DSM has been with us since, believe it or not, 1952, and we’re now on the fifth version. And it has lots of problems. DSM-II was the one I was trained under. Then, as now, DSM diagnosis seemed more important for the more severe conditions than for those treated in the outpatient setting, and nobody spent much time sorting out anxiety from depression from other conditions because treatment wasn’t all that specific; that was true for both psychotherapy and medication. Insurance companies weren’t nearly as much into reviewing claims as they are now, so most users politely ignored the weaknesses and limits of DSM-II.
With DSM-III in 1980 and subsequent revisions, the diagnostic categories were much more defined, and the general descriptions of diagnoses haven’t changed much in terms of how they’re presented: symptoms, duration, and exclusion factors were/are the main ingredients, along with encouragement to make more than one diagnosis if criteria were met. This greater definition made it somewhat easier to know what was meant by, say, bipolar disorder, but as before, a lot of other diagnoses were still very fuzzy and subject to the vantage point of the diagnoser. Most clinicians are and were well aware that many diagnoses were still vague, not specific, didn’t point to a treatment that worked. And that problem has not gone away. But insurers and other third-party payers now had something more tangible to glom onto in deciding whether to OK a claim. Treaters and patients had to agree somehow that a diagnosis had to be charted even though both knew that many diagnoses didn’t really fit. It’s a crazy-making scenario, and nobody felt or feels good about it.
So here we are, 73 years after the first DSM, and the revisions still have way too many loose ends hanging out. 73 years of research has illuminated some things, but we’re all still scratching our heads about DSM’s ongoing problems with validity and reliability with many diagnoses. And we now have even more diagnoses, many highly controversial and emotionally charged.
At the rate things are going, future DSMs might be more helpful and meaningful to treaters and patients, but it’s fair to say that we can’t depend on that. I don’t think it’s for lack of well-intentioned trying, but it says to me that there are limits to any attempt to put the breadth of human experience into categories. Some things fit fairly well into a disease or illness model, but many (maybe most?) don’t now and won’t later.
It’s gotten almost too easy to point out the downsides of DSM, just as it is to point out the downsides of most things that have become institutionalized and part of “the way things are.” I could do that myself here for a while longer, but I’ll wind up back where I started.
The current reality is that DSM is with us, that it’s (along with the ICD system) the foundation of how decisions are made about paying for care. That’s key, because those who want the DSM to “just go away” would need to pay cash for all of their care, as would the insured and uninsured among us.
Is there a better framework than the DSM? It’d involve changing some basic assumptions that are part of the DSM, some of which have been around for decades, like the idea that there are no mental illness a la Thomas Szasz, that people just have problems in living. It’s an open secret that some DSM categories really are problems in living, adjusting to life changes and stresses, and it’s not hard to make the case that those are not really “illnesses” and that it’s not helpful to call them as such. The only “good reason” to do so these days is to get someone to pay for the professional services. I think it’d be hard to defend the position that “I don’t really have an illness but I want my medical coverage to pay for the service I believe I need.”
There are some conditions/disorders/illnesses in the DSM that seem to fit the medical model better than others; bipolar disorder, schizophrenia, OCD, PTSD might be in that group. Nonbipolar depression and personality disorders are some of those which don’t. If the next versions of DSM leave out those conditions which don’t remotely fit an illness model, we’re left with the problem of who pays for services related to such problems in living?
I suppose it’s possible to have a society which says we’ll pay for treatment on demand and doesn’t look at DSM at all. Even past efforts at single-payer government-financed health care wouldn’t allow for some attempt to control costs, and DSM was/is a way to do that. I can’t imagine the costs of a system that didn’t have some way to track treatment need, progress and effectiveness. It’s not an argument that DSM is so wonderful, but it is what we have now, warts and all.
There are some efforts in the last several years to find a DSM substitute. Not too surprisingly, they don’t have much traction yet, but their existence underscores the fact that DSM leaves a lot to be desired. (Some of this was covered in a MIA podcast with Jonathan Raskin back in 2019.)
One is the Hierarchical Taxonomy of Psychopathology (HiToP), which seems to take a more dimensional, personality-trait view, different from the symptom-oriented DSM. It could be useful for the less severe matters treated in the outpatient setting, but it seems less useful for the more severe ones. It isn’t clear how it’d be helpful for matters currently more commonly treated with medications or other somatic treatments.
A group of British psychologists have developed the Power Threat Meaning Framework, which is not exactly a DSM replacement, but provides another way to think about people’s problems. As they say, “it summarizes and integrates a great deal of evidence about the role of various kinds of power in people’s lives, the kinds of threat that the misuse of power pose to us and the ways we have learned to respond to those threats.” I’d say it’s good to have alternative vantage points, especially about social and societal influences, but it still seems that the issue of how services are paid for is beyond this system.
And there’s the Research Domain Criteria (RDoC), which is a project of the National Institute of Mental Health (NIMH). This is about identifying biological markers for mental illnesses/conditions/disorders. It’s the kind of thing that, if successful, can really help sort out whether a person has a given diagnosis, almost like a biopsy or reliable blood test. There is a long list of biological measures that, for a while, raised hopes, and the number that have stood the test of time is exactly zero. This has been true for the entire history of psychiatry, and as DSMs have shown, we’ve either got a long way to go, or there will not ever be a marker we can find for many or most DSM categories.
The ICD-10 is a worldwide system that is somewhat similar to DSM but does have some differences, especially for things like personality disorders; there’s an ICD-11 which is not used in the USA yet. I doubt it’d be a game-changer.
DSM-6 is probably a few years away, and there’s not much reason to think it will be leaps and bounds better than what we have now, even if some things are a little clear and newer genetic or other findings are incorporated. It suggests to me that the limits of diagnosis—no matter what framework we use—are a fact of life. I think it’s unlikely that some other framework won’t have its own downsides. It’s not entirely fair to bash DSM for its shortcomings. It’s baked in to any system because it’s the nature of human beings and our experiences to defy any attempt to fully cover all the things that we go through in our lives. Just because we use our brains to have those experiences does not mean that they can all be measured, detected, or otherwise assumed to be similar to those of others, even if we use the same language to describe them. If I say I have pain, or anxiety, or depression, and you think “ Oh, I know what you mean because I’ve had that, too,” that’s not anything you can say with certainty.
We humans have a need to make categories. We do that to organize things in our minds. It’s a good thing and it’s necessary. And it goes way back in history. Even in the first chapter of Genesis, God is already categorizing things like day and night, sky and earth. In the second chapter, Adam is categorizing the animals, and fast forward, DSM continues that pattern.
No categorization of any kind is going to be without controversy and dispute. There have been endless debates about exactly how you tell when day ends and night begins, or whether some animals fall into this category or that. Drawing sharp boundaries always seems easy to do until you have to start doing it.
It’s not a defense of DSM to point out this out, but I think we need to remind ourselves of what DSM is trying to do and how, perhaps, impossible it is to do it. It’s the nature of the task, not simply the fault of the APA, Pharma, psychiatrists and other mental health professionals. As I noted earlier, our experiences, the limits of our language to communicate them, and the limits of those we’re trying to communicate with all conspire to make DSM imperfect before it even starts.
So where does that leave us? I have no idea if any of the DSM alternatives I discussed, or new ones to come, will be an improvement; but they, too, will have their limits. We should be open to those new ones, but not expect them to avoid the built-in problem of categorizing the uncategorizable. It’s hard to see the world doing away with DSM any time soon, and DSM is not going to be leaps and bounds better any time soon, either.
We have to acknowledge that DSM might be a necessary evil for billing and insurance, but it doesn’t have to force treatment to be in lockstep with the diagnoses for which there is weak or no data that the benefits outweigh the harms. Patients need to be educated about the limits of DSM that most professionals know exist, but also to understand that those limits are mostly due to our limited understandings.
Professionals need to be extra humble about how well we understand patients’ experiences that we ‘translate’ into symptoms, and to resist the natural temptation to think “Oh, I’ve seen this a million times before.” Those are two of the many reasons diagnoses are made incorrectly and why working relationships crumble. The patient has to feel that the person sitting across from them is making a good-faith effort to understand without making wrong assumptions. Not every person who says “I’m having panic attacks” is describing what the DSM defines as one.
DSM is supposed to be about helping helpers help people in need. It’s a tool, and neither a bible nor a perfect tool. We all need to make it work as well as it can until a better tool comes along. Since that may be a long time coming, let’s try to play this hand as well as we can.
Richard, I trained under the DSM II and even then thought it had some issues. You don’t discuss insurance except for tossing out private play. That’s how the rich and wealthy get away without dx and labels. Your same old same old does not help change just the old bromide what cha goin to do?
Who is diagnosed with schizophrenia and its cohorts? Who is disgnosed with in the old days hysteria and now borderline labels? Many othered folks in different ways and females ( other genders too) with hysteria and borderline . Artists always get labeled bipolar but all of the artistic path is cyclical. Artist create more than not from the trauma of life. Its is a tapestry of multi and mixed media of sometimes brilliance and then the simple elequence of clay.
Trauma is not considered . Any type of trauma.The book and its five interations is descriptive of what some people see in folks in multiple kinds of crisis in multiple environments all over the globe. War, famine, life and a generational life in a refugee camp, life in Jim Crow South, life in a gulag, life in a Siberian village , living life in the Congo under Leopold II, life in Central
America during the intense civil wars, life as an untouchable in India, one can go on and on.
The book does not touch the light and life of human civilization. It describes in a certain standardized white more than not male view humans acting from crisis, trauma, colonialism or any historical overreach of oppression of any kind, along with medical issues and or with environmental toxicity. It is not the be end and end all. It is at is most base an insurance payment formula.
And it belies the fact that those using it have been part and parcel of human life and therefore more than not had trauma in their own life and also diagnosable by the book.
See Shem Fine (pen name) and his House of God and other novels. He has come out and has some interesting thoughts over the years.
Kay Redfield Jameson is out with a new book. I don’t know – oh my the New York Review of Books had her still diagnosing Paul Robeson as depressed. His brilliant life and mind ruined by racism and the government with his HUAC issues ( his speech just absolutely brilliant you should read it) and many sides used him.
Of course he was depressed but not from biology from his life which because we are both mind and body soul and every living species have neurological and gut and whatever affects to name a few systems involved with existence on this planet.
How do you think those psychiatrists who were Freedom Riders ( Daniel Stern was one) would address this issue? How would Robert Coles?
How would Fritz Redl? Don’t be a shill for insurance companies give yourself more respect than that. How many heroes like Roger ? the Irish social justice hero who saw what Leopold II social economic policies were were doing in the Congo and then went on to study and protest ongoing concerns in South America and then Ireland where he was killed after the Easter Rising partly because of his LBGQT plus status – again how many heroes has psychiatry produced? Can you be one ?
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Thanks for weighing in. You covered a lot of ground.
