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:

Thanks so much for posting the Schmitt lecture @Bosky !

I saw that years ago- before even being aware the GI issue- as I came to it through looking at approaches to trauma and therapy.

I don't know if I would have even able to re-find it, so I'm so grateful.

Watching it again now, I am struck by two worlds of interest colliding- and perhaps how I had an immediate dis-ease and questioning of the narrative around, and approach re gender stuff when I first became aware of it.

So fascinating to watch this again in the light of current events!

The ethics section from about the 40 minute mark
(Max Weber: Ethics of responsibility and Ethics of conviction) is particularly worth watching for its relevance in what we see playing out right now if anyone doesn't want to watch the whole thing (though I recommend you do if you can!)

Really interesting talk thanks for linking.

It explains a lot especially the rapid growth of ASD, ADHD, and transgenderism. Also makes sense how certain diagnoses can become fashionable and others fall out of fashion. At least with ASD they've not gone down the route of medicating those children (afaik) yet, but the meds that they push onto those diagnosed with ADHD or transgenderism is shocking for conditions with no biological or scientific basis.

I have many so-called ASD traits plus anxiety plus I was so dysfunctional as a teen and well into my twenties, it makes me shudder to think what they would have plied me with if I was a youth of today. I used to feel frustrated that my father never sent me for counselling as a child but actually I now feel that I might have dodged a bullet!

None of this is incompatible with there also being real mental illness.

All of these things are pointing out problems with how we define a lot of what we call mental illness, how we decide what kinds of symptoms go together, what we think their origins are or why they manifest in a certain way, how we determine the line between normal and abnormal, and then also looking at the influence of environmental pressures, iatrogenic symptoms, and pressures from industry.

With a lot of these diseases there aren't even very solid diagnostic criteria.

It's also not really controversial that most psychiatric disorders, the named ones that you find in the DSM, are culture specific. Which raises a lot of questions about how we think of them in terms of a diagnosis or disease history.

Excellent article on Twitter - a clinical look at 'gender dysphoria'.

https://x.com/Psychgirl211/status/1808825717204922755

That was a good read. Thanks for posting.

I found the suggestion that 'Gender Dysphoria' should be renamed 'Body Anxiety Disorder' and treated like other anxiety disorders logical and convincing.

Yes, she says that gender dysphoria doesn't exist, but this doesn't mean that people aren't distressed, it's just that they're mistaking a symptom for a cause.

...Gender Dysphoria is just a new, false and incredibly dangerous explanation for psychological distress arising from developmental, psychosocial and neurobiological conditions that mental health professionals have known about and which we have successfully treated forever.

I am not saying that people who think they have Gender Dysphoria are not feeling something. Their unhappiness and distress is often real. But this is being ascribed to the wrong cause. A calamitous and ruinous misattribution is being made. Namely that there is a mismatch between a person’s presumed gender identity and their supposedly incongruent physical body. Thus, the ‘born in the wrong body’ trope.

I posit instead that Gender Dysphoria belongs in the family of anxiety disorders and should be renamed ‘Body Anxiety Disorder’ (BAD). Psychologists are well able to treat anxiety disorders through talking therapy and behavioural modification. Treatment for BAD would be no different than standard psychotherapy for, say for depression, or anxiety, or relationship problems.

As soon as you say that Gender Dysphoria is real, that allows everything else to follow - from medicating children to letting men into women's sports to giving people the ability to legally 'change sex' and all that follows from that. But if we acknowledge that gender dysphoria isn't real and is just a symptom of distress from other causes, the whole house of cards collapses.

Worth noting that dysphoria presents differently by age and sex. 'Gemital dysphoria' in young children strikes a very different chord than 'body dysphoria' in a teenage girl, and very different again in a middle aged man.

Practically speaking I wonder if it would be easier to push for a greater range of diagnoses within the GD umbrella? Or is it better to just point out that the umbrella is a bullshit.construction?

