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:

https://www.nbcnews.com/nbc-out/out-health-and-wellness/homosexuality-psychiatry-dsm-disorder-rcna146579

This history could be very relevant to contemporary discussions of conversion therapy.

From the article above:

'Kunzel is among those who look at homosexuality’s decadeslong evolution in the DSM and see at least a partial parallel to the more recent effort to depathologize transgender identities.
“Transsexualism” first entered the manual in 1980, enraging many trans activists for, they argued, turning their identity into a sickness. This was replaced in 1994 by “gender identity disorder” — an effort by the APA to mitigate stigma that nevertheless left many trans people unappeased. Then, in 2013, that diagnosis was replaced by the current “gender dysphoria,” which distances the source of distress from the core sense of self and attributes it more to society’s stigma toward gender nonconformity.
Today, there is sustained pressure on the APA to discard the gender dysphoria diagnosis and, just as with gay and lesbian people, totally depathologize trans people in the eyes of psychiatry. However, because receiving hormones and transition-related surgeries is key for many trans people to fully realize their identities, and given that insurance companies require a diagnosis to cover such treatment, a tension remains that may prove irreconcilable.
Levounis, the current APA president, declined to take a position on what should become of the gender dysphoria diagnosis.
“It’s a very active debate within our field,” Levounis said. “Unlike other discussions within the APA of yesteryear, we do involve a lot of lived experience in our work — people who are transgender,” including psychiatrists and nonpsychiatrists alike, “who do help inform us in these discussions.”
Hartmann said the effort to depathologize homosexuality has “a mixed relevance to the present, very lively and argumentative field” of gender identity — one in which he hopes to see further research that will yield clearer insights.'

A prime motivator behind the DSM is the monetised American healthcare system, where it provides "billable" codes for accounting purposes. I am deeply suspicious of it.

I am starting to quite like the ICD-11 the more I use it, although (self-) teaching this old dog new tricks didn't come easy. The seismic change in the classification of personality disorders is particularly tricky. The full, searchable ICD-11 is available as a tool from the WHO here:
ICD-11 for Mortality and Morbidity Statistics (who.int)

I have a number of grey hairs named after various psychiatrists at work... but let's not go there!

Interesting that paraphilias are an exclusion for 'gender incongruence'.

I wonder if this is the reason some transwomen are refused a GRC.

In terms of diagnostic criteria for gender dysphoria/incongruence in children, there seems to be very little difference between the two.

ICD-11
https://icd.who.int/browse/2024-01/mms/en#344733949
Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender; and make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The incongruence must have persisted for about 2 years. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

DSM-5
https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria
The DSM-5-TR defines gender dysphoria in children as a marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least 6 months, as manifested by at least six of the following (one of which must be the first criterion):

• A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender)
• In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing
• A strong preference for cross-gender roles in make-believe play or fantasy play
• A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
• A strong preference for playmates of the other gender
• In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities
• A strong dislike of one’s sexual anatomy
• A strong desire for the physical sex characteristics that match one’s experienced gender

As with the diagnostic criteria for adolescents and adults, the condition must also be associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

There seem to be only a couple of small differences between the two. One is that the ICD says that for a diagnosis of gender incongruence there must be some dislike of their sex characteristics or desire for those of the opposite sex, but the DSM implies that this doesn't need to be present, so a diagnosis could just be based on behaviours. Another is that the DSM criteria say that that there must be clinically significant distress or impairment in functioning, while these aspects don't seem to be required under the ICD criteria.

Also the ICD have reclassified this as a sexual disorder not a mental disorder.

Psychiatry sits on very shaky foundations, especially where women are concerned. It’s been lovely to read your posts!

Psychiatry and psychoanalysis have plenty of shameful history where women (and gay people) are concerned, of course. But it obviously not the only branch of medicine which has fucked up terribly over the centuries (and acted according to shaky or even fictional foundations), acting in many cases as a pretty much armed wings of the patriarchy.

Part of my current job involves speaking to women who have had traumatic experiences in childbirth related to alleged malpractice and negligence. In cases of terrible practice in gynaecology and obstetrics the whiff of misogyny is very often not far away.