I wrote this partly out of my longstanding awareness and concerns about the shortcomings of DSM. I also wanted to try to get a little beyond “DSM is biased and unscientific and misused” and see, as my title indicated, if there’s a way to have a better system. So far I don’t have a good answer, which is not the same as endorsing DSM as it is now, which my blog is lightyears from doing.
I’d be curious to know if you have some thoughts about whether DSM can be improved, or, as I pose to myself and readers, should it be replaced. My view is that we can’t do without some system of classification, and it doesn’t have to be one of diagnoses. But a diagnosis-free system is not going to be practical for some of the reasons I wrote about.
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Well thanks for responding. There are several layers in your reply for thoughts. Back in the day ICD 9 was hoped to be a panacea but no. I am not sure if DSM is a global insurance go to and what about universal health insurance? The AMA at times wanted then did not want universal care coverage. It makes sense to me.
Do we even need diagnostic categories?
Why do third parties need to know our private issues?
Does psychotherapy in these times really work with the standard once a week approach? Psychoanalysis was five times a week and could be accessed for free if one accepted a training analyst.
And if medication an ongoing concern and many issues with research funding and ethics what to do? I am reminded of the doc with his One Boring Old Man Blog who saw after retirement oh my something is wrong and helped with I think the Star ? research through his training in statistics. Medical treatment as in pills or ECT were not working well in the eighties and it is still not working well. Sometimes it works but a strong wave of folks who write here and other places say it does not work . . And sometimes there needs to be something when a human being is beyond distraught and oh my then no other way but I would posit prevention would make that less and less of an issue.Rape Crisis Centers all those areas where abuse and violence from infancy to elderly could be part of the system. EDs ( 1960’s federal legislation) were not funded for crisis support( trauma centers really don’t address emotional trauma of any sort. They can’t with their design and purpose) and it’s very low level care at best. It would actually help them to have a place to use instead of trying to multitask every issue. Sometimes you can catch a person before they cycle up and or down or get super high or drunk. Or do other things like get a gun and plan. . A lot of times there can be sequence or pattern if you know the person well. And because we don’t have a solid system those moments of possibility slide by to the detriment of us all. We have a world on fire and all the indicators of health and wellness codified or not show downward trends for all. This is in many areas though cancer if there were still funding has had and other illnesses some amazing efforts.
So ipso facto the approach of using DSM and making it medical not working well.
Humans have minds and bodies that interact on multiple planes of intersectionality. We are only just beginning to see how we interact with all the layers on this planet and civilization. You all are really babes in the woods. So go in a different direction. Throw it out.
I would see creation of some sort of wide but neighborhood trauma/ crisis / drop in or community use place. Similar to Gigi ‘s Playhouse or Gilda’s Club or in Ohio The Gathering Place. All free and some have satellite offices and in many states with alternative therapies.
So if you had a place you could stop by after a hard day or I could or a police officer, or a teacher, or a mayor , whoever children and teens and pick and choose alternative therapies like dance, music, art, animal or botanical, meditation, poetry, drama – vast systems and-what works best in learning coping skills or sustaining coping skills or having a safe space to talk it out even if talking it out lasts for hours because that energy or non energy one gets when stressed out to the max you either go big or go low.
Thus is similar to settlement houses. There are still some but many have changed. Almost every city has one or more. There is also the Catholic Worker movement and the old Friendship House project. So a form of community psychiatry. With also somehow another place of safety if needed. Soteria House developed by Loren Mosher might work fior that . His program funded by NIH and NIMH until certain people got worried about how the project would change the same old same old.
Folks would need to be consulted because every city or rural area has its own unique characteristics. What would work in Mingo County West Va would not work in LA Coubty California. What would work in Huntsville , Alabama might not work in Boston Ma.
And let the insurance companies figure it out themselves you are not their caretaker. They will have to because of Climate Change re evaluate their role so they will have to do it with medical care as they will with other type of insurance.
The film and story of Patch Adam’s is one way to handle this situation.
I would find it freeing and not anxiety producing to be an actor in the change of a new type of medical theater so to speak. You don’t have to live your life in Waiting for Godot mode. You can be a change agent like Loren Mosher and finish his job. How cool would that be?
I also would have you watch Michael Moore’s Sicko as it covers part of your concern.
And some of this in Ohio had been started decades ago with trying to have a peer run community center. Like the Wildflower Alliance. I just see the need for more creative all types of tools needed. Visit these places and then come back and let us know. I know all of them. Also read about Henry Street and Hull House , Goodrich Gannet , and other places. Visit a Catholic Worker Center and or farm. Read about the FriendshipnHouse in Shreveport Louisiana. Darn the JCC in any community too. Or a Sanga.Or temple or club or cultural center. The rudimentary elements are still there.So many but all isolated and one could make a chain or link.
It’s not that it cannot be done – the throwing out of DSM with a new totally new supportive reconfiguration – it can be done or we all can see it go downhill further and slide into total disaster. Some folks with the new federal presidential orders on homeless folks and or the take down of anyone who might be undocumented would say we are already there.
And I bet a statistical analysis like maybe by Matthew Desmond (two books on poverty) author and or Joseph Stilgitz ( economist) could show it’s a viable plan.I would bring in others and every diverse expert we have on all this somehow. There are so many. Get a group instead of a journal club and do an action club. . The APA unlike the AMA has not moved and tragic because they hold keys that would unlock hope. Open the group to all graduate students and those of us survivors. So much better than getting stuck on an old method that never really worked that well.
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You have some interesting ideas there, but I’m still trying to figure out if our system ( such as it is now or might be in the future) needs some way to classify. I tend to think it’s our nature to classify things and it will be irresistible to have some way to do that.
I’m not at a point in my life or career to be a leader in that, so the MIA is a way for me to put this out there in what I hope is a constructive way.
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Well there is always classification and sometimes a snap shot of you helps but you are never ever the snapshot.
But again if one’s looks to history the lexicon of almost anything from botony ( Carl Linnaeus then to the names used by the Indegenious peoples) to human emotion is always changing. The four humours. Aristotle and Hippocrates. Andrew Solomon as you must know used The Noonday Demon as the title of his book which was a term used in the medieval days. Things change. The old phrase problems in living which would cross all boundaries though the word problems in itself problematic
Life issue – Infancy to Elderhood.
Kind of a SOAP format.
S Elderly widow life concerns
O Young elderly female
A Needs support
P Help her discover supports.
There is no need for further details. And if you want to do a PE and a differential dx fine but do it! ( many medical students with a focus on helping stayed away from psychiatry and went into family medicine at my county general hospital attached to a major university) This quasi medical approach not helpful.
And all systems , all organs are involved in trauma, abuse, ( verbal, physical, sexual). or stress or environmental toxicity or human civilization oppression and rights violations. Look at the skin the largest organ . Whippings, cigarette burings, hand holding, hugging are all part of the human body and soul. Even
spirituality evidenced by the old Mind and Body Institute( Harvard) with Jon
Kabat Zinn and Joan Boysheneko with the studies of the monks in deep meditative states.
And the DSM reminds me of the Dewey Decimal Sysyem . It was created to be confusing.
Thanks for your dialogue. I find it very interesting and helpful.
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Maybe part of the solution is to allow those who get labelled, correctly or incorrectly, by the DSM a voice in relaying their experiences. Mental health system is the only field of medicine that refuses to listen to those they treat and actually uses the very afflictions we face as a rationale to ignore our lived experiences.
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Ironically, or maybe I should say hypocritically, while fraudulently claiming to be “holistic, Christian talk therapists,” and other lies.
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Have you seen the author? That would require psychiatrists to humble themselves and they’re generally incapable of letting go of their framework that lets them be the lone infallible experts gazing down upon their poor, low-insight cattle.
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Arrogance is endemic in a profession that conflates power with insight.
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Richard quote: “It’s not a defense of DSM to point … this out, but I think we need to remind ourselves of what DSM is trying to do and how, perhaps, impossible it is to do ….” Pardon my editing, hopefully, it made your comment clearer, and my editing was true to your intended meaning.
Nonetheless, I agree what the psychiatrists are trying to do is “impossible.” Largely since distress is part of the human condition, not a “disorder,” nor disease. But wouldn’t that rather be evidence of the “delusions of grandeur” of psychiatry, Pharma, psychology, et al … as opposed to its patients?
“It’s the nature of the task, not simply the fault of the APA, Pharma, psychiatrists and other mental health professionals.” Or as I asked above, maybe it is the fault of the unrepentant “delusions of grandeur” of the – basically avarice only inspired – “mental health professionals,” Pharma, et al.
Mary quote: “Artists always get labeled bipolar but all of the artistic path is cyclical. Artist[s] create more than not from the trauma of life.”
Yes, a warning to all my fellow artists and designers … as an artist/designer who had all the legitimate worldwide distress of 9.11.2001 blamed upon a “chemical imbalance” in my brain alone, by an easily recognized malpractice and child abuse covering up psychologist … when I was picking up her doctored up medical records.
Maybe Jesus was right to recommend repentance, and changing from one’s evil ways … as opposed to not quickly changing from one’s evil ways nor taking personal responsibility for one’s own “delusions of grandeur,” due to psychiatry’s attempt to do the impossible (for nefarious reasons)?
Maybe the Holy Spirit blaspheming psych industries need to garner insight into the fact that it is not your job, nor right, to be the judges of humanity? That is a “delusion of grandeur,” on your part, since that is actually the job of the Triune God, not you.
But I’m glad some US psychiatrists are finally starting to wake up. They don’t call it the “great awakening” for no reason. May I suggest a couple of simple prayers for a quickening of your awakening, US DSM deluded? Especially given the fact that Jesus is supposed to “come like a thief in the night.” Please pray to awaken with the Holy Spirit. Then pray to be moved by the Holy Spirit.
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If the DSM were merely used to bill insurance companies, we’d be a lot better off. It is the pseudo-scientific efforts to “validate” what are obviously socially-defined and subjective categories, and to base “treatment” off of these misguided efforts, that leads us into big trouble. As soon as we decide that “depression” is a “disorder” that has “symptoms,” we have drug companies and other less than scrupulous researchers clamoring to “prove” that their “treatments” are “safe and effective.” The fact that this effort is heavily corrupted by money interests seems to be bypassing your analysis entirely. The lack of objectivity of these “diagnoses” makes it easy to fudge data and produce biased research that lines the pockets of those running the industry, and makes it unmanageably difficult for critics to overcome the endless propaganda spewed out by that industry.
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So we are agreed that DSM, for a combination of the reasons I mentioned and you expanded on, is full of flaws. Yes, you pointed out some things I didn’t cite, but I didn’t want to go on too long in my blog. Again, my challenge to myself and you and the profession and the insurance companies and the drug companies and the researchers and government and those who receive care is how to craft a better system. If we exclude any of the groups I just mentioned, I can’t figure out how that would work. Can you?