Thank you to all for this fascinating discussion, with so much critical thinking and so many informative links. As online discussions go - heaven!
Thanks especially to theDudesmummy, I really appreciated your posts, knowledge+a sense of humour is a great combo

Maybe keeping things straightforward and simple will be a good idea. There has been so much obfuscation and resistance to discussion about this (no debate and affirmation only) that I believe that making things easy for anyone to understand via simple clear language is needed to cut through all the crap.

We also don't need to accidentally add anything to the 'symptom pool' that can be seized upon and twisted.

It's all very simple in my mind.

1. Mammals cannot change sex.
2. Human Beings are mammals.
3. Having an anxiety disorder requires evidence based help/treatment that will treat/ease the anxiety disorder.
4. Having physical problems can be a cause of depression and anxiety. Therefore, treating someone who has anxiety (but has a healthy body) by damaging their body (potentially making them a lifelong patient, putting them on a path to surgeries with high complication rates, potential sterility, and increasing their chances of developing further medical issues) does not sound logical or helpful in the long term.

We also are becoming more and more aware of the lack of evidence around 'gender affirming healthcare' with each new revelation (Cass, WPATH files, what went on between WPATH and John Hopkins etc).

There might be some (I suspect they are very few in number) people who are helped by extreme body modification. So the question regarding that group then becomes 'how do we identify these people accurately so that no one else is caught up as collateral damage?' We still need proper evidenced based medicine for this possible group because, frankly, 'might be' is not good enough when you are going down a road where you can't reverse what you have done. Those orchidectomies, mastectomies, penectomies, hysterectomies etc are permanent.

That is such a good article,

She also acknowledged the sense in this response from xtwitter user Clive Simpson, I would add one small suggestion: BAD is also the abbreviation for Bipolar Affective Disorder. Would Embodiment Anxiety Disorder work do you think, to avoid confusion?

So - EAD instead of Gender Disphoria ('a venal lie') ? The whole tragic situation has harmed so many young people.

Just copy pasting over what I wrote in response to this (excellent) article over on the Women’s Rights megathread:

That’s a good article, I like it.

Western-Tumblr-Trans has already metastasised tho - many of the young people who now identify as trans aren’t gender stereotype outliers at all - the MtF are gamers and world-of-warcrafters, and the FtM are into make up and fibre arts. Transition (if sex change were actually possible) makes them become GNC, they are overwhelmingly heterosexual (in old money!) so transition makes them into gay transmen or transbians.

It’s arse backwards from phenomenon such as the Fafafine or Kathoey, which starts out with naturally effeminate, homosexual boys and gives them a societal role to fulfil as adults.

Not to say that the western equivalent to Kathoey aren’t being medically transed (eg Jazz Jennings) but as a cohort of former Tavi kids they were the OG main population that rapidly became vastly outnumbered by ROGD girls, and more recently the teen boys who want their mums to call them she/her pronouns while they game crossdressed, but they don’t want to go out in the world in ‘girl mode’ at all.

I vaguely recall Mermaids refuting the idea that the Tavi were ‘transing away the gay’ by pointing out that the majority of the kids they ‘supported’ became gay after transition (or identified as bisexual/pansexual). On first glance it sounds like one
of the two camps must be telling porkies but actually the discrepancy was ex Tavi staff talking about the referrals seen 15-5 years earlier and Mermaids talking about current teens, many of whom were on long NHS wait lists/getting medications from GenderGP and not actually being assessed by the Tavi at all.

Anyway, imo we can’t resolve whatever Gender Dysphoria currently is solely by finding a better societal model for GNC kids (although we still should do that!) because the majority of the current crop of Transitioners were never GNC kids to start with, they are older males from Malaga Airport and teens experiencing a new culture bound disorder (that is disguised as an existing one).

There might be some (I suspect they are very few in number) people who are helped by extreme body modification. So the question regarding that group then becomes 'how do we identify these people accurately so that no one else is caught up as collateral damage?'

Perhaps controversial but I suspect that as it’s unlikely to ever become truly evidenced based medicine, reclassification away from medical treatment into extreme body modification would probably help enormously.

