Does DSM-5 Matter? Yes; but not for Psychiatrists

Vivek Datta, MD, MPH
18
919

Read the news and you may be forgiven for thinking there is some violent fervor about the release of DSM-5. Its arrival is apparently “long awaited” and “hotly anticipated.” Petitions denounce it. Organizations note their “concern”. Lobby groups have called it unsafe, unfit for the purpose. Campaigns for the abolition of psychiatric diagnoses appear. Survivor groups issue premature pronouncements of psychiatry’s death. I’ve been wondering: who exactly has been awaiting its arrival? It’s not researchers: The National Institute of Mental Health has made it clear that the psychiatric research agenda has moved on from categorical diagnoses. It’s not clinicians: most psychiatrists do not even use the DSM to make diagnoses. It’s not insurance companies: even in the US, most payers do not accept the DSM for billing purposes. It’s certainly not patients: a new system of classification will not improve patient care or revolutionize treatment. So then, what’s all the fuss about? Does the release of DSM-5 even matter? The answer is yes, but not as a psychiatric document. What makes the DSM so pernicious is that it is a cultural document whose influence transcends not only psychiatric practice but also the Western civilization from which it originates. Each revision of the DSM rescripts and reimagines how we make sense of our experiences, reinterprets what thoughts, feelings and behaviors are socially sanctioned, and ultimately what it means to be human.

Psychiatrists Don’t Use the DSM

One of the fiercest criticisms of DSM-5 is that it will expand the borders of mental disorder and thus psychiatrists will wrongly diagnose and treat people as mentally ill. Allen Frances, former chair of the DSM-IV task force, most ardently voices this criticism. He comes across as a silly old man nursing a narcissistic injury (he was excluded from DSM-5), throwing his toys out of his pram. He makes the assumption that psychiatrists use the DSM to make diagnoses. It is an open secret most psychiatrists in fact do not! If most psychiatrists used the DSM constructs we would not see an epidemic of bipolar diagnoses in children as young as two. In fact, most of the patients who come to me with the label of bipolar disorder, do not meet the criteria for the DSM-IV bipolar disorder construct. Schizoaffective disorder, which is supposedly a rare diagnosis, is possibly the most common diagnosis I see in the charts of inpatients which is deeply suspicious. More systematic studies show diagnoses patients garner have little to do with the DSM. For example, one study in the Veteran’s Administration system suggest 25% of schizophrenia diagnoses did not meet DSM criteria, and psychiatrists often made up diagnoses so Veterans could get benefits. In the private systems, fraudulent diagnoses are given as diagnosis determines remuneration.

Most psychiatric diagnoses are not made by psychiatrists but in primary care. Most primary care physicians do not know the diagnostic criteria for most of the common mental disorders as described in the DSM, but that does not stop these labels being used. Even for some common mental disorders most psychiatrists do not know the diagnostic criteria off by heart, and even if they do, take no heed. Take posttraumatic stress disorder as an example. This is a common mental health diagnosis. The diagnostic criteria for the construct are many and complex. I would hedge that over 90% of psychiatrists do not know the diagnostic criteria verbatim. Even if they did, one criterion is than an individual responded to a traumatic event with “fear, helplessness, or horror.” I do not know of any psychiatrists who ask their patients whether they responded in one of these three legitimated ways of responded to severe adversity, and if they did, their patients would probably be puzzled. Having no immediate reaction, or feeling anger or shame instead of “fear, helplessness or horror” to rape will not preclude a psychiatrist making a PTSD diagnosis, but if you stayed faithful to the DSM-IV, PTSD cannot be diagnosed. For depression, the bereavement exclusion is going and there has been concern people will now be diagnosed with depression following bereavement. It is already happening and has been happening for years.

That is not to say that diagnostic assessments are never useful, but this goes beyond the DSM. Diagnosis is important when it comes to identifying whether the morbid mental state is secondary to a medical condition. For example, I have treated patients who present with ‘depressive psychosis’ but this is due to myxedema coma, or those who are behaving bizarrely but have a metabolic encephalopathy. It is also important to identify whether the individual has fried their brains with drugs such as methamphetamine, ‘bathsalts’, or ‘spice’ which can lead to florid perceptual distortions and erratic behavior.

