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  Feb 25, 2012                  

DSM-5: A good plan for the DSM-5


   "It is impossible for someone to lie unless he thinks he knows the truth. Producing bullshit requires no such conviction. A person who lies is thereby responding to the truth, and he is to that extent respectful of it. When an honest man speaks, he says only what he believes to be true; and for the liar, it is correspondingly indispensable that he considers his statements to be false. For the bullshitter, however, all these bets are off: he is neither on the side of the true nor on the side of the false. His eye is not on the facts at all, as the eyes of the honest man and of the liar are, except insofar as they may be pertinent to his interest in getting away with what he says. He does not care whether the things he says describe reality correctly. He just picks them out, or makes them up, to suit his purpose."

   -- professor Harry Frankfurt, on Bullshit (<-Wikipedia)
My bolding and coloring.

Given yesterday's Nederlog with the title me+ME: A good report on XMRV I hardly could escape today's title:

There is - what seems to me - a good plan for the DSM-5 by dr. Rockwell whom I quoted earlier in my three-part series on Allen Frances vs the American Psychiatric Association (the link is to part 3).

In brief, and in my words, the plan is to ditch the DSM-5, if necessary with help of the US government and US politicians, in the interest of rational, moral and scientific health-care, that is liberated from the pseudoscientific bullshit the American Psychiatric Association seeks to introduce with the DSM-5, and to impose on all US citizens in search of health-care.

In case you doubt my qualifications: Check out the fine point-by-point criticism of the DSM-5 that was published last year by the British Psychological Society (BPS).

Here is the plan as presented by dr. Allen Frances in yesterday's Huffington Post, in an article entitled (link to the original in the title):

Is Government Intervention Needed To Prevent Unsafe DSM 5?

Donna Rockwell, Psy.D. was once a CNN reporter covering Capitol Hill. She is now a psychologist and a member of the petition committee calling for an independent scientific review of DSM 5. (..) She hopes to stimulate government intervention to ensure that DSM 5 meets its public trust. Dr Rockwell sent this email on Feb. 17:

You recently described the press as the one last hope to ensure that DSM 5 will be safe and sound. While I certainly agree that the press can do a great deal, there is an additional last hope you didn't mention, one that could be even more powerful. Don't discount the role of government intervention as a way of influencing the American Psychiatric Association.

I am currently networking on Capitol Hill and also with the Department of Defense and with the Veterans Administration. My goal is to increase awareness of the risks of DSM 5 and to recruit government assistance in forcing APA to abandon dangerous suggestions.

I tell government officials that DSM 5 will have a big impact on many important public health and public policy decisions that will directly affect their constituents. My short list includes: 1) raising the percentage of our citizens who are considered to be mentally ill -- they are surprised to learn that it is already an astounding 50% lifetime; 2) increasing the cost of drug treatments and their harmful side effects; 3) pulling scarce mental health resources away from those who are really ill and most need them; 4) distorting benefit determinations for insurance, disability, compensation, and school services; and 5) creating great confusion in the courts.

The people I speak to all quickly understand the public health and public policy significance of DSM 5 and that government has a big stake in making it safe.

I am especially reaching out to the HELP (Health, Education, Labor & Pensions) committee chaired by Sen. Tom Harkin (D-IA), which oversees mental health issues and to Sen. Charles Grassley (R-IA), who has been very successful in holding doctors accountable. People in government are particularly concerned when I tell them that DSM 5 will have its worst impact on the most vulnerable populations -- children, teenagers, and the elderly; veterans; and the severely mentally ill. I think the sentiment is growing that government intervention will be necessary to protect the public interest from the guild interests of the American Psychiatric Association and the economic interests of the drug companies.

I use concrete examples to get my points across. Most alarming, that DSM 5 will increase the already shameful overuse of antipsychotic drugs in kids and thus contribute to the dangerous epidemic of childhood obesity. DSM 5 will also greatly expand the diagnosis and medication treatment of ADD and indirectly facilitate the booming illegal market in prescription stimulants. DSM 5 will turn normal grief into depression. And DSM 5 will scare people into thinking they are on the road to dementia when all they have is the normal forgetfulness of aging. The Hill staffers I talk to all seem understand the risks of DSM 5 and I hope they will soon hold hearings. There is also considerable interest in the risks of DSM 5 at the VA and at DOD, where polypharmacy has been such a big problem.

The general public can help by calling or emailing congressional representatives to request protection from DSM 5. People should demand that DSM 5 be subjected to an outside, unbiased scientific review before accepting the controversial proposals that are getting so much negative press attention. I hope a legislative option can be forged in this battle to protect the nation's mental health from the excesses of DSM 5.

