January 21, 2011


me+ME: More on the APA's mockery of medicine and morality


Note of March 6, 2011:

As it happens, this text ended with a rather famous picture of Freud with a cigar - who famously said "Sometimes a cigar is just a cigar" i.e. not what he in others would call a penis symbol - that was photoshopped to him holding a penis.

As it also happens, this is a file that, perhaps because of its title, was read a lot, it seems, but hardly ever downloaded. I had already provided a version without this Freud picture, but will today switch them, as I must infer that most of the readers of this text, very probably for the most part psychiatrists or psychologists, are too prurient to appreciate a bawdy visual joke on Freud. (**)

I wrote about the DSM-5 before:

and mentioned ME agenda's fine site about it

Incidentally, here is "the other side", so to speak - and I quote their own title as well:

As the term "Development" suggests, they are not humble about their own outstanding merits:

Top of page    : "DSM-5: The Future of Psychiatric Diagnosis"
Bottom of page: "
Representing 38,000 physician leaders in mental health
               © 2010 American Psychiatric Association. All Rights Reserved."

(Note the "physician leaders" and "mental health": Do these 38.000 psychiatrists really believe that? "Physician leaders"? "38,000", no less?!)

As I mentioned also before in

the chief editors of the previous two DSMs, doctors Spitzer and Frances, strongly disagree with the DSM-5, for what seem to me both intellectually cogent and morally honorable reasons.

And now there is an interesting article in the Washington Examiner under the main title Corrupting Psychiatry:

It is by one Max Borders, and starts like so:

There was a time when we could be more charitable about the vagaries in the APAís Bible, the DSM. But not anymore. If youíve never heard of the DSM, itís the Diagnostic and Statistical Manual series the APA publishes. Psychiatrists all over the world use the DSM as a guidebook for treating people with some form of mental illness. But the APA may test credulity with its upcoming edition.

I refer specifically to proposed changes in the DSM-V due out in 2013. Itís no accident these changes reflect new political realities about how psychiatric medicine gets paid for and by whom. Consider this from Reuters back in July:

Leading mental health experts [in Britain] gave a briefing on Tuesday to warn that a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is being revised now for publication in 2013, could devalue the seriousness of mental illness and label almost everyone as having some kind of disorder.

Citing examples of new additions like "mild anxiety depression," "psychosis risk syndrome," and "temper dysregulation disorder," they said many people previously seen as perfectly healthy could in future be told they are ill.

"It's leaking into normality. It is shrinking the pool of what is normal to a puddle," said Til Wykes of the Institute of Psychiatry at Kings College London.

Mild anxiety? Temper dysregulation? Risk syndrome? Reuterís clearly forgot the lesson of Watergate: Follow the money.

Here Mr Borders - and Mrs Wykes as well - seems to me to be quite right: Spot on, in fact - Yes, the new DSM-5 is "shrinking the pool of what is normal to a puddle", and yes: The all important questions are not so much about 'evidence based medicine' (*), as about Cui Bono?

That is: Who will benefit from the DSM-5?

The psychiatrists themselves, first and foremost, most of all, most definitely: All that limbering up of categories, all that giving up of such  preciseness as there was left, will enable them to brand far more people as "dysfunctional believers", from which their brotherhood of noble healers then will cure them, for money. And besides, it will enable them to get away with virtually anything, in the name of 'evidence based medicine' also, for their system of diagnosing seems designed to be irrefutable.

The health insurance companies, next: Many more patients with real diseases, both explained and unexplained, can now be manipulated into cognitive behavorial therapy instead of medical research, medicines, operations, treatments or health benefits, namely because they "thought themselves ill" or because they have "inappropriate coping behaviour", have "too much interest" in their own health, "care too much" for the moral and intellectual qualities of their medical healers, or what not: somatoformers all.

The state and state bureaucracies: Parts of the DSM-5 read as Soviet psychiatry, in that everyone who fails to be ill according to correct, bureaucratic APA-approved, health-insurance supported, State approved ways, will therefore and thereby be declared a "dysfunctional believer", "somatoformer" ("complex" or "simple", and that e.g. because while having cancer you are, according to your kind psychiatrists or his nice bureaucratic stand in, "overly concerned with your health", which makes you think you need an operation: Not so, you need to learn to cope with your psychological problems, at a much lesser cost for the insurance and the bureaucracy also.)