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The problem of corruption is something quite separate from the DSM, though the DSM enables it to occur, by design, BTW, at least from the DSM III forward. If you have not, please read up on the politics behind the conversion from the DSM II to the DSM III – it was a tactical decision to try and “medicalize” “mental disorders” in order to allow psychiatrists to reestablish dominance in the market. It has exactly nothing to do with “diagnosing mental disorders” more effectively. As I stated, the DSM is perfectly fine for billing purposes, it’s when it is taken seriously as a “scientific document” that we run into trouble.
If you REALLY want to start to attack corruption (do you?), a good place to start would be to stop researchers at universities from being allowed to profit from their “discoveries”, which again and again have been proven to provide very questionable and unreplicatable results. We could continue by banning DCT advertising, which uses the DSM as an excuse and explanation for using drug products and massively influences the views of the public. Altering the FDA’s policies regarding using drug company employees (foxes) to mind the applications for drug approvals (henhouse) would be another positive move.
So please stop saying that I need to find an alternative to the DSM in order to address corruption. My point is that you are avoiding a very salient point in your critique of the DSM, namely that it invites corruption by creating subjective “disorders” that can be manipulated by those wishing to make money out of creating lifetime “customers.” Any “alternative” would need to address this very directly. In truth, I don’t believe it is possible to have a pseudo-scientific categorization scheme pretending to define “disorders” that will not have the same failings as the DSM. Because the real problem is, the vast majority of the “mentally ill” are not ill at all, and don’t need “medical care.” Obviously, it would be more than possible to come up with an alternative funding mechanism that does not use medical insurance as the paying entity. This would be a more viable solution. Why that seems to impossible to you is beyond my understanding. We are not “stuck” with the DSM or something similar. It’s something the industry has decided to promote, for less than ethical reasons.
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So if it’s the case that the vast majority are not mentally ill and don’t need medical care, they presumably need something else. Depending on what you think they need, you’d have to make the case ( and I’m not to whom – insurers? – maybe not, they’re in the medical care paying business) that someone needs to pay for that care (not sure if that would be treatment).
You write as if finding alternative payment systems are going to be easier than I think. I hope you’re right. Who would foot that bill? Would that include hospitalizations at all? That might put us back in the medical-model business.
By the way, I don’t think it’s necessary to talk about corruption in order to talk about what to do about DSM. Even if there were zero corruption, DSM is full of holes, so I’m not avoiding, as you put it, I’m focused more narrowly. Fine if you want to expand the perspective.
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If there were zero corruption the DSM would have never been invented, and we wouldn’t be having this conversation right now, because we’d all know very well what needed to be done to “get better” and we’d all be doing it.
Insurance, perhaps, will always be with us. But proper insurance administration is based on cost, not “billing codes.” “My 500,000 dollar house burned down.” OK. You might have insurance that would help defray part of that cost. Same with “health insurance.” It would help you defray part of the cost of getting care. There is no reason for it to get all hung up with exactly what you were treated for.
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Very well said. Corruption is the problem and the DSM is simply the vehicle created to enable that corruption.
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You are missing the point, as I would have predicted. The basic PURPOSE of the DSM is to enable corruption through allowing payment for drugs and other pseudo-medical “treatments” for “mental illness.” The question of alternative payment systems is not by any means simple, yet there are literally billions of dollars being wasted in the current system that could be redirected toward that purpose. What makes it so difficult is the fact that so many practitioners and corporations have their collective snoots in the trough and don’t want to give up on their ill-gotten gains. Eliminate the graft and there is plenty of money to devise a better system that doesn’t require someone to be labeled with a “diagnosis” in order to get the help they may well need, and doesn’t FORCE such “help” on people who are inconvenient for society to manage. How do YOU address that issue in order to free up those billions for more effective “treatments” (or whatever better name we can come up with for such interventions)?
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Actually, we CAN think of a better system. One wherein psychiatry does not exist as a field or a profession at all. One where normal human responses to overwhelming situations are not medicalized and poisoned out of existence. One where people don’t need therapists because they have genuine support from friends and family.
And one where insurance does not exist either. I don’t really believe you’re so stupid as to think health insurance is necessary and helpful and we couldn’t possibly have a healthcare system without it… right? The question of who would pay for services is maybe the most ridiculous defense of the DSM I’ve ever heard.
I am motivated primarily by humanitarianism, and the DSM and the myths it’s embedded into the mainstream are so profoundly harmful that the question of who pays for services (that are ineffective) is almost offensively petty.
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A brilliant rejoinder!
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“I don’t really believe you’re so stupid as to think health insurance is necessary and helpful and we couldn’t have a healthcare system without it… right? The question of who would pay for services is maybe the most ridiculous defense of the DSM I’ve ever heard. . . I am motivated primarily by humanitarianism, and the DSM and the myths it’s embedded into the mainstream are so profoundly harmful that the question of who pays for services (that are ineffective) is almost offensively petty.”
My feelings exactly. It’s the most pathetic excuse for the DSM I’ve ever heard.
But it’s also a sign psychiatry has reached the bottom of the barrel.
“As long as WE get paid, WE’RE happy!”
Utterly disgusting.
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Thank you Steve. Your comment so succinctly captured my thoughts. It is not the classification per se, and if DSM was truly used only for billing, I could live with that. It is everything that you said, that I won’t repeat, regarding the false meaning that we are attributing to these DSM “labels” (not diagnoses since they don’t meet the definition of “cause” required to call something a diagnosis — we all know that a list of symptoms has nothing to do with the cause of those symptoms).
These false, non-science-based meanings that the field is attributing to the DSM labels, are my concern regarding where the field has been headed for a while. It is a problem that our treatments are moving ahead as if Mental Health is Medical when it is not. While I have only been in the field since DSM III was released, it has saddened me as I have watched where we have been heading. My part is to try to train others in our field about trauma, attachment, family relationships and the intrapsychic self that develops based on these. I even wrote a book on supporting families in this relational healing. That is all that I can do but I am trying my best. Again, thanks to all who contributed to this dialogue. I particularly felt connected to what you had to say, Steve, so again I thank you.
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Thank you, Author Pamela Parkinson. I will look for your book.
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I agree people aways love being labeled, it improves their self worth (their agency) makes them stronger….also makes the drug companies stronger..
The World Health Organization states there are about 20,000 diseases and disorders. TWENTY THOUSAND. So there is plenty of room for the DSM to grow.
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I can’t think of much that would make my head hurt more than to have even more DSM diagnoses. I think some make sense, more don’t, and I wouldn’t want to build on such a mushy foundation.
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Richard, you say that some DSM diagnoses make sense, while more don’t.
Could you explain how to distinguish between the patently nonsensical and ostensibly real psychiatric disorders (I’m not referring here to conditions such as dementia that have a demonstrable physical etiology)? What are the objective, scientifically verifiable criteria employed to make that judgment?
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*raises hand*
Ooh I know this one!
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Given the medical evidence that the antidepressants and ADHD drugs can both create the positive symptom of ‘bipolar.’ … “mania.” Which was largely proven, via Robert Whitaker’s research.
And the known medical evidence 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.
Which psychiatric “DSM diagnoses make sense” to you, Richard?
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Oh, Richard, Richard, please respond. I have a good doctor, by the name of Richard, who not only took my DSM misdiagnosis, off my medical records. But he also had me teach his Cleveland Clinic students about the truth of psychiatry’s systemic iatrogenic fraud.
So I know there are both good and bad Richards … please choose to be on the side of the good Richards, Richard. And I’ve told you above how to have a “quickening” of your awakening, to do that … two simple prayers.
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Contrary to the author’s view, I consider it eminently fair, rational, and justified to “bash” the DSM for its shoddy logic and facile, unverifiable categorization of states of emotional distress.
Psychologist Jeffery Schaller was absolutely right: The DSM is a great work of fiction. As such, it has no valid reason to be taken seriously. One day, I’m sure, it will be regarded merely as a curious relic of a certain period in human history, just like medieval Hammer of Witches treatise on sorcery, or pseudo-scientific racist tracts by such writers as Houston Stewart Chamberlain.
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What I said about bashing DSM – if I loved it, I wouldn’t have written this – is that any attempt to categorize is going to have problems, so it’s fine to bash DSM but that leaves us back with the options in my title. If we say it’s fiction, so let’s bash and trash it, tell me what’s next?
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Since so-called mental disorders are essentially socio-cultural constructs that cannot be diagnosed and treated like illnesses with a demonstrated physical etiology, I think it pointless to ask “what is next” after the DSM is rightly consigned to the trash heap of history, along with such relics as phrenology, Lombroso’s criminology, and eugenics.
In short, I see no need to devise a new detailed system for categorizing states of emotional distress.
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A real system of “mental health” would not be based on medical-like “diagnoses” as are used by Medicine (and they have their own problems).
There are many psychology words that have entered common parlance, and we can’t get rid of them now. They even have a certain usefulness. But we should not base any therapy on them. The best therapists of recent times don’t use labels. That’s the best way.
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What helps people is not a label , a toxic drug, and adverse effects that isolate, distort, and torture the patient.
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some people hate labels, some find them reassuring; not true that labels are all bad.
I don’t want to be defending DSM, but I am explaining that there is nothing in it about how to treat, with drugs or not
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Inasmuch as so-called mental disorders are metaphorical, not biological illnesses, it’s quite improper to speak of diagnosing and treating them except in a loose figurative sense.
As for psychiatric labels, they are inappropriate unless based on verifiable scientific findings, not on arbitrarily concocted DSM checklists of “symptoms.” Otherwise, they can be misleading and fraught with emotional and sometimes physical harm for clients who take their therapist’s words at face value.
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But you must concur that its main use is for insurance billing. It was never meant to be a scholarly work (was it?). And it certainly is not. Beyond its administrative use, it has gotten a lot of attention as a piece of propaganda.
Yes, some people prefer to identify with their “illness.” But I don’t know that this is really helpful. Sounds kind of sick to me.
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The DSM is the only book that deserves to be banned and burned. It is a tool used for social control. Likewise, slavery was inherently evil. It couldn’t be modified. Such things MUST be abolished.
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One might say that the Bible, among many other books, is a tool for social control.
Who’s in charge of deciding which books get banned? Want that job?
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There is no way you can compare the Bible to the DSM! And I’m not even a Christian (or a Jew or a Moslem).
The best way to “ban” a publication is to totally ignore it. Autocrats will attempt to destroy all copies, but that’s an impossible job.
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So true so very very true
One other book perhaps and that would Twelve Rules of Life…by Jordon Peterson lol
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Ha ha. However, I actually like Jordan.
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Apparently so did someone else. He purchased a 30 million facility near Phoenix to further the work of fools. Easy for a psych professor to get a loan for 30 million. I wonder who would give/lend him that kind off money.
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I think the term “bipolar” is about as helpful as the term “American” to identify the needs of the patient. There are sex related differences underlying the symptoms that get lumped under the bipolar label. Even within the same sex, there are important physiological variations that would seem to explain why some people become manic and others become psychotically manic. There are individual differences in our vulnerability to stress which impacts the immune system, so much that to simply treat the underlying causes of stress and inflammation would seem to be the Hippocratic way to go, but it would require more skills than just checking boxes and prescribing disabling pills. Dr. Vivek Datta has written about what psychiatrists need to learn.
