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  Feb 20, 2012                  

DSM-5: Some sensible ideas about the DSM-5 - P.S.

I thought and think that the last Nederlog

Some sensible ideas about the DSM-5

is quite good, but it seems that so far it has not been much downloaded.

Two possible reasons are that it is long (over 130 Kb) and that it is radical, to both of which I plead guilty:

As to the length:

I generally lack the health to compile shorter texts from longer ones, and what you get in Nederlog, and indeed on my site, albeit with some exceptions of long existing philosophical texts and some others, is usually the first version of my first effort, after which I tend to collapse for a while, in bed, after which I may have found the energy to read it through, make some corrections, and upload these.

As to my text being radical:

It so happens that I am in my early sixties, have excellent degrees in psychology and philosophy, and am in my 34th year of being ill with a medically unexplained disease, which in this day and age, especially thanks to the efforts of psychiatric doctors Wessely, White and Sharpe, medical doctor Van der Meer and clinical psychologist Bleijenberg, means that I got no help whatsoever while being ill, while at the same time I get slandered and libelled as a matter of course by these gentlemen, and by bureaucrats who rely on their immoral lies and bullshit, namely as being someone who must be either thoroughly mad or a malingerer, and thus as one who is, in either case, making it all up - as if I could not earn 5 to 50 times as much as I receive in dole money by using my degrees or various talents.

As it also happens, it may be considered quite certain that I spent more time studying philosophy of science and logic than Wessely, White, Sharpe, Bleijenberg and Van der Meer spent studying for the degrees that allows them to libel and slander millions of ill people, including me, wherefore I am quite qualified to judge their prose, and my judgment is that it consists of lies, bullshit, baloney, fraudulence, medical malfeasance, and grossly immoral and dishonest "theorizing", for the gentlemen either must have an IQ under 100 or they must know that they are lying and deceiving with pseudoscientific bullshit that they have made up to deceive the public - and they are not that stupid. (*)

As to ME/CFS: It's simple common sense:

Either millions of people have been thinking themselves ill, for decades, for the most part not known to each other, with the same symptoms, and many of their medical doctors were and are right that they are ill but medical science presently cannot causally explain why - or else a handful of psychiatrists with a career-interest and a personal interest in finding patients to practice their art on for money have been deluded or lying. Which is more probable? (And note that if the handful of psychiatrists are right, the thousands of non-psychiatric medical doctors are wrong.)

Precisely the same as I said about the named psycho-medical worthies applies to the editors of the DSM-5 and the leadership of the APA that protects them: One can't write prose that is so atrociously bad and pretentious, while it so much serves their own interests as shrinks, and while it is so evidently so much in contradiction with sound philosophy of science, logic and rules of clear and honest writing, all ultimately at the costs of the interests of the patients in whose name its being produced, that I cannot morally or intellectually conclude that the gentlemen from the DSM-5 and the APA are honest and competent, just as I cannot believe that +4 is numerically less than +2.

Here is my main reason: They would write much better, with much less pretense and terminological bullshit if they were honest. ("Simplex siggilum verum".)

And after arguing for over 30 years, without help, that I am ill and need help, and receiving only slander and/or sadism in reply from bureaucrats, that is, if I received as much as a reply, while I only was helped by a few good medical doctors, who also are mostly powerless against the bureaucracies of the state or municipality, I have meanwhile reached the age that my future career cannot be put in danger (anymore) by my speaking the truth as I see it, which is one reason to do so, while another reason to do is that I have learned in my life that very few dare to write and speak truthfully anyway - and indeed with dangerous opponents it is safer not to.

Besides, it gives the named gentlemen a chance to defend themselves in court, where I will gladly explain that I think that one has no moral right to allow human degenerates to slander millions "in the name of evidence based medicine", and to drive thousands to suicide, and hundreds of thousands into dire poverty, namely by insisting that their kind of pseudoscientist is fit to diagnose, libel and slander the likes of me as malingerers or mad, and namely because they claim, fraudulently, that they can, and because they do so by the brazen fallacy that a medically unexplained disease is a disease that psychiatry explains: with the presumptuous lie that if it is an unexplained disease, psychiatrists "know" it is neurasthenia, pardon, conversion disorder, pardon, hysteria, pardon, somatoform disorder, pardon: bodily distress disorder.

And as to that - "bodily distress disorder" - here is a finding reported on Suzy Chapman's excellent site 

Dx Revision Watch

It concerns a revision planned in the ICD.

By way of introduction, I quote what the honest Ms Professor Sue Bailey, the President of the Royal College of Psychiatrists, had to say about that organization, and why patients in Great Britain need not worry about the forthcoming changes in the DSM-5:

“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.”

