A new article in Medscape Medical News—a leading online medical news service—addresses the controversy over psychiatry’s “Bible,” the DSM.
The American Psychiatric Association (APA) sells the manual for classifying psychiatric diagnoses, known as the Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM 5). It has been criticized by major figures in psychiatry, such as Allen Frances, the chair of the fourth edition Task Force and a key figure in the creation of modern psychiatric diagnoses, and Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002 to 2015.
Criticisms leveled at the DSM include its lack of validity and reliability, vague symptom lists, ambiguous diagnoses, and that its diagnoses are created (and sometimes removed) by consensus rather than scientific discovery.
However, the APA wholeheartedly supports the use of the manual despite these criticisms. Perhaps the greatest voice in support of the DSM is Jeffrey Lieberman, known for his prolific defenses of psychiatry, who was president of the APA from 2013-2014 and is now chair of psychiatry at Columbia and director of the New York State Psychiatric Institute.
In the current article for Medscape, Michael Vlessides summarizes the DSM’s history and controversies, including striking quotes from these larger-than-life figures in modern psychiatry.
Lieberman defends the DSM by acknowledging that it is flawed—and unique among medical specialties in its lack of objective measures—but suggesting that there is no better way to conceptualize distress:
“It’s easy to criticize the DSM […] But at this point, it represents a system that is as good as we can have, given our current state of knowledge […] Is it ideal? By no means. But there’s no better alternative. Hopefully, research will soon enable modifications that will lead to pathologic diagnostic assessments, like every other field of medicine has.”
One criticism of the DSM mentioned in the article is that—unlike other medical specialties whose diagnoses are based on understandings of the biology involved—psychiatry’s diagnoses are agreements among self-appointed experts regarding what personalities or experiences are “abnormal.” In fact, the diagnostic categories being considered for inclusion in the DSM 5 were circulated to the general public for comment—a tradition unique among doctors and researchers who are constructing supposedly scientific medical diagnoses.
Of course, this public accountability has its benefits. It is one reason why homosexuality is no longer technically a medical disorder, despite its inclusion in previous editions of the manual. It seems that sometimes a committee of experts believes certain ways of being—such as being gay or transgender—are “disorders” or “diseases,” but if enough people disagree, incremental changes can be made.
However, Lieberman does not believe this is a problem that invalidates the scientific integrity of the diagnoses—because he admits that there is no scientific data on which to base the criteria for psychiatric diagnosis.
“The consensus diagnosis issue is a legitimate concern, but I don’t think it’s a fatal flaw… Because if there’s no data, then what methods do you use?”
The Fatal Flaw
Other experts suggest that this complete lack of scientific data is a fatal flaw. Edward Shorter, a professor of the history of medicine and psychiatry at the University of Toronto, calls it “totally unscientific”:
“One of the strangely unscientific aspects of the DSM is that it’s largely the product of horse-trading […] People sit down around a big table and say, ‘I’ll give you your diagnosis if you give me mine.’
“This is a totally unscientific way of doing business,” he continued. “We didn’t come up with the speed of light by having a consensus conference, and it’s not how psychiatric science should be conducted, either. To think that this is responsible for the official psychiatry diagnostic manual is just gobsmacking.”
Nassir Ghaemi, a psychiatrist and author at Harvard and Tufts, makes a similar criticism:
“It was so popular that it became a bible,” he told Medscape Medical News. “We’ve created a bunch of terms―most of which were created out of the blue with no scientific rationale―but just because we would all agree on the definitions. And now we act as if they were handed down by God himself and can never be changed. And that’s essentially what’s happened in the last 40 years.”
Other criticisms came from two of the biggest names in psychiatry, Thomas Insel and Allen Frances.
In a now-infamous blog post in 2013, as the APA was preparing the current edition of the DSM, Insel—then the head of the NIMH—admitted to the world that the diagnostic categories were invalid and would not be tolerated by any other subset of medicine:
“The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century as we have understood that symptoms alone rarely indicate the best choice of treatment.”
He was not the first head of the NIMH to criticize the DSM. Steven Hyman, Harvard and Broad Institute researcher and leader of the NIMH from 1996-2001, famously called the DSM diagnostic system “an absolute scientific nightmare” when interviewed by the New York Times in 2013.
Nancy Andreasen, who served on the DSM III and IV Task Forces and chaired the Schizophrenia Work Group for DSM IV and was former Editor-in-Chief of the American Journal of Psychiatry, also criticized the DSM in a series of articles in the mid-to-late 2000s that mirrored Insel’s words.
For example, in a 2007 article in Schizophrenia Bulletin, she wrote,
“Validity has been sacrificed to achieve reliability. DSM diagnoses have given researchers a common nomenclature—but probably the wrong one. Although creating standardized diagnoses that would facilitate research was a major goal, DSM diagnoses are not useful for research because of their lack of validity.”
Allen Frances’ criticisms of the new edition landed even harder. In a 2012 blog post on Psychology Today, Frances urged readers to “ignore” the changes to the manual and called the publication of the DSM 5 “the saddest moment in my 45-year career.” He suggested that the current manual’s diagnoses lacked “scientific support” and even “defy common sense.”
According to Frances,
“More than fifty mental health professional associations petitioned for an outside review of DSM 5 to provide an independent judgment of its supporting evidence and to evaluate the balance between its risks and benefits. Professional journals, the press, and the public also weighed in, expressing widespread astonishment about decisions that sometimes seemed not only to lack scientific support but also to defy common sense.