I have some concerns about the presenter in the video, Dr James Davies

Clearly, from the video it is evident that Dr Davies holds some critical opinions in relation to psychiatry and metal health services. I agree with him on many issues.

Dr James Davies is part of a group of academics specialising in mental health issues, many operating out of the University of Roehampton. He is also a founder of the Critical Psychiatry Network (CPN)

Davies’s profile at the CPN here
<a class="break-all" href="https://web.archive.org/web/20140717044329/cepuk.org/members/" rel="nofollow" target="_blank">https://web.archive.org/web/20140717044329/cepuk.org/members/

I agree with Dr Davies that there are multiple serious problems with the DSM (I am especially concerned about dissociative disorders) and I agree that over-medication and misdiagnosis are rife. However I do not believe that Davies is offering any kind of solution. He and his associates at Roehampton are not going to make the current Orwellian situation any better.

On the contrary, anyone seeking support from the Critical Psychiatry Network (in my opinion a politically revolutionary organisation), especially if oppressed by the extremes of woke culture, is likely to find themselves transported from the jaws of the lion into the jaws of the crocodile.

For anyone disbelieving that the CPN is a revolutionary organisation here’s a link to start your journey of discovery, if you feel so inclined

<a class="break-all" href="https://web.archive.org/web/20240506103806/www.criticalpsychiatry.co.uk/news/dialektikon-event-12th-february/" rel="nofollow" target="_blank">https://web.archive.org/web/20240506103806/www.criticalpsychiatry.co.uk/news/dialektikon-event-12th-february/

This is the event it is advertising

Dr Davies’s is significantly involved in the APPG Beyond Pills which is evidenced below in the speech “Beyond Pills: UK Parliament Must Support Social and Psychological Services Instead”

Anyone interested can read the speech here on the Mad In America ( a “mad pride” website);
<a class="break-all" href="https://web.archive.org/web/20240505122510/www.madinamerica.com/2023/12/beyond-pills-uk-parliament-must-support-social-and-psychological-services-instead/" rel="nofollow" target="_blank">https://web.archive.org/web/20240505122510/www.madinamerica.com/2023/12/beyond-pills-uk-parliament-must-support-social-and-psychological-services-instead/

Not everyone is happy about the Beyond Pills APPG, in fact the group is extremely controversial and it’s founders include Dr Michael Dixon

For those who don’t know Dr Dixon is a notorious promoter of quackery and pseudoscience within the NHS

Some links of interest re Dr Dixon
https://www.quackometer.net/blog/?s=dr+michael+dixon The Quackometer
https://edzardernst.com/?s=dr+Michael+dixon Prof Edzard Ernst’s blog

Professor Ernst has something to say about the Beyond Pills APPG of which Michael Dixon and Dr James Davies are prominent members. I have reproduced Prof Ernst’s letter below, with permission;
Dear ‘BEYOND PILLS All Parliamentary Group‘please let me begin by stating that I am all in favour of reducing over-prescribing. Who isn’t? The clue is in the name ‘over– prescribing’! Yet, at the same time, I would like to alert you to the fact that your group’s name ‘beyond pills‘ is of questionable merit.It implies that conventional medicine consits only or predominantly of prescribing pills. My own career as a clinician – long ago now – was in physical medicine and rehabilitation, a discipline that certainly does not rely on pills. Many other areas of healthcare also do not exclusively rely on pills; take surgery or psychosomatic medicine, for instance. As for the rest of the physicians, they will, no doubt, have learnt in medical school that over-prescribing is wrong, dangerous, and not evidence-based.By putting ‘beyond pills’ on your banner, you either disclose your ignorance of the facts, or you deliberately undermine trust in conventional medicine. Some less benevolent than I might even get the impression that you employ the ‘strawman fallacy‘ in order to push a hidden agenda.I hope these lines might motivate you to reconsider and alter the irresponsible name of your initiative – how about ‘evidence-based medicine’?SincerelyEdzard Ernst

Source:
https://edzardernst.com/2023/12/my-open-letter-to-the-new-beyond-pills-all-parliamentary-group-in-westminster/

About Prof Edzard Ernst (he is one of the most renowned anti-quackery activists in the world)
https://edzardernst.com/about/

As a former mental health professional with a commitment towards anti-racism, diversity and equality I first encountered many of these academics on a professional basis, when I, to some extent, shared their utopian dream and before the Orwellian nightmare it really is became apparent to me.