I do wonder how loudly must the public and the professional mental health community shout, "Stop!", before reason prevails. We need a government agency or elected official to take the lead in protecting the American people from the impending crisis of medicalised normality and excessive prescription drug use. The government must apply the brakes on DSM-5 before pharmacological over-kill impacts harmfully on even more people."

Everything so far was quoted from dr. Frances' article, where you can also find more text, including his final paragraph:

To date, APA has failed to provide appropriate governance. DSM 5 has proven unable to govern itself, is not governed by APA, is not responsive to the heated opposition of mental health professionals and the public, and is insensitive to being shamed repeatedly by the world press. Government intervention may turn out to be the only hope to prevent massive misdiagnosis and all its harmful, unintended consequences.

I agree and I like the plan, and I very much hope that it will succeed.

But I do not have a good estimate for its chance of success, since I am not an American and do not know much relevant  good information. Then again, dr. Rockwell is quite right in maintaining or implying that the government and politicians should be much interested in and also should be much concerned about the plans of the APA to radically overhaul psychiatry and its diagnostic manuals, and replace them by untested and unverified diagnostic terminology, while also refusing - for years now - to engage in any real public rational debate with highly qualified critics such as dr. Frances, and while radically altering both the contents and the terminology of psychiatry, which has very many far going implications, for example as regards the use of a deeply flawed diagnostic manual such as the DSM-5 will be in US courts of law.

And dr. Rockwell is also quite right that it should not be difficult to convince most anyone who is interested, and who has some scientific knowledge or degree in a real science, that the DSM-5 is full of dangerous, unscientific, irrational and untested nonsense: Very few people who are not psychiatrists will fail to understand this, if given the evidence, and indeed dr. Frances himself is an important American psychiatrists with quite a few colleagues who agree with his criticisms of the DSM-5.

Then again, my own guess is that the APA will play the card they have been playing for several years now: "Only we psychiatrists are the authorities in psychiatry; only we can determine who is mad or not; only we are fit to judge the qualities of our own manuals that will have nearly biblical force in the courts: You should shut up in the face of authorities like us!"

All of this APA line of argument is fallacious, but the APA knows very well that fallacies are precisely what many people easily are deceived by, and one fallacy many people do swallow easily is that something is so, simply because supposed "medical authorities" claim  it is so, while the APA will no doubt also insist that all its members have some basic degree in medicine, and therefore count as "medical doctors", and should be given the authority that goes with a medical degree at the very least. (*)

It  is therefore probably helpful and sensible to get other medical people on board: The vast majority of medical doctors who did not specialize in psychiatry but specialized in some truly scientific branch of medicine, and who should and can know, if they take some time and do some reading, that the DSM-5 contains a lot of dangerous nonsense without empirical or rational foundation. (Which they also find explained by dr. Allen Frances, the chief-editor of the DSM-IV [N1], in his series in Psychology Today on the DSM-5.)

The  acceptance of the DSM-5 as diagnostic manual in medicine, in courts, and by the institutions of the state will have the following consequences, among quite a few others, also unpleasant or immoral, as listed by dr. Rockwell above:

(1) it much endangers the lives, well-being, rights and personal interests of very many ill people, namely by the psychiatric DSM-5 innovation that these ill people are in fact not really ill but are "ill" with "bodily distress order" (ICD-wise) aka "somatic symptom disorder" (DSM-5 wise) [N2] and "therefore" they need psychiatric paid assistance much rather than help or research from some real medical doctor, who got a medical degree in some field of rational medical science. (**)

(2) It much endangers the practice and livelihoods of many medical doctors, namely by the psychiatric DSM-5's implication that non-psychiatric doctors are often not qualified, because the psychiatrists who edit the DSM-5 have decided that any disease that medical science at present does not know, or cannot fully explain, or has no decisive tests for, must be classified as madness, but madness with a new tricky name. such as "bodily distress disorder"/"somatic symptom disorder" [N2], and besides that psychiatrists need to be involved, for pay, of course,  in very many ordinary diseases, namely "to help the patient learn to cope" and/or to take care of what the DSM-5 worthies call the "biopsychosocial" (***) dimensions of disease, that the same worthies have decided should be their field of practice.

In fact, a large part of the DSM-5 is based on this atrocious logical fallacy, that occurs again and again in various forms and disguises:

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.

This is totally fallacious, for the following reason (among others):

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.

But given this amount of presumptuous madness on the part of the editors of the DSM-5 and the leadership of the APA, another group of professionals that may and should be interested are U.S. comedians:

The contents and prose of the DSM-5 and the stances of the leadership of the APA are eminently fit for sketches by sharpwitted people like Jon Stewart and Bill Maher, to make fun of, that would help a lot to get the American public interested in the APA-antics, that also threaten their own personal chances for receiving any rational scientific medical treatment for what ails them, instead of the pseudoscientific fare the APA wants to reserve for and impose on them, for pay to its psychiatric members, and instead of the real medical help ill people should get.