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Yes, many differences among individuals that lead to mania, psychotic or otherwise, and some are more stress-related than others. There is not a lot of strong data – so far – linking inflammation ( I know there is some), and there’s not much yet to support anti-inflammatory treatments for mania. Maybe that will come.
One of the big problems with DSM is that it isn;t that helpful for – nor intended to be – guiding treatment. If we agree there is something called mania – do we? – the current ( not forever and not final ) evidence is that lithium is the best treatment ( not the only one, not forever, not without downsides) so far. Emphasis on “so far.”
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You make my point for me, Richard. If the DSM is not helpful for guiding “treatment,” what use is it at all, except so people can bill the insurance companies? Yet it IS used for guiding “treatment,” because the REAL purpose of the DSM is to justify the medicalization of “mental illness” and the consequent prescription and use of drugs by psychiatrists and drug companies. Folks make billions of dollars off of this effort, and so of course have zero interest in changing it. But it is inherently absurd to identify “diagnoses” that neither guide treatment nor identify the cause of the “diagnoses” in question. The only reason to do so is to enable the corruption that Larry and I have both identified, but which so far you have chosen to deflect or ignore.
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RE: “There is not a lot of strong data – so far – linking inflammation ( I know there is some),”
I don’t expect to see publication of a lot of strong data while there are multiple obvious conflicts of interest to obstruct the collection of data. Epistemic Justice would enrich the data. I know what I’ve seen. I know what others have seen. I know the research supports what we have seen. I see what appears to be confusion surrounding the topic of inflammation and wish that naysayers would read the literature to educate themselves. Would it help discussion to substitute the term” immune response” for “inflammation”?
As for how to treat the inflammation / immune response that results in a presentation which will be called mania, that would depend on what is causing it. Is there an active treatable infection, or has there been chronic stress in context of poor nutrition and high blood sugar, etc? Has the toxic nature of a particular medication, kindled the mania?
Communication with family could help to identify the circumstances that kindled a mania. Yet, the medical history of many ER patients is not available. Therefore, an “inflammation-informed” treatment response should be conceived and reliably used, to reduce iatrogenic harm that is so common with the ” rush to treat” the patient with alleged antipsychotics.
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I think Richard, you are suffering from continuing to believe in the DSM categories, despite your protestations to the contrary. We don’t need to show that inflammation “causes bipolar disorder” because “bipolar disorder” does not exist so nothing can “cause” it! It is, as you say, a billing category. The proper question is, do SOME people get labeled with “bipolar disorder” or act in the ways described due to inflammation? If say 20% of such cases were affected with inflammation as a contributing factor, that’s 20% of cases that can be improved by addressing inflammation! Who cares what percentages are “caused” by inflammation? We’re talking about genuinely helping people here! A huge problem with this categorization is that it’s based on nothing but social bias and speculation. Categorization into those suffering from inflammation and those who aren’t is a genuine categorization that suggests a possible cause AND a possible treatment approach, both things you say the DSM fails to do. So toss the DSM and treat the inflammation, or the trauma, or the life circumstances the person is suffering from, and figure a way to pay for that from the billions of dollars saved from being wasted on psychiatric interventions that often don’t work and often make things worse but keep people hooked on drugs for life!
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YES! That is so helpful………..But, given the history, do we dare to hope for the useless labels to be quickly replaced with meaningful Differential Diagnoses and true therapeutics? There are big changes happening. New loyalties are quickly being created with relocation of pharmaceutical companies to America happening right now. Pharma needs to keep profiting. Playing tonight on PBS is an expose with excellent content and presentation. But, the producers of “Making A Killing: The Untold Story of Psychotropic Drugs” have been stigmatized to discourage people from associating with them. Will Pharma transition to different products that have favorable risk-benefit ratio?
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Carol, I am associated with them.
CCHR is part of a program focused against Psychiatry. It is not there to advise on alternatives. I suppose the implication is that if Psychiatry were to just become honest and straight, that would be good enough for starters. Because who else wants to deal with a screaming maniac, or someone threatening to hurt others around them?
So I have taken it upon myself – outside of what CCHR and the church are doing – to advocate for a different approach to the mind based on an understanding of Spirit and its capabilities. The general public – but of course researchers and therapists in particular – need this understanding to move ahead. It is the obvious missing piece, and is part of our name for the subject, based on the Greek “psyche.”
Pharma has no place is the non-medical handling of “mental health.” So they are not going to go along with this. But the paradigm shift necessary to embrace Spirit is so great for most people, that many who hate Big Pharma and Psychiatry won’t go along, either. So I see the Medical Model persisting for some time to come (to our detriment) unless some unforeseen major shift occurs.
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“do SOME people get labeled with ‘bipolar disorder’ or act in the ways described due to inflammation?” Or, as in my case, do some people get the adverse effects of a NSAID, misdiagnosed as “bipolar?”
Not to mention, as documented by Robert Whitaker, the adverse and withdrawal symptoms of the antidepressants and ADHD drugs can also cause what looks like the “bipolar” symptoms.
But both those misdiagnosis issues, which I personally dealt with, are why the scientifically “invalid” DSM “bipolar diagnosis” is unacceptable. Since that diagnosis is really functioning as nothing more than an iatrogenic illness covering up diagnosis … which is, i believe, illegal … not that the lawyers are taking obvious cases of such complex iatrogenesis.
But I will admit, pretty much every doctor I’ve had to deal with subsequently, is quite embarrassed by these forms of complex iatrogenesis being calmly explained to them.
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i love your response. Daylight! Bring it on!
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Pray to God we’re bringing the dark to light, Carol. Since the truth will set us free.
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Toss it out completely. As a woman I’ve found myself desperately needing help but instead I felt vilified. In high school I had such terrible PTSD that I developed excessive sweeting and I will never forget the psychiatrists face when I told him. He mocked me and asked if I had sweet dripping down my face. Immediately he must have thought I had some major disorder. I had a creepy teacher following me around the halls at school and didn’t feel safe. But we never got to that part because I shut down. It was abusive. No time was taken to understand me.
At 37 I suffered a terrible brain injury and i I was labeled as having a personality disorder instead of ever receiving any help. No doctor ever once helped me. I was always dismissed. For 150 days after my injury was messaging doctor’s that I was getting worse and that my head was hurting more. I couldn’t get a single doctor to take me seriously. I became extremely suicidal and saw a psychiatrist and I left the psychiatrists office with a referral to a parenting coach. She saw me as an attention seeker. I was so incredibly sick that I lost 10 lbs in 4 months, which the psychiatrist has in her notes.
I saw at least 5 psychiatrists over 5.5 years and not a single one believed me when I told them I had changed significantly after my brain injury. I couldn’t get traction with any of them. Immediate labeling and at that point you can’t ever move past that as a patient. Doctors aren’t interested. They don’t care. They know they are right and close the case.
As it turns out, I had suffered a frontal lobe contusion and had frontal lobe syndrome. It would have been so life changing for me and my kids if I had been able to move past the PD diagnosis. Doctors are absolutely labeling patients after a 10 min conversation.
Not one listened to me when I told them I didn’t have any of my 20+ issues prior to my injury. And the way I was treated was horrible. Doctors don’t try to help their patient if they have one of these diagnosis’s.
Finding out about my severe brain injury so long after it happened was traumatic. I became extremely depressed. I went to a psychward because I had bought a gun. I told the psychiatrist about my diagnosis and he didn’t believe me at all. I tell doctors I have a brain injury and they think I’m lying.
Whatever personality diagnosis that is in my medical records I will never overcome. No doctor will ever listen to me because of it. These disorders are being weaponized against women. My medical records cause me harm.
I’ve heard of ER doctors diagnosing women with personality disorders based on their presentation in the ER.
It is an absolute nightmare to have this on what I now call my criminal record. I’m done trying to get help because I have realized that I always walk away worse than I was before I tried went. It’s unfortunate because I would love help but it’s not going to happen. No doctor wants to help a woman with a PD. You can continue to lie to yourselves and say these labels aren’t harmful and do some good but I have yet to hear of it helping anyone. Doctors are labeling women with these conditions without doing any real background. Doctor’s are very, very far from being ethical as we were told growing up. My two daughters are fully aware of these games doctor’s play and know that mom can’t get help because of the close mindedness of countless doctors over many years who all decided I was lying.
It’s a nightmare. If I had known how difficult it is for women to get medical treatment I would never have had children. I would not have brought them into a world where they had a 50% chance of being a girl and therefore not going to get help when they grow up.
I’m not free. I’m not able to get help. I don’t have my health and there is absolutely nothing I can do about it.
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I’m sorry about your nightmarish story.
Forgive me for not saying more about that, but with regard to DSM, you said you had PTSD in high school. I know people use that term casually, but it’s a DSM diagnosis, so you’re either using it casually, or you believe you did have that DSM diagnosis, which couldn’t have been made if we, as you said at the start, toss it out completely.
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Richard in this year of 2025 the DSM terminology has been saturated into the general public consciousness. No public Health campaign just marketing and advertisement and entertainment books, films, songs. She was just using a common word for trauma that in a weird way fits because it does not get into specifics. Other phrases in the past such as stress fatigue or taking to my bed. Cultural aphorisms.
Who really wants to give the details of their life story? Remember kindness and compassion yes?
Then the other thing not at all discussed is TBI and CTE. The DSM does not handle and my bet many many diagnosis that were wrong because the truly neurological issues were not examined When you are called to evaluate a human being there should be a neurological protocol as in how many car accidents have you been in, what sports did you play and any injuries? Along with what is your story? What can you tell me so I can help you? And it seems you switch on being for or against the DSM and a little anger which is fine but always try to kind and when you get snarky apologize.
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To Richard and to Mary. So rather than referring to our trauma, are we not allowed to refer to it, but only to seek performance coaching? Trying to find the right terminology to express anything is like trying to sneak through a house with squeaky floorboards.
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Carol – These last comments of yours seem to neglect at least some of what I wrote, and impute bad motives to me which are undeserved. I know MIA is about validating personal experiences, but that’s not all it is. There’s plenty of opportunity for that, and I think that is a good thing. If that’s the primary reason for MIA, so be it, but telling our stories ( including yours and mine) don’t automatically lead to things getting better. We learned that from psychoanalysis.
(1) when I responded to Cleveland, I first acknowledged the story and asked for forgiveness in moving on to the topic that started this series of responses, DSM. I suppose I could have said more about those experiences, but would you say that at some point, it’d be OK to say “Let’s talk DSM”? No matter when I or you said that, we’d be sort of shutting Cleveland down, unless we wait for Cleveland to say “OK to move on”. So saying that you’re “not allowed to refer to it” is not close to what I did, and the sarcastic crack about performance coaching came from you, not from me. I’m fine with not agreeing, but that seemed unfair, whether I’m a psychiatrist on MIA or not.