As it happens - and as I must surmise the honest Ms Baily knew very well - the ICD seems to be ready to overthrow their classification of diseases in similar ways as is happening in the DSM-5, since there are now proposals to introduce

Body distress disorders

16 Bodily distress syndrome
     (new – was unexplained somatic complaints)
17 Health preoccupation
18 Conversion disorder
    (was dissociative disorder)

as one can find in

Journal of International Psychiatry

Volume 8 Number 1 February 2011
ISSN 1749-3676

namely in what's called a "Guest Editorial", by "David Goldberg", the "Chairman, WHO Advisory Group for Classification in Primary Care", that is entitled

A revised mental health classification for use in general medical settings: the ICD11–PHC 1

There one finds such passages as this:

However, some of the ICD10–PHC disorders were equivalent to existing categories in the parent classification, and did not take into account developments in diagnostic thinking. An interesting example of this concerns ‘medically unexplained symptoms’, which appear to have fallen out of favour with our GP colleagues, who have taken the view that even some medically explained symptoms can be abnormally prolonged and accentuated. Psychiatrists have taken a similar view: the new concept of ‘complex somatic symptom disorder’ being field tested for DSM–V also draws attention not to whether somatic symptoms can be explained, but to the cognitive components that may accompany them, whether they are part of a known physical disease or not.

This leads up to the concept of "Body distress disorders" that is recommended by Mr Goldberg in terms such as these:

A new category called bodily distress disorders will include conversion disorder (fairly common in some lower-income countries), health preoccupation (a new disorder similar to hypochondriasis) and the less severe ‘bodily distress syndrome’. In the syndrome, the patient is both distressed and concerned and has three or more somatic symptoms in one bodily system. This is diagnosed only if the patient does not have one of the three dysphoric disorders

If your kind doctor or psychiatrist believes that you are - perhaps - not ill then, according to the likes of Mr Goldberg, you are not ill - and rather than say that they do not know what ails you, or perhaps, that they fail to see what makes you ill, they should conclude, if Mr Goldberg has his way, that you are making it up, perhaps unconsciously - that is, if you are not already mad to start with ("does not have one of the three dysphoric disorders").

What the rest of medical science cannot explain, psychiatric pseudoscience will and does explain as madness, but wrapped up in euphemistic terms for better public consumption and deception.

It really comes to this, and it is evidently pseudoscientific bullshit and nonsense:

You cannot scientifically both not know how to explain an illness, outside psychiatry, and know how to explain the same illness, inside psychiatry. Either the rest of medical science is real science and psychiatry is not, or psychiatry is real science, and the rest of medicine be better terminated as dangerously mis- and under-diagnosing madness.

Back to Mr Goldberg, who is under no illusions about what he proposes:

These proposals are radical indeed, and by no means all of the proposed disorders will survive the field tests.

I incline to suppose that in fact he has little to fear from "the field tests". Here is one of my reasons, that Mr Goldberg himself presents as follows:

In our early discussions, many of the disorders in ICD10–PHC are recommended to be retained – often with suitable amendments – but there have been several interesting new disorders suggested, as well as several disorders proposed for removal.

I note the "with suitable amendments" in passing, and note that Mr Goldberg's words give no reason to believe that these "several interesting new disorders suggested" were in any way discovered, or indeed are in any sense real, or at least are based on some rational scientific hypothesis. The same applies to what is "proposed for removal", and again shows the way of Mr Goldberg's thinking:

Perhaps the most radical proposal is to abandon the distinction between anxiety disorders and mood disorders, and to gather them all under the single umbrella of ‘dysphoric disorders’.

So the earlier distinctions, now to be "abandoned", were (also) mere make-belief, mere terminological inventions, with little or no rational scientific theory to base them on, it seems safe to infer, since psychiatry has little enough in the way of solidly rational empirically supported knowledge, to be in a positition to "abandon" what little they have, and indeed what they have themselves enshrined in their diagnostic manuals. But then it is also true that Mr Goldberg's new proposal has the great merit, in a pseudoscience, of keeping things as vague and multi-interpretable as possible.

The sort of pseudoscience that Mr Goldberg recommends has progressed to the level where all unpleasant feelings whatsoever will be thrown onto one big terminological heap, caught by one comprehensive anti-septically phrased label: The ‘dysphoric disorders’.

Which is to say, that you are "disordered", in the new science of psychiatry, if you feel unhappy, are afraid, depressed, bereaved, worried, lovesick ... : Be glad, for under the new psychiatric teachings and terms you may so lucky as to help enhance a psychiatrist's income by getting Cognitive Behavioural Therapy (perhaps with Graduated Exercise Therapy thrown in, so as "to help you learn sound work habits"), namely as a sufferer from the freshly invented Goldbergian psychiatric disorder called 'dysphoria'.

