The DSM Files: Investigating the Incoherence of Psychiatry’s Bible

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Sometime during the spring of 2021, I decided to read the Diagnostic and Statistical Manual of Mental Disorders, the DSM, the so-called “bible” of psychiatry. I had a couple of things in mind for this project: first of all, I teach a class about the intersection of mental health and literature, and while I had the literature part down well, and lived experience plus some peer specialist training for the mental health part, the class has been taken by quite a few psychology and social work majors over the years. I needed to up my game.

A Bible-like book with "DSM" embossed on the coverSecond, I was interested for quasi-personal and quasi-philosophical reasons. My own mental health history involved what I interpreted as severe depression brought on by a profound spiritual crisis. I sought help for this in the early ‘90s, when anti-depressants targeting the serotonin system were starting to dominate the scene. Prozac and Zoloft were the “go-to” meds, promising a revolution, the end of unhappiness as we knew it. Within 15 minutes of my appointment with a locally prominent and well-respected psychiatrist, and after having taken what I later found was a modified version of the Hamilton Scale for assessing depression, I was prescribed Prozac and told that I had a “brain disease” that would require medication for life.

This was partially a relief: medical science was validating my feelings! I had a thing called depression; officialdom had signed off on the problems that made me a shitty college student and a terrible romantic partner.

But I was also troubled: my depression was a feeling, sure, but it also arose, in my experience, from a sense that the world had no meaning, that the progressive Mennonite world in which I had grown up did not square with a cosmology I was beginning to believe was better informed by astrophysics than theology. I couldn’t believe, but I also couldn’t disbelieve, worried about the state of my immortal soul—if, that is, I even had one.

Were these concerns, concerns common throughout the past two centuries of philosophical inquiry, merely bad brain chemistry? Could they—and, importantly, should they—be “cured” by a simple pill? And why had the psychiatrist, supposedly the brightest and the best, never even asked about these things? Were my thoughts irrelevant to my feelings?

The question about whether or not to fill the prescription (for Prozac) was also complicated by the fact that a friend of mine had taken it and gone precipitously from depressed to suicidal. This was years before any SSRI had received a black box warning about potential suicidality. Not that it would have mattered: all of my cohort of friends were college-age at the time, and the black-box warning only applies to children on the drug. We would all have aged out; any suicide attempts made after the drug was given would have been (and still would be) attributed to the depression, not the drug.

But it scared me, and I felt that I was not getting my needs met, my spiritual crisis addressed. I felt, in a word, dismissed.

So, being a 20-year-old male, I dismissed psychiatry as well and didn’t fill the prescription. I never went back.

I remained conflicted about this for years, still repeating the bromides that all mental health problems were chemical imbalances, genetic in origin; that modern medicine cured them with medications; and that people so afflicted would be afflicted for life. That did not mean that I wanted treatment, but it did mean that I planned not to ever have children, for who would want to pass on this internal turmoil to another generation? Take me and my flawed genes out of the gene pool, I reasoned. There were still plenty of non-depressed people to fill up the Earth, and anyway, it was, even then, becoming increasingly clear that more people just meant more of a burden on a collapsing ecosystem, more carbon spewing into a warming atmosphere.

This did not mean that I was happy. Indeed, the issues that led to my depression, more complex than I had realized, manifested in various ways over the years, and, while I eventually became a decent college student, I was still a terrible romantic partner, an uneven writer, and and erratic employee. I did, eventually, become a decent self-advocate, though, which I had to be in order to actually find support for my mental health in a landscape that was (and still is) primarily focused on psychiatric drugs. It took 20 years and a lot of work, but I eventually did find someone who worked for me—someone who respected my choice to end our therapeutic relationship when I had met my goals, someone, notably, who helped me articulate therapeutic goals in the first place.

But after all of this, I had only read specific parts of the DSM, such as the entry on depression, and a few others of interest along the way. (The entry on borderline personality disorder is interesting if you’re studying feminism, by the way.) By the time the fifth version of the DSM came out, DSM-5, I knew I had to read it. This one was more controversial than the previous ones, notably for eliminating the “bereavement exclusion” that in previous versions had excluded grief as a form of clinical depression.

By the time I actually got around to reading the DSM-5, 8 years after its debut, I had another reason for doing so: due to work that I had done in the mental health field and my own approach as a writer, I was interested in the DSM as the story psychiatry says about itself, as part of a long-term narrative about how we should think about mental health, as a marketing device displaying the product psychiatry has to offer the world—and, indeed, as a world view, the story psychiatry articulates about how we should think about what is going on inside our heads.