DSM diagnoses no longer guide treatment

Perhaps diagnosis informed treatment once upon a time, but this does not seem to be the case today. This is at least partly true. Individuals have experiences of mental life that cause distress and lead them to behave in ways others feel are bizarre or un-understandable. As a result they may see a psychiatrist. The psychiatrist can engage in the semiotic act of making a diagnosis. In order to do that, he engages in a precursor semiotic act, which involves recoding individual experience and observable mental phenomena or behaviors into ‘symptoms’ and ‘signs’ respectively. If he stops there, he can, and often does ‘treat’ the patient. If those ‘symptoms’ and ‘signs’ are regarded as psychosis, he will end up on a neuroleptic. If the patient is seen as ‘depressed’, he may end up on a serotonin reuptake inhibitor. If he appears ‘anxious’, perhaps a benzodiazepine will be prescribed. If ‘mood swings’ are observed, lithium or an anticonvulsant will be the order of the day. Many patients have experiences that are recoded into a bewildering combination of depression, elation, irritability, psychosis, anxiety, and may end up on an ‘antidepressant’, anticonvulsant, neuroleptic, and benzodiazepine, and if there is no response, this experience will be interpreted as ‘treatment-resistance’ and another medication will be added! I would like to say that this is a caricature of American Psychiatry, but this appears to be the rule rather than the exception. This is not how I practice, and am fortunate to have thoughtful trainers, but outside the academic ivory tower and in the community rampant polypharmacy is the rule. This happens in spite of diagnostic constructs in the DSM, not because of them. Sometimes response to cocktails is even used to support a diagnosis in a backward logic. In this way the DSM is largely irrelevant to the practice of psychiatry. Systems of psychiatric classification are relevant in the consultation room more from their influences on cultural consciousness and experience of the self, than from use in guiding diagnosis and treatment.

Redefining Personhood

Throughout history there have always been individuals who have been regarded as mad, or as Philippe Pinel called it, suffering from ‘mental alienation.’ For Pinel, to be mad meant one’s “character, as an individual of the species is always perverted; sometimes annihilated”. Without reason, man is no different “from the beasts that perish”. It is not madness that causes one to relinquish personhood, but to be identified as such. Psychiatrists, as the moral arbiters of mental life are thus also the high priests of personhood. Psychiatric diagnoses today extend far beyond ‘mental alienation’ and include a wide array of behaviors and experiences regarded as deviant. The removal of homosexuality from the psychiatric cannon is the best example of how personhood was restored to individuals previously regarded as pathological and deranged. For DSM-5, ‘gender identity disorder’ is being replaced with ‘gender dysphoria’. This is similar to homosexuality being replaced with ego-dystonic homosexuality before being expunged altogether. So whilst transgender individuals will no longer be regarded as mentally ill, it is a mental illness if you feel shit about it. A step to reclaiming personhood perhaps, but the transperson’s response to an intolerant society is still seen as pathological.

Far away from the locked psychiatric unit and the consultation room, the DSM exists in classrooms, libraries, the internet, the popular imagination. Each diagnosis at once hijacks personhood and redefines it. With the disappearance of Asperger’s syndrome, a cohort of socially awkward computer geeks have been disenfranchised and forced to rejoin ‘neurotypicals’ or be redefined autistic. The DSM provides the script of how we should respond to trauma; the narrative of resilience replaced with vulnerability. It is a veritable ‘how-to’ for those wanting to be anorexic or bulimic and join ‘pro-ana’ communities. It conveniently rewrites the ways we can be seen as ill, seek professional help, gain compensation, or even moral exculpation for our behavior. From Portland to Port Moresby, the DSM unites us with a global template for being mentally ill. In doing so, the DSM not only seeks to describe the landscape of psychopathology, it actively shapes it. Whilst removing the bereavement exclusion for diagnosing major depression may not change the psychiatrist’s attitude, it does refashion the cultural expectations of what constitutes acceptable misery. What is pernicious about the DSM is not how it shapes psychiatric practice directly – it doesn’t. Instead, it at once erodes personhood from those seen as ‘mad’, and for everyone else creates a cultural expectation that we are all sick and in need of treatment.

