for example, a focus on homogenous experiences of distress would aid research, the use of case formulation would aid treatment. Unfortunately, the pharmaceutical industry can see little profit in either alternative and, instead, continue to swing their considerable weight behind the DSM.”
This I do not know enough about to weigh, but it is clear that the DSM is a vested interest of rather a lot of players in and around health-care, because it benefits them financially and/or enables a seemingly scientific and moral system to classify people, in categories that will determine their treatments, rights, and status.
Richard Bentall, Chair of Clinical Psychology at the University of Bangor, said:
“I share the widespread concerns about the proposed revisions to the DSM diagnostic system. Like earlier editions, this version of the manual is not based on coherent research into the causes or nature of mental illness.
Quite so: It is made up in closed committee, in camera.
For example, it treats ‘schizophrenia’ and ‘bipolar disorder’ as separate conditions despite evidence that this is, at best, an over-simplification. It also looks set to widen some of the diagnostic criteria, for example by removing the grief exclusion from major depression, and by expanding the range of psychotic disorders to include an ‘attenuated psychosis syndrome’ (my own research on this, in press, shows that only about 10% of people meeting the attenuated or prodromal psychosis criteria are likely to go on to develop a full-blown psychotic illness).
All of this may be so, but I can't judge. But again, my general judgment is that the DSM seems to be not well-based on either real fact or rational empirical theories while being formulated in obscure and to a considerable extent arbitrary or vague or ambiguous terms.
As there is no obvious scientific added value compared to DSM-IV, and as there are some obvious risks associated with this expansion of diagnostic boundaries, one is bound to ask why there is a need for this revision, or who will benefit from it. It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.”
Yes, I agree, and it also states a clear and feasible alternative: "Just say, No!" - give up on the DSM-5 and stick to DSM-IV or perhaps a revision of that.
But then, while feasible it is not likely to happen: The APA's leadership probably believes the DSM-5 must be finished and published, if only in its own interests.
Dr Lucy Johnstone, Consultant Clinical Psychologist, Cwm Taf Health Board, Mid Glamorgan, South Wales, said:
“The DSM debate is all about how we understand mental distress. DSM and the proposed revisions are based on the assumption that mental distress is best understood as an illness, mainly caused by genetic or biochemical factors.
Indeed, although my own take is that in the end and between the ears it is - probably (*) - all biochemistry, but that may be caused by many kinds of events and facts.
It is important to realise that, with the exception of a few conditions such as dementia, there is no firm evidence to support this.
Yes, quite possibly so, but then the main reason is that there is not enough knowledge about how the biochemistry of the brain get to be the ideas, feelings, desires, hopes and fears of the human being whose brain it is.
On the contrary, the strongest evidence is about psychological and social factors such as trauma, loss, poverty and discrimination. In other words, even the more extreme forms of distress are ultimately a response to life problems.
Perhaps, but then this is quite vague, and "life problems" also is not a clearly defined empirical term, to my knowledge.
Then again, I agree that most of what I read of psychiatry has convinced me that it is not a rational empirical science, in the way physics, chemistry, pharmacology and considerable parts of medicine, for example, are, and so there are good grounds to desire either a better and more rational psychiatry or no psychiatry at all, at least not as a scientific medical discipline - though it may, perhaps, be added to theology, as a specialization of that: The - hypothetical, would be - science of the soul, as Aquinas, Calvin, Heidegger or the Inquisition taught mankind, and the editors of the DSM5 seem to like to do also, in their own multi-dimensional multi-interpretable Psychiatric Newspeak.
We need a paradigm shift in the way we understand mental health problems. DSM cannot be reformed – it is based on fundamentally wrong principles and should be abandoned.”
I agree it makes a lot of sense to abandon the DSM.
Dr Warren Mansell, Reader in Psychology & Clinical Psychologist, University of Manchester, said:
“Contemporary research across genetics, neuroscience, psychology and culture all point to the fact that the majority of psychiatric disorders share the same underlying processes and are treated by very similar interventions. Therefore in further emphasising different categories of mental health problems, DSM5 is heading in completely the opposite direction from the most pioneering research across the field of mental health.”
Yes, that seems to me to be so, and indeed at least genetics, neuroscience and psychology are sciences in a different sense, and with different assumptions about what science is and how it should be done, than is psychiatry.
