Friday, September 13, 2013

Psychiatry - the Emperor with No Clothes

This may come as a surprise to you but there actually is no medically based diagnostic test for any psychiatric illness. The second sobering thing to understand is that the diagnostic process that is used for any psychiatric illness cannot in any way be described as "accurate" and upon closer inspection certainly not scientific. "Diagnosis" - if it can be called that - is performed by observing "behaviours" and then checking them off a list. The behaviours are described in the DSM - the diagnostic and statistical manual, the "bible" of psychiatric diagnosis. To understand psychiatric diagnosis, we first have to understand this manual and how it gets put together. 

This is from the Neuroskeptic

In these studies, the reliability of the new diagnostic criteria for different psychiatric disorders was measured. The new editorial is a summary and discussion of the field trial data.
Two different psychiatrists assessed each patient, and the agreement between their diagnoses was calculated, as the kappa statistic, where 0 indicates no correlation at all and 1 is perfect.
It turns out that the reliabilities of most DSM-5 disorders were not very good. The majority were around 0.5, which is at best mediocre. These included such pillars of psychiatric diagnosis like schizophrenia, bipolar disorder, and alcoholism.
Others were worse. Depression, had a frankly crap kappa of 0.28, and the new ‘Mixed Anxiety-Depressive Disorder’ came in at -0.004 (sic). It was completely meaningless.

This, by the way, was performed and compiled by the DSM-V committee in which the psychiatrists were hand picked. What this essentially boils down to is that the people who are authoring the manual upon which psychiatric diagnoses are based can't even accurately diagnose anything using their own criteria. Let me repeat that for you - the very people responsible for compiling the new (and since released) diagnostic manual that psychiatrists around the western world will depend on for diagnostic guidance and criteria cannot diagnose anything accurately based on their own diagnostic criteria. 

You might also be surprised at how "disorders" get included in the manual; they're voted in by - get this - a show of hands. 

Canadian psychologist Tana Dineen reports, “Unlike medical diagnoses that convey a probable cause, appropriate treatment and likely prognosis, the disorders listed in DSM-IV [and ICD-10] are terms arrived at through peer consensus”—literally, a vote by APA committee members—and designed largely for billing purposes.

The “science-by-vote” procedure is as surprising to a layperson as it is to other health professionals, who have witnessed DSM voting meetings. “Mental disorders are established without scientific basis and procedure,”
[my bold - brad] a psychologist attending the DSM hearings said. “The low level of intellectual effort was shocking. Diagnoses were developed by majority vote on the level we would use to choose a restaurant. Then it’s typed into the computer. It may reflect on our naiveté, but it was our belief that there would be an attempt to look at the things scientifically.” [my bold - brad]

In 1987, a “self-defeating personality disorder” was voted in as a provisional label. Used to describe “self-sacrificing” people, especially women, who supposedly choose careers or relationships that are likely to cause disappointment, the “disorder” met with such protest from women it was subsequently voted out of DSM-IV.

Yes, you read that correctly; "disorders" can be voted in and then, on the basis of a protest, be voted out again. There is nothing medically scientific about voting "disorders" in and out of existence. Homosexuality was once a "disorder" that was only removed (for the 1980 edition) after strong protest from gay activists. 

And there's more. This from lead DSM-IV committee member Allen Frances, who in a (year) 2000 interview with Wired magazine, declared,

"There is no definition of a mental disorder. It's bullshit. I mean, you just can't define it." ... "These concepts [of distinct mental disorders] are virtually impossible to define precisely with bright lines at the borders."

Frances became so alarmed at where the new DSM-V was going that he has become an outspoken critic of the entire diagnostic process and of psychiatry itself. 

And finally, the lead psychiatrist over the formulating of the DSM-V openly admits that there is little or inadequate "scientific research" done to back up the diagnostic claims in the DSM.

"A primary purpose of this group then, was to determine why progress has been so limited and to offer strategic insights that may lead to a more etiologically-based diagnostic system. The group ultimately concluded that given the current state of technological limitations, the field is years, and possibly decades, away from having a fully explicated etiology- and pathophysiology-based classification system for psychiatry." [bold all mine - brad]

Michael B. First, M.D. A Research Agenda for DSM-V: Summary of the DSM-V Preplanning White Papers. Published in May 2002.

So not only is there no clear etiology for any psychiatric disorder, by their own admission they're possibly decades away from having one (granted this quote is from eleven years ago and neuro-imaging technology has advanced considerably since then).

And this isn't mentioning the ties to drug companies that many DSM committee members have or how much funding the pharmaceutical industry supplies to the American Psychiatric Association

And just to give further idea, there's this. This was from a neuroscience paper the source for which I no longer have. My apologies. 

neuropsychiatric (NP) disorders ... can still be viewed as part of the most complex disorders that are of unknown etiology and incomprehensible pathophysiology. The complexity of NP disorders arises from their etiologic heterogeneity and the concurrent influence of environmental and genetic factors. In addition, the absence of rigid boundaries between the normal and diseased state, the remarkable overlap of symptoms among conditions, the high inter-individual and inter-population variations, and the absence of discriminative molecular and/or imaging biomarkers for these diseases makes difficult an accurate diagnosis.”

