On the podcast this week we turn our attention to conflicts of interest (COIs) and new research from the British Medical Journal (BMJ). Mad in America has previously examined the problems with conflicts of interest in research but this time we extend that to look at the potential effect of COIs on diagnostic tools such as the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Joining me today are Lisa Cosgrove and Brian Piper, two of the authors of a paper which appeared in the BMJ. The paper is entitled “Undisclosed Financial Conflicts of Interest in the DSM-5 TR: Cross-Sectional Analysis,” and it was published in January 2024.

Lisa Cosgrove is a clinical psychologist and Professor at the University of Massachusetts, Boston where she teaches courses on psychiatric diagnosis and psychopharmacology. A former Research Fellow at the Edmond J. Safra Center for Ethics, Harvard University, her research addresses the ethical and medical-legal issues that arise in organized psychiatry because of academic-industry relationships. She is co-author, with Robert Whitaker, of Psychiatry under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform.

Brian Piper is an Associate Professor of Neuroscience at Geisinger Commonwealth School of Medicine in Scranton, PA, with a secondary appointment at the Center for Pharmacy Innovation & Outcomes with Geisinger in Danville, PA. He maintains an active program of research in the pharmacoepidemiology of controlled substances including opioids, cannabinoids, and other controlled substances, behavioral neurology methods development and quantitative medical ethics.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

James Moore: Lisa and Brian, welcome both of you. Thank you so much for joining me for the Mad In America podcast. I’m delighted to have you on to get to talk a little bit about your work.

Lisa Cosgrove: Thank you. We’re delighted to be here.

Brian Piper: Thrilled to be here.

Moore: To get us underway, could tell us a little bit about yourselves and your areas of research interest?

Cosgrove: I’m a clinical psychologist by training. I’m also affiliated with the Ethics Center at the University of Massachusetts, Boston. The research that we do broadly looks at the ways in which academic-industry relationships can have a corrupting influence on medicine and, in particular, on psychiatry and psychiatric diagnostic and treatment guidelines.

Piper: I’m an Associate Professor of Neuroscience at Geisinger Commonwealth School of Medicine. I also have a secondary appointment with the Center for Pharmacy Innovation & Outcomes with Geisinger in Danville, Pennsylvania. I have two lines of research. One is on conflicts of interest in medicine broadly, looking at influential information sources that are used by physicians and other healthcare providers. Then I also have another line of research on pharmacoepidemiology, looking at the increasing use of medications, whether it’s for attention deficit hyperactivity disorder, depression, or for a wide variety of other psychological disorders.

Moore: We’re here today to talk about conflicts of interest, and in particular, a piece of work that you both did examining financial conflicts of interest and the DSM. But before we get to the paper itself, I think people probably have a broad sense that conflicts of interest can be bad. But I wonder if we could talk about specifically why they can be such a problem?

Piper: If we think about the history of psychiatry for a little bit, people are pretty well acquainted with Sigmund Freud and his very close relationship with cocaine. Cocaine is mostly associated with being a recreational drug that is smoked, but it also was and continues to be used as a medical drug, particularly for eye surgeries. Sigmund Freud was a major advocate for it. He wanted his friends to use this drug, he wanted his family members to use this drug. He was also a major user for an extended period.

When medical historians say, “This particular person got an appreciable amount of money from a pharmaceutical company, in this case, Merck and Parke-Davis,” we want to know how much money it is. When he says that there are no cravings associated with cocaine, we want to know, is that advice coming from his expert opinion having used this drug quite extensively, or do those conflicts of interest and the money that he was receiving influence the medical care that he was providing? That was an issue then, and that continues to be an issue to this day.

Cosgrove: The only thing I would add to Brian’s excellent point is that conflicts of interest can incur implicit bias. It’s part of the human condition to have biases and to remain blissfully unaware of them. We often assume, quite wrongly, that the scientific process can protect us from those implicit biases. So, one of the reasons why conflicts of interest in medicine are problematic is because they do lead to these implicit biases, what some have referred to as pro-industry habits of thought. In terms of the DSM, it hasn’t been that long that we’ve had this medicalized view of emotional distress, and the medicalized view of emotional distress is certainly an industry-friendly perspective because it leads to the development of psychotropic medications as interventions, but it’s not necessarily in the public’s best interest.

Moore: And of course, some of the people involved are what are known as key opinion leaders, aren’t they? So, they’re quite important figures in the field of psychiatry and one gets a sense of them acting almost as a marketing tool rather than a tool of science.

Cosgrove: Yes, that’s a very important point. There are key opinion leaders in all areas. Nike knows that to sell sneakers they’re going to tap a very famous athlete and in much the same way that Nike knows that, so too do the pharmaceutical company executives.