In my professional training in mental health I was introduced to the theories of Marx, Foucault, Marcuse and Fanon alongside the psychoanalytic literature I had paid to learn.

In the light of our new dystopian world I am much more sceptical and nuanced in my perspective.

I just would like to suggest caution really. So much more to share but no time

Take care everyone

More complete reply after watching the video, but the ‘self defeating [personality] disorder' was a proposed personality disorder in 1980 that was never included in the DSM, ever.

I didn’t have the time to watch the video. Dr Davies is a social anthropologist though, he has no psychiatric or psychological credentials.

Reminds me of a friend, also a Dr in social anthropology, who told me my morning sickness was ‘all in my head’ and going on about other cultures where pregnant women don’t get morning sickness, even one where allegedly only the father got it. She firmly believed morning sickness was “made up” until she got pregnant and had it! 😜

James Davies is a member of the psychology department and the anthropology subject area. He obtained his doctorate in social anthropology from the University of Oxford, and is also a qualified psychotherapist. He has practiced in various settings including the NHS (Oxford).

<a class="break-all" href="https://web.archive.org/web/20160525222840/www.roehampton.ac.uk/staff/James-Davies/" rel="nofollow" target="_blank">https://web.archive.org/web/20160525222840/www.roehampton.ac.uk/staff/James-Davies/

You can become a psychotherapist with a degree in social work, or social anthropology. You don’t have to have a single degree qualification in psychology or psychiatry. That’s why most psychotherapists stick to marriage counselling, they can’t diagnose any mental illness or prescribe any medications, HTH.

Yup, all these labels are social constructs created by a small bunch of white male psychiatrists in the US. The DSM is hugely influential including to the ICD, and it helps it is given out free as sweeties by the drug companies. Dr Davies also does an excellent presentation on ADHD and the most prolific researcher into the diagnosis, a psychiatrist who has been payed millions by the drug companies to fund his research. What better way to make money that get kids diagnosed with a life long condition that needs medicating, ensure it's pushed on all the algorithms on social media and kerching, a lifetime of lucrative income! Someone get me some shares in big pharma!

You can become a psychotherapist by buying a business card with your name on it saying "psychotherapist". It is not a protected title, as I'm sure you are aware. Anyone and their dog can set up in business as a psychotherapist and nobody can stop them. People can, and do, set up their own accrediting bodies, sadly it happens all the time.

I did not criticise Davies's clinical practice or lack thereof as I have no idea about it and it does not concern me, I am concerned about his involvement in various organisations that seek to influence public policy re mental health services. He uses his identity as a psychotherapist working within the Psychology dept of the University of Roehampton (a mental health professional surely?) to give credence to his arguments

The organisation he co-founded, the CPN and allied organisations and institutions are influencing NHS policy via APPGs and other activities and their influence affects some of the most vulnerable people in our society.

As a result we see mental health services that are at best inadequate and at their worst risk radicalising vulnerable people.

Of course academics are entitled to believe whatever they like.

They are free to believe that auditory hallucinations are evidence of repressed memories, that body psychotherapy will bring about a glorious revolution, they can enthuse about Marx, Hegel, Marcuse, Gabor Mate, Stan Grof, Peter Levine, Wim Hoff, whatever I respect people’s right to have their own opinions.

I strongly object to the bait and switch in which academics and mental health professionals (whether involved in clinical work or in policy formation) claim to provide support and care to mentally ill people while instead providing recruitment into political radicalisation.