Nothing here should be read as a denial of internal suffering, turmoil, and pain—again, I have gone through these myself. Rather, it takes a critical view of the way the DSM categorizes internal suffering and makes sense (or sometimes nonsense) of it. It is about a story that is full of loose ends, inconsistencies, and bad logic. This is a retelling of a story of a field that has gone astray, a paradigm ready for a shift, an industry we have come to depend on to explain everything from personal pain to population-level suffering but that is ill-equipped for the task. It is told from the perspective of lived experience, from a personal place, but also from the place of a writer and a literary critic, from the place of an advocate for my peers who have experienced internal turmoil and extreme states of mind.

We want, and we deserve, better.

Others have observed that our lives are increasingly medicalized. TV, radio, and credible text sources exhort us to consult our family doctors when taking on such risky tasks as eating, exercise, or having sex. The opinion of an MD is recommended as a way of mitigating the perils or working, aging, youthfulness, childhood, and giving birth. Psychiatry has followed suit. Over the past 60 years, the DSM has expanded from 106 diagnoses to 365 today. There is scarcely a part of one’s thoughts or feelings the DSM does not potentially cover, from one’s beliefs about the world to one’s sadness, happiness, or lack of feeling at all. Both optimism and pessimism are noted, as well as worry, carelessness, anger, and joy. Thoughts impossible to follow are mentioned as well as thoughts and actions that are too tightly ordered, as well as the lack of thought. The DSM rarely wades into what normal is, but it certainly implies it.

Critics of the DSM point out that few medical conditions are declared diseases only at the judgment of the patient, except for purely cosmetic issues, but this does bring up a serious issue: at what point is psychiatry, as with the rest of medicine, expanding past the point of providing relief from pain or repair of damage and into the messy and highly individualized realm of everyday life? If I know the DSM’s definition of depression, will I spend my days worried that every down mood is the start of a dangerous psychiatric pathology? When I read that anxiety is “comorbid” with depression, will I begin to worry about worrying about being depressed?

The level of diagnosis and treatment has also been on the rise, with concomitant increases in disability designations for many of those so diagnosed. According to statistics from the National Institutes of Mental health, cited in a recent TED Talk by Phil Borges, disability due to mental health diagnoses almost quadrupled between 1988 and 2008, from 1.24 million to 4 million, with 1100 people added to the rolls each day. Are we really sicker now, or are we just more often, or more readily, diagnosed? As the number of diagnoses available in the DSM increase, are more of us who would once have been considered normal now nuts?

It is, of course, likely that we are, indeed, sicker now: jobs are less stable, work is more stressful, workplaces and schools more competitive. It is harder to build wealth, harder to enjoy leisure. Access to public services and spaces have decreased as the private sector has expanded; tax revenue has declined, and confidence in public institutions has eroded. There is a good life out there to be had, but it costs too much for most of us to enjoy. By all measures except the access to technology, such as smart phones and social media, life has gotten worse; over the same 40 years that the DSM has blossomed, our lives have gotten harder economically and more hopeless compared to the relative heyday between the end of WW2 and the mid-1970s. Perhaps the DSM has simply expanded to meet the need. Or perhaps both things have happened: as there are now more things making us crazy, so, too, there are more ways to be crazy.

But this creates problems for the DSM’s current model—or, rather, implied model. Absent from the DSM is an over-arching notion of what “mental” actually means: the only references to “theory of mind” have to do with a potential patient’s ability or inability to recognize the thought patterns of others. The very field that will deem you disordered for the lack of a theory of mind does not actually have one in the most serious, scientific or philosophical senses.

That said, as with normal, while nothing is stated, much is implied. The DSM frequently refers to “genetic and physiological” “factors” in mental disorders, often without citing specific studies that determine these. The DSM, in certain cases, ties genetic “factors” to the prevalence of the disorder (or its symptoms, barring definite diagnosis) in “first-order relatives,” somehow forgetting the obvious, that a trait can run in a family without being genetic: mannerisms, a taste for Victorian furniture, wealth. As often, so-called “twin studies,” studies of identical twins reared in separate households, are cited as showing genetic “factors,” studies that are problematic at best, presenting circular logic, methodological inconsistencies, and false assumptions, even as they have been widely cited.

And sometimes, the notations of physiological or genetic “factors” are simple asserted with no citations at all. The listing for generalized anxiety disorder is a case in point. The DSM-5 states: “One-third of the risk of experiencing generalized anxiety disorder is genetic, and these genetic factors overlap with the risk of neuroticism and are shared with other anxiety and mood disorders, particularly major depressive disorder.” Who says? The DSM doesn’t tell us. And what are these “genetic factors”? The DSM cites no genetic tests that will determine whether or not any given individual has these factors, which you’d think treating psychiatrists, and certainly their patients, would like to know.