18 COMMENTS

  1. If only psychiatrists could convince policymakers, insurance providers, judges, families, of their lack of interest in the DSM, lobby for the reduction of diagnostic requirements for benefits or just understanding of ditress. However, we have seen decades of organized lobbying of the opposite.

    I think this double speak psychiatrists do of both preparing and profiting from DSM as a cultural (and legal and economic and political and religious) document that is needed to maintain their expected expertise of psychopathology but at the same time do not demonstrate the interest or competency to use it actually guide diagnosis irked me a lot when I was in clinical social work school. As a student, I was expected to memorize DSM diagnostic criteria (and did), was extensively tested on differential diagnosis (and was graded favorably), and told that this is what clinicians do, use the best available science/expertise available and apply it to practice. If social workers were being indoctrination into the use of DSM (a Faustian deal they made to abandon previous previous principles in order to get insurance reimbursement in private or community practice), how could psychiatrists be so careless and snide and proud in their own “healing” powers to blatantly disregard the document. I don’t think I ever believed that diagnoses were particularly valid, but I did believe that many were constructed to be rarely diagnosed so if a diagnosis was given, it was because something very serious was being experienced by someone (whether or not it was a brain disorder). So when I saw psychiatrists diagnose bipolar disorder because someone said they had sometimes been sad and was currently talking at a speed the doctor thought was fast(without consideration to medical history, substance use, or how long symptoms were around or even asking about someone’s typical rate of speech) and then billed insurance and prescribed mood stabilizers, it really was disillusioning. This happened in all sorts of evaluations.

    Dr. Datta, I appreciate your apparent understanding of a lot of the cultural frames in which psychiatric power embeds itself and emerges, but I would love to hear more about what you might suggest Psychiatry do in getting out of the business of defining personhood and what else you think they should be doing? As I reread your article, I am struck by your ability to make distinctions between how Psychiatry as systemic force has such profound impacts on legal proceedings, cultural understanding, and personal subjectivity and that somehow psychiatrists themselves (at least the “smart” ones who have clinical professorships in university settings) can go along just fine without being influenced by that systemic force or act without regard to it. I just don’t see how that is possible. If psychiatrist don’t use the DSM in practice, why keep making them? Why get resentful at other clinicians for engaging in mental healthcare for not finding it important either? I guess I am still seeing psychiatrists wanting to have it all ways, to be leaders of the mental health field and claim expertise of people’s inner experiences, claim that their leadership is based on their intelligence, training, and understanding and application of science, but then when science is lacking also claim that leadership just on their cultural power that the science supposedly gives them in the first place through the development of such documents like the DSM(even though it is lacking in science).

    Perhaps I am trying to get an answer to what you think “good” psychiatric practice looks like, why do you think it looks that way, and why don’t more psychiatrists practice that way. What would have to be different systemically for this to happen? How can psychiatrists help in engendering those systemic changes? How are they impeding them?

  2. Become cyber activists! There are so many good writers with much knowledge and experience in MIA, but sometimes I feel it is wasted on people who have good attitudes already, in other words, you are preaching to the choir. All these good comments should be put on sites read by people who normally don’t come to MIA, like the Guardian, New York Times etc. That’s where we can make a difference. And we may always refer readers to MIA! One tip: Google e.g. on “antidepressants comments” and choose setting “within last 24 hours”. Then you will have the opportunity to reply to people who have no idea about all the positive things MIA readers already know about. This will really be useful activism that may reach millions.

    • That is a great idea!

      I have often wondered what might be possible if people spent the same energy trying to communicate these ideas with people outside of the circles of dialogue as they do debating and expanding ideas amongst ourselves/one another…well, a lot could be said.

      I am going to make a personal commitment to try to conscientiously comment on at least one ill-informed article or comment thread per every couple of days…

      If anyone wants to start a club of some sort, to post on non-allied sites – in a sincere and not-trollish way – message me. Some sites are triggering and even nauseating to just glance over and people can be very nasty when their ideas are challenged, even if they are challenged kindly.

      @researcher, that’d be an interesting research project: Psychiatric Human Rights, Cyber Activism and the Impact of Strategic Messaging in the Context of an Evolving Dialogue.