The US drug companies are absolutely complicit in pushing mental health diagnoses that "require" their medications. Of course, many physical diseases are not treated on prescriptions alone. For example, If we successfully treat diabetes through preventative and holistic treatments, this reduces meds needed, but we still need some medication for diabetics who can't manage their condition with food and exercise alone. However, we don't give insulin to someone without a positive diabetes marker, do we? Yet, in mental health, diagnoses is not based on an objective biological marker, instead, it's dependent on the patient's description of their symptoms and the doctor's interpretation and observation. That's not sound scientific data capture.

On another note, Peter Boghossian commented recently that only half of all psychology academic research can be replicated. That's pretty damning. He's in the US, so I don't know if he meant American research only, but still, that would be a very high number regardless.

Thanks for the different perspectives, all. I imagined it would be a complex and contested area.

I suppose there's all the anti-psychiatry of RD Laing, etc, though it's not an area I know much about.

It is online for free. No one uses the hard copy, and hasnt for donkeys years.

This article, which is an excerpt from a book, came out 3 weeks ago and is very much related to the op.

I have bolded the relevant points but the whole article is well worth a read.

:

"And I co-opted the language of medical professionals who treated me. “Mental illness can happen to any of us,” I wrote in Vice in 2014, “like a cold or a cancer.” I broadcast messages I’d been told were facts: the root cause of mental illnesses are biological abnormalities in the brain; mental illnesses are illnesses like any other.

....

The turning point came a few months before filming, when I visited Trinity College Dublin to interview neuroscientist Prof Claire Gillan for a mental health charity podcast. Gillan was studying feelings and behaviours across a variety of psychiatric diagnoses. I was accustomed to softball media engagements about fighting stigma, and expected more of the same. I asked what she had discovered.

“OCD is not a biological reality,” Gillan said, very matter of factly. “That’s what the data increasingly shows.”

A lump rose in my throat. I fumbled for a response. Hadn’t researchers proved that OCD brains are different biologically? (Some neuroimaging studies show increased activity in various cortices.) “Abnormalities in these regions are by no means exclusive to OCD,” Gillan said. “A great many disorders show the same kinds of brain changes.”
I didn’t know this. I thought my brain shared the same abnormalities as everyone else with OCD and that these were the root causes of our obsessions; that we had brains that were measurably different from the brains of people with, say, ADHD or anorexia. I thought this was the definition of “official” diagnosis. Gillan explained that, on the contrary, psychiatric diagnoses are not based on biomarkers, they are subjective constructs.

I felt torn with nerves for the rest of the interview. I wanted to dismiss what I’d heard, and yet felt compelled to learn more. Afterwards, I started reading, and was incredulous to discover innumerable similar assessments. Apparently, Prof Allen Frances, who literally wrote the book on diagnosis as the lead editor of the fourth edition of the Diagnostic Statistical Manual of Mental Disorders (the handbook widely used by doctors), had said psychiatric diagnosis was “bullshit”. As he told Wired magazinee* in 2010, “These concepts are virtually impossible to define precisely with bright lines at the boundaries.”

Article would help!

https://www.theguardian.com/society/2024/apr/13/i-was-the-poster-girl-for-ocd-then-i-began-to-question-everything-id-been-told-about-mental-illness?CMP=ShareiOSAppp_Other

I know a journalist working on the dangers of mental health self-diagnosis in young adults who then demand 'official' DSM diagnoses from practitioners and whether practitioners are in error of not putting in enough guardrails at initial visits, so thanks to all posting here...I'm funneling her the discussion.

Or, or, there are no biological realities that we can measure with todays medical science

In ye olde days we couldn’t see microscopic lifeforms- bacteria, viruses, prions, even certain parasites. So doctors said certain symptoms were caused by an imbalance in the humours or a volcanic eruption or sinfulness.

truly

More recently, we thought eating processed foods led to stomach ulcers and cancer..we didn’t know a virus could cause stomach cancer at all. We also didn’t know genital warts were linked to cervical cancer. HPV wasn’t known as a “bio marker” to test for cervical cancers. It was just an annoying, but harmless STI.

Just because we have no test for it, and we don’t know what we are looking for, and it even might be under our nose like HPV was, it doesnt mean there are no bio markers for mental illnesses.

Give it time.