Besides, the APA has very conveniently dreamed up all manners of psychiatric disorders - "alcohol use disorder", "marihuana use disorder" a.s.o - that seem to be intended to make the US State maintain the laws by conveniently making anything the state forbids some form of "disorder", Soviet style.

I cannot see any patients being benefitted by the pseudoscience of the APA - but then the patients have hardly any voice in the APA or the DSM-5, though they will have to pay the bills and suffer the consequences.

Mr Borders agrees, and ends his piece as follows - with which I again quite agree:

I don't agree with everything psychiatrist Thomas Szasz has to say. But I agree with this:

For centuries the theocratic State exercised authority and used force in the name of God. The Founders sought to protect the American people from the religious tyranny of the State. They did not anticipate, and could not have anticipated, that one day medicine would become a religion and that the alliance between medicine and the State would then threaten personal liberty and responsibility exactly as they had been threatened by the alliance between church and State.

The ongoing blurring between psychiatry and the state is a means to an end. But it is not and end you and I share. It is collusion between guild and government for mutual gain -- only we pick up the tab.

Quite so. Unfortunately, Mr Borders, who seems American, in the middle of his article is mostly concerned with what seem to be Libertarian or Republican ideas about health care and the State.

As it happens, theoretically I can see, as the phrase is, "where he's coming from" - but in empirical fact I am European, and I know full well that a fine and fair health care system is quite possible under full capitalist conditions as existed in the Netherlands in the 1950ies and 1960ies, which also were poor conditions compared with later European riches.

But yes: It existed; it was fair; everybody paid premiums; everybody was insured for most treatments; and it worked. For decades - until it got corrupted and then sold out and destroyed by Dutch politicians and bureaucrats, largely - it seems - to their very own nephews and nieces or at least fellow party members in Dutch NGOs, who then privatized it all appealing constantly to the blessings of The Free Market Forces - since when the premiums have tripled, the medical care given halved, the health bureaucracy quadrupled, all talking with medical doctors set to strict time limits, and a part of the poorest cannot afford the premiums.

So it seems to me I have decades worth of evidence that Mr Borders is quite mistaken about the solution of the sick US health care problem - but then he is quite right about the tendencies and motives of the sick American Psychiatric Association, which seem best summarized as: Medical fraud in the names of science and patients' interests.

Indeed, one finds this on the APA opening pages. I sow some numbers for my comments that follow - and let me note that I speak as a psychologist and a philosopher of science in these notes:

The DSM-5 Task Force and Work Group members are working to develop criteria for diagnoses that not only reflect new advances in the science and conceptualization of mental disorders, but also reflect the needs of our patients. [1] We encourage you to delve into the wealth of information contained within this site to become familiar with some of the advancements in scientific and clinical knowledge that will assist in making diagnoses more accurate, valid, and clinically useful. [2] We also hope that this knowledge will pave the way for further research in these important areas. [3]

Your input, whether you are a clinician, a researcher, an administrator, or a person/family member affected by a mental disorder, is important to us.  [4] We thank you for taking part in this historic process and look forward to receiving your feedback. 

David J. Kupfer, M.D., DSM-5 Task Force Chair

Darrel A. Regier, M.D., M.P.H., DSM-5 Task Force Vice-Chair [5]

[1] No, you are not, and you are lying, knowingly: What you advance is not real science but pseudoscience. What you are trying to do is to redefine psychiatry in such a way that what psychiatrists do will be more paid and more selected as therapies by insurances and states.

[2]  No, you are not: you're doing this not on the basis of real science but on the basis of self-interest and verbal and statistical flimflam, and your changes will not assist the making of honest and rational diagnoses in clear unambiguous language, but will enable enormous amounts of psychobabble and nonsense to pose as 'evidence based medicine'.

[3] No, you do not: What you hope is to save the financial interests of an essential unscientific group of psychobabblers, by making real rational science in their fields impossible, namely by limbering up terminology, fudging methodology, and making statistics meaningless because of vague terms:

Soon one's diagnosis will depend on whether the mood of one's consultant psychiatrist dictates whether one is oneself "too much", "overly" or "very" something or other the APA frowns upon, somehow, somewhere in the DSM-5, or indeed whether one's family-members are "too much" or "overly" concerned with one's health, for this is then what the APA now calls a "Factitious Disorder", for which one's kind psy can section or legally persecuted one's "overly" worried mom. (She thinks you are ill; the psy thinks that will cost the State and the Insurance too much money, so you and she have "Disorders": You are a "Simple Somatoformer"; your mom is "Factitiously Disordered" - she thinks you're ill, and the kind psy says no - and both of you are thinking yourself ill at out fine society's financial costs. You see? No? Then you ought to be in court.)