Moore: Let’s turn to your BMJ paper, “Undisclosed Financial Conflicts of Interest in the DSM-5 TR: Cross-Sectional Analysis.” What was the question that you were trying to answer with your work and how did you go about the research to answer that question?

Piper: I can start with a little broader perspective on the research question. So I’m coming at it from the pharmacology side of things. I teach pharmacology for medical students, for residents, and for graduate students, and influential materials can have a very profound effect on the practice of medicine.

Members of my team have been doing studies for the past 10 years, looking at point-of-care databases. We’ve been looking at a lot of different information resources, like the New England Journal of Medicine and the Journal of the American Medical Association, and the general pattern is that the conflicts of interest are really important. The National Academy of Medicine says, that if you’re going to put together clinical practice guidelines that you can trust, you should have authors that don’t have a conflict of interest wherever possible.

The American Psychiatric Association (APA) and their publications require that authors disclose conflicts of interest. So we were a little bit surprised, maybe even a little bit mystified that the APA, in publishing the most recent version of the DSM, didn’t have some sort of preface about the conflicts of interest, even in small font. That information wasn’t available. So, we wanted to help them out, if you will, and get this information into the public domain.

Moore: And it was the Open Payments Database you used, is that right?

Piper: Yes, it is an amazing resource that has been available for the past few years. At the risk of a digression, I would suggest to every listener: Before you go to your primary care provider, your psychiatrist, your physician assistant or your nurse practitioner, do a quick Google search for CMS Open Payments, and with a little bit of practice, ideally, if you know their middle initial, you can look up their conflicts of interest. And that’s what we did for the 160 or so contributors to the DSM.

Moore: If these people are aware that anyone can go and find that information, and they’re obviously happy to accept industry money, and for it to be presented as public information, do they not think it’s an issue? Do they not mind that this information is out there for researchers to grab and present to the public?

Cosgrove: That’s a good question. It is curious because when Shelly Krimsky and I first did our study in 2000 (published in 2006) on conflicts of interest in the DSM-IV, we found that almost 60% of the authors had financial conflicts of interest. Then, a year before the DSM-5 came out in 2012, we published a study looking at the conflicts of interest and, at that point, the APA did institute a conflict of interest policy. I’d like to think that maybe our 2006 study had a small role to play in that. At any rate, they did have this policy. And yet, what we found was approximately the same percentage of panel members had ties and the ties were particularly strong in those areas for which pharmacological treatment was the first-line intervention.

So as Brian was saying, it is curious that, given our past publications and their conflict of interest policy, they didn’t have one for the 2022 DSM-5 Text Revision (DSM-5-TR). What’s unique to this study, even though in many ways it’s a replication of our previous work, was that we were able to use the Open Payments database which started in 2014. Shelly and I weren’t able to do that in 2006 or 2012. So what Brian was saying is so important because as long as you’re in the US, you can look up any physician and see not only how much money they’ve received, but the type of funding and, as you were referring to James, you can see if they were, in fact, key opinion leaders.

Moore: Thank you so much. And can you remind me of the total amount that you found again? Was it $14 million?

Piper: It was $14 million, completely undisclosed. So the readers of the DSM wouldn’t know this. Unlike in the APA journals where there is this information, or at least you know the names of the companies, none of this information was available.

Moore: In reading the paper, one thing that struck me as really important was that if there was some regulation mechanism at the diagnostic end, that might help matters. If there were an objective biological test for example, that itself might regulate the increasing trend in diagnoses. But because we appreciate that psychiatric diagnoses in the main are quite subjective things, then if someone is looking to the DSM and doesn’t necessarily realize that there’s been industry influence, there’s nothing at the back end to help regulate the number of diagnoses coming through. Is that right?

Piper: Yes, that’s completely right. So, depending on how you count it, of the 300 or so disorders in the psychiatric bible, the DSM, there’s only a handful that have an objective laboratory measure. That includes defining an objective laboratory measure pretty broadly. You could include something like a scale like a weight scale for anorexia or, for narcolepsy, hyper creatinine deficiencies occur in about a third of patients. But for the vast preponderance, this is based on very expertly, very carefully obtained but subjective information.

Cosgrove: There are actually no biomarkers for any of the DSM disorders. So Brian is right and I just want to emphasize that point.

Moore: In the paper, you’ve done a breakdown of how much money was coming in per group of disorders. It was quite interesting to see that the biggest one was medication-induced movement disorders. Which I guess speaks that there seems to be an avenue there that the pharmaceutical industry is quite interested in exploring, and therefore is trying to maybe pump money into it to stimulate some demand.