Other “risk and prognostic factors” include “temperamental” and “environmental” factors. Temperament, then, and by implication, is not genetic or physiological, but the DSM also does not tell us how temperament comes about, just that, in the case of generalized anxiety, it includes “neuroticism,” “negative affectivity,” and “harm avoidance.” From the point of view of this writer, all of these terms are merely recapitulations or descriptions of what a person who is anxious is like. I suppose that has value in that it helps show a treating mental health provider a picture of the generally anxious, but it lacks an etiology, an origin story; it answers the question of what makes up an anxious person, but it does not answer the question of what makes a person anxious.

Maybe it comes from a person’s individual story. That makes intuitive sense: you’re generally anxious because things in your life have made you so (at least the two-thirds that are not genetic). Environmental factors for generalized anxiety disorder, though, are described thus: “Although childhood adversities and parental over protection have been associated with generalized anxiety disorder, no environmental factors have been identified as specific to generalized anxiety disorder or necessary or sufficient for making a diagnosis.”

So, no, then?

That would be news to those suffering from anxiety. My work in the mental health field brought me into contact with many people with this diagnosis, and, importantly, with their stories. If you listen, they can almost all tell you what makes them anxious, but you have to be listening for that, and you have to ask them to share their stories.

To be fair, the DSM does take care here to separate “associations” (correlation) from “factors” (presumably causation), but it does not weigh in on why the correlation exists, and, as noted, does not show us the causative link between the “factors” and the disorder—and, in the case of the “temperamental” factors, does not provide anything plausibly causative at all, merely descriptions.

And so the language here presents the facade of precision with the substance of confusion. As a writer, this is fascinating: are the authors of the DSM really trying to make sense of what they know here, or what they think they know? Is the material just too slippery for precision of thought? Or is this flim-flam, an attempt to convince those reading, and maybe those writing, that things are better settled than they really are?

Implied is that mind arises from the genetic and the physiological, that it is influenced by the temperamental, or perhaps expressed through the temperamental, which, presumably, is a set of fixed qualities that every human has. All other associations are just that, associations, and we mustn’t put too much stock in what people say about being anxious because they’ve been abused, traumatized, or because they have bad bosses or terrible partners. Or, at least, people are not generally anxious because of these things. If you’re looking for something specific, just flip to the back of the chapter, and there you’ll find specific anxiety disorder or unspecified anxiety disorder, both with much more vague descriptions and much lower thresholds for application. No matter what you say about your anxiety, your psychiatrist can find a disorder to fit it without bothering with the problematic “factors” and “associations” found in the description of GAD.

Notably, in this diagnosis and others, the DSM lists temperament, genetics, and physiology as “factors,” but culture and gender as “issues.” The DSM is not kind enough to tell us the difference between a factor and an issue, not even in its glossary. But, again, they are implied. Back to generalized anxiety disorder: “There is considerable cultural variation in the expression of generalized anxiety disorder,” and “generalized anxiety disorder is diagnosed somewhat more frequently in females.” Presumably, then, a “factor” is causal or etiological, and an “issue” is a matter of expression or frequency of diagnosis.

Confused yet?

Me, too.

It’s entirely understandable that inner states, such as anxiety, would vary in their expression across cultures. Different cultures have different languages, different sets of expected behaviors. Some cultures express anxiety through sleeplessness, a surplus of energy, substance use, and so forth; others with feelings of heat throughout the body, or other somatic symptoms. How, then, do we know that these different expressions are, at their core, the same thing?

And then there is gender. According to the DSM, women are more likely to receive the diagnosis of anxiety. Is this because women are biologically more likely to experience anxiety? The simplest explanation is that women are more likely to be socialized to express their inner turmoil in ways that our society calls “anxiety.” But according to the DSM, this is impossible, since no environmental factors are specific to the diagnosis. Perhaps, then, psychiatrists are simply more likely to diagnose women, for one reason or another (sexism?). Yet the DSM’s authors take pains to assure us of the objectivity of this diagnosis.

As a writer trying to make some sense of the story the DSM tells about what it means to be crazy, what it implies about what it means to be normal, and what it says about itself, the DSM seems more confused than deceptive, more incoherent than infamous.

For a statistical manual, its numbers, at least in the case of generalized anxiety disorder, don’t add up; for a work that uses the term “mental” frequently, it presents no unified notion of what a mental phenomenon or, for that matter, a mind, even is. The average work of science fiction presents a more coherent universe than the worldview presented in the DSM.