Nor is this the end of Mr Goldberg's innovations in the pseudoscience of psychiatry:

Within this important group, two innovations are proposed. First, some simple operational criteria will be tested in field trials to assess whether clinicians in the field find them useful;

This is why - it seems to me - that Mr Goldberg can be quite confident about any "field trials": What matters is not whether the proposed changes are based on fact, or on rational theory, or whether they - perish the thought! - might serve any patient's real interests: What matters is "whether clinicians in the field find them useful", and that even without saying in what ways or to what ends these are to be "useful".

Here are the benefits this brings, in Mr Goldberg's words:

The simple scales will allow a clinician to diagnose depression and anxiety on their own, or the combination of both – to be called ‘anxious depression’.

I stand in awe. But this is not all. There is more to be "innovated", if Mr Goldberg is to get his pseudoscientific way with the new ICD:

Second, where any of these three disorders achieve the severity required for a ‘case’, any somatic symptoms not part of a known physical disorder will be assumed to be related to the dysphoric disorder. Those whose symptoms fall short of the requirements for any of these three diagnoses, but who are distressed and disabled by their current symptoms (whether dysphoric or somatic), are to be given the residual diagnosis of ‘distress disorder’. Distress disorder replaces a motley collection of minor disorders, including neurasthenia (or chronic fatigue) and adjustment disorder....

That is to say, as I said:

What the rest of medical science cannot explain, psychiatric pseudoscience will explain as madness, but wrapped up in euphemistic terms for better public consumption and deception.

And that euphemistic term is "dysphoric disorder" or indeed "disorder":

You feel not happy about something - anything whatsoever, including politics or your menstrual pains - while it so happens that your doctor or psychiatrist does not feel or see it quite like you do? It's because of your "dysphoric disorder", stupid! - and you better take their prescribed tranquillizers if you want to avoid further "dysphoria" caused by your benevolent doctor or psychiatrist, "all in your very best interests", for they have diagnostic manuals to prove just that!

Besides, if you dare to protest, the kind of diagnostic manuals proposed by Mr Goldberg have you readily classified: You then also must have 'distress disorder'! And if you dare to breathe anything in protest to that, these renewed handbooks will have you in for 'contrarian personality disorder' - and all three will in your medical dossier for life. That'll teach you not to be "disorderly"!

Then again, if you were so mentally disturbed as to talk about chronic fatigue, according to Mr Goldberg, writing in 2011, you really must be a neurasthenic, although he may not say so in public, where it probably will be "distress disorder", "dysphoric disorder" and "adjustment disorder", that he will diagnose you with ("distress" because you feel bodily distress, "dysphoric" because that makes you feel unhappy, and "maladjustment" because you have dared to say 'no' to a psychiatrist).

In fact, it seems Mr Goldberg has been busy on this kind of psychiatric medical science since 1985, the message always being the same:

We psychiatrists know everything that other medical men don't know: What the others don't know as diseases we psychiatrists know must be madness, lately restyled to "disorder", whether "dysphoric", "distress" or "adjustment"! Trust Us!

I don't. In fact what it reminds me of, perhaps as an opening choir to a new civilization that is dawning upon the West is, the Action T4. Check it out!

The fine new "science" of psychiatry that has been invented by the folks behind the changes in the DSM-5 may not be quite there, and doctors named Goldberg and Wessely may want to pretend to be very upset that I as much as mention and link such a clear analogy, but then my father survived several German concentration-camps, though my grandfather was murdered there, so for this and other reasons, such as 33 years without help with a real but medically unexplained disease, I do know a little more about human degeneracy and its hypocritical disguises than many others do.

A claimed "science" that produces prose as I have read of Mr Goldberg, Mr Wessely and many others just cannot be a real science and cannot be other than a pseudoscience, and therefore should be terminated as science. Postmodern psychiatry is pseudoscience with a non-scientific agenda.

For more on this theme see - for example - my

- me+ME:  Russell  Tribunal on Psychiatry
- ME + me :  On the DSM-5TM

I may later return to Mr Goldberg's prose.

(*) So again: I formulate in radical terms because so few dare to, and indeed perhaps few can afford to. And I am not as dogmatic or ambiguous as psychiatrists tend to be, but as it happens I do have a lot of relevant knowledge, both theoretically and practically, of their kind of trade and claimed "science", and I also do have the right sort of academic qualifications, although they fall short of a degree of psychiatry (happily for me, and indeed I do not have the required talents to be a good one, such as exist also, for to do good to patients often no more than common sense and kindness are necessary, both of which I can indeed manage, for quite a few, but not on a daily basis, to most anyone, for money).

Corrections, if any are necessary, have to be made later.
-- Feb 21, 2012: Removed a link and corrected a few typos and unclarities.


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 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.
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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