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Saturday, Apr. 30, 2016

The new DSM and what it means to you

Friday, March 16, 2012

I have been a critic of psychiatry for many years because I see it as a pseudo-science rather than a science and the new DSM 5 doesn't do anything to allay those concerns. The DSM is short for Diagnostic and Statistical Manual of Mental Disorders and the first edition was printed in 1952. The first edition relied largely on the experiences of service members who had returned from World War II. That was followed by DSM II in 1968, DSM III in 1980, DSM IV in 2000 and DSM V, scheduled to be published next year. Long before the first DSM was published, 22 psychiatric diagnoses were listed in a 1917 manual. 350 were listed in the latest DSM and that number is expected to increase significantly with the DSM V, although the hundreds of psychologists and psychiatrists contributing to the book were required to sign nondisclosure agreements which prevent them from revealing any text before it is published in May of 2013.

It is believed the new manual will make binge eating a formal diagnosis with an imprecise, almost laughable definition: "eating an amount of food that is definitely larger than most people would eat." They're also considering formal diagnoses for Internet addiction and sex addiction.

Despite all the furor surrounding the new publication, the DSM 5 will almost certainly help APA (American Psychiatric Association) members bill insurance companies for more conditions and I suspect that is the driving force behind it to begin with because in America in 2012, regardless of the subject, all you have to do is follow the money.

Although I know it's hard for many of my readers to accept, I'm pretty old-school in many ways and that has to do with being a child in the '50s and '60s. When a child misbehaved at home or at school, they were punished and the behavior was extinguished. Then psychiatry developed the diagnosis of Attention Deficit Disorder (ADD), developed Ritalin to "calm" the disorder and overnight, redefined the trouble-makers as victims. My former wife told me a couple of years ago that over three fourths of the 5 year olds in her kindergarten class were on regular doses of Ritalin as a result of their ADD diagnosis.

Psychology is responsible for the new trend of giving every participant in an athletic event a participation medal so that the losers won't get their feelings hurt. When I was in school, you got to graduate twice; once from high school and once from college. Now we have kindergarten graduation, grade school graduation and junior high graduation so the children can experience completing a goal early on. That "accomplishment" is then expected to empower them to complete other goals as they trudge through life.

But the most overpowering evidence of pseudo-science takes place in criminal trials across the country when a defendant pleads not guilty by reason of insanity. During trial, the prosecutor calls one or more psychiatrists who testify that the defendant is sane while the defense attorney calls one or more psychiatrists to testify that the defendant is insane. That's simply art posing as science. Science yields quantifiable results which have to be verified in replicated studies before the theory is accepted as fact. In the trial scenario, you have just the opposite result.

Thomas Szasz, a psychiatrist, authored a book in 1960 called "The Myth of Mental Illness" that has since become a classic for those who question the scientific validity of psychiatry and psychology.

He claimed that the only kind of mental illness a person could have would be the result of a neurological malady that would be clearly observable to any scientist that looked. Any other condition that didn't have a physical cause was nothing more than "problems in living" as he put it.

People are insecure about many things and those insecurities cause some people to act away from the norm as a way of compensating for their shortcomings. We're insecure about our status or our income or our education or our social skills and so some of us overeat, overindulge in alcohol or drugs, gamble excessively, brag to others constantly about the achievements they accomplished once upon a time, and many other coping mechanisms that sometimes help them get through the day but just as often, make their situations even worse.

This is what Szasz called problems in living; it's what the DSM V will call a mental illness.


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That's the best article I have ever read on mental illness, Mike!

In the "Road Less Traveled" by M Scott Peck, MD he talks about mental illness from the perspective of a practicing psychiatrist.

He states, "This tendency to avoid problems and the emotional suffering inherent in them is the primary basis of all human mental illness."

Thank you for the great article, Mike.

-- Posted by JohnGalt1968 on Fri, Mar 16, 2012, at 9:32 PM

Mike,

I find it odd that you have such hatred for a "pseudo-science" since you are yourself a teacher of yet another. I agree with you that it is not a "hard" science but the disdain you have for a discipline so closely associated with your own is surprising.

Also, your coup de grace, criminal insanity defense, is weak at best. Sociologists and Criminologists (isn't that what you are?) tell us that less than 1% of defendants try such a plea and of those less than 1% are successful. If it is the most overpowering evidence, it is rather underwhelming in my opinion if it works .001% of the time.