(2) I agree with the problem with terminology you raise. But, without getting again into whether these conditions exist in “reality,” current research says that most people who are traumatized don;t get PTSD, so, yes, there’s a shorthand, but we’re also discussing whether DSM diagnoses ( including PTSD) have any merit. Not asking for agreement, but if one says ” I have or had PTSD, am I allowed to wonder if that’s a diagnosis ( and who made it and is it accurate) without belittling?
I wrote in my blog about the problem with language; perhaps you hadn’t seen it, but your point about terminology is a big one for me and always has been. I’m pasting what I wrote here for you–
“it’s the nature of human beings and our experiences to defy any attempt to fully cover all the things that we go through in our lives. Just because we use our brains to have those experiences does not mean that they can all be measured, detected, or otherwise assumed to be similar to those of others, even if we use the same language to describe them. If I say I have pain, or anxiety, or depression, and you think “ Oh, I know what you mean because I’ve had that, too,” that’s not anything you can say with certainty.”
I had written a few days ago that I wasn’t going to keep responding to commenters, but I opted to respond here. I’m not doing so to make arguments about DSM or psychiatry, but I’m pointing out what I thought were comments worth commenting on for different reasons.
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How was this comment not moderated for being extremely uncivil? This person writes an entire long empassioned account of the abuse she suffered due to trauma and being gaslit about her suffering, disbelieved, condescended and abandoned, and your only response is to call “gotcha” because she used the term PTSD? A term so pervasive in the mainstream that people quite literally do not have an alternative for “struggling with flashbacks and terror following a traumatic incident?” The only DSM label that rightly acknowledges trauma as the source of suffering? We absolutely did not need the DSM for the grand epiphany that traumatic events cause lasting suffering.
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You definitely not a Dead Soul….brilliant perhaps but not dead
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I agree. And, as one who had all the worldwide distress of 9.11.2001 blamed on a “chemical imbalance” in my brain alone … as I was picking up my medical records from an insane, child abuse covering up, psychologist.
I do agree, psychologists are sometimes insane people, who blame legitimate societal distress, on an individual … which is crazy. We have real societal problems, that should be properly addressed.
Sorry for all you experienced, Cleveland, I agree the medical community, the religions, and our societal systems, are too paternalistic. But as a female “tailor who sings with the Lord,” I do believe Cleveland is a blessed city, that houses the Rock and Roll Hall of Fame for a reason.
So I do hope and pray you search for Him, since I believe He is our healer, thus savior. I do have medical evidence Jesus died for my sins, thus prevented me from dying from 14 different egregious anticholinergic toxidrome poisonings. And I believe He’s here to save us all. God bless.
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I didn’t read your article but I was thinking about this question today. My idea was to scrap it and let an intern rewrite it from scratch as a 10 page document with double-spacing and wide margins. Whatever they come up with would be an improvement. The entire section on personality disorders should be struck in the new version as I was implying in a comment to an earlier essay in MIA.
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who will decide which intern, and what should be his/her qualifications? and then…?
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You don’t want to do the hard work of building a better future and that’s okay, how about you just leave it to the tortured left in psychiatry’s wake, the people who know how the machine works because they have been chewed up and spat out by it, to actually fix things instead of sitting around asking “what if”s you seem to think are gotchas when we actually HAVE answers that you just refuse to listen to?
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Thanks, Dead soul. That’s the essence of it. Asking “gotcha” questions is a form of window dressing.
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In my opinion, the DSM and ICD are full of ‘junk criteria’ and are all imaginary. Psychiatrists love to use these “junk criteria” for their own gain. Because this love comes from seeing themselves as a way to protect their title of ‘doctor’.
Are psychiatrists doctors? Debatable… At least for mainstream psychiatrists… Except for honest psychiatrists who do not practice biopsychiatric interventions (treatments) — they do not serve (obey) mainstream psychiatry.
What is the real truth about DSM and ICD criteria and biopsychiatric treatments?
DSM and ICD criteria… with the help of psychiatrists, are maiming and killing millions of people worldwide every year. Silently, secretly. And they call it “treatment for mental illness.”
DSM and ICD criteria… with the help of psychiatrists, are damaging (chemically damaging) the healthy brains of millions of people worldwide. While the vast majority of these individuals struggle with this chemical brain damage in their own homes, some are forced to live in mental health facilities such as mental hospitals, care homes and nursing homes requiring “in need of care.”
The DSM and ICD criteria… with the help of psychiatrists, make people “in need of care.” They become dependent on the care of others. But psychiatrists have found “this job the easy way out.” They distort this “in need of care” as “progression/worsening of mental illness.”
What does all this tell us? Does it mean that psychiatrists are doctors or that they are charlatans? My words are directed solely at those mainstream psychiatrists who serve mainstream psychiatry and are dishonest. In this case… how accurate is it to view psychiatrists as doctors?
***
DSM and ICD criteria and biopsychiatric interventions (treatments)… are not ‘mental health treatments’, they are management ways of ‘controlling’ people. There is no ‘treatment’ here, only ‘controlling’ people’s behavior. Controlling people’s behavior… is achieved through chemical brain damage. Chemical brain damage is also called ‘treatment of mental health/illnesses.’ This is the real truth. I hope we can understand what mainstream psychiatry, the DSM and ICD criteria… do to people.
Thanks Richard Moldawsky. Best regards…
With my best wishes. 🙂 Y.E. (Researcher blog writer (Blogger)
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thanks
wonder if you think there should be any attempt to classify whatever we’re going to call the reasons why people seek help? Sorry to say, but if you were deciding what taxpayers or private companies should pay for, would you either just say OK to all, deny all, or have another way to make those decisions? I just don’t see a way of avoiding that question; do you?
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Abolish psychiatry as a field and teach people to be emotionally intelligent and supportive, empathic listeners. Return to community support.
Now it doesn’t matter what they’re suffering from, now they all get support and no one has to pay for anything. Closer to the way it was for 99% of human history. You’re just unimaginative.
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Perfect.
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More than perfect. Has to happen.
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The reason people seek ‘help’ is because the mainstream doctors, who are dangerously paranoid of a non-existent legitimate malpractice lawsuit, proactively prevent such, with the use of complex psychiatric iatrogenesis. .
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What makes you say Bipolar fits the medical model better than most? Do you take the DSM criteria at face value? One manic episode equals a lifelong chronic illness?
To me it seems like another problem of living; massive stress, fight or flight response.
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I did not say it fits the medical model. I do think it is more like a medical illness than, say, major depression because there are more commonalities in bipolars with regard to genetics, course of illness ( sorry:), and response to treatment. It’s not a perfect fit, just one of the better ones.
No, some people do have a single manic episode and they should not, in my view, be called bipolar as if it’s a lifelong condition.
We can say that massive stress is tough on everybody, but there is something about what people with mania have more in common than say PTSD
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Are you suggesting that there is some discernible genetic cause for most cases of “bipolar disorder?” I would be most interested in hearing what scientific evidence exists for this belief. My understanding is that “bipolar disorder” is diagnosed entirely through the applicable DSM checklist, just like every other DSM diagnosis in the book. If there is really some objective way to discern these genetic “causes,” please enlighten us.
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“With DSM-III in 1980 and subsequent revisions, the diagnostic categories were much more defined, and the general descriptions of diagnoses haven’t changed much in terms of how they’re presented: symptoms, duration, and exclusion factors were/are the main ingredients, along with encouragement to make more than one diagnosis if criteria were met. This greater definition made it somewhat easier to know what was meant by, say, bipolar disorder, but as before, a lot of other diagnoses were still very fuzzy and subject to the vantage point of the diagnoser.’
Psychiatry was facing a crisis of legitimacy until the DSM-III. Psychiatrist Robert Spritzer saved Psychiatry with shoddy statistics and a linguistic sleight of hand. This came back to bite Psychiatry in the ass when the DSM-5 failed its field trials. Showing itself to be mathematically unreliable. Robert Spitzer’s revolution in Psychiatry with was based on a lie.
For instance, schizophrenia as defined by the DSM is so diffuse as to be meaningless in the scientific context. You can have two separate patients diagnosed with ‘schizophrenia” with non-overlapping symptoms. Then there is the fact that it has a poor inter-reliable statistical kappa score of .46 instead of .70 (satisfactory) or better.
Scientifically it is game over : it is pointless to look for brain defect correlates or genetic defects.
…and constructs such as bipolar disorder don’t fair much better.
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Not to mention, what I feel like I’ve already pointed out way too often, as the complex iatrogenic symptoms of “schizophrenia,” created with the psychiatric drugs … via anticholinergic toxidrome and neuroleptic induced deficit syndrome.
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I agree, Richard. I have also heard of or directly seen manic epsiodes only in people of one personality type. In the lower general psychological health levels they show the traits of emotionally instable personality disorder (Borderline). Overall, their personality corresponds to type four in the nine-type-personality theory, Enneagram.
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Funny how we are bashing the DSM as unscientific and you bring up the Enneagram.
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The DSM does no good for. anyone..It simply is a newer way to justify the modern day MKUltra….
Explosive: the federal government BUYS all sorts of medical and psychiatric drugs, which they give to patients free of charge
Conflict of interest? There isn’t any conflict. Just interest. Just corruption.
Here’s the set-up. The government studies the drugs, approves the drugs as safe and effective, buys the drugs, and gives them away.
You think the government wants to admit any of the drugs are toxic, destructive, ineffective?
That would be confessing to major crimes.
For the hundredth time, I cite Dr. Barbara Starfield’s JAMA review (July 26, 2000), in which she concluded the medical system kills 106,000 Americans a year with FDA approved drugs. That’s over a million KILLINGS per decade.
So yeah, lots of medical drugs ARE killers.
And the government is buying them and giving them away.
Here are a few of the federal drug buying programs:
The Veterans Administration: Buys medical and psychiatric drugs for millions of veterans.
Dept. of Defense War: Buys these drugs for service members, their families, and military retirees.
Federal Bureau of Prisons: Buys the drugs for inmates.
Indian Health Service: Buys the drugs and gives them to Indian treatment centers.
There are a lot more federal drug-buying programs. But you get the idea.
In some cases, the patients pay a very small amount for the drugs. Otherwise it’s all free.
The practice of giving free SSRI antidepressants to federal prisoners—wow. The drugs are known to push people over the edge into violence, including suicide and murder. And what about giving these SSRIs to active, trained, highly aggressive military members??
—So it isn’t just the CDC buying $5 billion worth of vaccines every year and giving them away to children. The whole federal complex is one giant drug dealer for the nation. Dealer and donator…
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Sadly, I’m pretty certain you are right.