Cosgrove: Yes. And again, there are two points I’d like to emphasize. One is that, once again, what we found was that the categories for which there was the most industry money were the categories of disorders for which pharmacological treatments are the first-line intervention.

But the other point that I want to emphasize is that we’re not in any way suggesting wrongdoing or any sort of quid pro quo mechanism at play here. Again, the issue is implicit bias that creates this pro-industry habit of thought which reinforces a medicalized view of emotional distress. So it’s not the case that we think that there are any sort of backdoor deals but, rather, by medicalizing distress, we deflect attention away from the upstream causes such as austerity policies, unsafe or inadequate housing, food scarcity and so on.

Moore: Is this a problem that’s particularly prevalent in psychiatry or does it affect all sectors of medicine?

Piper: I would argue it’s a really broad problem that isn’t limited to psychiatry. We’ve done other work looking at cardiology and oncology journals. This is a broad issue. I continue to do these studies beating on this drum that self-reporting conflicts of interest doesn’t work. I submit these manuscripts and some of the anonymous reviewers come back and say “Yeah, we’ve known for a decade that self-reporting doesn’t work and that mandated reporting is the way to go.” However, journals continue to rely on self-reporting. And I don’t want to disparage my gender at all. However, people with a Y chromosome have a particular difficulty with this issue.

We keep on seeing this over and over in studies. We’ve looked at contributors to the point of care database like Medscape. So we’ll look at it up and it’s like, oh, you’ve received money for the major products for Parkinson’s disease. You write an article on Parkinson’s disease and even though you receive $400,000, you say you have no conflicts of interest. That’s curious.

This is a widespread issue and I’d argue this isn’t just an American issue. We really should be grateful that America has a tool like CMS Open Payments that’s been mandatory for a decent period. In some other countries, it’s either more recent or non-mandatory.
So in some ways in America, we have our challenges, but at least we have some tools to begin to deal with this whereas some other countries are less further along in having tools like this.

Moore: Understood. Your study appeared in the British Medical Journal, which is a pretty prestigious publication. It only came out in January, it’s March now, but I wondered what kind of feedback you’ve had since you published your article.

Cosgrove: The APA did write an editorial immediately after it was published and they didn’t disagree with any of our findings. They tried to say that these conflicts of interest didn’t affect them, which, again, is problematic, because it’s just part of the human condition to have implicit bias.

The other thing I just wanted to circle back to thinking about what Brian had just said is what’s unfortunate are the downstream effects of the conflicts of interest. By that, I mean the fact that psychiatrists and other prescribers are not receiving balanced, accurate information. We know that there’s certainly a connection between industry funding and pro-industry results. And unfortunately, the peer review process is not robust enough to protect against that.

So like Brian, I teach a psychopharmacology class to masters and doctoral students. We did a study a few years back looking at conflicts of interest in psychopharmacology texts, and they are rampant. So one has to be concerned about our medical students and doctoral students receiving accurate and balanced information from the text. I would argue that when there are lots of conflicts of interest on the part of the authors, we need to be skeptical about the information that’s being disseminated.

Piper: Lisa’s done a fantastic series of studies on this topic. And we did get some interest from media organizations and podcasts like this. I had some particularly interesting comments on Reddit which is a fairly snarky place. Some of the people were just like, “Ho-hum. We know this, kind of yawn”. So yes it is getting out to the general public but this is an unfortunate situation where if the APA loses trust, it’s really difficult to gain that back. There’s an easy solution to prevent that, there are tools like open payments if they can list the link in the next version of the DSM. I’m young enough and Lisa is energetic enough so we will be there to do this for the next version of the DSM but we hope we don’t have to, we hope they will do that for us.

Cosgrove: To Brian’s point about the sort of Ho-hum response. If you told people that eating a candy bar increased longevity and overall health then they found out that that study was funded by Hershey, most people would be certainly skeptical. They wouldn’t have to be schooled in conflicts of interest. And yet, sadly, when it comes to medicine, I don’t think people are as aware as they could be of the ways in which these conflicts can result in imbalanced and sometimes inaccurate information.

Moore: You talked there about the next version of the DSM. So if we look to the future, is it sufficient to have these conflicts writ large in the work? Or should we go further than that, and examine some split between industry and how it contributes to research? Is it enough just to name these things or should we go further?

Cosgrove: Definitely. We should go further.

Piper: Just disclosing isn’t sufficient, it’s the management of these conflicts of interest that is important. The National Academy of Medicines’ dream would be to use people who don’t have conflicts of interest. Also, as the former chair of the DSM-IV task force has indicated, 80% of psychiatric meds are prescribed by general practitioners. So why not have general practitioners and other people that are involved in this process? So no conflicts of interest and other voices on those DSM working groups and panels to have those other folks better represented. That would be my dream.