-- Posted by SWNebr Transplant on Sat, Mar 17, 2012, at 6:11 PM

Mike,

Good job at perpetuating myths and reinforcing stereotypes! Always nice to see an open mind. I have not seen the criteria for a diagnosis for "binge eating", but I somehow doubt that it will be its own diagnosis. It sounds to me that you are once again talking about something you understand imperfectly, if at all. Again, I don't know, but I would imagine 'binge eating' would be more along the lines of a symptom than a diagnosis. Sorta like these criteria for Narcissitic personality disorder.

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

2.Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

3.Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

4.Requires excessive admiration

5.Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

6.Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

7.Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

8.Is often envious of others or believes others are envious of him or her

9.Shows arrogant, haughty behaviors or attitudes

See, none of those are its own diagnosis, just a criteria. I would imagine that your, "eating an amount of food that is definitely larger than most people would eat" would fall more under a criteria rather than a formal diagnosis. But what do I know? Feel free to spout off about things that you are wrong about. I am sure folks will agree with you. Of course, some of us actually know what you are attempting to pontificate about and can point out the hooey.

-- Posted by Sir Didymus on Sun, Mar 18, 2012, at 3:00 AM

I am always intriqued by insults disguised as psuedo intelligent replies. It might surprise some but written words can be proved as truth or untruth....actually pretty easy to do. I do understand that because of the wall of privacy created by usernames it is much easier to insult or be mean but isn't it perhaps a bit more ethical to research the subject then comment on it? I don't always agree with Mike's articles but I am intelligent enough to research what he writes and appreciate the fact he doesn't think like "everyone" else. Oh I also pay close attention to the word "Opinion".

-- Posted by codeeber on Mon, Mar 19, 2012, at 9:22 PM

codeeber,

You are correct, I should have researched it more. However, after doing so Mike is still being misleading, if not wrong. I was suprised that it would be called Binge Eating Disorder. But, in the spirit of fairness, here are the possible proposed criteria for Binge Eating Disorder that maybe could be in the DSM V slated to be released in May of 2013.

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

1. eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

2. a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)

B. The binge-eating episodes are associated with three (or more) of the following:

1. eating much more rapidly than normal

2. eating until feeling uncomfortably full

3. eating large amounts of food when not feeling physically hungry

4. eating alone because of feeling embarrassed by how much one is eating

5. feeling disgusted with oneself, depressed, or very guilty afterwards

C. Marked distress regarding binge eating is present.

D. The binge eating occurs, on average, at least once a week for three months.

E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

As you can see, there are some critical parts left out if Mike's criteria for a diagnosis. Forgive me for wishing for honesty when presenting "facts", even in opinion.

P.S.

By the way, I wasn't trying to disguise my insults at all. I was trying to shed some light. Any insults I laid out were totally transparent. I do applaud your use of your own veiled insult while rebuking for diguised insults. It made me smile.

-- Posted by Sir Didymus on Mon, Mar 19, 2012, at 10:46 PM

This article is on target because this is not the first time DSM will have caused a problem in America.

The following comes from a highly experienced psychiatrist:

A prime example of the damage DSM can cause is the 'false epidemic' of Bipolar in Children after DSM-IV expanded Bipolar categories and criteria.

This lead to a 4000% (yes, forty times) increase in diagnosis of bipolar disease in America. Many of these children were misdiagnosed based on the presence of volatile and aggressive behaviors.

It is one reason why the former Chief of DSM-IV is one of the prominent people warning about DSM-V.

For the particular area of DSM-IV misdiagnosis of "Bipolar NOS" in children, there is a new book (and website) that addresses the issue called "Hope for the Violently Aggressive Child." What the author reveals is sometimes there was no mental illness at all; that the patient had a physiological issue called "immature adrenaline system activity" which could be treated with simple, adrenaline acting drugs.

DSM-V does not overtly state that Bipolar NOS was a mistake, it simply relabels it. Meanwhile, there is a section of the population that need this more accurate and effective treatment.

This dramatic epidemic of Bipolar did not occur in other countries. They do not use DSM.

Help spread this important information please!

-- Posted by WDHommel on Tue, Mar 20, 2012, at 6:50 PM


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Mike Hendricks
Mike at Night