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I recently heard on NPR, that AI is, even among educated academics, showing several clear signs of causing “cognitive atrophy”. I mention this because it seems to me that the DSM has had a not dissimilar effect on mental health professionals over the past several decades. The author of this blog effectively laid out a thesis that posits the DSM (and especially the RDoC et al) as intellectually vapid; a thesis better made elsewhere in droves. My point here, apart from the dialectical between a vapid document and the professionals who’ve been educated around its dictates and constraints, is that I’m confident that if the DSM was scrapped from existence, that whatever filled the miasma vacuum of that void, could only be made worse if its replacement came at the hands of psychiatry, or those willing or otherwise obtusely subordinated by the psychiatric ethos.
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Right on Bro..
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A vapid document from vapid minds.
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I’m not sure why this article was approved for this website, except as a way to start a discussion. It’s not that the DSM needs to be trashed, it’s that it IS trash. It is based on a wholly fraudulent concept of what “mental illness” is and how it should be handled. It cannot be handled by any sort of traditional medical process, as true mental problems are NOT medical conditions. Until psychologists, at least, realize this, the subject cannot move forward.
I know some therapists who are making good strides in the field of mental health. They are of course not in the “mental health system” and not paid through insurance companies.
One is Steve Burgess (UK) who uses regression techniques heavily in his practice. His model is: 1) Someone comes in with a complaint. 2) They are put under a light trance, and the “subconscious” (there are lots of terms for it) is asked what needs to be addressed. 3) The indicated experiences are addressed. No labels (although we will always get people saying “he’s so neurotic” or whatever). No billing codes. Just good results.
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The National Institute of Mental Health (NIMH), under Thomas Insel, in 2013, already decided to trash it. They won”t be using it for any research purposes because it is invalid.
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That’s nice, but I’m not concerned about its research uses; I’m concerned about its propaganda uses, which continue full steam ahead.
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This might just be the worst article on this site yet.
“So I KNOW the DSM is unscientific and unhelpful and sucks at categorization (and the act of categorizing people with immutable personalities NEVER leads to any bad outcomes) and is just a tool for insurance but… But… Who will PAY for your care if not insurance!”
Like it’s seriously such an insult to survivors to let psych shills come here literally defending the DSM while pretending they’re actually just concerned with their “patients”. Prove there’s any such thing as brain disorders and THEN we can see about taking a medicalized approach.
WE KNOW ALL OF THESE “””DISORDERS””” ARE JUST TRAUMA RESPONSES IN ORIGIN.
This website needs to die if it’s just going to claim to be about “social justice” and then post articles like this and let this guy trample over survivors with WAY more insight on how to “””improve””” psychiatry.
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With that comment you may not be completely dead……..they are working on it however. Soon they will be voting on which new “diseases” to put in the DSM or rather which new “diseases” they can make shit loads of money on..like the vaccines…billions and billions.
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I call myself Dead Soul because the sheer amount of unpunished injustice in the world has literally felt like a mortal wound. I cannot live in a world in which psychiatrists and nazis can literally do eugenics and we’re not allowed to be mean or violent to them. I cannot let these people get away with this shit when they are doing ten thousand times more heinous torture and violence. The more I see people telling me to be nice to these fuckwits actively doing genocide, the more I start to believe humanity is too stupid to ever learn from its mistakes and isn’t even worth saving. I don’t want that to be the case, but all this injustice has me begging for death every single day. I have been like this for as long as I can remember, because the world is absolutely evil and backwards and fucking unbearable. I cry for people I’ve never met whose lives were ruined and whose stories will never matter enough for them to get justice. I don’t want to live in this world if even MIA is going to abandon the people it was supposed to be for.
Abandonment is the single most painful trauma for me. It’s the easiest form of evil.
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Your words just crushed me. I would love to be able to communicate directly with you. I have an anonymous email address below, if you send an email to this one I can give you my contact information and the things I am working on. It about clarity no therapy.
[email protected]
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“This might just be the worst article on this site yet.”
It’s in the top two, that’s for sure.
I get the despair, Dead soul, but that’s when you need to remember not to let other people’s stupidity and corruption get the better of you.
Don’t let psychiatry make you abandon yourself.
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Given the choices, I’d vote for trashing it. But the answer is deeper than that.
Maybe we need to shift the focus away from symptom management to systemic dysfunction—recognizing mental distress as a real (and valid) output of dysfunctional systems of governance.
The real issue might reside in our centralized systems of governance—economic, political, social, and religious—designed to rule the masses. Which “ism” is the best way to rule the masses?: communism, socialism, capitalism, authoritarianism, facism . . .
What if people aren’t supposed to be treated and governed as masses (by a few) in the first place? What if all of the “isms” rise in answer to the wrong question?
These systems create the conditions that break people down—socially, economically, and emotionally—and then we turn to psychiatry to “fix” them, labeling their pain as disorder and getting busy treating those “disorders.”
We’re expecting individuals who have been damaged by a sick society to become happy, “healthy,” and productive members of that same society. That’s not healing, it’s assimilation into dysfunction.
Instead of clinging to a national or institutional “we”—expecting everyone to assimilate neatly into a fiction of mass unity—we should be redefining “we” as those within our own communities, the people who actually know and care for one another (as they might naturally if living under different circumstances).
Real healing may start there, not in diagnostic manuals or bureaucratic systems that exist to keep the dysfunctional machinery running—the same systems producing the results we find unacceptable.
These are the results of these systems. We live those results. Why do we expect different or better outcomes from them? These are, effectively, the results they were designed to produce.
Treating an individual as the cause of what is, in reality, a systemic result isn’t “healing” to that individual. Instead, it’s iatrogenic.
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This is the way. Realize that it’s not a matter or who’s in power or why, but why we are so desperate to be governed, and what it means to reclaim self-governance.
What is it in life we’re really so “maladjusted” to to cause such widespread suffering? Why do we start from the assumption that these things are necessary evils that can or should be compromised with?
What would society look like if we shaped it to ease our suffering? It would not look like a nation of 330 million crammed into concrete jungles with plastic food and few green spaces having to compromise with people on the other side of the continent (or world).
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Mark Fischer puts that into his book titled Capitalist Realism, there are some good book reviews on YouTube worth watching..in the mean time here is a quote from the book:
“The pandemic of mental anguish that afflicts our time cannot be properly understood, or healed, if viewed as a private problem suffered by damaged individuals.”
― Mark Fisher, Capitalist Realism: Is There No Alternative?
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Mark Fischer was a writer, musician and philosopher who espoused forms of Critical Theory (neo-Marxism) and blogged under the moniker “k-punk.”
He struggled with depression and suicided in 2017 at the age of 48.
It’s a shame that he, and many of his generation, never discovered (or perhaps rejected) more workable ways of understanding life on Earth.
I don’t believe or agree that the current situation on Earth was created by “capitalism.” Our development into “modern” times has been guided and perhaps enforced by our earlier (pre-Earth) experiences living in techno-police cultures. As most of us have completely forgotten these experiences, they act as a subconscious, or hidden, influence on our behaviors and choices.
Though this line of inquiry has been rejected by most “serious” academics, it is possible to do research in this subject using scientific methods. The rejection is part of the subconscious dramatizations, which are unfortunate.
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Did you read his book “Capital Realism” Larry
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No I did not. Have you read Dianetics: The Modern Science of Mental Health?
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It appears you merely cut and pasted the description wikipedia then tossed in the what most MIA readers would regard as stigmatism by using terms like “Critical Theory and (neo-Marxism)” and “k-punk”.
This is how the practice of psychology and psychiatry manage to marginalize and stigmatize their clients. Lets not call them patients instead lets call them the “mark”.
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Our systems of governance are so effective at breaking people that we’ve developed labels to describe the patterns of damage people incur under these systems of governance.
The DSM is, in a sense, a collection of labels describing the injuries people endure under these prevailing social, political, and economic governing forces. We give diagnostic names to known, predictable responses to the isolation, exploitation, and unnatural stresses produced by these systems, as if the problem lies within the individuals rather than the environment that shaped them and the dysfunctional systems governing their lives.
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Dan you are spot on. Spot on…thank you.
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The extent to which a being is willing to take responsibility for its own condition is proportional to its spiritual development. The people of Earth are not very spiritually developed, except a few. So you tell them they are responsible for their condition and they resent it and think you are beating them up emotionally. That is the situation here.
But a therapy based on never getting the being to increase its responsibility level is limited, because that is an important part of personal well-being. If you have ever run into someone who blames other people for everything they suffer from, you might see how this is so.
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You asked me if I have read L Ron Hubbard’s book “Dianetics”, and I have not read it, however since you have stated that you have not read Mark Fischer’s book Capital Realism and felt free to categorize it I shall do the same. Do drawing on the extensive research from wikipedia:
L. Ron Hubbard was a prolific writer for pulp magazines. He attended George Washington University engineering school, but did not graduate.[8] The Church of Scientology considers the book Dianetics: The Modern Science of Mental Health as a representation of Hubbard’s concepts of “the human mind, its functions, and the problems related to these functions.” Hubbard presented Dianetics as a “therapeutic technique with which can be treated all inorganic mental ills and all organic psychosomatic ills, with the assurance of complete cure in unselected cases.” In this body of work, Hubbard also attested that human beings are motivated “only” by survival.[9]
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Arguments evoking notions of personal responsibility and blame assume we actually have full freedom to take responsibility and assign blame.
But if thinkers like Shapolsky and Denton are right that free will is an illusion, then ideas like ‘personal responsibility’ and ‘blame’ become incoherent — people can’t be faulted for the conditions they didn’t choose. After all, no one chooses their genes, their childhood, or the circumstances that shape their character and desires.
Some may argue that we chose our lives before we were born, but how would we verify that?
Notice that determinism doesn’t preclude anyone from learning, growing, and changing — it simply means those processes, too, have causes.
And that everything is caused isn’t to say that some causes may not lie beyond our current ability to perceive or scientifically observe—leaving room for causes of a spiritual nature.
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Stop listening to “thinkers” Dan, and start finding out what real researchers have discovered. Causes of a spiritual nature CAN often be observed scientifically. That’s what so many people are missing.
The research is being done, just not reported on.
And it finds that the native state of a spiritual being is total cause. The very common state of a human being is often closer to “effect” or “slave.” So it’s a matter of bringing human beings back up through all those lower states to cause. Not the easiest thing in the world to do.
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As plants need water to grow, people need empathy and humility. Without some degree of empathy or humility opening a door to learning about life from another perspective, a person is determined to assign blame to what they don’t understand, guided by the false wisdoms they’ve been exposed to and mistake for being true.
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Dan I appreciate your reply to some of these comments and wonder if you would be willing to work with me on some other projects I have as well as any you might have…hope we can talk. [email protected]
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I value the objective of this article; It’s a very good question to raise. I feel compelled to respond as a mother whose whole family has been traumatized by how two of us have been iatrogenicaly battered, tortured, exploited, and pushed to despair by the outdated, neglectful paradigm of care in psychiatric wards. Many of us still have loved ones living under this type of oppression and danger.