  3. Thank you for this extensive article. A question occurred to me – How is it that psychiatric diagnosis for the purpose of remuneration is not insurance fraud? If my doctor told me, “This diagnosis is just for insurance coverage,” wouldn’t I technically and legally be required to report that to my insurance co. (or Medicaid, the VA, etc.?)

  4. Dr. Datta,

    I too want to express my appreciation for your honesty and decency in telling the truth about what goes on behind the scenes with psychiatry to the great detriment of those in emotional distress who are all too frequently betrayed and even destroyed by the encounter with a “mental death profession” in reality.

    I regretted not telling you that when you wrote here before. I have thought about you recently with the hope that you would write here again. I’m so happy you did write on this important topic especially.

    I totally agree that bogus psychiatric diagnoses applied to people suffering great emotional distress or trauma from life crises and toxic environmental/social stressors is degrading, dehumanizing, cruel, abusive, dishonest, stigmatizing, ostracizing and humiliating. Such “spoiled identity” per Goffman’s STIGMA serves as what has been called a degradation ceremony or ritual by one sociologist whereby a powerful person incites a vicious mob to attack and degrade a person to destroy their reputation, humanity and place in a group or community. This is exactly what psychiatry does with its bogus biological pretense when stigmatizing and degrading people. Dr. Joanna Montcrieff has written an article about psychiatric diagnosis being used as a political device for social control with little in common with the real practice of medicine.

    http://discovery.ucl.ac.uk/1306242/

    I believe this is a despicable practice and that those who medicalized psychiatry to the point of the junk science DSM III to the DSM V did it only for their own self aggrandizement and fraudulent medical pretense. To achieve this they sold out to BIG PHARMA at the horrific expense of the millions of people who would be deceived and destroyed by these apparent psychopaths lacking any conscience whatever while pulling off this appalling deceit with BIG PHARMA to brainwash the public and vulnerable people in crisis. The latest ADHD and bipolar fraud fads are the most pernicious medical frauds and crimes against humanity ever per Dr. Fred Baughman, Neurologist, and author of ADHD FRAUD and many articles.

    I hope you keep sharing your views on MIA.

