We need to talk about the DSM

[ArabellaScott]

The DSM is effectively used as the 'bible' for treating mental health issues.

I'd.always assumed it was a compendium based on masses of rigorous research and represented the settled consensus of the whole corpus of medics, psychologists, psychiatrists, etc.

This man claims that it is effectively the consensus of a tiny group of people and based often on little or no research at all.

This seems a very important watch, for all sorts of reasons.

The presenter mentions one disorder in particular ' self defeating disorder' that was argued was liable to be used against women victims of dv.

Also touches on the explosion of diagnoses of autism.

And gender issues are implicated.

I urge a watch:

The DSM:

https://www.psychiatry.org/psychiatrists/practice/dsm

I do not consider the DSM as the "bible". It is heavily used by American psychiatrists . Most psychiatrists in the UK, in my experience at any rate, including myself, use the ICD, now on edition 11. I do consider the DSM to be deeply flawed. ICD isn't perfect.

Yes, I watched this the other week, and posted it somewhere.

How the hell does this all get sorted out?

Having said that, in clinical work many prefer not to use a coding system but to be more holistic. In medico-legal contexts it is often required.

Yes, the DSM criteria were quoted in the court case about the girl being treated by Gender GP.

Thanks for clarification re UK clinical usage - I've seen the DSM talked about so often, and wasn't even aware of the ICD until a couple if years ago.

I find it worrying that so much of psychiatry is basically made up.

I guess the best case scenario is that it’s made up of techniques or drugs people have shown can help in extreme situations which are causing significant dysfunction, but it’s very different from most branches of physical medicine.

I was shocked to discover, when I experienced a number of unusual neurological symptoms to discover that two thirds of people presenting with neurological problems are not diagnosed.

Obviously the brain and its function is very poorly understood.

I noted the best case scenario before. Obviously we’re currently witnessing the worst case scenario, where a charlatan introduced a dubious physical treatment for an obvious mental health disorder (delusion or confusion about reality) and then others have run with it, including still delusional patients (as the aim was no longer to cure the delusion, but rather had the theory that it was easier to bow to it than fix it) to the point where thousands of children have been harmed.

And yes, I’d assumed there was a lot more rigour involved and that the NHS in particular, wouldn’t fall into the trap of using unevidenced protocols. All this has come as a shock to me.

Same, Prion.

When I originally trained in psychiatry, in London in the late 1980s/early 1990s we were very much taught to use the ICD as our primary classification system. Of course we maintain an awareness of the DSM and its evolution. ICD-11 came into force last year, fot most of my career it had been ICD-10. I am still getting used to 11!

I would (of course!) disagree that most of psychiatry is "made up". I would agree that uncertainties and interpretation remain at the heart of many aspects of it, but not that it is made up. Good psychiatrists work holistically, aware that they are not surgeons, can't see the damage on a scan or x-ray and have to rely on much more complex detection instruments, many within our own minds.

By that I do not mean for one minute that un evidenced treatment and lack of scientific rigour can ever be defended.

Do you have any thoughts about how the cohort of people who go into psychiatry, or into the more broader counselling world, has changed over the time of your involvement theDudesmummy?

I'm wondering about the arrival of the activists.

I'm just recalling hearing about psychiatrists in that era (90s) having to 'cure' themselves of homosexuality before being allowed to practise.

It was only around about, what, early 2000s that this changed, no?

The psychiatric profession and people who go into counselling are two very very different groups of people. I cant say much about counsellors apart from the fact that you need no qualifications or experience whatsoever to put yourself out there with that label, it is not a protected description, so they are no one type of person and as you can imagine there is a pretty wild west element to some of what goes on...

Psychiatrists come in all flavours of course, and my experience is solely the north London psychiatric circles, but my direct colleagues have tended to be overtly centre left, politically outspoken, although many are surprisingly "socially conservative" in their quite conformist private lives. Some socialists among us of course. And some colourful figures.

I would see some of the Tavi people as a very different group from the people I know and work with. I can't speak for everyone, but those colleagues of mine that I know well enough to know this about them are all terven. (I won't say exactly where and in what field I work as this would be incredibly outing).

Thanks!

@ArabellaScott that was not still the case in my era and I trained with a large number of out gay men. But as I say, north London so not necessarily representative if everywhere.

*of everywhere

That's an interesting question. I wonder how many activists originally came from inside professions versus all the activists from outside (Stonewall, Gendered Intelligence)? Despite their lack of credibility / professional knowledge they were given a free pass (sacred caste reasons) to impose their disordered beliefs on institutions with no challenge allowed (transphobic to challenge).
Which would (if that's right) allow some reflection about how to stop the next lot of flat earthers from influencing society to this extent.

I mention homosexuality because I wonder if the relatively recent structural homophobia within psychiatry has had a resulting backlash in the form of genderism.

https://www.researchgate.net/publication/12686135_British_Psychiatry_and_Homosexuality

I don't think the scandal of experimental treatment for gender distressed children is evidence that activists have changed the profession. Psychiatry has a long history of implementing unevidenced treatments that cause incredible harm and don't help much, they always involve charismatic, arrogant men and trendy new theories and social movements.
The one that I often think about in relation to the current crisis is Deep Sleep Therapy, which was practiced by psychiatrists at a private psychiatric hospital in Sydney.
https://en.wikipedia.org/wiki/Deep_sleep_therapy
The nurse whistleblower had to rely on the help of two journalists who were scientologists, and therefore very suspicious of all psychiatry. I think of that when women's rights activists are slandered for "being in bed with the right" in their efforts to stop the butchering of children. Scientologists are properly dodgy, in my opinion, and their reasons for not trusting psychiatrists are, again imo, unsound. But by working with them the whistleblower saved people's lives.

That post sounds like I think psychiatry /only/ implements unevidenced treatments that cause harm. I don't, I don't even know if it's more error prone than other areas of medicine.
But I've worked as a psychiatric nurse, and been a psychiatric patient, so I know more about it's downsides.

https://www.who.int/news/item/11-02-2022-icd-11-2022-release

The ICD.

I'd be interested to know if any psychiatrists here think the ICD 11 provides a better diagnostic frame for whatever it is that's going on when kids (or adults, I guess) say they're trans?

"ICD-11 has redefined gender identity-related health, replacing outdated diagnostic categories like ICD-10’s “transsexualism” and “gender identity disorder of children” with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” respectively. Gender incongruence has been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. "
Both WHO and APA endorese WPATH, I think? They both seem just as captured as eachother to me but I'm happy to be corrected.

I've posted this video twice in recent weeks.

It's becoming clear that that the DSM is nothing more than a handbook put together by a number of (mainly male) psychiatrists off the top of their heads, with all of them competing to create new and more niche classifications — and none of them based on real physiological science.

I can't watch it all right now but does James Davies mention gender at all in the talk? I've read Cracked (it's a decade old at least, pre a lot of people's awareness of the current iteration of trans rights) and although gender medicine isn't mentioned, it's impossible not to think of it in parallel all the way through. Highly recommend.

Only 'transsexual' as a diagnosis.

I've been told this morning that the video is several years old, though.