I support constructive discussion in this thread. However, It’s a GOOD THING we really DON’T have to win dueling word games and challenges about terminology, etc. in order to improve the care of OUR OWN loved ones in psychiatric wards today or in the future. I need to choose constructive thinking and hope for innovative strategies that MIGHT make a difference.
It’s ok for weary activists to become skeptical, disillusioned, and step aside for their own health and their families, but as long as families have skin in the game, we must do what makes sense to US rather than quarreling about words. We owe gratitude to activists who fought for everyone against the inhumanity and we must not expect them to do everything for us relative newbies. But, we have to be who we are and do what makes sense based on what we have learned about the needs of our loved ones which are neglected.
We DON’T need to argue endlessly about the terminology, etc. We need to recognize the opportunities that remain and to create new opportunities. Maybe I WON’T accomplish my objective. Maybe I will accomplish NOTHING. But, I choose to keep thinking about how to make a difference , and MAYBE I will make a difference. I have to keep a positive focus and avoid negativity.
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I have come to believe that the creator of this article is suffering from Anosognosia.
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I think this whole website is suffering from anosognosia now, fellow pothead.
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Why so?
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Because pothead knows
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That he does.
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The DSM is not just a tool. It’s corrosive document that’s created a culture of pseudo-illness, something Richard seems unwilling to meaningfully address.
He’s chosen complacency instead.
Why is it so hard for him to imagine a world without the DSM?
Or a world without psychiatry?
It’s clearly become a case of the tail wagging the dog.
A dog that’s not housebroken.
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Loved your last line!!! 🙂
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🙂
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Thanks for this article.
You say: A group of British psychologists have developed the Power Threat Meaning Framework, which is not exactly a DSM replacement, but provides another way to think about people’s problems…. I’d say it’s good to have alternative vantage points, especially about social and societal influences, but it still seems that the issue of how services are paid for is beyond this system.
The PTMF was developed by British psychologists AND survivors of psychiatry, working together in the core author group, along with input from other survivors in the wider group of contributors. It is dismaying how often their contributions are omitted…. And we do not have the dilemma of ‘how services are paid for’ in the UK. That is a problem arising from privatised welfare systems, and not a reason for retaining the DSM or any other diagnostic system.
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Excellent point, Lucy!
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As of the moment, the site says that my blog was opened (read?) by over 840, and there’ve been 88 comments by many. I expected it to be met with all kinds of challenges, though the breadth of them did surprise me some. I don’t think I posed a simple question, what to do with the DSM, though some of you had easy and quick responses. Some of you don’t think any kind of classification is needed. Some think the DSM was created with malice and for purposes of power and social control, describing “mental disorders’ that some of you simply believe do not exist. Some think it’s a metaphor. Some believe that if there is no identifiable reliable biological finding for something, it therefore cannot be an illness.
And some of you think I am naive and can’t see what is so clearly obvious to you, which suggests to some of you that I am so far into the system that I can’t see its flaws, in which case my comments maybe have to tolerated but that’s about it. And you wonder why MIA would bother allowing this to be posted.
And some of you found the piece thoughtful or thought-provoking in a good way, and noticed that someone so totally under the thumb of the psychiatric-medical-pharma-socialcontrol forces probably wouldn’t write what I wrote.
I was tempted to respond individually some more to what you all have posted, but I don’t think it’s productive and would mostly lead to more heat than light. I had the same experience with my first blog in July, and at some point, the back-and-forth becomes endless. I’m sure I missed something someone wrote in my attempt to summarize what you have written, but I tried here to say ” OK, I hear you, and you have some good points, some I just disagree with, and some that took things way beyond the scope of my blog.”
I’ll make a couple of brief comments which you are, of course, welcome to respond to, but I am not planning to continue the comment-and-respond. I can’t do that with everyone, and I don’t want to pick and choose who gets a response. I have read every single word of what you all have written. Every word.
Final points:
–I don’t agree that the DSM was created to enable corruption. It may have been misused in corrupt ways by some, maybe more than some, but that’s different
–just because a drug can cause schizophrenic symptoms or mania does not mean that there isn’t a separate condition that we ( yes, using DSM) call schizophrenia or mania
–the idea of abolishing psychiatry and insurance is kind of tempting, but what comes after that is still hanging out there
–changing society probably could lower what we call mental illness, but to assume it is a big leap. many cross-cultural studies have shown the incidence of some mental illnesses ( Yes, DSM again) to be relatively stable, even though they may look different, say, in aboriginal society than in Chicago
–I Agree that the lack of firm scientific evidence (including genetics) for even bipolar is a big concern. Fair to differ, but I have seen enough of what most call bipolar to say that it’s not just a metaphor or a reaction to stress or to capitalism or communism or iatrogenic behaviors. I won’t ask you to un-see what you’ve seen. Goes both ways.
–there is something to the role of inflammation and what we’re calling mental disorders. It’s not clear yet, nor is it the case that giving anti-inflammatory treatments have been shown definitively to help. But it’s promising.
–Yes the NIMH is not thrilled with DSM, but the RDoC has not yet been shown to shed more light. Yet.
–Anosognosia! – it’s a great word which our commenter chose not to define, so I will. It reflects some neurological condition in which someone is not aware of one’s mental or neurological deficits.
Thanks for reading this far.
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The reason your article and especially your responses were so upsetting is because the people who frequent this site who have been hurt by psychiatry, which is the population this website should be for, have been traumatized and disillusioned by psychiatry having not only personally suffered its failings, but more importantly, being disbelieved, talked over, met with antagonism upon asking questions, and having their rights and autonomy stripped from them all in the name of whatever DSM label has been branded upon them. All by people who said they were just there to help.
They have seen the “intractable disorders” like bipolar or schizophrenia disappear without meds but instead with changes to diet, environment (sociocultural support), monetary support, emotional support, and when they finally leave abusive people. They have seen psych meds make everything worse. They have learned not to trust doctors because of the repeated harms they’ve suffered. They have learned from experience that psychiatrists can and will twist their words and gaslight them.
So it is very upsetting to then see a psychiatrist stroll into what should be our space, after we’ve been on MIA long enough to know specifically how each of the labels in the DSM are unscientifically broad, harmful in practice, stigmatizing, and exist to blame patients for suffering that absolutely is caused by trauma and environment. Like, there are studies on this site that refute what you claim about schizophrenia and bipolar. Psychosis happens, and there are separately people with persistent hallucinations, but if they manage to cure it by treating brain inflammation or with a niacin regimen and trauma work, psychiatrists will just say that it means they never really had schizophrenia in the first place. The narrative of reality changes to fit the DSM. Then the reality that persistent hallucinations happen globally gets used, assuming schizophrenia is already a real disorder, as evidence THAT it’s a real disorder. Whatever disagrees with the DSM is assumed to be wrong BECAUSE it disagrees with the DSM. How is that scientific? Where’s the evidence backing up its classifications?
You claim you’re not defending the DSM, then your entire article is about how despite all the problems with it you recognize, we have to keep it for a while because YOU can’t figure out how a system would work without it. You can’t imagine how YOU would function without it because the DSM IS your “proof” of these disorders.
When people provide answers to your unanswerable questions, you dismiss them as unworkable or pivot to insisting that we still need a way to categorize people by diagnosis, despite the fact that this is to diagnose “disorders” with no provably distinct biomarkers or physiological changes. Arbitrary guidelines that are just billing codes, except that you also argue they’re legitimate genetic disorders, and in practice these labels guide the course of “treatment”.
We feel we are being yet again talked over, dismissed and ignored. And we are mad at MIA for allowing this in what should be our space to discuss LIBERATION FROM psychiatry, because our combined experiences have taught us that that is the only way to address these forms of suffering in a way that respects autonomy, personhood, identity and imagination. When you say you won’t ask us to unsee what we’ve seen and vice versa, what we’re hearing is “I hear you but I’m not going to listen to you and am only going to go off of what I have personally experienced. I will not listen to anything you say that disagrees with my already-established views.” And there’s a quiet hint of “I’m the expert, not you,” which is part of the problem with experts when they’re experts in pseudoscience.
This is exactly why we hate psychiatrists so much we’re motivated to get very mean. We have been abused enough by this egocentric attitude where psychiatrists will pat themselves on the back for being saviours and helping people and learning a couple things about drug tapering and how the DSM labels are flawed, and they think they’re on our side, but then we keep finding that the conversations that should be about abolishing psychiatry end up being mostly other still-practicing psychiatrists jerking each other about how to ease their consciences by doing as little as possible to actually change the profession in practice because that would JUST be TOO hard.
Because the real solution is cultural reform, which is beyond psychiatrists’ power, so they instead go “well I can’t change the world, but I can give you drugs so let’s just keep doing that unless you can wave a magic wand and change the world.”
If destroying capitalism would end the global burden of suffering; and I believe it, among other things, would; then that’s what we need to do, no matter how hard it is. But we cannot have elitists debating about how to “improve” psychiatry while talking over the people this entire reform is supposed to be for. MIA does not represent survivors and it is unforgiveable. Nothing about us without us.
But that also means you can’t just dismiss what we say because of what you’ve seen. Psychiatrists deserve an olympic gold for how deftly they’re able to outright deny the blatant reality of anything that disagrees with the DSM or their gospel. And here, in this article and comment section, we are feeling like we are the reality being denied because it doesn’t fit the DSM.
Why is MIA letting psychiatrists talk over us and deny our realities like this? Why would they allow you to so cruelly ignore a person’s account of how the DSM labels hurt them beyond measure, just to claim some kind of “checkmate” for using one of them? This is directly just a psychiatrist abusing a survivor and I cannot even begin to explain the fury I bear for everyone else here seeing MIA allow this and demanding we survivors police our language so as to cater to the feelings of the bullies (and IDF murderers) they let dominate the narrative here.
This is actively just harmful to the community of psychiatric survivors so if MIA really wants to help us, they either need to stop working with practicing psychiatrists, or shut down this damn website. Or take the fucking “science” AND “social justice” off the tagline cause it’s all just about fucking psychiatry now.
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“And yet there’s a quiet hint of “I’m the expert, not you …”
THAT comes through loud and clear to me…
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“… we keep finding that the conversations that should be about abolishing psychiatry end up being mostly other still-practicing psychiatrists jerking each other about how to ease their consciences by doing as little as possible to actually change the profession in practice because that would JUST be TOO hard.”
Yup. Lip service is psychiatry’s favorite sub-specialty. It lets them say to themselves, “Well, I did MY part.”
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I appreciate this.
It is clear to me (but perhaps not to others) that most critics of psychiatry and the DSM have not done their homework concerning what is the correct way – or a better way – to handle these problems.
Another situation that seldom gets brought forward is that there are already different groups that handle “mental illness” in different ways. The psychologists often prefer therapy and reject drugs. But they mostly take paying customers that have less difficult problems. Some psychiatrists are also in this camp, while others work in “institutional” psychiatry which is practiced mostly in mental hospitals and jails/prisons, not in “normal” hospitals. This second group indulges in more violent practices that sometimes result in the death of patients. Patients also die from taking drugs prescribed by psychiatrists in private practice or “normal” hospitals.