“DSM 5 has neither been able to self-correct nor willing to heed the advice of outsiders. It has instead created a mostly closed shop, circling the wagons and deaf to the repeated and widespread warnings that it would lead to massive misdiagnosis.”
Frances argued that the new manual would lead to overdiagnosis and overmedication because its new diagnostic categories were broad enough to subsume normal experiences of mild distress—which could now be considered “diseases.” He also took aim at “fad diagnoses,” which “littered” the history of psychiatry—and stated that the DSM 5 was featured at least “a half dozen” such “disorders.”
Frances also called out a massive financial conflict of interest—the DSM is the APA’s biggest money-maker since every professional in the mental health field must purchase the expensive, massive manual each time it is updated in order to stay abreast of the newest diagnoses and criteria changes.
“There is an inherent and influential conflict of interest between the DSM 5 public trust and DSM 5 as a best seller. When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM 5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only — so that DSM 5 publishing profits can fill the big hole in APA’s projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM 5 preparation.”
A New Yorker article in 2013 summarized many of these complaints succinctly:
“Indeed, the D.S.M. has frustrated scientists, who note that the most common symptoms of mental disorder—sadness and worry, for instance, or delusions and hallucinations—appear as criteria for many different diagnoses; that many patients can be diagnosed with more than one disorder; and that the few solid findings about mental illness that have emerged from genetic and neuroscience studies indicate that the D.S.M’s categories simply don’t correspond to biological reality. Looking for the neurochemistry of mental disorders that don’t necessarily exist has turned out to be as futile as using a map of the moon to get around Manhattan.”
John Talbott, another former president of the APA and University of Maryland psychiatrist, was also interviewed by Vlessides for the Medscape article. He mirrored Frances’ advice to professionals to “ignore” the diagnostic categories they disagree with.
“If you let the specifics of the DSM tie you down, it prevents you from practicing the art of medicine. So, I would hope people would not be bound by it but be flexible and use their clinical judgment instead.”
It is hard to imagine another medical society’s president urging its doctors to ignore the specific criteria in their manuals and suggesting that the published criteria for diseases actually impede good medicine.
Alternatives to the DSM
The new model of the DSM is one where periodic updates will be made online, although it is unclear whether this will improve anything about the current system.
An alternative to the DSM, proposed by Insel during his tenure as head of the NIMH, is the RDoC (Research Domain Criteria) system. This system was created to provide a structure for analyzing potential biological correlates of psychiatric complaints—without being beholden to the DSM categories. That is, the RDoC is focused on genetics and neurobiology.
Unfortunately, in a 2017 Wired interview, Insel said that $20 billion toward genetic and neurobiological research has resulted in “cool papers published by cool scientists” but, in terms of clinical outcomes, it was a complete waste of time and money:
“I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that, I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”
Another alternative system mentioned in Vlessides’ Medscape article is called the Hierarchical Taxonomy of Psychopathology (HiTOP), which uses factor analysis to “nest” psychiatric diagnoses on a dimensional scale. However, HiTOP is currently in its infancy—more an idea than an actual, usable system.
Lieberman, quoted in the Medscape article, suggests that the diagnostic system being “terrible” does not mean we should stop using it:
“If somebody has something better, please publish it or bring it forward,” he said. “But to say, ‘This is terrible, and we’re not going to use it,’ well, that’s just self-defeating.”
Although Lieberman does not acknowledge it, other frameworks can be used. One notable alternative system was not mentioned by Vlessides: the Power Threat Meaning Framework (PTMF), which has been supported by the British Psychological Society.
The PTMF is unique among psychiatric diagnostic systems in that it was developed with service user input—rather than the consensus among professional experts. The PTMF is a framework for understanding distress as a result of trauma and oppressive power dynamics and a framework for caring for people that consciously avoids replicating those situations.
According to the PTMF, current mental health services continue to retraumatize service users and replicate oppressive power dynamics. For example, imprisoning people in psychiatric hospitals against their will (known as “involuntary commitment”) is a key function of psychiatry, as is forcibly medicating those who do not wish to be medicated. Likewise, “anosognosia” is another key aspect of psychiatry—the notion that the people they treat are sick because they refuse to believe they are sick.
This notion is reinforced by prominent psychiatrists, such as Ronald Pies, a psychiatrist at Tufts and SUNY who was Editor-in-Chief of Psychiatric Times from 2007-2010. In a recent interview on Psychiatric Times, Pies argued that one could not trust the experiences reported by psychiatric patients. If they report that their psychiatrist told them they have a chemical imbalance, for example, Pies suggests that we should ask their psychiatrist what they were really told:
“And, yes—we often hear anecdotes concerning patients who tell their current clinician some version of, ‘My psychiatrist said I have a chemical imbalance . . .’ But where is the evidence that this is what patients were actually told? Who has contacted the patient’s psychiatrist, or reviewed his/her case notes, to see if that was really what the patient was told?”
That is, the psychiatrist’s case notes are the only real arbiter of what is real. This is known as “epistemic injustice,”—in which patients’ experiences are invalidated by the person with more power. The psychiatrist has all the power—he can say or do anything—and the patient has no real power. No matter what the patient may report about inappropriate behavior from the psychiatrist, Pies suggests we should defer to what the psychiatrist himself says happened. The patient isn’t to be believed.
The interviewer, Awais Aftab, pushed back on Pies’ statements, but Pies hand-waved his statement away, saying that in a clinical encounter, he would listen to the patient and ask how that made the patient feel. He then suggested to Aftab that “listening seriously and respectfully is not the same as listening credulously.” That is, he would listen “seriously and respectfully” to the patient—but not actually believe the patient’s report of what happened.
