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  Feb 26, 2012                  

DSM-5: 50 reasons to stop 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.

  There’s no sense in simply revising the psychiatrist’s diagnostic bible: it will need to be totally replaced to fit the emerging science…

Nick Craddock, professor of psychiatry at the Institute of Psychological Medicine and Clinical Neurosciences at Cardiff University School of Medicine, quoted on
Dx Revision Watch

This is both a follow-up to yesterday's DSM-5: A good plan for the DSM-5 and a repeat of a part of DSM-5: Some sensible ideas about the DSM-5 from eight days ago.

My reasons to repeat it is that I do think that the reasons I give are good, but that they are likely to have been missed by most readers, because they are in the middle of a long text that few will want to read from beginning till end.

But the reasons make sense, so here they are again, with a brief introduction on how they came to be:

From my discussion of the opinions of mostly British scientists and researchers on the (de-)merits of the DSM-5, that were gathered by the British SMC, that I found on Suzy Chapman's excellent site about the DSM-5:

Dx Revision Watch

The fifty reasons are gathered from my own comments to these quoted opinions by British scientists and researchers in DSM-5: Some sensible ideas about the DSM-5,  and the initial numbers from [1] onwards, link to the place in my comments in the original Nederlog whence they were gathered.

50 reasons to stop the DSM-5 (*)

  • [1] The DSM-5 is mostly a classification without sound theoretical or empirical basis, and is rather akin to alchemy before real chemistry arrived.
  • [2] 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.
  • [3] 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.
  • [4] 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.
  • [5] 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.
  • [6] 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.
  • [7] 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.
  • [8] There is a far closer confluence of financial interests of drugs companies selling medicines and psychiatrists prescribing them than is morally justifiable.
  • [9] 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?
  • [10] 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.)
  • [11] 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."
  • [12] 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.)
  • [13] 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.
  • [14] 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 psychiatrists, 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".)
  • [15] 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.
  • [16] 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.

  • [17] 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.
  • [18] 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.
  • [19] 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.

    A manual that is phrased in such terms is unfit for making honest rational diagnoses.
  • [20] 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.)
  • [21] 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.
  • [22] 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.
  • [23] 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).
  • [24] 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.
  • [25] 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.
  • [26] 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. 
  • [27] 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.)
  • [28] The public game of the  APA and DSM-5 as to free public discussion seems to be that only they themselves are competent to decide who is competent to judge their work: Nobody else is. (Again much like the Catholic Church.)
  • [29] 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.)
  • [30] 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.)

  • [31] 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 - that implies, as does the DSM-IV and as will the DSM-5, on a larger scale, that the majority of ordinary people are not quite sane).

    I suggest that a manual of mental illness that implies that the majority of mankind is mad, is far more likely to be designed by mad psychiatrists than to be true of most of mankind.
  • [32] 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.")
  • [33] 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.
  • [34] 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.
  • [35] 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 [21] and [22])
  • [36] 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 (with a bit of postmodern styling thrown in for free):

    " 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.)
  • [37] 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.)
  • [38] 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 needs to 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. DSM-5 is neither.)
  • [39] 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 in medicine apart from psychiatry.)
  • [40] 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.
  • [41] 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.
  • [42] 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.)
  • [43] 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.)
  • [44] 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.)
  • [45] 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?
  • [46] 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?
  • [47] 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.)
  • [48] 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.
  • [49] 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.
  • [50] 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).

More to follow soon in Nederlog on the topic of the DSM-5 and psychiatry, namely in connection with the Rosenhan experiment, that any reader who is interested in psychiatry should know. Here is a link to the full text in html:

On Being Sane In Insane Place

Highly recommended reading: well written, well argued, very informed, and valid ever since its publication in 1973.

(*)  As said, these are culled from my DSM-5: Some sensible ideas about the DSM-5, where they stand hidden in the middle of a long text. I reproduce because I wrote them out because I think they are good reasons - which does not mean that there cannot be easily given a hundred or more equally good different reasons.

Indeed, quite a few of these can be found in dr. Allen Frances "DSM 5 in distress" series in Psychology Today - and dr. Frances is the chief-editor of DSM-IV, and professor emeritus psychiatry of Duke University/

(**) By "quantifiers" terms such as "some", "all", "many", "few", "more than 80%", "probably", "more probable than not" etc. are meant, that indicate what range of facts or exactness or support the writer has in mind for his claims.

Psychiatric Newspeak tends to abstract from all of these basically because it is much easier to present
bullshit in terms without quantifiers, because this makes it very much harder to understand what is really said, and virtually impossible to refute. Here is an example in the style of the DSM-5:

"Evidence has been found that may suggest that blond women may be more perverse than blackhaired women, but more research is needed"

is a virtually irrefutable claim of the kind and in the style of the DSM-5 that embodies very many similar claims: The "evidence" is not produced but only claimed (or perhaps listed in the references, but then without any reason why and where and how those references support the claims they are said to be "evidence" for: One is forced to trust on faith); "may suggest" coupled together or by themselves are one of the favourite tricks in the DSM-5 literature to insinuate all manner of things that are not provable fact or tenable theory, but that the DSM-5 editors want its readers to believe without being refutable; and that "blond women are more perverse than black haired women", without any quantifiers, can be defended as "true" because undoubtedly one can find one or two blond women who are - in some sense - "more perverse" than one or two black haired women one can also find, while the favourite style the editors of the DSM-5 strongly prefer is this: "blond women may be more perverse than black haired women", which is totally irrefutable innuendo, for any claim that is not a logical contradiction "may be" true.

Finally, the invocation of "the need for more research" the reader can find in almost all psychiatric published prose, in my experience. Two reasons are that psychiatrists crave research funding like junkies crave drugs, and that this again is innuendo that suggests that their unquantified insinuations and suggestions are based on real facts.

The above is an accurate portrayal of how the diagnostic manual of the DSM-5 makes its cases:

The general strategy is to provide a "diagnostic manual" based on claims like

"Evidence has been found that may suggest that blond women may be more perverse than blackhaired women, but more research is needed"

in order to suggest something that can be claimed as meaning - "as has been said in the Journal of Psychiatry" - that "all or most blond women are more perverse than all or most blackhaired women", and can defended as claiming no more than the mere logically tenable logical possibility that - it "may be suggested that" - "one or two blond women may be more perverse than one or two black women".

This is not the science of medicine: it's the science of sleaze, of astroturf, of innuendo, of insinuation, of advertisement, of bias and propaganda, of bullshit, and of crafty rhetoric. See also my lemma on fallacies. (And no, I do not think the editors of the DSM-5 are so stupid as not to know what they are doing.)

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


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

Is Psychology a Science?

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

Short descriptions of the above:                

1. Ten reasons why ME/CFS is a real disease by a professor of medicine of Harvard.
2. Long essay by a professor emeritus of medical chemistry about maltreatment of ME.
3. Explanation of what's happening around ME by an investigative journalist.
4. Report to Canadian Government on ME, by many medical experts.
5. Advice to psychiatrist by a psychiatrist who 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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