  5. In the UK we now have ‘Care Clusters’, here it is:

    The Mental Health Care Clusters into which the presenting needs of the PATIENT may fall are:
    Care Cluster 0: Variance – Despite careful consideration of all the other Mental Health Care Clusters, this group of PATIENTS are not adequately described by any of their descriptions. PATIENTS who cannot be initially assigned to a Mental Health Care Cluster Super Class during the clustering process will be automatically assigned to this Mental Health Care Cluster.
    Care Cluster 1: Common Mental Health Problems (Low Severity) – This group of PATIENTS has definite but minor problems of depressed mood, anxiety or other disorder, but they do not present with any psychotic symptoms
    Care Cluster 2: Common Mental Health Problems (Low Severity with Greater Need) – This group of PATIENTS has definite but minor problems of depressed mood, anxiety or other disorder, but not with any psychotic symptoms. They may have already received care associated with Care Cluster 1 and require more specific intervention, or previously been successfully treated at a higher level but are re-presenting with low level symptoms
    Care Cluster 3: Non-Psychotic (Moderate Severity) – This group of PATIENTS have moderate problems involving depressed mood, anxiety or other disorder (not including psychosis)
    Care Cluster 4: Non-Psychotic (Severe) – This group of PATIENTS is characterised by severe depression and/or anxiety and/or other disorders, and increasing complexity of needs. They may experience disruption to function in everyday life and there is an increasing likelihood of significant risks.
    Care Cluster 5: Non-Psychotic Disorders (Very Severe) – This group of PATIENTS will be severely depressed and/or anxious and/or other. They will not present with hallucinations or delusions but may have some unreasonable beliefs. They may often be at high risk for suicide and they may present safeguarding issues and have severe disruption to everyday living.
    Care Cluster 6: Non-Psychotic Disorder of Over-Valued Ideas – This group of PATIENTS suffer from moderate to very severe disorders that are difficult to treat. This may include treatment resistant eating disorders, Obsessive Compulsive Disorder etc, where extreme beliefs are strongly held, some personality disorders, and enduring depression.
    Care Cluster 7: Enduring Non-Psychotic Disorders (High Disability) – This group of PATIENTS suffer from moderate to severe disorders that are very disabling. They will have received treatment for a number of years and although they may have an improvement in positive symptoms, considerable disability remains that is likely to affect role functioning in many ways.
    Care Cluster 8: Non-Psychotic Chaotic and Challenging Disorders – This group of PATIENTS will have a wide range of symptoms and chaotic and challenging lifestyles. They are characterised by moderate to very severe repeat deliberate self-harm and/or other impulsive behaviour and chaotic, over-dependant engagement, and are often hostile with services.
    Care Cluster 9: Cluster Under Review – Note: This Mental Health Care Cluster is under review by the Department of Health and should not be used.
    Care Cluster 10: First Episode Psychosis – This group of PATIENTS will be presenting to the Mental Health service for the first time with mild to severe psychotic phenomena. They may also have depressed mood and/or anxiety and/or other behaviours. Drinking or drug taking may be present but will not be the only problem.
    Care Cluster 11: Ongoing Recurrent Psychosis (Low Symptoms) – This group of PATIENTS have a history of psychotic symptoms that are currently controlled and causing minor problems if any at all. They are currently experiencing a period of recovery where they are capable of full or near functioning. However, there may be impairment in self-esteem and efficacy and vulnerability to life.
    Care Cluster 12: Ongoing or Recurrent Psychosis (High Disability) – This group of PATIENTS have a history of psychotic symptoms with a significant disability with major impact on role functioning. They are likely to be vulnerable to abuse or exploitation.
    Care Cluster 13: Ongoing or Recurrent Psychosis (High Symptoms and Disability) – This group of PATIENTS will have a history of psychotic symptoms which are not controlled. They will present with moderate to severe psychotic symptoms and some anxiety or depression. They have a significant disability with major impact on role functioning.
    Care Cluster 14: Psychotic Crisis – This group of PATIENTS will be experiencing an acute psychotic episode with severe symptoms that cause severe disruption to role functioning. They may present as vulnerable and a risk to others or themselves.
    Care Cluster 15: Severe Psychotic Depression – This group of PATIENTS will be suffering from an acute episode of moderate to severe depressive symptoms. Hallucinations and delusions will be present. It is likely that this group will present a risk of suicide and have disruption in many areas of their lives.
    Care Cluster 16: Dual Diagnosis – This group of PATIENTS have enduring, moderate to severe psychotic of affective symptoms with unstable, chaotic lifestyles and co-existing substance misuse. They may present a risk to self and others and engage poorly with services. Role functioning is often globally impaired.
    Care Cluster 17: Psychosis and Affective Disorder (Difficult to Engage) – This group of PATIENTS have moderate to severe psychotic symptoms with unstable, chaotic lifestyles. There may be some problems with drugs or alcohol not severe enough to warrant dual diagnosis care. This group have a history of non-concordance, are vulnerable, and engage poorly with services.
    Care Cluster 18: Cognitive Impairment (Low Need) – People who may be in the early stages of dementia (or who may have an organic brain disorder affecting their cognitive function) who have some memory problems, or other low level cognitive impairment, but who are still managing to cope reasonably well. Underlying reversible physical causes have been ruled out.
    Care Cluster 19: Cognitive Impairment or Dementia Complicated (Moderate Need) – People who have problems with their memory, and/or other aspects of cognitive functioning resulting in moderate problems looking after themselves and maintaining social relationships. Probable risk of self-neglect or harm to others and may be experiencing some anxiety or depression.
    Care Cluster 20: Cognitive Impairment or Dementia (High Need) – People with dementia who are having significant problems in looking after themselves and whose behaviour may challenge their carers or services. They may have high levels of anxiety or depression, psychotic symptoms, or significant problems such as aggression or agitation. They may not be aware of their problems. They are likely to be at high risk of self-neglect or harm to others, and there may be a significant risk of their care arrangements breaking down.
    Care Cluster 21: Cognitive Impairment or Dementia (High Physical or Engagement) – People with cognitive impairment or dementia who are having significant problems in looking after themselves, and whose physical condition is becoming increasingly frail. They may not be aware of their problems and there may be a significant risk of their care arrangements breaking down.