The PTMF was designed to reduce this power differential and eliminate these situations in which abuse and gaslighting can be a part of supposed psychiatric “treatment.”
Read the Medscape article by Michael Vlessides here: https://www.medscape.com/viewarticle/942694
What are known as psychiatric disorders and mental disorders are not medical or biological disorders of the brain or body. Mental refers to the mind, not the brain.
Psych-ology and psych-iatry supposedly study the psyche. It’s in the name. And psyche means mind.
“If somebody has something better [than the DSM], please publish it or bring it forward”. There is something better, and far more accurate. The psyche model.
While the psyche model disproves the biological and medical models of the mind and ‘mental illness’, it works with theories or models that actually work, such as the Power Threat Meaning Framework.
Then again that was a really dumb thing for Lieberman to say.
Sounds like he’s admitting that it’s hogwash lol. Which of course he is.
And it’s true, he as a shrink knows that it can be called garbage overnight.
Actually, “psyche” is more commonly defined as “the human soul.” That is what these people should be studying. And that’s not a medical subject, particularly. It currently comes under the heading of “parapsychology” in academia.
Actually, “psyche” is defined as “the human soul, spirit, or mind” and “the mental or psychological structure of a person, especially as a motive force.” (from dictionary.com, so that’s the actual and literal definition). Psyche refers to mind, AND soul, AND spirit. The word origin also refers to breath and live/life.
I agree, it’s not a medical subject. The brain is biological and physical, the psyche is psychic and energetic. Therefore, the medical, biological, and disease models of the mind are inherently flawed, because the mind isn’t biological.
Parapsychology may study the soul, but regular psychology currently studies the psyche, they just have it separated into many theories to explain many different psychological functions, like personality, emotions, morals, etc. All those many theories are looking at and explaining different aspects of the psyche, it’s what psych-ology and psych-ological theories do. They just don’t have a single model or language to unify all those many psychological theories into one psyche-logical theory. Or rather, there is a single model that unifies those theories into a single model with a single language, based on the works and language of Carl Jung, it’s just not accepted yet. It’s called The Map of the Psyche, or the psyche model.
My definitions are per Webster’s New World, 2nd Ed., 1984. Dictionaries vary. The “soul” is sometimes thought of as the spirit-mind complex.
Most psychologists believe in mind=brain in spite of what psyche means.
Hubbard also proposed a unifying model. Jung, I am told, was interested in Spirit, but afraid to go there for reasons of his professional status. Failure to address Spirit and Spiritual memory has been the downfall of psychology. It is key to understanding the human experience.
If I had a repair manual for a lawnmower and tried to apply it to an airplane engine, you’d be pretty disturbed if I said, “If somebody has something better…” you’d think that I was pretty stupid or unethical. Either the model works or it doesn’t. If it doesn’t work, you work on developing a new model. You don’t continue using the model that doesn’t work, and you especially don’t claim that the principles of this model apply to the situations where we know they do not apply.
Absolutely, Steve. But this is what their defences actually boil down to. They have nothing else. I made the same point in ‘A straight talking introduction to psychiatric diagnosis’:
‘British psychiatrist Simon Wessely said: “A classification system is like a map. And just as any map is provisional, ready to be changed as the landscape changes, so is classification.” But this depends on whether DSM and ICD do provide at least some guide to the territory. If they don’t, then we are, quite simply, using the wrong map. A map of Cornwall is of no help if you are driving round Scotland. You would be better off with no map at all than one which directs you down the wrong route.’
There is an easy alternative, ICD 11, which has much better clinical application and none of the arbitrary committee generated criteria of the DSM. it is available online from WHO, unlike the DSM, which is a profit-making enterprise.
Can you provide some kind of assessment of ICD-11? While it is true that ICD is not commercial, and that it is used flexibly in many different countries, I’m not sure you can consider it at heart different from the DSM-system. They are both polythetic systems suffering from problems with validity. And applied within a biomedical frame of reference it still leads to the same sort of biologizing and individual pathologizing that the DSM is often critiqued for. However, the mental health part of ICD has to my knowledge not been the object of critical reflection in the same way as the ICD. If anybody knows of critical pieces concerning the ICD-10/11 it would be much appreciated with a link.
It is my understanding that the ICD codes were derived from or coordinated with the DSM.
Thx for the link. And I think you are right – DSM and ICD are overall coordinated so they are not that far apart. The reason I’m asking is that in the European context I’m in, it is often claimed that clinical practice using ICD is much better, more flexible and experience based than what is often described as the American cook-book like approach in the DSM. Nancy Andreasen of Broken-Brain-fame, for instance, writes that North American psychiatry has lost its connection with the phenomenological approach to diagnosing. This connection – which entails development of a nuanced repertoire of tacit knowledge on the part of the clinician – is sometimes used in defense of the ICD. Kind of like: Yes, but ICD is only a rough guide, what matters is the ‘art of psychiatry’. So I wondered if anyone in this thread knew of a more thorough analysis of ICD – because such a thing is hard to find. Probably because DSM usually is the target of critique. And the kind of defense for the ICD system mentioned above is in a way more subtle and is supported by a more philosophically savvy understanding of what constitutes disorders, e.g. self-disorders as central to the diagnosis of schizophrenia.