Simon Wessely, Professor of Epidemiological and Liaison Psychiatry at the Institute of Psychiatry, King’s College London:
We have arrived at an opinion of professor Wessely, who is rather infamous with patients with ME/CFS for insisting that he, professor Wessely, KNOWS the explanation for their "sufferings": If not malingerers, they are insane and have thought themselves ill.
This dr. Wessely invented from thin air ca. 1988, probably to make a career, having no idea about the internet, and probably tacitly relying on a fallacy most non-medical people when faced with what purport, pretend to be, or really are "medical authority": They cave in, not because they are shown to be mistaken, but because they are not themselves supposed authorities with the degrees to prove they might be.
Then again, dr. Wessely did not achieve fame in spite of publishing over 500 papers, so I will not further discuss his ravings about and around ME and turn to the opinion he delivered on the DSM-5, which - patients with ME/CFS may be most surprised to find - for a change make rational sense.
“We need to be very careful before further broadening the boundaries of illness and disorder.
Indeed, Simon. May I suggest that you are one of the psychiatrists who has been, ever since 1988, most bent on deliberately confusing the distinctions between illness and disorder? Namely by pretending that you had knowledge that showed that people with ME/CFS are not really ill and "therefore" must be making it up, although you had no real evidence, and slandered and maligned many millions of people, most of whom undoubtedly are ill. It is psychobabble quackery, Simon, and you knew and you know it.
Back in 1840 the Census of the United States included just one category for mental disorder. By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision.
Here professor Wessely speaks the undiluted truth, that the interested reader also can find on Wikipedia, but that indeed is quite relevant here, and deserves serious consideration: What have all these recently invented categories of "mental disorder" in fact achieved? How did these new terms for possibly new aberrations help people or clarify their problems? Was there a real and credible evidential basis for introducing these mental disorders, or did they, like much that is new in the DSM-5, arise from the fertile fantasies and personal interests of the psychiatrists who made them up?
Besides... while professor Wessely correctly mentions one of the many rather strange facts about psychiatry - the strange fact here being mostly that many supposed mental illnesses have been introduced on speculative grounds, with little good evidence: it is not as if they were empirically discovered like rare animals or stars or the moons of Saturn have been discovered - he does not mention an equally strange and possibly even more disquieting fact about psychiatry:
Many of the illnesses diagnosed for generations, with confidence, and a show of "medical evidence", as being caused by psychiatric causes were misdiagnosed by thousands of psychiatrists, at the cost of much suffering for the patients thus misdiagnosed. Thus, for many decades ulcers and homosexuality have been treated and described and diagnosed by many thousands of psychiatrists as if these were due to mental illness.
Do we really need all these labels? Probably not.
Here Wessely indulges in Psychiatric Newspeak, that tends to phrase all problems in terms of the needs of an unspecified "we", thus confusing many things, including the often opposing interests of patients and psychiatrists, and that tends to make judgements for which most relevant parameters to gauge their rationality have been carefully deleted: Who is "we"; what "needs" and whose "needs" is he talking about; which "labels"; and by what standards "Probably not"?
But he may not have been doing it on purpose but from habit, and he does offer a statement that, stemming from his fertile imagination, has the considerable if, for him, rare merit of being true:
And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.”
And if so - which seems quite probable, indeed - because psychiatrists like Simon Wessely have been working for decades to confuse the terms and standards by which medical and psychiatric diagnoses are made.
Professor Sue Bailey, President of the Royal College of Psychiatrists, said:
“We recognise the importance of accurate and prompt diagnosis in psychiatry. The classification system used in NHS hospitals and referred to by UK psychiatrists is the World Health Organisation’s International Classification of Disease (ICD). Therefore, the publication of DSM-V will not directly affect diagnosis of mental illness in our health service.”
Following hard on the heels of professor Bailey's esteemed colleague professor Wessely's opinions, I must remark that it is false that "The classification system used in NHS hospitals and referred to by UK psychiatrists is the World Health Organisation’s International Classification of Disease (ICD)."