And then there is the language. Everything is a disorder. OK, that is an exaggeration: the “manias,” the “philias,” the “phrenics” and so forth get their own designations, but the DSM’s default is to disorder.

The formula works thus: modifier + undesirable state or behavior + “disorder” = diagnosis.

You’re not depressed; you have “major depressive disorder.” You’re not traumatized; you have “posttraumatic stress disorder.” You’re not compulsive or obsessed, you have “obsessive-compulsive disorder.”

Not to be pedantic, but, again, from a writer’s perspective, a good deal of this makes no sense whatsoever.

Given that there are already perfectly good words being used, there is no semantic sense in slapping “disorder” on most of these diagnoses. Why not just call depression depression, anxiety anxiety?

All of this would be somewhat laughable if it weren’t so serious. Not only are people’s lives at stake when the risk of suicide looms, people’s quality of life is at risk when the DSM fails to makes sense of what is really going on. Decisions about a person’s fitness for work, play, family membership, and even ability to walk the streets freely depend on the descriptions in this book. The media and the general public, not to mention those who seek help from mental health service providers, are often uncritical of the diagnoses being meted out and accept prescribed treatment without question.

Having worked in the field, though, in a position that tried to shift the culture from one focused only on diagnosis or treatment to one focused on recovery, I can say that the reality is quite different: some people are helped by the system and go back to work, school, and family life; some are partially helped and still struggle, often on disability, and many for years, if not decades; some are not helped at all, and they drift in and out of the system, often facing homelessness, hopelessness, and incarceration. All are medicated.

The most frequent complaint I heard—and it was part of my job to listen seriously and as a peer to their stories—was “My psychiatrist/therapist/case manager doesn’t listen to me.”

And why should they? If a person’s experience does not comport with the incoherence that is the DSM, the content of which is used by insurance companies and managed care organizations to justify billing and allow for service provision, it is a null set. The provider is inclined by training and forced by financial realities to make the person’s experiences fit the descriptions in the book.

There is a lot in the DSM about how things can go wrong, almost nothing about how they can go right. Normality is relegated to the purgatory of implication, and the one thing every interaction with a service-provider ought to focus on, what a person receiving the service actually wants out of treatment, is nearly absent in the book’s 947 pages.

In the end, the DSM says as much about psychiatry’s fears as it does about its certainties: fears of odd behaviors and thoughts, fears of unpleasant feelings, fears of positing what a mind is. It is an expression of the fear that without disordering everything, people will start to see the sense in what is bothering them, how it has helped them cope or how it is a manifestation of what has happened to them—and then they will look elsewhere for ways to help them help themselves change.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

9 COMMENTS

  1. Thanks for the blog Lael.

    “In the end, the DSM says as much about psychiatry’s fears as it does about its certainties: fears of odd behaviors and thoughts”

    It’s not even about “odd behaviours/thoughts”.

    They will obviously ALWAYS see a problem with the way someone is, does or speaks. Basically the labels amount to accusing someone of being a societal menace. No credibility.

    Just like the word “treason”. And all they really have to do is say it. Point a finger and accuse someone. And they have to keep doing it until they retire. And they have to stick to it for the rest of their lives. Their income and saving face depends on it.

    I obviously have met a few shrinks in my time and yes, they are pretty much the labels they hand out. My GP woke me up to that years ago.

    Shady characters. Yes I’m sure there are a few “nice guys” (it all depends where you meet them)

  2. One of the common headaches about psychiatric “diagnosis” is that the shrinks pay little attention to your experiential world, thereby knowing little to nothing about your real mental status, raising the likelihood you’ll be ineptly or improperly treated by the shrink’s medication efforts.

  3. Article:

    Notably, in this diagnosis and others, the DSM lists temperament, genetics, and physiology as “factors,” but culture and gender as “issues.” The DSM is not kind enough to tell us the difference between a factor and an issue, not even in its glossary. But, again, they are implied. Back to generalized anxiety disorder: “There is considerable cultural variation in the expression of generalized anxiety disorder,” and “generalized anxiety disorder is diagnosed somewhat more frequently in females.” Presumably, then, a “factor” is causal or etiological, and an “issue” is a matter of expression or frequency of diagnosis.

    The author’s “factor” versus “issue” discussion is very helpful.

    Diagnosis all comes down to bias which is social, cultural and external.