    • Thanks for posting these “Care Clusters” – fascinating alternative, but I can still sort of see how there would be some, ahem, issues.

      In the meantime, this cracked me up: “I’d like to submit for Cluster 9 – kellogs Crunchy Nut Cluster…”

      😀

      • we hate the Care Clusters here because it it’s not really an alternative it’s still diagnosis by numbers, you can easily see which diagnoses go into each cluster. Then each cluster has it’s “evidenced based” treatment i.e. drugs and/or CBT. I also dislike the fixation on ‘severity’ we have here. This means that people cannot access support unless they are face down on the floor in a really bad way so referrals are denied. Put aside how bad services are for one moment because we don’t a have fully functioning complete alternative set of services to go to instead. Due to severe cuts to our mental health budget people are being turned away and some of the NGO’s and survivor-led groups have also suffered many cuts to their funding.
        Yeah I’m thinking of saying if anyone asks me what my cluster is to reply Kellogs Crunchy Nut

  6. Dr. Datta,

    After reading your added comments, I felt that I must have misunderstood your original article in that you seem to be arguing against the pernicious effects of the DSM and then say in your comment that you aren’t for or against it being used leaving me confused about your position.

    Thus, I reread your article more carefully and found somewhat of a blaming the victim attitude for the many crimes against humanity perpetrated by the mental death profession and their cohorts in power in society at large.

    Yes, it is true that DSM stigmas are used to get benefits for certain deserving and undeserving people while psychiatry and BIG PHARMA make money either way. Often, psychiatrists refuse to help those deserving workers’ compensation, disability income and other critical resources because that would mean they would have to admit environmental stressors played a role when their whole bogus biological psychiatry paradigm lies and denies this especially to protect and serve their true “patients,” the power elite from any accountability including themselves. They fraudulently claim the victims’ bad genes, chemical imbalances, faulty brain wiring or just being crazy, bipolar, delusional and paranoid caused the problem to deprive the victims of even survival never mind compensation and validation.

    A perfect example of this is the victims of all types of social abuse, bullying and trauma that require outside experts to step up to the plate due to psychiatry’s refusal to acknowledge the traumatic and lethal effects of domestic, school, work, community and other types of abuse, bullying and mobbing, which is deliberately incorporated into their pseudoscience victim blaming DSM.

    Dr. Heinz Leymann, coined the term, mobbing, to describe the horrific consequences when an evil probably psychopathic or narcissistic bully targets an envied person and instigates a vicious group mobbing process that consists of nonverbal and verbal psychological terror that often results in severe PTSD that psychiatry then stigmatizes as bipolar, delusions and paranoia. Dr. Leymann exposes that the effects of such a mobbing process are so lethal that victims often lose their careers permanently along with all else in their lives, which frequently drives them to suicide.

    Here is a link to Dr. Leymann’s MOBBING ENCYCLOPEDIA:

    http://www.leymann.se/English/frame.html

    Here is another link to the book, BULLYING: FROM BACK YARD TO BOARDROOM whereby the authors who are doctors expose that such bullying or mobbing can lead to stress breakdown for the victims of this lethal process:

    http://books.google.com/books/about/Bullying.html?id=4RTRC0aAT2kC

    Per Dr. Peter Breggin’s book TOXIC PSYCHIATRY, if the victim makes the fatal error of going to a psychiatrist or any mental death expert ruled by the bogus victim blaming DSM, they will be stigmatized as crazy, which will play right into the bully, mobbers’ hands.

    Obviously, being subjected to bullying and mobbing in any environment or group is especially lethal when the increasing traumatized target reacts NORMALLY in such a way that their self esteem, reputation, appearance, health, tendency toward self blame and the typical downward spiral without understanding this horrific process can and often does completely destroy one’s life.

    Thus, the target needs validation and a medical/mental expert to intervene on their behalf to stop this deadly process.

    Sadly, the mental death profession’s bogus, victim blaming DSM was created to do the very opposite by blaming the victims while aiding and abetting their fellow abusers and/or the most powerful, so they will side with the bullies like themselves and stigmatize and destroy the victim further. Of course, the victim is not yet aware of biopsychiatry’s true purpose of political, social control to rob victims’ of all their human, civil, democratic rights and due process when they annoy, inconvenience or challenge those in power in the guise of mental health to hide the fact that what they are doing is fascist and unconstitutional.