When many critics refer to psychiatry or the mental health system, they are really only referring to private practitioners or those working out of “normal” hospitals. Most of those patients have a “normal” life, but are having a hard time. One could argue that many of these people aren’t even “mentally ill;” they are just experiencing the challenges of modern life.
Institutional psychiatry, on the other hand, is more rarely reported on and deals with people who are often more “hard core.” A lot of iatrogenic crime is committed in that sector. It needs to be handled, too. And I think a lot of critics are missing this aspect of things, as it is more hidden from the general public. Being critical of something is rather easy to confront. Getting rid of evil and replacing it with good is more difficult.
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“Anosognosia is a condition in which a person with a disability is cognitively unaware of having it due to an underlying physical condition. Anosognosia results from physiological damage to brain structures, typically to the parietal lobe or a diffuse lesion on the fronto-temporal-parietal area in the right hemisphere…”
https://en.wikipedia.org/wiki/Anosognosia
True “anosognosia” results from brain damage and is defined by inability to recognize a physical disability. The word has been stolen by psychiatry to apply to those who are “unaware” of their “diagnosis,” meaning anyone who doesn’t accept their psychiatric diagnosis without argument or complaint. This is a completely inappropriate use of the word. In the absence of actual brain damage, anosognosia does not apply.
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What you say about anosognosia holds true for the vast majority of other psychiatric disorders. This term is just one more blatant example of medical terminology being misappropriated by a field that bases its raison d’etre on totally subjective hypotheses instead of rigorous laboratory tests and verified findings.
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In my view the DSM is not to blame for psychiatry failing their patients.
The problem is that psychiatrists have established a culture of disregard and violence towards their patients. This culture was established in the late 18th century – well before the first edition of the DSM hit the market.
It is this culture of violence that counters every trial of psychiatry to develop into a serious scientific endeavour for the good. Because sooner or later it corrupts the integrity of everyone who works in the field.
When psychiatrists do research they don’t take the outcome of their studies seriously when it contradicts their expectations but they thwart the results, blame the patients, and ask taxpayers for more money to try to prove their fantasies of how they think things should work.
As long as this culture of disrespect and harm against the patients of psychotherapy and psychiatry is not stopped, psychiatry is doomed to do harm – no matter with which theoretical models psychiatrists (and clinical psychologists) work.
It’s a no brainer – but probably that’s just the reason why nobody gets it.
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“The problem is that psychiatrists have established a culture of disregard and violence towards their patients. This culture was established in the late eighteenth century – well before the first edition of the DSM hit the market.”
Indeed.
Psychiatry is the dark side of the eighteenth century’s so-called “Enlightenment”, an era that birthed the delusion that science alone could explain the human condition. This foolishly set in motion the bullheaded belief that brute science holds all the answers—dismissing the spiritual/emotional as irrelevant or irrational. It’s when science’s obsession with categorization took root, when classification was canonized, where naming became knowing and knowing became control. And control is what psychiatry is all about.
The result? A world of rationalist overreach where people genuflect to psychiatry’s DSM.
A cultural relic that, like psychiatry, refuses to die.
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“The problem is that psychiatrists have established a culture of disregard and violence towards their patients.”
YES!!!
The idea that people should seek medical attention for emotional problems is where the violence begins, a violence that cruelly dismisses or ignores the wisdom of the body and soul’s ability to restore itself.
The DSM was rewritten in 1980 as a way to stop the migration of patients to non-medical psyche professionals that were finally allowed to practice without the supervision of a psychiatrist.
But the DSM’S aggressive medicalization also changed the public’s perception of their emotional and spiritual challenges, now commonly referred to as “mental illnesses”.
The sad result being millions of people now believing their brain physiology is defective. And worse yet, best corrected with psychiatric drugs.
Psychiatry, and to a lesser degree psychology, both reflect the worst in human nature: an obsession with power coupled with the insatiable desire to dominate and control a narrative that’s not even theirs to narrate.
That theft—the most violent act known to mankind.
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So well said.
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Thank you, Carol.
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What is needed is Connection. And tolerance of different provisions for connection. Any family, regardless of cultural or spiritual affiliation is going to have it’s challenges and stressors from systemic arrangements and biases, and from different degrees of ignorance of what they need to know about the needs of their own family. Any family can be harmed not only by psychiatry but by being trapped in settings of political turmoil such as even in the public schools where indoctrination is forced on children. Psychiatry is anti traditional family and so has been the public school system too often. When someone has had a very nurturing and positive childhood in a traditional family, they are often accused of being privileged. So we also have dilemma about how to categorize each other and have our own conflicts of interest. Yet , all families can become stressed from demands of life and begin to falter in their adaptation to that stress. Life’s continual
challenges require downtime to process with sensitive communication and encouragement. Sometimes we stumble or fail. What we don’t need is to be exploited during our downfalls by either psychiatry or by politics. I really appreciate the article entitled “Recapturing Humanism at the Dawn of Post Humanism” by ???? And was published at this website madinamerica.com
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Here is a quote from a new article from Peter Gøtzsche well know for his that firmly establishes the pharmaceutical companies as “drug cartels” and the Doctors who prescribe them as “drug dealers” and “mafia”. This quote accurately describes the “DSM” article above:
“You cannot expect leading psychiatrists to admit that their career has been a failure and that they have harmed their patients because of their belief in biological psychiatry, which has never produced anything of value for the patients.”
Sounds about right does it not? Thus I use the term Anosognosia advisedly to describe this situation. Using the language of the oppressor to accurately describe them.
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Trash. Obviously.
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I think the real issue is overcoming our culture’s mistaken idea that emotional problems have to be pathologized and categorized as illness in order to qualify for payment.
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RIchard, thanks for reading every word. Did I tax your patience?
Regarding inflammation and Bipolar diagnosis, and I will add misdiagnosis ( long story), I witnessed the failure of the psychiatric system to provide patient education re: the evidence-based-anti-inflammatory lifestyle to reduce episodes of mania. My daughter suffered greatly AND Translational Lag due to conflicts of interest is the most likely reason. We don’t need to wait for a new drug to treat inflammation. We can start “Yesterday” to help patients increase their insight and their skills to improve their health. Some patients will not be able to manage their health on their own but, we can reduce iatrogenic harm and disability rates with functional holistic strategies that will reduce
the dependency on toxic pharmaceutical drugs. I understand the topic is whether to keep the DSM, but we can’t envision a better system until we acknowledge the value of the neglected resources that already exist. The outcome of patients labeled bipolar is perfect example of failure of the system. We need freedom and functional holistic paradigm of care from birth.
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“The current reality is that DSM is with us, that it’s (along with the ICD system) the foundation of how decisions are made about paying for care. That’s key, because those who want the DSM to “just go away” would need to pay cash for all of their care, as would the insured and uninsured among us.”
From first to last, it’s about the bottom line. The DSM is a means of doing bizzness. Its categories aren’t about distinctions in the world based on beauty, like God looking on creation’s goodness, but money, and power to make money off people’s misery. Medicine is only ostensibly or secondarily about health care. Medicine monopolizes and commodifies health care to extract profit. People’s actual health is incidental, and if more harm than good results, recalling that the medical industry leads official records of death and injury, then that’s also just the price patients pay for being exploited as customers from cradle to grave.
Those who just do their jobs in this system, or racket, may have the best of intentions, but accepting there is no alternative is to consent to real madness. This world has been reduced to cold calculations of capital where care and compassion and community and all that makes us human and whole are counted as deficits, and we wonder why health and well-being are constantly in decline? The food we eat, the water we dink, the air we breathe, the very basis of life cries for healing from abuse and trauma of so-called civilization. We’re captive to toxic relations, physically and psychologically, but we are to be kept looking to build a better prison by medicine marketing disease in categories masking social causes, just to treat symptoms with more poisons pumped into us by drug pushers of the Pharmafia, if only to prove to be cures worse than disease.
This hardly does justice to the injustice taken for granted as just the way things are. But until we begin to revolutionize society on a different basis than profit and power over people, things just aren’t going to get better.
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The quoted statement is untrue. “Billing codes” are some sort of arbitrary add-on to the medical insurance game; they aren’t needed. You could do well enough with just one code: “Doctor visit.”
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“So-called civilization”
This guy gets it. When the British colonized the world and forced their culture on everyone, they saw themselves as “civilizing” the “savages”.
But modern western life seems closer to “savage” than “civilized”. Cities with millions of people packed into a few square miles, in an overdeveloped hellhole full of strangers in a dog eat dog game to see who can extract the most wealth from everyone around them? I don’t understand how anyone thinks people can or should live that way.
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I think a closer look would discover that “the British” never colonized anything. A loose group which I call “Corporate” worked through a series of countries and monarchs, including Holland, Portugal, Spain, France and Great Britain to find resources for their enterprises, including slaves. They also worked through the Catholic Church, which was sort of embedded in old European society.
Their propaganda was always that the countries they invaded were “primitive.” I think, though, that besides their financial and political goals, they also sought to disable the spiritual practices of Africa, India, Asia and the Americas and replace them with “safer” practices (which were Catholic up until rather recent times.) I think they could appreciate the sophistication of the peoples they conquered, but were afraid of it. They thought they had conquered magic with their technologies, but they found it in all these places, so tried to conquer those places and so suppress their magic.
I have visited several “big cities” and many parts of them aren’t that bad. They contain many neighborhoods where people are friendly with each other and don’t feel that crowded. There are places where there is terrible crowding and poverty. But I think the big problem with cities is that most of them were built by Corporate for their own purposes. And Corporate attracts Big Crime, which can turn a city into a hell hole.
The time of large factories, with cities to hold all their workers, is coming to an end. And so the role of cities is changing. The role of Corporate in cities has changed, and Big Crime has also adapted. But I think it’s nice to have all sorts of shops just a few blocks away, so I don’t have to spend loads of time and energy just to get food and clothes. Most people are sort of stupid about cities, though. Corporate just needed people in their cities as workers. They were never taught how to create communities of people that could enjoy activities together. But some people learned how to do that anyway.
I don’t think many people realize the situation we are in. It’s a very rough universe, and the corporate model dominates it. Corporate runs high-tech police states, and when people get too unruly or difficult, they send them to places like Earth. In these places, we are spiritually restrained, and deprived of spiritual knowledge so that we can’t figure out how to escape. But escape to what? The universe is full of war and suffering, not just Earth. So I say, learn to deal with what we have here on this planet and try to make the best of it. We are actually very fortunate here to have some extremely useful knowledge at our fingertips. But most of us don’t realize this, and many of us suffer for the lack.
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What is the DSM code for prescribing “Electro Shock Therapy”. How much does that pay?
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How about DKWTFETDBPEI as in “Don’t Know What The Fuck Else To Do Because Psychiatry Equals Idiocy?
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