  4. Absolutely. Right on. I’m so grateful for my humanities background now that I’m working in the field, and for the emerging trauma-informed paradigm. The prevailing meidcalized framework has no concept of mind at all, so it’s incessantly begging the question and ends up being pretty crazy-making and spooky itself. It’s authority is based on circular reasoning: you’re depressed because you have these symptoms which you have because you’re depressed. Well, ok, then. Phew!
    Also the power dynamic is problematic: if I’m the authority on your problem, if I own its proper name, then by implication, I own its solution which makes me the gatekeeper of your future, your well being. How is this not a recipe for domination? And in the absence of a concept of mind, that assumed authority is baseless. Knd of fraudulent. I think a lot of trauma survivors can smell this kind of thing a mile away. I know I can.
    Stay awesome and soldier on!

  5. Defense attorney: “He did not start this.” He did start this with an assault weapon. Insane. Dangerous to others. Lock him up, at least in a psych ward, not me. “Factors” ignored for a white boy: “issues” such as an illegal loaded weapon which he intended to use on other people.

    Kyle Rittenhouse was able to actually commit murder and receive financial help and help from the judge for getting off free.

    Comparatively, based on nothing, no gun, no violence, no death, no threats, I was accused of being potential school shooter material, subject to psychological torture under the false guise of keeping my teaching job, forced to meet with two hack shrinks who ripped me to shreds as they were paid to do (upon horrendously erroneous legal advice that drained my bank account), suicided swatted, set up for psychiatric calamity and crime, as part of a premeditated plan, then locked up for being suicidal to silence me, on a day I said I was trying to “save my life” on Facebook from employer’s attack.

    Pervasive misogyny, eventually criminal psychiatry, pushed by my higher ed employer, to cover employer misdeeds, not mine, has ended my life except for the mental torture.

    White boy Rittenhouse, murderer, is free with support and celebrated.

    February 22, 2013, white male Dr. Andrew Muzychka was not on site and did not evaluate me, or supervise first year intern Nicole Shattuck, who did not have the authority to evaluate me or illegally deny phone calls, or transfer me unconscious to the looney bin from the emergency room, but she did, based largely in societal sexism as well as a total lack of training and over-sight.

    And there was never ever moneyed group offering legal help for me.

    This country is getting much worse, not better. Michigan USA became hell on earth for me nearly a decade ago, without relief, no end in sight, not until I am dead. Things only get worse for me as I age and run out of options.

    Psychiatry is part of the problem of Our Dying America. It ended my life.

    I looked quickly but could not find whether they made the white boy Rittenhouse, gun holder, gun shooter, conservative star, murderer, subject to psychiatry after he actually murdered!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  6. “By the time the fifth version of the DSM came out, DSM-5, I knew I had to read it. This one was more controversial than the previous ones, notably for eliminating the ‘bereavement exclusion’ that in previous versions had excluded grief as a form of clinical depression.”

    I will say that it’s pretty sad that so many working within the “mental health” system have never even read their DSM “bible.”

    But me, I got around to reading the DSM-IV-TR in about 2005. And I will say, don’t forget the psychiatrists – controversially – took this common sense disclaimer out of the DSM5:

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    The DSM5 came out three years after Robert Whitaker wrote his “Anatomy of an Epidemic,” which pointed out that both the antidepressants and ADHD drugs can create the “bipolar” symptoms, and over a million American children had already had the common adverse and withdrawal effects of those drug classes misdiagnosed as “bipolar.”

    “This is a retelling of a story of a field that has gone astray, a paradigm ready for a shift, an industry we have come to depend on to explain everything from personal pain to population-level suffering but that is ill-equipped for the task.”

    Yes, an insanely delusions of grandeur filled, DSM “bible” billing group of industries that believed that distress caused by 9.11.2001, is distress caused by a “chemical imbalance” in one person’s brain alone, in my case. At least according to my prior psychologists’ confession, when I was picking up her medical records in 2005.

    “We want, and we deserve, better.” Indeed.

    “Are we really sicker now, or are we just more often, or more readily, diagnosed?” I’m pretty certain it’s the latter, since theorized and claimed “genetic illnesses” shouldn’t be just popping up in people, who have no “genetic” history of such “mental illnesses.”

    “Absent from the DSM is an over-arching notion of what ‘mental’ actually means: the only references to ‘theory of mind’ have to do with a potential patient’s ability or inability to recognize the thought patterns of others.”

    As one who had my entire life declared to be a “credible fictional story,” by my wildly misinformed psychiatrist, I eventually learned in the end. I’d say there is a problem with the psychiatrists’ “inability to recognize the thought patterns of others.”

    “And sometimes, the notations of physiological or genetic ‘factors’ are simpl[y] asserted with no citations at all.” Or due to out and out lies by a psychologist – who fraudulently claimed that because a person’s grandmother was allergic to Stelazine, this means that that person’s wonderful, non-“psychotic” (according to me, my entire family, and my grandmother’s own doctor) grandmother – was “psychotic.” A psychologist who’d never met my grandmother, by the way, so had no legal right to defame her as “psychotic.”