Miss Baily may be right in a vague, general and statistical sense - I don't know the relevant facts well enough to say, with rational confidence - but she is certainly wrong in the case of many British patients with ME/CFS: These have definitely not been treated nor judged nor described, namely not by professors Wessely, White and Sharpe in accordance with "the World Health Organisation’s International Classification of Disease (ICD)", but in opposition with the same, and namely so because professors Wessely, White and Sharpe insisted for over two decades, by logical implication, though usefully carefully omitting to mention the fact that they opposed the WHO and ICD, that they knew better than their non-psychiatric medical colleagues, and that people with the unexplained disease of ME/CFS, are malingerers or not sane, and had to be rendered unto psychiatrists to be cured from their delusions or pretensions.
May I kindly suggest, as an elderly psychologist and philosopher, who found out in 2009 that messrs Wessely, White and Sharpe have been libelling and slandering me, and millions of others with my disease, and thereby making my getting any help with my quite serious illness impossible, for 33 years now, that persons like messrs Wessely, White and Sharpe seem to me rather a lot more deserving of a psychiatric diagnosis than the millions they falsely misdiagnosed? Because that was in their personal and career interest?
The British Psychological Society has released a statement on the DSM-5 which can be found here: BPS Statement on DSM-5
It is nice of the President of the Royal College of Psychiatrists to refer to a report by her psychological colleagues (this is the link to the actual pdf of it), that I have read, and that indeed is a fine and rational and scientific report, but it also seems to me to be a bit of a cop out, and playing for time, to be honest, while clearly refusing to commit herself personally.
Anyway... it probably is true that in Great Britain the official rulebook for psychiatrists is not the DSM but the ICD, which would be more of a relief if it were not also palpably true that some of Miss Baileys very own psychiatric colleagues have been, publicly, and one must infer: with Miss Baily's tacit consent, and for decades, been wiping their asses with the very rules their own President here affirms have been in place all the time.
* The fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be published in May 2013 by the American Psychiatric Association.
Endnote: I have arrived at the end of my little exercise, and for those who skipped, and also for those who didn't, here is a summary in points that I take from my own comments rather than attribute them to the persons I commented on, since they are my opinions and my words, although they may agree.
To provide the context, I have numbered them from  onwards, and clicking these numbers leads to the context of the statement above (which I may have restated somewhat in the following list of points). And yes, they are 50 points, and you can skip these too, and jump to the end where I give my reasons to write this text and collate these points:
-  The DSM-5 is mostly a classification without sound theoretical or empirical basis, and is rather akin to alchemy before real chemistry arrived.
-  The DSM-5 and psychiatry in general lack the required knowledge of how the brain generates experiences, and lack the required knowledge of how human personalities, selves, meanings, capacities and problems arise from a mixture of genetic, organic, social and environmental causes.
-  What the DSM-5 offers, like the alchemists did, is mostly descriptive terminology without real empirical foundation of the genesis and dependencies of the things described, and also without good theoretical justification.
-  There is an enormous mix-up about ends and means in the so-called "science of medicine", that supposedly exists first and foremost in the interest of ill people, where in fact the profits of the pharmaceutical companies and the incomes of psychiatrists and medical doctors have often become the end, or at least the motor, of many more health-care activities than is compatible with the end these persons are supposed to serve: The interests of ill people; the care of the ill; the rational understanding of illness and the creation of effective and safe treatments.
-  It seems to me that the DSM-5 intentionally manufactures unclarities, ambiguities and possibilities of multi-interpretation: Given their truly awful "English" prose, that is much worse than the worst of incompetent writers would produce from mere incompetence, it seems likely that they want to introduce areas of vagueness of extension and ambiguity of terminology (intension) that allows them to get away with anything, while leaving themselves as the only experts on the validity of their own judgments.
-  That also seems the point of their much praised "dimensional analyses": Make psychiatry irrefutable by making all its claims inherently vague in fact and inherently vague in terminology, leaving the psychiatrists free and uncontrollable in their judgments, and unfalsifiable by their own manual's standards.
-  One important reason that the language of the DSM-5 is so atrocious is to make it a lot easier for psychiatrists who appeal to the DSM-5 in justification of their diagnoses, to get away with almost anything.
-  There is a far closer confluence of financial interests of drugs companies selling medicines and psychiatrists prescribing them than is morally justifiable.
-  As to the DSM-5 in general: What good does a topography of fictional disorders do for people with real disorders? Especially if the topography of fictional disorders is the basis for deciding on their real treatments?