Jonathanledlarsen, Steve McCrea is right when he says (below) that the ICD people try very hard to coordinate with the DSM people, and the ICD psychiatry section differs very little from the DSM. However, when you say that the ICD is not commercial, well, I tried to find out what they do with their profits from sale of the ICD, and they would not even reply to the question. I also asked them what is the route for people to file claims when they have been harmed by use of the psych labels in the ICD, and they did not reply to that either. We do know that Allen Frances’s DSM-IV brought in more than $100 million in sales, and there is no evidence that they spent a single penny of that money to redress any of the harm done by the labels in their manual. In fact, they dismissed with no attention to the merits the nine ethics complaints we filed about that harm. Not surprising.
Hi Paula – Thx for weighing in. ICD as a WHO publication is available online for free. In my country, Denmark, the ICD is not sold by the WHO – it is sold in a versioned, Danish copy of chapter V which has been adjusted by a danish working group. It is then published by ‘Munksgaard’ – a Danish publisher who publishes lots of different genres. There must, I agree, be some financial incentives in this whole process. I’m not sure WHO are responsible for registering harms from psych-drugs. In Denmark it is the national health authorities who are responsible for this. In Denmark you can file a report online. This is in Danish, but this details the how reports of harm are handled: https://laegemiddelstyrelsen.dk/da/bivirkninger/bivirkninger-ved-medicin/registrering-og-overvaagning#
It says that the company, not the authorities are responsible that the medicine works as advertised – nevertheless the authorities do some weighing of evidence, e.g. harm-reports, reports from companies when making recommendations. This process seems somewhat opaque.
It is a interesting that there is not the same kind of attention to interests and money flows involved with the ICD compared to the DSM where literature on this is readily available. Perhaps it has to do with the nationalization of how ICD is used. The areas are much smaller – and e.g. European psychiatry does not have the same impact as US psychiatry. As I understand it there is probably also a major impact due to the different ways the American vs. most European health systems are funded, how medicine can be advertised, how reimbursement and legal questions are handled and so forth.
When I trained as a psychologist, the DSM was considered more precise (particular for research purposes) than ICD. But today attempts are more often made to distance the use of ICD from that of DSM. That does signal some change, I think.
“If you let the specifics of the DSM tie you down, it prevents you from practicing the art of medicine. So, I would hope people would not be bound by it but be flexible and use their clinical judgment instead.”
Well sorry, not good nuff. Nope, sounds like another attempt at saving everyone’s asses.
Psychiatry is a self protective, job keeping, insulated bunch of weirdos who are so anti social
that they basically try to ruin a person that exposed the shrinks own needs.
If we are not “bound” by the DSM, and the DSM is de facto not useful to determine what we need to do, what is the freakin’ point of the DSM? Is he finally admitting that the only real purposes of the DSM are as a billing code manual and as a doorstop and back up toilet paper dispenser?
Yes he was admitting that.
Just not in so many words.
I agree, the DSM should be flushed.
Psychiatrists genuinely do tend to be weird and socially not well-adjusted… and that explains a lot, too
I see all this as a form of elaborate avoidance of the true issues.
The truth is that most medical doctors don’t know what a mind is, and would prefer not to. Yet they want to retain their eminence in the field of “mental health” regardless of their failures at “reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”
This is because – and it is obvious to me just from the language used – you can’t get a mental result by simply treating the body. Medicine should walk away from this subject. They can’t make themselves do it because they are addicted to the high profits they can steal from us by pretending to know what to do about something they are actually totally ignorant about. The gullibility of the public in this regard, by the way, is truly stunning!
Can we, as observers of this scene, refuse to give these sorts of debates our energy and attention? They are deeply meaningless and fail to address any concerns outside of the profession. It does nothing to change the fact that these are charlatans, fakers, criminals.
“Medicine should walk away from this subject. They can’t make themselves do it because they are addicted to the high profits they can steal from us by pretending to know what to do about something they are actually totally ignorant about.”
So true, and the mainstream medical community has also totally bought into the systemic crimes of the psychiatric industry, they can’t walk away from their fraud.
I’ve literally pointed out to a pediatrician that the ADHD drugs and antidepressants can create the “bipolar” symptoms, so the pediatricians should stop misdiagnosing the common adverse effects of those drug classes as “bipolar” in children.
Then I pointed out to that pediatrician that the antipsychotics / neuroleptics can create both the positive symptoms of “schizophrenia,” via anticholinergic toxidrome. And the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.
That pediatrician was shaking like a leaf, because she knew I was speaking the truth she’d been taught in med school. But then she told me she would not stop defaming children with the “invalid” DSM disorders, because “it’s too profitable.” It’s just disgusting.
Just a note on Ronald Pies logic that the patient can’t be believed when they say the care provider used the “chemical imbalance” theory. This theory was recently used during a care provider’s testimony during a Jarvis Hearing and can be substantiated by reading the court transcript. Everyone in the courtroom heard it. So much for Pies’ argument.
The “chemical imbalance” theory is also touted on many mainstream medical websites, and in pharmaceutical advertising. It’s absurd, and ungodly disrespectful, that Pies says patients are not trustworthy, when we say we were told this lie.
Is it slowly sinking into shrink awareness that the DSM’s aren’t good for diagnosing anything, much less something that pertains to actual actual successful treatments? It seems to be taking quite a while.
Lordy, they always knew. They are mostly busy with keeping their individual jobs, so lots of work involved in trying to make themselves sound medical.
See after such things as taking over the world and colonizing it, we are not done yet. The WHO is the next step into colonizing.