    “To be fair, the DSM does take care here to separate ‘associations’ (correlation) from ‘factors’ (presumably causation), but it does not weigh in on why the correlation exists.”

    It seems the DSM is intended to aid the “mental health” workers – away from searching for the actual causes of a person’s legitimate distress – and misdirects the “mental health” workers into mislabeling and neurotoxic poisoning people for profit instead.

    “As a writer, this is fascinating: are the authors of the DSM really trying to make sense of what they know here, or what they think they know?”

    I’m pretty certain both psychiatry and psychology are mostly about obstruction of the truth, primarily the truth that our society has severe child abuse, rape, and pedophilia problems. Given the history of psychology, and the fact that over 80% of today’s psychiatry clients are child abuse survivors.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    “Although childhood adversities and parental over protection have been associated with generalized anxiety disorder, no environmental factors have been identified as specific to generalized anxiety disorder or necessary or sufficient for making a diagnosis.”

    And we all now live in a “pedophile empire,” largely thanks to the psychological and psychiatric industries’ obstruction of the truth about our society’s pedophilia and child sex trafficking problems.

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://medicalkidnap.com/2018/08/05/america-1-in-child-sex-trafficking-and-pedophilia-cps-and-foster-care-are-the-pipelines/

    And the “environmental factor” that the psychologists and psychiatrists want to obstruct people from understanding is that the men need to stop raping the women, and especially stop raping the children.

    “All other associations are just that, associations, and we mustn’t put too much stock in what people say about being anxious because they’ve been abused, traumatized, or because they have bad bosses or terrible partners.”

    We need to start arresting the pedophiles, child sex traffickers, and systemic child abuse covering up criminals instead, actually.

    “Or is this flim-flam, an attempt to convince those reading, and maybe those writing, that things are better settled than they really are?”

    I’m quite certain it’s about covering up the truth, I guess that would mean the DSM is “flim-flam.”

    “But according to the DSM, this is impossible, since no environmental factors are specific to the diagnosis.”

    But all DSM diagnoses seem to be highly correlated with covering up ACEs – in other words, child abuse and rape – which is an “environmental factor.” Albeit, an “environmental factor” which is NOT billable for the DSM “bible” billers.

    “Perhaps, then, psychiatrists are simply more likely to diagnose women, for one reason or another (sexism?)” Or since women stand against child abuse, more than the men?

    “but the DSM’s default is to disorder.” Largely since the “mental health” workers’ can’t get paid, unless they defame people with their “invalid” DSM disorders.

    http://psychrights.org/2013/130429NIMHTransformingDiagnosis.htm

    “The formula works thus: modifier + undesirable state or behavior + ‘disorder’ = diagnosis.” And God forbid one be a woman who stands against child abuse (the most ‘undesirable behavior’ a person can have, to many psychologists and psychiatrists, who systemically profiteer off of covering up child abuse, it seems largely for their religions).

    “Not to be pedantic, but, again, from a writer’s perspective, a good deal of this makes no sense whatsoever.” No, it’s all “bullshit,” and about systemic child abuse covering up crimes.

    https://www.wired.com/2010/12/ff-dsmv/

    “people’s quality of life is at risk when the DSM fails to makes sense of what is really going on. Decisions about a person’s fitness for work, play, family membership, and even ability to walk the streets freely depend on the descriptions in this book.”

    And, again, the DSM is all about “bullshit” and the “mental health” industry’s completely sick, systemic, child abuse covering up crimes.

    “I can say that the reality is quite different: some people are helped by the system and go back to work, school, and family life; some are partially helped and still struggle, often on disability, and many for years, if not decades; some are not helped at all, and they drift in and out of the system, often facing homelessness, hopelessness, and incarceration. All are medicated.” Not all, some of us made our “great escape.”

    But not without knowing that attempting to murder and/or steal from all the mommies who stand against child abuse is the mantra of the psychologists and psychiatrists in my direct personal experience.

    “The most frequent complaint I heard—and it was part of my job to listen seriously and as a peer to their stories—was ‘My psychiatrist/therapist/case manager doesn’t listen to me.’”

    Literally, my psychiatrist declared my life to be a “credible fictional story,” after I told him about all his misconceptions about me, and that the medical evidence of the abuse of my child had been handed over. And he bizarrely told me the best way to help a healing child, who’d been abused four years prior, was to have him neurotoxic poisoned. Bye, bye, crazy, sick, twisted psychiatrist.