    Unfortunately, I don’t think your article includes this opposite side of the coin whereby a target of bullies, psychopaths and/or malignant narcissists (or just plain evil people per THE PEOPLE OF THE LIE by Dr. M. Scott Peck) desperately need help and validation to maintain their careers they worked so hard to achieve, families, homes, custody and very survival. These people aren’t looking for any handouts, but rather struggling to survive and maintain what they’ve earned through very hard effort and lots of sacrifice.

    Not only will biological psychiatry and its DSM/BIG PHARMA fraud not be willing to help or validate the targets of such evil, but rather, they will pretty much ensure that the victim’s fate is sealed with a bogus DSM crazy stigma so the bully mobbers can complete their demolition enterprise and push the victim to probable suicide or at best a totally destroyed life with the loss of everything that ever mattered.

    I hope you will reconsider your seeming belief that many people eagerly seek life destroying DSM stigmas to game the system when many are seeking to survive and protect the careers/jobs and assets they sacrificed so much to achieve that serial bullies and mobbers can easily destroy while being aided and abetted by the mental death profession guided by the junk science victim blaming DSM. Though you say psychiatry does not use this manual, it certainly influenced the huge bogus epidemics of increased bipolar, ADHD, social phobia and other fraud to push the latest lethal drugs on patent.

    Here is another link to a great bullying web site that covers this pernicious abuse in all types of environments such as the family per the link below:

    http://www.bullyonline.org/related/family.htm

    Anyway, I may have misunderstood your article in that I thought you understood the horrific consequences to normal people under attack from evil serial bullies, but when I reread it, you seemed to focus mainly on those you feel are gaming the system either deliberately or inadvertently. I sure don’t deny the great brainwashing effects of the nefarious psychiatry/BIG PHARMA cartel with billions spent on marketing and infiltration of every social institution, government and advertising, which you do acknowledge.

    And bullied, traumatized people are especially vulnerable to such further brain washing after enough humiliation and ostracism to fill them with enough self doubt and robbery of all human dignity and self esteem. Thus, they will initially believe the so called mad doctor giving them a diagnosis due to their encounters with real doctors only to find that they have been horribly betrayed. Many targets of such evil monstrous fraud do wake up due to the many resources available exposing the fraud and huge harm done by biopsychiatry once they suffer the horrible consequences of seeking help from a mental death expert. Such enlightened victims of the latest holocaust against humanity by psychiatry’s latest eugenics/euthanasia agenda targeting all normal humans often become experts on the real menace to the world, psychopathy, that psychiatry ignores for the most part because it hits too close to home.

  7. Dr. Datta,

    Thank you for clarifying your position. Perhaps I over reacted based on your comments, but did get confused about your position on the DSM and how psychiatry harms people with DSM stigmas that can destroy their careers, marriages, custody of their children, ability to buy life, health and disability insurance and loss of all human, civil and democratic rights with forced drugging and commitment laws. I’d say that’s a pretty heavy consequence of getting a bogus DMS stigma and the psychiatry profession has done all in its ill gotten power to fight for more of it rather than trying to reduce the harm in any way.

    Anyway, I did have a positive reaction when I first read your article, but I hope you will consider the opposite scenarios I pointed out in my comments whereby not only are no benefits whatever obtained by getting a bogus DSM stigmas, but rather, one’s career and entire life can be destroyed by such stigmas.

    Again, thanks for your feedback.

  8. In considering alternatives to DSM such as Formulation we might also want to consider and share our own rich and varied terms to describe our experiences.

    Perhaps there could be a blog on this editors?

    Voice hearer is such a fine example because it doesn’t denote any specific model, you have to ask the person what their voices mean to them,i.e. where are they from/what are they etc.
    I also for example refer to ‘differences in perception’, and ‘iatrogenic trauma’. I never use the word ‘disorder’ so would refer to ‘eating distress’ for example.
    The two medical words I haven’t yet found alternatives for are depression and paranoia.
    I have a friend who names her diagnosed OCD as ‘Marigold’ [after the brand of Marigold kitchen gloves]