-  Many publicly stated psychiatric opinions, for example to the effect that sleeping pills are unhealthy, and that Cognitive Behaviour Therapy is much healthier to learn to sleep, seem framed to provide psychiatrists with income at the cost of the interests of patients, who could to much better and much cheaper and also much more effective with a sleeping pill - that indeed does not provide psychiatrists with a living. (Arguing in favour of CBT "to teach one to sleep", as the Dutch shrink Bram Bakker currently is doing in Dutch media, just is quackery inspired by greed, also because he always manages to miss the point that CBT is in the order of 100 - 1000 times more expensive than sleeping pills, while being less effective.)
-  The DSM-5 appears to be, in professor Pilgrim's words, in a friendly reading: "a form of collective madness for all those complicit in the continuing pseudo-scientific exercise."
-  In a less friendly reading, what may look like collective madness from a rational scientific point of view, looks like intentional obfuscation and pseudo-science so to enable psychiatrists get a better grip and more power over a larger part of the health-market, and also over patients. (Very much like the Catholic Church, that is, for clearly understandable reasons that are the same in both cases: Power and money, rather than the saving of souls.)
-  The DSM-5 editorial committees are simply inventing their definitions, diagnoses and proposals from thin air, for the most part, possibly even honestly, at times, if in fact always hampered by a very unscientific set of prejudices combined with a great lack of knowledge of philosophy of science, methodology, logic and analytic philosophy, and also of real sciences: Anybody who knows any physics or chemistry knows that compared to these psychiatry is a pseudoscience or fringe science, at best, even if it exists for honourable reasons, and sometimes benefits patients.
-  One of the intellectually and morally sickening things of - especially - the DSM-5 is that psychiatrists, while in fact playing with the human rights and personal interests of whoever is given a psychiatric diagnosis, also pretend that patients have no right to worry about their rights, or to worry about the intellectual competence or moral integrity of psyschiatrists, and that they even suggest that if they do so that counts as proof of their madness or their family members (See "Munchhausen by proxy".)
-  For what I have read of and around the DSM-5, the end of the APA is to create a manual useful to the interests of psychiatrists, and that does so by pseudoscience, psychobabble, contrived obscurity and ambiguity. If it were honest, it would be better written, but if it were better written, the public would find out themselves how bad it is.
-  A scientifically tenable rational and empirical psychiatry will need to be radically overhauled and rescued from its present delusions as more becomes known about how the brain generates human experience.
-  What has been called the "medicalising normal variation in behaviour" is one of the - many - worrying things the DSM-5 does, although perhaps the term "psychiatrizing normal behaviour" is the descriptively more correct term.
-  What should be in a morally and intellectually valid DSM must be based on sound and objective research evidence (rather than as is: Pretensions this exists, while it doesn't, or is manufactured by the very persons who say it exists), and should allow only such psychiatric interventions as serve the interests of patients, as are of proven and reliable effectiveness, and wherever possible do no harm, or do so only with prior consent of the patient, based on real knowledge. What is in the DSM-5 mostly does not pass these sound criterions.
-  The DSM-5 does not "map on to" real fact: It's mostly a terminological slicing up of a territory that is for considerable part fiction, and that the DSM-5 consistently describes in ambiguous and vague terms and poly-interpretable terms. An manual that is phrased in such terms is unfit for making honest rational diagnoses.
-  My own view is that it is better to ditch the DSM-5: It is too much nonsense, in too bad prose, with too many supposed disorders, with too little factual support, produced by committees that now for years have proven to be not amenable to reason and not to be willing to fairly, rationally and publicly argue with qualified critics. (All like the Catholic Church, that has the comparative merit of not claiming its teachings are based on rational science, but on revelation, which seems not unlike to the inspirations of the DSM-5 editorial committees.)
-  To me it seems more rational and more moral to simply ditch the DSM-5, and to try to do better than it does and can do, e.g. by making in a public wiki like Wikipedia, but with only academically qualified non-anonymous contributors, e.g. on the example of the Stanford Encyclopedia of Philosophy, and with contributors from many more fields than from psychiatry alone, so as to arrive at a rational, clear and factually tenable classification of mental illnesses.