    “And why should they? If a person’s experience does not comport with the incoherence that is the DSM, the content of which is used by insurance companies and managed care organizations to justify billing and allow for service provision, it is a null set. The provider is inclined by training and forced by financial realities to make the person’s experiences fit the descriptions in the book.”

    And the DSM “bible” is a child abuse covering up “bible,” by design.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    “Normality is relegated to the purgatory of implication, and the one thing every interaction with a service-provider ought to focus on, what a person receiving the service actually wants out of treatment, is nearly absent in the book’s 947 pages.” Indeed.

    “In the end, the DSM says as much about psychiatry’s fears as it does about its certainties: fears of odd behaviors and thoughts, fears of unpleasant feelings, fears of positing what a mind is …” and their fears of being caught for systemically covering up child abuse and rape for their religious “partners” in crime.

    The DSM “bible” belief system “is an expression of the fear that without disordering everything, people will start to see the sense in what is bothering them, how it has helped them cope or how it is a manifestation of what has happened to them—and then they will look elsewhere for ways to help them….”

    And, yes, researching into the systemic child abuse and rape covering up DSM “bible” religion – after having the medical evidence of the sexual assault of my child handed over – did make it easy to allow the second child abuse covering up ELCA psychologist, that was sicked upon me, to make an ass of himself. This is a systemic problem with the ELCA religion, and its DSM deluded “Lutheran social service” “partners.”

    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    Plus, this was confessed to me by ethical pastors – of a different religion – to be “the dirty little secret of the two original educated professions.” And I have met with Catholic parents of a child abuse survivor, to whom I had to recommend Whitaker’s book, so it is a systemic problem within the Catholic religion as well.

    Thanks, Lael, for your relevant and truthful assessment of the DSM.

  7. Tragically, some still believe the outright lies of mass media —bought and paid for— by the very people who have tried to destroy their lives—Big Pharma. Much of what comes from mass media and even some politicians come from this narrow, idiotic and unjustified persepective. Please remember if you believe the mass media and that includes the major networks, including some major cable networks, and many major newspaper and other news organizations, then you too also believe the very people who may have destroyed your live. There is no success or joy in life until one can extricate one’s thinking process from these illegitamate and immoral sources and one can finally think on one’s own. Until then, drugs and psychiatry rule one’s life. Thank you.

  8. (I use the word “you” mostly as a general term).

    Lael what a fantastic writer, philosopher, genius you are. I respect your clarity immensely. It gives me satisfaction when any “sides” on the great debate about psychiatry have the scrupulous integrity to test the reliability of their own assumptions before picking at anyone elses. To me, that is the ennobling thing about truth seeking. It is not about “being right” it is about moving out of the way of truth in order to let the truth shine resplendent on its own. I think Mr Whitaker is unparalled in doing similar moving out of the way to show the “isness” of what “is”.

    Lael, maybe your spiritual background has helped you have this humility?

    I like it when an article I do not agree with nonetheless brings me, welcomes me, to draw close and explore.

    I make a distinction between any book and the good or bad behaviour of the humans who use the book as an excuse to weild authority and bad treatment. A book is not bad treatment unless you thump.a sibling with it. A book is an inanimate object made of paper written to excuse or back up a sense of authority, but the authority energy comes first from the wish of the reader of the book to reap havoc. An inanimate object on its own cannot have the power of mind control, any more than an inanimate vase of flowers can. The DSM is made of trees and ink and binding glue. Just like Lady Chatterly’s Lover is.

    I make a difference between any inanimate object and the user of it. I make a difference between an inanimate object and BAD TREATMENT meted out by a person who is not and inanimate object. BAD TREATMENT is horrendous. It must be stopped. If we naively think that by burning the book we get rid of what causes a human to mete out BAD TREATMENT then we are not TREATING the ILLNESS in humanity that lets that continue to spring up in other paradigms. Using new trusty books. Focusng on the book is useful at examining what humans who like to give BAD TREATMENT make of casual sentences, but no casual sentence is ANY excuse for cruelty. We hear casual sentences in the media all day without flipping out into acts of wonton cruelty. We must examine not so much the silliness of the inanimate book but the messy human reader of it. What motivates the human to pronounce authoritative “understanding” over a complete stranger? This question is more intriguing to me.

    My own glib take on the DSM is parked badly, as one does with a vehicle I mean to go back and reverse it more neatly into where I feel it should be. So bear that in mind.

    My first ever psychiatric book at aged nineteen was a charity sale mouldy musty volume on inkblots, by handsome Mr Rorschach. He, of the seeing the Madonna in a slice of toast artistic bent. I was fascinated. My second psych book was stolen in a act of petty theivery. A medical book shop. Big fat book gamely shoved inside a raincoat. Not saying it was me.