Moore: Is there any reasonable chance of that happening?

Piper: I’ve been a little underwhelmed. I’m a neuroscientist who came from the decade of the brain and was excited to be learning more about the biological underpinnings of psychiatric disorders. And even when there’s been progress in some psychiatric disorders and genetic components, the number of geneticists on the DSM panels is extremely limited, it continues to be underwhelming. So I’m not optimistic, frankly.

Cosgrove: I think the DSM could be a more helpful diagnostic instrument if you included the people who are affected by the conditions. We have to remember that the creators of the DSM don’t just have the authority to change symptomatology or add a new disorder, they also have the authority to narrow diagnostic categories or even take out previously included disorders. Homosexuality would be a good example.

Moore: Was there anything else we should talk about that I hadn’t got to?

Cosgrove: Two things come to mind. One is the issue of guild interests. As I was mentioning, that’s why I think if you have a diversity of people on the panels, and on the task force, you’re going to get a more well-rounded instrument. What’s that saying… Never ask a barber if you need a haircut, a psychologist if you need psychotherapy, or a psychiatrist if you need medication. So the guild interests are another inevitable part of what it means to be human. I wouldn’t trust a guideline on psychotherapy if it was written by all psychologists. You need methodologists and you need more than just content experts. You need people who don’t have skin in the game, in terms of what they’re recommending.

Then in terms of the explosion of diagnoses, there was a really interesting article that came out a couple of months ago on what’s called the prevalence paradox. One of the things that the authors pointed out is that in areas of medicine other than mental health, when you have good treatments, then the prevalence of the disorders goes down. Antibiotics would be a paradigmatic example. Infectious diseases and bacterial infections went way down, a real game changer for humanity.

We don’t see that in the mental health field. We have more treatments, but we have an increasing number of people with disorders. Now I think the reason for that is multi-determined, it’s certainly not just related to industry and conflicts of interest. I think that social media has played a significant role, particularly in the increase in ADHD diagnoses. And there’s this part of the zeitgeist now, many people are encouraged to identify with disorders in a way that I don’t know is necessarily helpful for humanity.

Piper: I have just a big-picture thought. Lisa and I played an important role in this but there are others as well. I want to shout out for Lauren Davis and students at Geisinger Commonwealth School of Medicine and students at UMass Boston who played a key role in collecting and triple-checking this information and making this publication happen.

Moore: It’s clear from reading the paper how much effort went in and I’m so glad to see it in such a well-read place as the British Medical Journal. Thank you both for taking some time to explain your work and approach.

Cosgrove: Thank you so much.

Piper: Thank you.

***

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16 COMMENTS

  1. The interviewees apparently do not YET question the very existence of “psychiatric disorders,” or the validity of any DSM.

    Neuroscience may soon utterly debunk psychopharmacology entirely, but first it must rid oneself of all that is not science, something it seems too thoroughly biased to realize.

    “Psychiatric disorders, or diseases,” as opposed to true disorders or diseases of the brain/neuroendocrine system have the same validity as “sinfulness,” in my opinion.

    Had psychiatry followed Jung rather than Freud, then we might now realize that
    “The human condition : lost in thought, ” as Eckhart Tolle put it and I believe Jung would agree, and existential angst, human suffering results from our need to make the unconscious conscious, and not from a need to poison our brains with anesthetics
    or other neurotoxins.

    Even such admirable, laudable discussions as the above lend psychiatry, coercive psychiatry, psychopharmacology, “neuropsychiatry” and the DSM’s an entirely spurious validity.

    But thank you very for the meticulous hard work and for the insights, all the same!

    Comfort and joy!

    Tom Kelly.

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  2. So-called “psychiatric diagnoses/disorders” are NOT diagnoses or disorders. They are merely OPINIONS voted into existence by a group of EXTREMELY BIASED PSYCHIATRISTS in conferences funded by pharmaceutical companies. The agenda of the former is status while the agenda of the latter is money. There’s nothing “scientific” about it.

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    • CLARIFICATION: “psychiatric diagnoses/disorders” DO NOT REPRESENT discrete, biologically verifiable conditions. They are merely lists of “symptoms” arbitrarily agreed upon by a group of biased psychiatrists seeking to expand the number of FICTIONAL ‘diagnoses’ in order to increase their patient load.