-  This new set-up could have the contributions of psychiatrists, of psychologists, of lawyers (the edition of the US law I read in the 1970-ies had a quite sensible terminological system of classification), of medical doctors of all kinds, of social workers and counsellors, yes perhaps even of politicians and of philosophers! And it would be really an open document, rather than a closed and mostly hidden that is only pretended to be open, as the DSM-5 is.
-  One of the things psychiatrists seem to mostly avoid to discuss in public is that all power tends to be abused, especially if uncontrolled, and that psychiatric power has been much abused, indeed in ways that seem inconsistent with medical morality (primum non nocere).
-  The whole classificatory and terminological system of verbiage that is the DSM-5 just is too vague, too imprecise, too little founded on fact, and embodying too much fiction to admit as a diagnostic manual of mental illnesses.
-  The DSM-5 is a mostly non-rational, non-empirical classification of fictions and vague hypotheses, mixed up with some morsels of fact or rational hypothesis.
-  Power and income of psychiatrists, also, are things that tend to be far from the public discussions of the APA or the DSM-5, that tends to present itself as benevolent workers for health, as free of human interests in power and money as priests once were assumed to be free of sexual interests, by God's grace.
-  The general message of the APA and the DSM-5, while pretending to be interested in public discussion of the DSM-5 is that anybody who does not belong to the leadership of the one or the other is incompetent to judge it well. (Again much like the Catholic Church, and quite unlike real science.)
-  The public game of the APA and DSM-5 as to free public discussion seems to be that only they are competent to decide who is competent to judge their work. (Again much like the Catholic Church.)
-  A reason for the fact that the APA hardly has discussed the many criticisms of the DSM-5 is that it knows quite well that it is hard to defend a product like the DSM-5 in a rational - moderated - open, honest discussion with qualified persons from various professions such as psychology, medicine, law, philosophy of science and logic, with anything like a chance of success. (Again much like the Catholic Church.)
-  Very much of both the DSM-5 style "English" and the "English" that psychiatrists write is not so much English as a contrived dialect that may be styled "Psylish" or "Psychiatric Newspeak". Much of this consists of not using quantifiers, and presenting nearly all argument - except the conclusions that harm patients - in modal terms, with many occurrences of the hypothetical good that some psychiatric theory or intervention "may" and "could" or "might" do: It's all innuendo wrapped up in contrived vagueness and ambiguities, artfully crafted to be logically irrefutable. (For anything whatsoever that is not a logical contradiction "may" be the case.)
-  Already the DSM-IV, at least as it has been applied, if perhaps not as it were intended, involved a system of classification in which it is - supposedly - normal to be mad, according to that system of classification. This makes madness a Catch 22: In such a situation one must be mad (quite abnormal) if one is not mad (according to the diagnostic manual).
I suggest that a manual of mental illness that implies that the majority of mankind is mad, is far more likely designed by mad psychiatrists than to be true of most of mankind.
-  A very fundamental problem with the DSM-5 is that it is effectively a form of Psychiatric Newspeak, that seems to be artfully designed to mean what the psychiatrist wishes it to mean, and to be flexible enough to always allow him to do so. (See Orwell's "Politics and the English Language.")
-  The labels, terms and style of language that the DSM-5 uses, where quantifying terms like "every", "some", "90 percent" seem to have been actively repressed as too precise or too easily open to empirical refutation, does have considerable benefit - if one's end is to make psychiatric diagnoses multi-interpretable and irrefutable.
-  I'd like to know much more about psychiatric incomes, from therapies and from medicines: If there is no clear evidence whose interests psychiatrists are really serving, the inference must be that this is because they serve their own interests in the first place.
-  The DSMs have turned out to generate quite a nice bit of income for the APA, which is also why they will not want to give it up, even - or especially - if that means that a much better system of classification, with many more specialists than psychiatrists, such as psychologists, lawyers, social workers, and philosophers of science, is torpedoed or not realized. (See  and )
-  The language of the DSM-5 is a kind of Psychiatric Newspeak. It is not English, and it is best explained as a designed form of Newspeak, meant to confuse, and designed to allow psychiatrists to get away with anything, and not to be refutable at all.