(*)  It is as true as it is unfortunate, the last in view of its marked lack of real scientific theorizing, that psychiatry is a specialization in medicine, which implies that psychiatrists must have a basic medical degree, but it is not true this makes the majority of psychiatrists real medical doctors, simply because most of them did not do the work nor did they receive the training in medicine that real medical doctors do get, after their basic degree.

Indeed, one cynical estimate of a medical doctor I knew who indeed was not a psychiatrist (but a doctor of internal medicine) is that folks tend to specialize in psychiatry once they found out that they are unfit for practising real medicine.

In any case: If psychiatry were a real science, or indeed if psychiatric textbooks would read as if they were real science, there would be a basis to argue that it might be desirable, for various practical reasons, that doctors of mental health are also doctors of physical health. Since most anyone with knowledge of real science who reads psychiatric handbooks concludes that what they read is not science but for the most part is fiction, the unfortunate consequence of attaching psychiatry to medicine has been to give authors of bullshit theories the status of medical men or women, that they really did hardly earn nor deserve.

(**) The naive reader should realize that - as I can testify now, in my 34th year of ME/CFS - this psychiatrizing of real illnesses will very often mean that the patient will get no help and will not be entitled to any help other ill people are entitled to because they are ill:

Psychiatrists will insist - and states and bureaucrats and health-insurances will love to hear, since it promises to save them much money to help genuinely ill people - that people who psychiatrists claim to be not really ill will have no rights to be treated as if they are ill, indeed precisely in the way that psychiatrists have insisted for decades that peptic ulcers and homosexuality and multiple sclerosis are mental diseases or are caused by mental diseases, and that these complaints should and can be treated by psychiatrists, and need not be treated or researched or helped by real medical doctors.

(***) "biopsychosocial" is one of the many bullshit terms beloved by the APA and the DSM-5, fundamentally because it makes their pseudoscientific bullshit apparently cover everything: It's not that they have any clear definition for their terms, for they don't, and indeed they do not want to, since providing clear definitions would enable others to see that what the APA offers in the DSM-5 is not science but is pseudoscience - it is that by insisting that all human suffering is "biopsychosocial" that the APA tries to bullshit itself into profiting from the patients and victims of each and any form of human suffering, however caused or explained.

For terms and claims like "it is biopsychosocial" enable the following line of highly profitable argument: Whether your suffering has a social or (bio-)medical cause or not, in any case you still do need - Trust the honest and financially disinterested folks of the APA! - psychiatric help (translation: Your shrink still wants to squeeze money out of your problems and suffering), wherefore your suffering has now been termed "biopsychosocial", and you, as a patient, have to pay a shrink to be "helped" with shrink-wrapped "health-care" for your psycho-dimension, that the DSM-5 wizards and warlocks have unearthed in any and all human suffering, namely by a process of "objective evidence-based medical science", they want you to believe, that is so enormously difficult, that it has been kept secret by the DSM-editors, who have all been sworn to secrecy, and discuss their most honest insights only with their fellow DSM-editors.

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

-- Feb 27, 2012:

[N1] It was kindly pointed out to me that I made a typo when I wrote that dr. Frances is "the chief-editor of the DSM-5": Of course it should be "DSM-IV". Furthermore, the full regalia of his office then amounted to this title: "Chair of the Task Force for DSM-IV". As it happens, I don't like terms like "Task Force" and "Mission" in nearly any context, since they sound like euphemisms or like military or religious cant terms, while I strongly dislike neutered euphemisms like "Chair": "Chairman" is a euphemism for "Boss" or "Leader" to start with, and its being neutered to "Chair" to save the feelings and protect the politically correct delusions of postmodern feminists just sickens me.

So... I left my term standing, as it seems to be descriptively correct and proper English; I corrected the "5" to "IV"; and I can't find the cynicism to make dr. Frances - who seems a brave and sensible man to me - into a "Chair" even if that is "correct" aka "appropriate" in this day and age. ('O tempora, o mores!')

[N2] It was kindly pointed out to me that I confused the bullshit terminologies of the DSM-5 and of the planned ICD.

I have rectified this: The argument against either bullshit term is the same, but it does make sense to correctly refer which organization tries to introduce which bullshit terms. And yes: Some of the same shrinks as push for "somatic symptom disorder" in the DSM-5 seem to push for "bodily distress disorder" in the ICD. They may even do so on purpose, in order to try to make a public show off "scientific progress" if and when the same bullshit term will be used by both DSM and ICD, or to trick or confuse folks into battles about which of two bullshit term is "best" for their brand of manipulative fraudulent "evidence-based" "science".


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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