      It’s a process where diagnoses are created OUT OF THIN AIR in order to suit people in a position to profit from MORE diagnoses—which leads to one inescapable conclusion: PSYCHIATRY DOES NOT REPRESENT LEGITIMATE MEDICAL SCIENCE —

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  3. “Then in terms of the explosion of diagnoses, there was a really interesting article that came out a couple of months ago on what’s called the prevalence paradox. One of the things that the author pointed out is that in areas of medicine other than mental health, when you have good treatments, then the prevalence of the disorders goes down… We don’t see that in the mental health field. We have more treatments, but we have an increasing number of people with disorders. Now I think the reason for that is multi-determined, it’s certainly not just related to industry and conflicts of interest. I think that social media has played a significant role…”

    Quit passing the buck. Psychiatric misinformation starts in medical school from textbooks underwritten by pharmaceutical companies—misinformation that could be extinguished through social media if the American Psychiatric Association wanted to.

    Why not place blame squarely where it belongs?

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  4. Birdsong, it can be challenging to zoom out, but most rewarding, I believe, and to try and view us humans as Prot in “K-PAX” might, a bit…or that guy in extremis on a cross who reportedly opined:

    “They know not what they do.”

    Some say that Socrates said “Who knows what is right will do what is right,” or something to that effect. If so, I believe he was right.

    And Mary Wollstonecraft Shelley: No man chooses evil because it is evil; he only mistakes it for happiness, the good he seeks.”

    And Sancho Panza: “…for we are all as God made us, and many of us much worse.”

    And A.N. Other: “Thee but for the Grace of God go I.”

    “Seek first the Kingdom,” Jesus is reported to have advised and, assuming he meant one’s highest levels of consciousness and, with them, of course, one’s senses of humor, compassion etc., and those many mansions of Paradise, I wholeheartedly agree:

    “Laugh, and the world laughs with you;
    Weep, and you weep alone;
    For the sad old earth must borrow its mirth,
    But has trouble enough of its own….”

    https://www.poetryfoundation.org/poems/45937/solitude-56d225aad9924

    What contemporary psychopharmacology, arguably now the state religion in any jurisdiction which mandates the drugging of children considered to have “ADHD” and the forcible detention and drugging of law-abiding citizens accused of suffering from “a mental disorder,” seems to me to tell us, inter plurima alia, is that

    1. You cannot have a “personality illness,” because, if we suggested you could, you might reasonably laugh us out of town, as you should have done when we spoke of “double depression,” and as you ought to do, anyway, if only you would think clearly.

    2. “Physician burnout,” though it necessarily includes “depression,” is a psychological condition, not a psychiatric disorder, because we, the judges, alone shall judge the judges.
    Oh, and “depression” is not simply hopelessness any more than “anxiety” is “excessive” fearfulness, worry and fretting: No; no; NO! “Depression” CAUSES feelings of hopelessness, just as “anxiety” CAUSES excessive feelings of fearfulness, worry and fretfulness!

    3. When you come to us saying you are too unwell to trust your own judgment and agree to ingest psychotropic poisons we prescribe you, we agree with you; when you say you are now sufficiently recovered to have regained insight and wish to quit, we cannot agree with you.

    4. You have but one single, short, finite, human lifetime to live: You’d better get it right and serve society and the economy as best we think you might as long as you are here. And, basically, if you drink more than us, you are an alcoholic; if you have greater focus, you are hypomanic, if you are more carefree than we are and than we think you ought to be, you are manic etc. Oh, and as Thomas Szasz pointed out, your having some “gambling disorder” if you simply suffer from bad luck.

    5. You have a “personality disorder:” That is to say, either you got off on the right planet with the wrong personality or on the wrong one with the right one, contrary to the opinion of one 16-year-old lady who, on hearing the term “personality disorder,” responded:

    “PersonALity disorder?! Ya can’t have a personALity disorder! Your personALity – that’s, like, who you ARE! That’s, like, THEE rudest thing, EH-VUR!”

    6. You ARE your mind, your thoughts and emotions, for that is all there is to the psyche, and not anything else which can or could possibly observe or direct or halt your mind: You ARE your personality, or, in some cases, personalities. This being the case, of course, logically, any “mental disorder” you acquire or exhibit which does not result from truly scientifically diagnosable congenital/acquired, organic illness, deficiency, toxicity, metabolic disorder, neoplasm, infection, infestation, physical trauma etc., must, therefore, result from the disordered response of your disordered (i.e. wrong) personality to its environment/”stressors.”

    7. Much as other medics get away with preaching the transparent nonsense that (non cephalopod) animals have nociceptors or pain-receptors everywhere but in their brains, we psychiatrists get away with preaching that a mind may have a disorder rather than that any mind, left to its own devices, is egoic, is mad.