And it’s simply the poor, always the “poor and uneducated”, and how the “poor” miss out on either the right religion or the right medicine and how it’s really unfair that we allow them to suffer the great wraths, so we have to save them.
unethical horrors, disguised as ethics and altruism.
Wow, thank you Peter this analytical article is brilliant! Everyone needs to read this!!
The general public has this hugely false notion that psychiatry is privy to superior knowledge and science, and that psychiatry is about ‘helping’ people in difficult circumstances improve their emotional or mental well-being. When in truth psychiatry has NO Science, very little knowledge and only a few psychiatrists who appear to actually ‘care’ about people or want to ‘help’.
The harshest realization for me has been that rather than ‘caring’ about the people they see many psychiatrists instead harbor feelings and attitudes of contempt and disdain for their patients.
Excellent article and the kind of article that we need more of.
While Dr Insel did a public service by admitting the weaknesses of the DSM and for saying that $20 billion was essentially wasted in the futile search for biological/genetic causes/treatments. This $20 billion is part of an overall drive to medicalize psychological problems. His 2013 TED talk (https://www.ted.com/talks/thomas_insel_toward_a_new_understanding_of_mental_illness?language=en) is a rather appalling example of this distorted thinking. I critique in detail here (http://adaptivetherapy/chemical_imbalance_myth.html#insel_TED).
Even the term “mental illness” furthers this medical narrative. Something that the 1999 report of the Surgeon General debunks “there is no definitive lesion,- laboratory test, or abnormality in brain tissue that can identify the illness.[…] These clues are grouped together by the clinician into recognizable patterns known as syndromes” (p. 44, “Mental health : a report of the Surgeon General”).
But the conflict of interest angle of the DSM is also key to note. Marcia Angell (former Editor in Chief of the New England Journal of Medicine) writes about the DSM-5 “[Chairperson] Dr. Kupfer reports having served on advisory boards for Eli Lilly & Co, Forest Pharmaceuticals Inc, Solvay/ Wyeth Pharmaceuticals, and Johnson & Johnson […] 56 percent of members of the work groups disclosed significant industry interests.” (https://www.nybooks.com/articles/2011/07/14/illusions-of-psychiatry/)
(this is an excerpt from the article I wrote “How Drugs Are Pushed Over Psychotherapy” https://www.creationsmagazine.com/2020/06/01/how-drugs-are-pushed-over-psychotherapy-by-michael-etts/).
This rabbit hole goes deep…
It’s unbelievable to me how people in the field themselves admit it’s bogus but the average “layperson-expert” will call you crazy (or worse a Scientologist) if you raise these points…
Thanks for this summary and for pointing us towards this article. And also for mentioning the Power Threat Meaning Framework – which is a meta-framework, not a model as such, and as Ragnarok says, can thus be used to support a whole range of non-medical models, of which we have many. The idea that ‘we don’t have anything else’ is just nonsense. What about the many countries and cultures which have struggled by without the dubious benefits of the DSM for the whole of human history? – and where, according to the best research, recovery rates are better than anything Western medicine has produced? Don’t they count?
Small point: ‘The PTMF is unique among psychiatric diagnostic systems…’ The PTMF is not a diagnostic system of any kind. In fact it is not a ‘system.’ It is a set of principles, and an imperfect, evolving attempt to get right away not just from medical models, but from their conceptual underpinnings – including the assumptions that can be summarised as positivism -which are so deeply embedded in Western thought. It therefore opposes any individualistic, pathology-based understanding, including psychological and psychotherapeutic ones.
Wow, Peter is always coming in with the hard-hitters! Thank you so much for this perfect summary of the dissent within the field about the validity of these diagnoses. Super-shareable article, too
“‘I think nosology should be taken out of the hands of the APA ― which is a professional guild, not a scientific organization ― and given to a scientific organization, such as the Karolinska Institute or the NIMH, and start again from the ground up.
“‘In other words, there should not be a DSM,’ Shorter added. ‘The whole concept of how we classify illness needs an entirely new goal, with entirely new people at the helm.'”
I couldn’t agree more. Especially since we all know, “Problems cannot be solved with the same mind set that created them.”
Thank you, Peter.
Does anybody know if a parallel review of ICD mental health-diagnoses exists? There exists a narrative that ICD is ‘less wrong’ than DSM because it leaves more to ‘clinical judgement’. This is supposed to be connected with how it is designed to be implementable in widely different health-systems around the world. Any links or references would be appreciated…
Sorry, but after a remark plummeting of how good it gets, and is it far enough: I can’t read this for want of wondering whether Navalny really was that pervert Rasputin’s mother or father…..
It’s concerning to me how much might easily be manipulated here! And would that be easier from one side, just.
Look into so much, to begin with the movie Born Free, where it starts because there was a man-eating lion, which who said that that’s what was going on. I’m sure they don’t like lions there, when they eat livestock, but does this mean in the US that we should murder anyone that partakes of McDonalds fries. I mean in Iraq now it’s mostly drug wars, rivalry factions of it and the US goes in there and is manipulated to keep it going as if it’s fun.
And beyond that, where does this help those that actually have a diagnosis. Actually, mind you, not Hollywood beatrics (beatitudes with tricks in there) coming in from nowhere wanting to know how to act out without actually caring about art.
And the amount of….
When you go to your doctor and say you have a tooth-ache, but he thinks that it’s a bone fracture from an accident you haven’ t had, but that’s what the book says, and he’s allowed to make you have surgery to fix it, or put your head tied up in a vice when you have to make your living by the skin of your teeth…..