Here is a taste of how it is done when the statement I just made is rewritten the PN way:
" Evidence exists that the language of the DSM-5 may be an example of what might be seen as a kind of alternative "language" (or proto-language: See De Saussure) that might not be just like a "natural" "language", and that could, conceivably, have been "created" to allow the "existence" of the possibility of the eventuality that "shrinks" may use it to what may be seen as "misleading" to achieve their "hegemony". "
See also: Postmodernism Generator. (One should be made for DSM-5 diagnosing and prose! Much of it is in postmodernist prose-style, and also the use of quotation-marks I just showed is fully de rigueur, in pomo-prose and in psych-prose.)
-  It seems that at present the DSM fails in one of its primary ends: To make diagnosing at least more or less consistent - the same symptoms leading to the same diagnosis. (Then again, if the language designed to arrive at the diagnosis is deliberately vague or multi-interpretable then lack of consistency follows and is rationally explained.)
-  The DSM-as-is is a vested interest of rather a lot of players in and around health-care, because it benefits them financially and/or enables a seemingly scientific and moral system to classify people, in categories that will determine their treatments, rights, and status. (Neither need be an immoral end, but in order not to be so the classification system must be based on rational empirical science, and be phrased in clear unambiguous English. It is neither.)
-  In fact, and quite at variance with the public sayings of both the APA and the DSM-5 editors, the DSM-5 is made up in closed committee, in camera. (As in Stalin's Politbureau and the Catholic Churches conclaves, and unlike as is normal in physics, chemistry and medicine apart from psychiatry.)
-  Judged in terms of techniques of propaganda, the DSM seems to be quite successful: It is not well-based on either real fact or rational empirical theories while it has been formulated in obscure and to a considerable extent arbitrary or vague or ambiguous terms, all of which makes it very useful to confuse detractors and to further the interests of psychiatrists.
-  One clear and feasible alternative to the DSM-5 is this: "Just say, No!" - give up on the DSM-V and stick to DSM-IV or perhaps a revision of that.
-  Most of what I read of psychiatry has convinced me that it is not a rational empirical science, in the way physics, chemistry, pharmacology and considerable parts of medicine, for example, are.
Therefore there are good grounds to desire either a better and more rational psychiatry or no psychiatry at all, at least not as a scientific medical discipline.
(It may, perhaps, be added to theology, as a specialization of that: The - hypothetical, would be - science of the soul, in the traditions that Aquinas, Calvin, Heidegger and the Inquisition taught mankind, and tried to impose on them, of course "in their own best interests" and like the editors of the DSM5 also seem to like to do, in their own multi-dimensional multi-interpretable Psychiatric Newspeak.)
-  All sciences I know something of are sciences in a different sense, and with different assumptions about what science is and how it should be done, than is psychiatry - that has been from its inception much more like theology than like science, and for sound reasons: Lack of knowledge how the human brain generates human experiences. (That is not bad either: What is bad is to pretend knowledge when one knows one has no knowledge of the kind one pretends.)
-  Very much of psychiatry is rife with fallacies, and psychiatrists tend to defend their claimed "science" with fallacies, one notable one is the fallacy of authority: Only psychiatrists, or so psychiatrists claim, have the requisite education and insight to understand the workings and aberrations of the human mind. (Again just like the Catholic Church claimed for ages about its priests.)
-  Seeing that the number of diagnosable distinct - supposed, claimed - mental illnesses have been exponentially growing since the start of psychiatry, to the financial benefit of psychiatrists:
What have all these recently invented categories of "mental disorder" in fact achieved? How did these new terms for possibly new aberrations help people or clarify their problems? Was there a real and credible evidential basis for introducing these mental disorders, or were they, like much that is new in the DSM-5, arise from the fertile fantasies and personal interests of the psychiatrists who made them up?
-  What about the strange and disquieting fact about psychiatry that many of the illnesses diagnosed for generations, with confidence, and with a show of "medical evidence", as being caused by psychiatric causes, were in fact misdiagnosed by thousands of psychiatrists, at the cost of much suffering for the patients thus misdiagnosed? Thus, for many decades ulcers and homosexuality have been treated and described and diagnosed by many thousands of psychiatrists as if these were due to mental illness. Why should one trust or rely upon "a science" that very recently made hundreds of thousands of such misdiagnoses, all in the name of science, also?