[4] No, you are evidently lying: It is extremely difficult for almost anyone, including the chief editors of the DSM-III and DSM-IV, to be seriously involved in whatever is happening besides the scenes, and any "person/family member" who is not personal friends with messrs Kupfer and Regier will get updates on the progress of the DSM-5 only in unpredictable driblets.

[5] Sorry gentlemen: Either everything I learned the last 40 years about psychology, psychiatry, logic, statistics, methodology and philosophy of science was benighted nonsense, falsehood and delusions, all thought up by people that are far inferior intellectually and morally to messrs. Kupfer and Regier - or else what you're cooking up, mostly in effective secrecy, mostly in small committees of some obscure group of anyway financially much involved persons of your very own financially strongly interested professional group, is mostly fraudulent redefining, obfuscating, fudging, ambiguating of psychiatric research and terminology.

As far as I can see, with the DSM-5 the APA has shown itself morally, medically and scientifically incompetent, and dangerous to the public, who will be judged in its terms: Already for the DSM-IV, as published in the Brit. Jn. Psychiatry: 78% of the British are not sane, and who also, once having been smeared, have to pick up the bill for getting cured from the imputations they have been smeared with:

Top of page    : "DSM-5: The Future of Psychiatric Diagnosis"
Bottom of page: "
Representing 38,000 physician leaders in mental health
               © 2010 American Psychiatric Association. All Rights Reserved."

Well...."  physician leaders: pseudoscientific con men but indeed, one must kindly assume, in present and future fine " mental health " : financial health. (**)

In brief... what the APA is now, in so far as it implements the DSM-5, is a society of pseudo-scientists

Pseudoscience is a claim, belief, or practice which is presented as scientific, but which does not adhere to a valid scientific methodology, lacks supporting evidence or plausibility, cannot be reliably tested, or otherwise lacks scientific status. Pseudoscience is often characterized by the use of vague, exaggerated or unprovable claims, an over-reliance on confirmation rather than rigorous attempts at refutation, a lack of openness to evaluation by other experts, and a general absence of systematic processes to rationally develop theories.


(*) Maybe I should add clearly that manipulative propaganda terminology like "evidence based science" and "evidence based medicine" are pleonasms in real science and real medicine, and therefore are only, but then indeed ad nauseam, used by pseudoscientists.

My strongly evidence based finding about "evidence based science" is that - in modern times - all and only pseudoscientists insist that the pretentious bogosity they peddle is "evidence based science".

Indeed, I know of no work of real science - physics, chemistry, mathematics - that insists it is "evidence based science".

It is quite like honesty: If it is so, it goes without saying; if honesty is insisted upon, it likely is not honest.

And so with the pseudosciences - clinical psychology, psychiatry - that insist they are 'evidence based': The reader is consciously lied to.

(**) For those whose consciences are clean or Christian, or who simply are prurient or in love with authorities: The Father of Psychoanalysis can be seen in an unbowdlerized version picture: Plus Freud (and Fliess?), that may not be fit for family-viewing.

I wouldn't want my arguments not considered for prurient reasons.... ()

P.S. Corrections may have to be made later.

- 22 jan 2011: Added the above (**) with squeaky clean file for the whole community.

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 (many 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)

Short descriptions:

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 understands ME is an organic disease
6. English mathematical genius on one's responsibilities in the matter of one's beliefs:
   "it is wrong always, everywhere, and for anyone, to believe anything upon
     insufficient evidence
7. A space- and computer-scientist takes a look at psychology.
8. Malcolm Hooper puts things together status 2010.

    "Ah me! alas, pain, pain ever, forever!

No change, no pause, no hope! Yet I endure.
I ask the Earth, have not the mountains felt?
I ask yon Heaven, the all-beholding Sun,
Has it not seen? The Sea, in storm or calm,
Heaven's ever-changing Shadow, spread below,
Have its deaf waves not heard my agony?
Ah me! alas, pain, pain ever, forever!
     - (Shelley, "Prometheus Unbound") 

    "It was from this time that I developed my way of judging the Chinese by dividing them into two kinds: one humane and one not. "
     - (Jung Chang)


See also: ME -Documentation and ME - Resources

Maarten Maartensz (M.A. psy, B.A. phi)

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