    8. As your psyche does not consist of your mind and any eternal personal/collective awareness/consciousness which is capable of witnessing and directing your thoughts and emotions but only of your very own mind, the workings of your right and left brains, when we consider that mind to not be functioning as we consider it ought to be under the circumstances, we are mandated by society to experiment on it as we wish with virtually limitless combinations of neurotoxins, always insisting that, in our expert opinion, the benefits may be expected to outweigh the risks of harm, and, when things turn out badly, that they might have been still worse but for our interventions

    Oops, I should maybe stop there, as it’s not too funny anymore, and my sense of humor seems to have deserted me once more.

    When I feel a need to try and regain perspective, my sense of humor, or first principles, I may ask myself such questions as

    1. What is there at the edge of space – what is this big bang expanding into, if not our awareness, of the imagination which Einstein reportedly reported encircles our world?

    2. Assuming I am a mere mortal, what are the odds of my living one human lifetime in the middle of timeless eternity if not one over infinitude? And, if I am an immortal being, if not one hundred percent?

    ‘Besso died in Geneva, aged 81. In a letter of condolence to the Besso family, Albert Einstein wrote “Now he has again preceded me a little in parting from this strange world. This has no importance. For people like us who believe in physics, the separation between past, present and future has only the importance of an admittedly tenacious illusion.”[8] Einstein died one month and 3 days after his friend, on 18 April 1955.’

    https://en.wikipedia.org/wiki/Michele_Besso

    3. What are the odds of there being anything rather than nothing, or of my being me rather than you?

    4. If Jesus could and did levitate/walk on water, why did he not levitate off to a sick Lazarus in a hurry instead of arriving days late for the funeral?

    5. If Jesus had no sense of humor, why did he ghost in through that door to frighten the daylights out of the Apostles who thought him dead, before rebuking them all over again for their hardness of heart and unbelief, and then requesting refreshments?

    6. How could I possibly take myself seriously, given the stuff I have done?

    7. Other stuff which, lamentably, I may always be too sober to share.

    God rest ye merry, all.

    Tom.

    PS: Steve, if you publish this, many thanks. If not, hey, it’s okay, too, thank you: I kept a copy. Now if only I could remember Steve McCrae’s own very choice remark about “personality disorders” some months back…? WELL worth quoting…

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    • Tom, life’s too short to get caught up in psychiatry’s endlessly fickle pseudoscience. And who knows, maybe the same goes for religion’s endlessly circular reasoning.

      Come to think of it, aren’t these one and the same?

      Anyhow as I recall Jesus himself had no trouble calling a spade a spade, which could mean that God gave us instincts for a good reason…

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      • Life has no known beginning or conceivable end, Birdsong, but please hurry up and entertain us with your favorite Jesus spade-identying joke before I do.

        Life is too long to miserable, or Judaeo-Pauline-Psychiatric, denying-things-and-we-are-EVER-precisely-as-ought-to-be:”If-I-were-you-I-wouldn’t-be-starting-from-there-at-all- and way-the-fug too short, of course, too.

        “The measure of Love is to love without measure.”

        “The meaning of Life is it can always only get better.”

        Thank you, Birdsong. Please sing on.

        Tom.

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      • Yes, Birdsong, but if by referring to “God” we mean to imply a single intelligence creating/permeating/perpetuating/unfolding the only cosmos (which may mean any number of parallel and/or other universes/realities, then that very same God gave us all of Psychiatry as we know it, too – right?!

        Let’s go FIGURE, eh?!

        Thank you very much!

        Tom.

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        • Tom, there is good and evil on planet earth, and everything in between.

          However, humans are born with the uniqiue capacity to not only discern good from evil (in its most basic sense) but are also born with the unique capacity to call out evil (and good) when they see it.

          And in the final analysis, I don’t think it really matters where these capacities come from.

          Ephesians 5:11 – “Take no part in the unfruitful works of darkness, but instead expose them.”

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  5. “Psychiatric diagnoses” are NOT biologically verifiable conditions. They are labels concocted in the minds of diagnostically myopic psychiatrists.

    Maybe fear is the reason these interviewees neglected to mention this one inescapable fact, which btw is where their “research” should have started.

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  6. “Do not tell my future mother in law that I’m a healthcare professional, I prefer that she believes that I’m a used car salesman.”

    I’m afraid that there is a herd of elephants in the room: the issue seems deeper than personal financial ties to industry of those who participated to the Manual and there is no reason for acting as frightened virgins.