    Once home, the book revealed itself to be the DSM. I spent a year being enthralled by it. To me it was a new horoscope. There was Clinical Depression for My aunt Dorothy the Taurean. There was Hyper Mania for Gemini for Sister. There was Bulimia Nervosa for my Scorpio friend Nicky. I found it fun to try to see who was a what. Virgo, Capricorn, Libra. I never did anything wrong to any people I entertained such frivilous assumptions about. Either zodiac or DSM or inkblotty assumptions. We live in a universe where we are drowning in assumption yet also using assumption as flotsam to stay afloat. The phenomena of using pronouns, whether you like it or not, is all about dealing with assumptions you may feel tired of drowning in but also guiding new assumptions you feel are nicer and which can offer bhoyancy in that sea of misunderstanding and snap judgement.

    I believe misunderstanding is a given, in a world where everyone places importance on others understanding them. As a triumphantly mad woman I no longer feel a need to be understood by anyone but me. This frees me to allow the assumptions of others, in the way a child is free to call me whatever they assume. Names will never hurt me. I think psychoanalysis made “love” important. A good thing. But love has gone out of fashion and so taking its place is “understanding”.

    Everyone no longer is believed in their “love” of you unless their “love” proves it is the real deal by being stacked with rigid tomes of near scientific “understanding” of who you are.

    Everyone is forced to understand you and if they do not they are told they are “damaging” you or “harming” you. How can someone merely not understanding you possibly damage you? How can someone understand you if you are not a static entity made of concrete but are a living ever changing enigma and mystery even unto yourself? Loving you even though you are a mystery, and even “because” you are a mystery, is a better indication of authentic unconditional non-controlling real real real “love”.

    This whole notion a person “A” telling another person “B”..

    “you dont love me unless you know what my pet dog was called in 1995, and what my best friend gave me on my birthday in 2003, and why I drew a donkey on the hall wallpaper, and why I cannot sleep on my left side, and what tunes I keep getting stuck in my head, and why my parents grounded me for a month in winter of 2005 or was it 2006? and what my shoe size is, and what sets off my nervous mood, and what sets of my uncontrollable sobbing, and what makes me generous, and why I cannot bear scented candles, and which bits of my…and on…and on…and on”

    And if you do not “understand” that long list then YOU DONT LOVE ME! And if you dont then you are DELIBERATELY DAMAGING ME.

    The “rule” is…
    1. You have to love me.
    2. Love is not enough.
    3. You have to understand me.
    4. If you do not understand me then you do not love me.
    5. If you do not love me then you are harming me.

    But since love itself has gone out of vogue, because nobody can make a profit from it or build marketable products from that simple healing accepting form of love, thus it must be dismissed as not good enough, into the area steps the religion of salvation through “ideal understanding”, that ministering angel everyone is taught to long for. Or pay for, or buy, by dressing in marketted ways that declare what specifically is meant to be vitally “understood” about you and then sucessfully “loved”.
    You are taught to mistrust and trample any old style simple “love” as if it is the work of the devil. This new “love” is coming to save you. The love that understands you.

    But like I have aired in a previous comment a few weeks ago, the only person whose “understanding” and “love” you really desperately need is your own.

    Back to the DSM. That zodiac. That bumper quiz book of assumptions, whose pages purport to be classical “understandings”. The world will NEVER not have its fav BOOKs of assumptions. Many religious books are full of assumptions that are trying to be “understandings” about self and others, often in order to perform wizardry about “love”. They may try to make it that “love” is not “genuine” unless it is….insert fussy rules….agape love or charitable love or martyish love or pure unblighted love or properly guided love. Such books become “love” experts or “love” specialists or “love” consultants. And you are told you must stay suspicious if anyone says they “love” you in the not specified perfectly understood way.

    I see this very ordinary human tendency in all human attempts to demystify the mysterious human by categorizing them. It has been with us since the caves and morphs into new paradigms add infinitum. What happens is a populace sees through the false promises inherent in gross assumptions and the lure that merely by being “understood” in that book’s way they might achieve feeling “loved”, and instead the population says to hell with that book, lets all invent a new book of assumptions that will “understand” everyone, everyone, everyone. A new paradigm’s book comes into bookstores for a petty theif to arm wrestle up into the nest of their sweater. But…alas…
    that new book repeats the same hubristic error of “trying to understand” as if “understanding” someone “is” loving someone.

    You do not need to understand the beautiful things in nature such as the Sun and the Moon and the Stars to worship them and adore them and love them and accept them. And they do not need your “understanding” to “love” them. They “understand” and “love” themselves so much that they shine resplendant as their own glorious truth.

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