And you can’t tell the doctor what actually is going or you have Anigsognosia……or rather Anogsognosia. but I mean Anosognosia….
And I’ve heard this on the bus. A guy had really bad cancer in his head, went to the hospital they’d supply after the treatment that was offered, him being a vet, and they detached his jaw – ask him how that’s done, if you can find him – in order to get into this head, and there they found the cancer that had been in his head, upon entering that place was gone. And I mean of course upon entering that place, was gone.
Of course I don’t believe him now, but what about then, and WHY do people feel free to lie to anyone with such sensitivity!? And watch their reactions, and keeping going at it till the person is totally confused and not there. This isn’t just psychiatry. It’s anywhere people get together, even at churches!
I must admit, hard to follow, but rather poetical with a flow and drive of spirited ongoings, in which I catch things. Are you breaking chains very carefully? Either way, in one of my songs, Psychic Straitjackets, I rap ‘Worldwide word expansive. Systematic random hogtied spontaneous passion….May be montage, death and laughter, hodgepodge coinage too rare too cash in. Runaway train of meaning’s all that I’m asking.’
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I cannot see where to reply to jonathanledlarsen’s last comment, so I will do it here. I was not saying that I had tried to find out where to file complaints about harm from psych drugs. That is totally different. I was saying that I had tried to find out from the ICD people where to file complaints about harm from PSYCH DIAGNOSIS! Everything bad in the mental health system starts with diagnosis, since the diagnoses have no scientific validity, and they so often cause vast harm. But neither the WHO (re ICD) nor the APA (re DSM) has the least concern about the damage that their diagnoses cause. They have made that very clear. I think it is crucial not to write as though the only harm that comes from psych diagnosis is what psych drugs do. If you go to psychdiagnosis.weebly.com, you can see a number of very brief videos that are about various kinds of harm that all started with psych diagnoses. They are devastating. Please help spread the word. In addition, this might possibly be of some interest: https://www.youtube.com/watch?v=-qIQqRl94_Y It is a lecture about this with some performance.
I think you focus too much on the diagnosis step. It is a step in the ritual of harm that precedes harm. If it did not precede harm it would just be a step in a ritual. When the intent is to harm, and society presses for a justification for that harm, doctors can point to the diagnosis. That lessens the harm in their minds and in the minds of those who believe in them.
But if there were no intent to harm, and diagnosis was not followed by harm, then no one would worry that much about the diagnosis. Just a formality for insurance billing purposes. And if there were no harm done, that’s all it would be!
So I think the problem to focus on is the intent to harm. Not many find this easy to stomach because that means you have to find the antisocial personalities in the crowd, and that begins to look like a witch hunt to a lot of people (particularly the anti-social personalities!). But if it is done well, and without intent to harm the ASPs (beyond suspending their right to practice medicine), then lasting benefit would be derived.
Look at this nation today. The founders set up the best “system” they could think of, and yet it is being defeated today. Why? Because it did not take into account that some people live with an intent to harm others. If we do not face this fact of life, all our efforts will eventually become null and void.
Thank you for bringing up this very important fact. And the damage happens right there in the shrinks office. He now views a human through the lens of his own bias. And the rest of medicine, the courts, every system now sees you through being a “mentally fucked” person.
The public is the least of your worries, since they will never know the diagnosis. Yet psych tries to blame stigma on the public.
The diagnosis itself is iatrogenic harm. No one should be allowed to make up bogus names and tell people that they are damaged. The DSM is the equivalent to a church system pointing out people as moral failures.
It surprises me that on some withdrawal forums I have seen the use of “clinical” labels. I suppose they deal only with chemical harm.
That was and remains a great video Paula.
Thank you for the kind words, Sam Plover! And you are so right to say the diagnosis itself constitutes iatrogenic harm!
To l_e_cox, I want to say a couple of things. One is that the diagnosis is THE FOUNDATION STONE of everything bad in the mental health system. It is getting someone labeled “mentally ill” that makes it possible for the professionals to do almost anything to the person in the name of “treatment.” And although some of the professionals may be guilty of intent to harm, in a way what I find more disturbing is that the vast majority actually think they are helping…and are so invested in seeing themselves as helpful and caring that they are not open to seeing when the truth is that they are causing harm (so they think things like, “She just needs to be on a higher dose of meds” or “Maybe I gave her the wrong label, and she is not bipolar but is schizoaffective, and thus I should stop doing X and do Y instead).
Incidentally, for those who want to keep up with my essays in the future, I will not be writing for MadInAmerica, but I will announce and/or post my work at paulajcaplan.net and on my Facebook and Twitter and Instagram pages.
It certainly does provide all the “cover” needed to do lots of disguised harm and have people believe you know what you’re doing. And the DSM III forward were designed specifically to allow psychiatrists to pretend they were doing “science.” There are no doubt many ways to screw our fellow humans over, but there can be no doubt that the DSM exists for the purpose of making the whole psychiatric worldview/deception viable.
Paula, I know I operate from a significantly different paradigm, but I am informed by considerable group experience. The sociopath is quite good and convincing himself that he is “helping” even as he goes about systematically ruining someone else’s life, or convincing some “colleague” that they should. These personalities are a real piece of work, and VERY dangerous people to be around. I have a hard time convincing others of this, but it’s the truth.
The diagnosis step is a valid step in the resolution of any problem. I used it all the time in my electronics repair work. If the diagnosis is based on a real understanding of the situation, and it is given with the intention to actually resolve the situation, and the technology exists to resolve that situation, then diagnosis is needful and useful.