    Firstly, the BMJ dare to publish a response to LC’s article. Applebaum and First claimed that the American Psychiatric Association «took the risk or appearance of COI very seriously” when responding to the article detailing the financial ties to industry of members of the revised version of the Diagnostic and Statistical Manual of Mental Disorders published by the Association in 2022.(1,2) They concluded that the article “ yielded results that are misleading and uninterpretable.”(1)

    Secondly, the Association website announcing the 2024 annual meeting (five days in New York City) could question if the Association could fulfil the criteria for a commercial enterprise targeting the pharmaceutical industry with:(3) a) an Exhibit Hall aisling “+200 exhibitors showcasing new and exciting products and services” where booth’s price ranges from $3,800 (Standard, 100 sq. ft.) to $45.00 (Island); b) a large fan of non-CME sessions such as “Product Showcases: 60-minute promotions sponsored by exhibiting pharmaceutical companies” ($87,500), Therapeutics Updates” ($55,000) and “Huddle Presentations: 30-minute thought provoking sessions hosted by sponsoring companies …”; c) a long list of derivative products such as “APA convocation” (“acknowledgment in the Program Guide …”) for $40,000, “Wi-Fi with splashpage” (“company’s URL and logo appearing on the splash page plus acknowledgment in the Program Guide …”) for $35,000 , “Aisle banner dangler” for $28,000, “Hotel key cards” or “DO NOT DISTURB door hangers” for $17,000 per hotel … Last, there is the announcement “Coming Soon: Promote Your Brand Through Strategic Partnerships and Advertising” stating “Extend your target audience through promotional opportunities specifically designed to help you maximize your visibility … Value for Exhibitors Perfect opportunity to: Generate new sales leads … Increase your marketing with branding opportunities”.

    Sadly, this attitude is neither new nor specific to psychiatry. In 2011, before the American Association for Cancer Research meeting, Bethyl Laboratories emailed to healthcare professionals: “Breaking news – AACR update” … “Dinner and a Drink on Bethyl Laboratories. Bethyl Laboratories (Booth 1259) will be having three drawings per day during AACR. Winners will receive $50 VISA gift cards.”(4)

    References
    1. Appelbaum PS, First MB. Clarification of DSM-5-TR COI review process and corrections of erroneous analysis in Davis et al”. BMJ 2024 online 11 January. Available at https://www.bmj.com/content/384/bmj-2023-076902/rr accessed 18 January 2024.
    2. Davis LC, Diianni AT, Drumheller SR et al. Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis. BMJ 2024;384:e076902. doi: 10.1136/bmj-2023-076902.
    3. American Psychiatric Association. 2024 Annual Meeting.
    Available at https://www.psychiatry.org/psychiatrists/meetings/annual-meeting accessed 18 January 2024.
    4. Braillon A. Bridging the gap between research and practice. Am J Med. 2011;124(11):e15. doi:10.1016/j.amjmed.2011.04.015

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  7. Much as I view mystic Carl Jung – with his message to a largely unomprehending humanity that it’s all about that Metanoia, Awakening , Repentance or Transformation of Consciousness to Consciousness – which comes from shining sufficient light on our “shadow,” side, making conscious enough of our unconscious or spiritual unconsciousness – in the same light as I view mystic Jesus of Nazareth, before him, with exactly the same message – “They know not what they do!” – and Eckhart Tolle, after him, making it even plainer for us all (with his You do not become good by trying to be good, but by finding the goodness that is already within you, and allowing that goodness to emerge. But it can only emerge if something fundamental changes in your state of consciousness.”
    – Eckhart Tolle, A New Earth: Awakening to Your Life’s Purpose)…..so I now view those DSM’s in much the same light as I view the First Council of Nicaea, wherein Emperor Constantine seems to have so thoroughly what others may view as an already corrupt “Christianity,” but what I see as mostly so many versions of Judeo-Paulianity,

    https://en.m.wikipedia.org/wiki/First_Council_of_Nicaea

    Plus ca change…

    In light of the revelations brought to us by James, Lisa and Brian, I wonder if many others found themselves as disturbed as I did on opening an e-mail from “THE CONVERSATION” entitled “Doctors under diagnose early-stage dementia” just after midnight and finding myself unable to post any comment to the article in question, by two authors said to be receiving funds from….drug companies?

    So thank you even more emphatically for your hard work, Lisa, Brian, James and MIA!

    God rest re merry and undisturbed.

    Tom.

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  8. If those among us with Down or Down’s syndrome are more unconditionally loving than the rest of us, perhaps they are more intelligent than us, and perhaps there may be perceived to be a genetic correlation and/or cause for this & as well as demonstrating how foolish our “intelligence tests” truly are?

    But, to the extent that such human beings, like the rest of us, are simply always doing their best and, like any blade of grass pushing up through cracked asphalt, following their nature, and being true to themselves as we all are, perhaps even they may not be our superiors, either?