-  Nearly all communications to the public by psychiatrists that I have read these last 40 years were couched in terms of what I call Psychiatric Newspeak: It wasn't honest communication aimed at conveying ideas - it consisted mostly of jargon-ridden pretentious obscurely phrased ukases or promises. (And that is not the scientific method: That is the priestly method.)
-  It is false that "The classification system used in NHS hospitals and referred to by UK psychiatrists is the World Health Organisation’s International Classification of Disease (ICD)", as the President of the Royal College of Psychiatrists is quoted as saying: At least in the case of patients with ME/CFS, both adults and children, that is demonstratively not so.
-  As an elderly psychologist and philosopher, who found out in 2009 that psychiatric professors Wessely, White and Sharpe have been libelling and slandering me, and millions of others with my disease, and who thus contributed much that made my getting any help with my quite serious illness impossible, for 33 years now, I'd like to suggest that persons like psychiatric professors Wessely, White and Sharpe seem to me rather a lot more deserving of a psychiatric diagnosis than the millions they have falsely misdiagnosed, while pretending to have rational and empirical scientific reasons for doing so, which was and is a lie.
-  I must infer from the words of the President of the Royal College of Psychiatrists that professors Wessely, White and Sharpe (and others) had her conscious tacit consent, for decades, to wipe their psychiatric asses with the very rules their own President affirms have been in place all the time (according to which rules by the WHO and the ICD I and hundreds of thousands of others in England are really ill, and are not malingering, nor insane, nor living for decades with "dysfunctional belief systems" that are, falsely, claimed by these professors to cause the symptoms of ME/CFS).
Finally... having arrived at the end of what is currently 129 Kb, let me briefly explain why I wrote it, being also ill and in pain, since decades, and without any help of any kind but minimized dole, since decades, that forces me to live, eat, clothe, buy books and computers from the very liberal sum of 10 euros a day (better than the allowances of my fellow patients in England who are implied to be malingerers or nuts by professor Wessely and his psychiatric cronies, who also pretend to take pride in avoiding these terms, though that is what they really mean) now for over 3 decades, with the best possible degrees in psychology and philosophy, because professor Wessely and his cronies were allowed since 1988 to apply to persons with ME/CFS what the DSM-5 editors now wish apply to persons with almost any disease, from 2013 onwards.
It may happen to you, or your family, real soon now, and for many more reasons than showing symptoms of ME/CFS: To be treated as if you or your son or daughter, are effectively to be counted subhuman, to whom ordinary rights - for assistance, for help with disease, for support, for getting help for shopping or cleaning one's house - are no longer applicable or available, for the likes of you, and are actively denied by the state's bureaucracy, all because a bunch of psychiatrists, posing as authorities, insist that you - if you are not very lucky - should be treated thus, "in your own interests", also with forced physical exercises and forced mental therapy, quite possibly also with forced tranquillizers or sectioning in case you protest "too much", and all "in the name of that benevolent, helpful, humane and honest science called psychiatry". (**)
(*) My reason to write "probably" is that while I do believe that the brain needs explanations in terms of biochemistry, and not of mental concepts, verbiage, or immortal supernatural souls, more than biochemistry may be involved, and indeed I don't mean to refer to a non-material soul, but to the possibility that, as Sir Roger Penrose holds, quantum-mechanics is required to explain mentality. He is one of the best living mathematical physicists, and explains his ideas in "Shadows of Mind", that did not convince me, but that is a serious work by a serious and informed writer, indeed unlike most writings in which - what is said to be - QM is related to health, healing, mysticism and what not, usually through the medium of verbiage.
Also, while remarking on physics and biochemistry versus souls, it makes sense to add a brief remark on a confusion that quite a few writers that oppose biomedical explanations of mind seem to harbour: That the brain works in terms of the principles of biochemistry (rather than the verbiage of Aquinas or Freud) does not mean that this biochemistry may not be caused by or partially depend on all manner of things, such as the social circumstances and pressures on a human being or the food he consumes or the beliefs or education he has. (It also doesn't mean it does: It's a largely unsolved problem of research.)
(**) But don't you worry: Professors Wessely, White and Sharpe (the last honourable man also active on the DSM-5) have very fine incomes since decades. They even are physically healthy! (And besides... who cares for the fate of ill people? What's the use of them? Especially in these days that we must all take severe cutbacks to help out our masters of Wall Street? Where money is scarce, and even the healthy can't find work?)