I’m saying that it doesn’t work in mental health because the thought leaders in mental health are criminals. That might be an unpalatable message to some, but if the thought leaders in mental health were good people, then mental health patients wouldn’t get sick and die, or never see their condition resolve. If you don’t address intent, you will never get there! I’m not talking about the average practitioner who really doesn’t know his subject that well, but prefers to follow “best practices.” I am talking about the people who decide what the “best practices” are going to be. To the extent that those practices hinge on assigning people labels from the DSM, then yes, diagnosis becomes a huge problem. But if the field were sane, I don’t think it would be.
As I read this, I think you’re both right. The DSM is, by design, not based on understanding of “mental health” (whatever they claim it to be), nor is it intended to heal anyone. It was originally a billing manual. But the use of the DSM is determined by people who don’t really want to help. So it is evil because it enables abusive “mental health treatments,” but it enables those because it is designed by people who are actually committed to making sure no one gets better.
It seems they can bill without a “diagnonsense”. Theoretically we can see doctors even if they do not come up with diagnosis. Happens in medicine regularly.
I’ve never seen a field like psychiatry explode with so many diagnoses ….. Overnight their science led to discovery of hundreds of illnesses LOL. And they all got prozac lol. It’s simply amazing how fast it is advancing scientifically. We live in amazing times of progress. All those new drugs too. Amazing.
Psychiatry is allowed it’s own brand of science and marketing. The FDA is also a sham. Our governments ARE psychiatry, the way they used to be religion.
Peter, Steve and Paula and everyone – I keep thanking everyone who has worked in anyway to get out the truth. After 32 years of being convinced I have a biological disease (bipolar 1), I find out the suffering and losses were due to Evil BS. My medical records of my most recent lock up because of a label in my chart read “pt. talking about the banality of evil”. They don’t even know what that means. So, I am the one in need of help because (I feel) they are idiots. I thought you guys might like that one.
A THANK YOU to everyone is an understatement. You all saved me and more importantly my SON. No one will EVER lock him up and chain him down because as a teenager he got sad in a very cold world.
Lcostanzo, your kind words mean the world to me — and I am sure also to Peter and Steve. This is what we hope will happen increasingly if we (this includes you) all keep trying to get the truth out. What is so tragic is that most people who turn to the System for help don’t even have enough of the facts to know what questions to ask or how/when to challenge what some professional says. I have long wanted to get a small grant to put together a brochure that would summarize some of the crucial info and have a list of questions to ask/things to consider when seeing a mental health professional AND some alternatives to seeing professionals…and then make it available at no cost online for people to download.
Sounds like a great project, Paul! “Things you should know before you see a psychiatrist.”
I love that plan too Paula. People have to know that they are virtually stepping into a self appointed court, with judges disguised as doctors…for their misery and that this court has the power and will use their power against you, by labels, words, that make you look worse than a criminal. One does not know the “mind” of psychiatry until one experiences it.
The few I met, let’s just say that now that I’m older, I can see that I was talking to someone not in the least bit socially equipped. Something is really off about these people.
And it’s the biggest joke to hear these people talking about “mental illness”
Why not have a fundraiser Paula? Even dribs and drabs would help. There are a lot of people that would help out.
Thank you for your reply Paula. All of your understanding and others on MIA are one of my very few life lines. Nobody will understand the fraud of Psychiatry that I discovered about myself. If and when I heal more, I would help make and even fund that brochure myself Paula. Hopefully someday. Right now as I know you all understand, my potential has been taken away from me in the name of Mental Health help. I can not even commit to a project like this. Soon I would like to do that.
People need to know – Fix your life, not your brain chemistry. I so wish a mental health professional would have helped me with that when I was a teenager. A couple years of psychology principles for how to live a good life would have saved me a 35 year torturous life of iatrogenic bipolar disorder. THANK YOU ALL AGAIN !!
Lcostanzo, I’m very happy to see you post. I too would be willing to pitch in.
Thank you Sam for the kindness. Since I read forced psychiatric drugging is called torture by the United Nations, I felt 99.9 percent of people are Evil. Your kindness helps me reduce that percentage.
I think we could get a pamphlet like that done. It does not sound too difficult I can be good at coming up with some money. Also, it would be more helpful than what I was doing. I thought I yelled at the Children’s Dept of Mental Health to “F___ your meeting and stick your meeting up your a__. Stop drugging the children”. I had the wrong meeting. Turns out it was a County Legislature meeting that shares the building. I got charged with the violation of harassment.
Using my anger in a more productive way would be good for me. Please let me know if we should work on it.
I see most people as selfish, not so much evil. It helps them to compartmentalize and justify their
selfish actions, so that the “evil” they do, is filtered. The evil, the bad and damage is a result of them
blocking the fact that it came from them and an ongoing misuse of their power. So I see them as doing
really senseless, stupid acts and really the attention is on the wrong people. It is time our governments stand up against systems that harm, or further harm. Psych is simply a replacement for selfish lazy bastards in politics. And in order to fulfil the role of psych, one does not have to be evil, but rather a cold ass selfish moron.
Sorry but your incident made me laugh except for the charges. And perhaps you did not get the wrong meeting after all, since legislature is what it’s about. Psych is allowed to be self governed. Basically government said, “here are the keys, do what you will”
I’m glad you mentioned the children, who no longer belong to the care society. That stopped long ago. Bad or imperfect parenting was disciplined, by taking kids away and subject them to further abuse. Psych and it’s minions are highly destructive, by fragmented, horribly damaging approaches. There is no actual care going on.