Limit it to over 18s (I’d prefer 25 but 18 is adult in most places!) and make it entirely self funded (like tattoos and tongue splitting are!) and it’ll end up in the same sort of zone as giant breast implants - most doctors won’t touch it with a barge pole if medical insurance/public health schemes won’t fund it.

A very small number of vulnerable people will still end up negatively affected but you’ll need a job and time to save up/build a credit record to fund it, so that will automatically rule out a lot of the most vulnerable.

Not retconning historical documents like birth certs and making any legal protections based on gender nonconformity (eg no sex differentiated hairstyle rules in the workplace) or belief/religion would probably help with getting society back in the reality zone/not enabling self harm while still allowing adults as much autonomy as possible.

Perhaps controversial but I suspect that as it’s unlikely to ever become truly evidenced based medicine, reclassification away from medical treatment into extreme body modification would probably help enormously.

This is exactly where it should belong. We know of the people who do extreme surgeries to look like a Barbie or an elf but it's not covered under medical necessity logic. Excessive tattoos and piercings, which I don't see as harmful outside minor risks like needle infection or lack of wide job prospects, are paid for by the person who wants them. Bodily modifications under the idea of trans should be the same- the adult is paying for these body modifications/hormones/dugs and if it's highly regulated, the risks should be clearly laid out. Maybe a requirement for some kind of recovery insurance should be mandatory for the person so NHS, collective insurance pool, taxes, etc. shouldn't be paying for an adult's lifelong urinary care due to complications of a gender surgery.

I also wonder if hormone and other 'gender-affirming medication' shouldn't be considered medication, it should be off-label drugs that aren't criminalized, but not prescribed due to medical reasons. If there's a risk of a physician being liable, that would decrease the use as well, I imagine.

'... they are overwhelmingly heterosexual (in old money!) so transition makes them into gay transmen or transbians.'

This is where sissy porn and yoai/slash fiction play their parts.

It explains a lot especially the rapid growth of ASD, ADHD

No, it really doesn’t. Neurodivergence has always existed, only in the past people were labelled with things like thick, lazy, problem-children, bone-idle, weirdos, oddballs and freaks. Would you prefer we go back to that?

Long and interesting article on the DSM and discussion of whether rape should be classed as a paraphilia.

https://www.tandfonline.com/doi/full/10.1080/09612025.2023.2197792

My DD, suffering dreadfully and suicidal with PMDD, was told firmly by a male psychiatrist that hormones had no effect on mood, and that this was the “feminist” position. He diagnosed her as bipolar and put her on lithium. She also asked me to attend her appointments with her because of his habit of staring at her breasts while speaking to her. Odious man.
She’s OK now, having had appropriate treatment, though it took some years to sort it out.

Sorry, meant to quote @SummerFeverVenice in this post.

I have long disliked the 21st century desire to diagnose any deviation from the norm as pathological. It not only demeans and diminishes people's achievements but has always been a weapon to disempower women. We don't have wandering wombs any more, but some other disability always appears to make us less worthy of being considered proper humans.

I have long disliked the 21st century desire to diagnose any deviation from the norm as pathological.

Not any deviation. Believing that you're actually the opposite sex isn't considered to be pathological.

I have long disliked the 21st century desire to diagnose any deviation from the norm as pathological.

Even deviations that involve people who hear voices instructing them to harm or kill themselves or others?

Of course not. That's delusions not deviation from the norm in the way that a diagnosis of Einstein as autistic describes and also belittles deviation from the norm, in that case genius.

However, there is a view that such delusions as you suggest, not all of which end in terrible violence, are a different way of perceiving the world rather than mental illness - but with such delusions we cannot take a chance. I was not speaking of delusions but of variety in the spectrum of human personality. It is possible to view mild autism as a disability or to view it as a particular sort of personality. We have chosen the pathological route thus diagnosing people who would once have been called 'outsiders' as autistic. I am an outsider - it would not help me at all to be diagnosed with a mild personality disorder and would also invalidate most of what I have done in my life, as not a result of my free actions but of my personality disorder acting on me. 21st century pigeon-holing in this way is deterministic and I have rejected determinism all my life.

It should be, because it is.