    On Our Unequivocal Ultimate Infinite Equality:

    Confucius, I guess: YES, HE knew:
    “Young man who fancy pretty nurse
    He must be patient, too!”
    Lao Tzu? Totally knew!
    Caesar? – Julius? – I’d say, too.
    Rumi? EViidently knew.
    Carl Jung? Yep! Exposed it, too.
    And Archbishop Des Tutu.
    Jesus, how HE preached it! – PHEW!
    Who understood him? Few! Few! Few!
    The Buddha, he most clearly knew.
    Buddhists, tho’? Perhaps? Some, too?
    The Sioux? TOTALLY! Told it, too…
    Very much as gnostics do.
    Descartes and then John Paul Sartre
    Don’ talk to me about those two:
    Blew it! Blew it! Merde de DIEU!
    ?SOME? dear old Founding Fathers – WHO!?
    IF they did, they chose not to
    Share it with all doubters who
    “Self-evidence” would quite eschew
    So that we might now live to rue
    Their desperate refusal to
    ‘Lucidate for motley crew
    How candidates who hatred spew
    Can be praised by those who view
    Them and selves as saintly few..
    But that, maybe, WE ought, too?!

    References:

    Tzu, Lao: “At the center of your being you have the answe: You know who you are and you know what you want!”
    Caesar, Julius: Please see what he wrote of the druids under “Philosophy “ here: https://en.m.wikipedia.org/wiki/Druid
    Rumi, Jalal al-Din Muhammad: ‘This is what is signified by the words Anā l-Ḥaqq, “I am God.” People imagine that it is a presumptuous claim, whereas it is really a presumptuous claim to say Ana ‘l-‘abd, “I am the slave of God”; and Anā l-Ḥaqq, “I am God” is an expression of great humility. The man who says Ana ‘l-‘abd, “I am the servant of God” affirms two existences, his own and God’s, but he that says Anā l-Ḥaqq, “I am God” has made himself non-existent and has given himself up and says “I am God”, that is, “I am naught, He is all; there is no being but God’s.” This is the extreme of humility and self-abasement.’ https://en.m.wikiquote.org/wiki/Rumi
    Jung, Carl: “I don’t believe….I KNOW!” “In all chaos, there is a cosmos; in all disorder, a secret order!” Etc.
    Tutu, Desmond: *Be nice to the whites, they need you to rediscover their humanity.”
    Of Nazareth, Jesus: “You are the Light of the World!”
    Of Nazareth, Jesus, acc. to Luke, 17:21:”Neither shall they say, ‘Lo here!’ or, ‘lo there!’ for, behold, the kingdom of God is within you!”
    Of Nazareth, Jesus, acc. to Gnostic Gospel of Thomas ‘Jesus said, “If those who lead you say, ‘See, the Kingdom is in the sky,’ then the birds of the sky will precede you. If they say to you, ‘It is in the sea,’ then the fish will precede you. Rather, the Kingdom is inside of you, and it is outside of you.”’
    Buddha, Gautama’ “Enlightenment is the end of suffering!”
    Sioux, A Story from: ‘The Creator gathered all of Creation and said :
    “I want to hide something from the humans until they are ready for it. It is the realization that they create their own reality.”
    The eagle said, “Give it to me, I will take it to the moon.”
    The Creator said, “No. One day they will go there and find it.”
    The salmon said, “I will bury it on the bottom of the ocean.”
    “No. They will go there too.”
    The buffalo said, “I will bury it on the Great Plains.”
    The Creator said, “They will cut into the skin of the Earth and find it even there.”
    Grandmother Mole, who lives in the breast of Mother Earth, and who has no physical eyes but sees with spiritual eyes, said, “Put it inside of them.”
    And the Creator said, “It is done.”’
    Sioux, Dakota: *We will be forever known by the tracks we leave.
    Seathl, of Susquamish, Chief: https://www.csun.edu/~vcpsy00h/seattle.htm

    When is a square equal to a circle? When infinite.

    So are all presidents, presumably, too – equal as immortals – and perhaps as mortals, too – iif ONLY they could all remember that!

    “What we do in life echoes in eternity!” – Maximus Decimus Meridius/Russell Crowe as Gladiator in “Gladiator.”

    “Death hangs over you. While you live, while it is in your power, be good. Think of yourself as dead. You have lived your life.”
    – Marcus Aurelius, from whom also:

    “It is not death that a man should fear, but he should fear never beginning to live.”

    …by learning to truly GIVE!

    “Those who WOULD govern us are the last people we should ever trust TO government us!” – John Cleese?

    Me? I pray for Messrs. Putin and Trump, and for their enlightenment, and for the enlightenment of their and or our worlds, and for the empowering faith that stranger things have happened and must happen, and that we all can and will all help MAKE them happen!

    Peace!

    Tom.

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