I wish Paula would post one last blog about possible pamphlets, possible fundraising along with a link to donation in the form of change.org or gofundme or other media. There are a lot of petitions that were signed, one being created here by friends. And perhaps a lot of those people who signed might be interested in getting some funds together? https://www.change.org/p/end-psychiatric-coercion-it-s-not-out-of-this-world-to-protect-human-rights?utm_content=cl_sharecopy_26331230_en-CA%3A2&recruiter=445094198&utm_source=share_petition&utm_medium=copylink&utm_campaign=share_petition&utm_term=share_petition
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It is wonderful that in Peter Simons’ article he writes about the wonderful Power Threat Meaning framework (though he mistakenly described it as a diagnostic system) created by Dr. Lucy Johnstone.
However, please note the following:
Re the reference to people who are now criticizing the DSM as “major figures in psychiatry, such as Allen Frances, the chair of the fourth edition Task Force and a key figure in the creation of modern psychiatric diagnoses, and Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002 to 2015,” and later to “two of the biggest names in psychiatry, Thomas Insel and Allen Frances.”
(1)Insel uttered not a peep against the DSM until years into his tenure at NIMH, after overseeing the giving of grants for research based on DSM categories. Did Insel suddenly realize how bad it was at that late moment? Insel’s credibility must be challenged, given that when trashing the DSM, he proposed the hugely expensive (and ultimately fruitless, as Insel admits now that it is too late) RDoC, which was based on the biological/medicalized model of so-called “mental illness.” Where is the heroism in that?
(2) Relevant to the mentions of Allen Frances, while royally trashing DSM-5, Frances has consistently and falsely claimed that HIS DSM-IV was “scrupulously scientific.” A great many people have shown that nothing could be farther from the truth about the DSM-IV. Readers would be helped by knowing to take whatever Frances says with a grain of salt (or a ton of salt), given that he so blatantly misrepresents what he did with DSM-IV (as documented, often with quotations directly from Frances himself, in https://www.amazon.com/They-Youre-Crazy-Paula-Caplan/dp/0201488329/ref=sr_1_1?crid=KTW5B3UVU8WU&dchild=1&keywords=they+say+you%27re+crazy&qid=1609862207&sprefix=They+Say+You%27re+Crazy%2Caps%2C157&sr=8-1
(3) Also relevant is that Gary Greenberg, in his excellent, The Book of Woe, as in his article in Wired magazine, reported his conversation with Frances in which Frances acknowledged freely that psychiatric diagnosis “is bullshit.” In light of this, it makes no sense to consider Frances as a reliable authority in the light of Frances both claiming that his DSM was scientific and admitting that psychiatric diagnosis is bullshit. (4)Further of relevance is Frances’s key role in the biggest conflict of interest scandal in the history of the modern mental health system, which has actually been written about here in MIA https://www.madinamerica.com/2015/10/diagnosisgate-a-major-media-blackout-mystery/ as well as initially in https://uottawa.scholarsportal.info/ottawa/index.php/aporia/article/view/3486 This scandal resulted in the pseudoscientific and clearly false but vigorous marketing campaign Frances and two colleagues designed — and were paid nearly $1 million for by Jansen (of Johnson & Johnson) — to sell the exceedingly dangerous drug Risperdal. This omission is all the more disturbing, given the extensive inclusion in this article of Frances daring to attack the APA for ITS conflict of interest in selling the DSM-5. (Simons writes: “Frances also called out a massive financial conflict of interest—the DSM is the APA’s biggest money-maker since every professional in the mental health field must purchase the expensive, massive manual each time it is updated in order to stay abreast of the newest diagnoses and criteria changes.”) Yet Frances breathes not a word about such a conflict of interest during the many years he was heading the DSM-IV Task Force. It’s not believable that Frances somehow evaded his own conflict of interest when he was in that role. Does anyone believe that Frances suddenly, as soon as DSM-5 was in the works, was struck by the realization that there was such a conflict of interest and that he had been in that very position as head of DSM-IV? And given Frances’s scandalous conduct with the Risperdal conflict of interest, he certainly should not be assumed to speak from expertise and from the integrity that warrants paying attention when he calls out someone else’s conflict of interest.
People who would like to read my future essays may want to friend me on Facebook or follow me on Twitter, where I will be announcing my publications, or on my Authors Guild website, which is paulajcaplan.net, since I no longer write for MadInAmerica.
Steve McCrea, Sam Plover, and lcostanzo, I am so glad that you like the idea of the brochure. I have a lot on my plate right now, but if I did set up a gofundme page to raise the few thousand dollars that would be needed to create the brochure, write the text, get artwork created, and pay for a website and domain name to “house” the brochure, can each of you please write to me through my paulajcaplan.net website, sending me your email addresses if I don’t have them, and I will let you know once the link is up. It would be great if you could help spread the word, because I cannot do it through MIA, so if you know anyone else who might chip in (donations will be tax deductible), please ask them, too, to contact me and send me their email addresses. I will post about it on Facebook and Twitter and Instagram, too. It’s so good to feel so supported. And I really think this little project could have considerable impact, because people can do a lot if they have the right information.
Readers of this essay might find my latest one of interest. It is just up today at https://www.madintheuk.com/2021/01/dont-believe-everything-you-read-words-matter-desperately/
Excellent article Paula. We need this education out to people who are so used to psych language.
People have not figured out how psych used language to manipulate it’s biz and how that language has led us further from any understanding of ourselves and others than ever before. It’s really a killer of communication.