This is essentially neuroscience confirming what Dr. Frances admitted - that "there are no bright lines between the borders" and that they have no idea what causes anything. 

I will repeat - any neuroscientist will tell you that the human brain is the most complex device in the known universe. Even with the most mind boggling advanced and highly tuned instruments yet devised, bleeding edge neuroscience doesn't even really fully comprehend what is going on in there and why. Do you honestly believe that someone going by a corrupted and highly unscientific check list is going to know? I'll say again - I was seen by about twenty psychiatrists. None of them had the same thing to say. None of them could explain anything to me. None of them gave any indications they understood why these things were happening to me in my mind. Aside from a routine CAT scan to rule out concussion damage and a test to analyze my brain activity while sleeping, no actual medical tests were ever performed. And this will be true of anyone ever "diagnosed" with a mood or psychiatric disorder. This is not medical diagnosis, not even close. It's modern day voodoo at best. I'd go with a tarot card reading before I ever put myself in these people's hands again. They have about the same scientific basis. 

And then - then! - these people, after this simple check list "diagnosis", are going to pull out a prescription pad and prescribe either a drug or more likely a combination of drugs to "fix" what they "think" is "wrong". Drugs which, as I've written before, lack any kind of scientific validity for long term efficacy, drugs which could induce suicide or violent behaviour or cause critical structural changes to the brain including tissue loss.

Back to the four year old who was killed by a "psychiatrist" and for whom Tufts Medical Center felt "The care we provided was appropriate and within responsible professional standards" (60 Minutes, 2009). Seriously? Drugging a four year old to death is "within reasonable professional standards"? Where were these people during brain anatomy classes? Read any neuroscience book. The brain is still in rapid development stage at that age. Not only are behavioural issues common at that age as the developing brain struggles to make sense of and adapt to a seemingly bizarre world but it is beyond comprehension that brain altering chemicals could ethically be given to children whose brains are still developing. Yet "paediatric bipolar disorder" is now a common diagnosis and infants as young as three or four are put on cocktails of powerful drugs. And brain development goes right up past adolescence (the brain also undergoes massive changes during the teen years) and this age class is increasingly drugged (and off label at that - the drugs were never approved for non-adult use). And this isn't "Billy Bob Psychiatry" hanging a shingle out in some back water town, this is a major medical centre. And this is who we trust with our one and only precious brains?

No. I say no. And this is only the tiny, tiny tip of the iceberg of what I found for psychiatric misdeeds, the financial ties between the pharmaceutical industry, the FDA and the American Psychiatric Association and what is available for long term studies and research into psychiatric drugs (and thus psychiatry itself) efficacy. You might want to watch some of former drug company sales rep Gwen Olsen videos in which she describes how drugs are pushed to psychiatrists' and doctors' offices, old age homes and schools in order to "gain market share" and "make sales quotas" like they were widgets or some other kind of everyday product and not something that we trust to treat our brains. 

Psychiatry doesn't have a shred of clothing to wear. They have no scientific basis for diagnosis and they prescribe medications that have no scientific validity whatsoever. These are drugs that the effects of which are unobservable in the human brain (unlike medications for other medical conditions) "treating" conditions for which no biological etiology has ever been established and accepted (please try to find one - I'd be interested in seeing it. But head to the Nobel Prize committee first; they'd be interested in this discovery). I see no validation whatsoever for the "Dr" in front of their names that they so proudly flaunt. They get by entirely by the infamous "God complex" - they simply believe they "know". By what criteria? Nobody knows. A reading of psychiatric history is a reading into some of the worst horrors ever inflicted on innocent people (psychology is not innocent of this either). The barbaric practices of ice pick lobotomies and insulin shock therapy (you'd have to read about this to believe it) are not far in their past. Under their watch we have seen an explosion of people debilitated by psychiatric illnesses, including a thirty-five fold increase among children.

Personally, I wouldn't trust them to treat a headache. Anyone who's been successfully "treated" by mainstream psychiatry most likely did so through belief in their doctor and placebo effects which makes it no different or better than the shamans and witch doctors that still operate in many cultures (my friends in the Filipino community told me some fascinating stories of this). If someone claims to have been successfully treated, I'd ask for the before and after medical tests that prove that. There are none. "Successful treatment" just means that you were one of the lucky ones. Or the condition just passed normally as they did for thousands of years before "modern" psychiatry began getting involved in our brains and behaviours.

Given the hundreds of "disorders" in the DSM that cover just about every human behaviour imaginable and the completely sham system of diagnosis (described by many as merely a system to justify insurance claims and writing prescriptions) or the medicalizing of perfectly normal human behaviours (bereavement following the death of a loved one is now considered a "disorder" in the new DSM-V), I find myself highly sceptical of anyone claiming a psychiatric disorder (and given the distinct possibility that the drugs to treat it are actually prolonging or worsening it). 

This is NOT to say that psychiatric disorders do not exist or that there are not people who genuinely suffer from them, only that there's a good chance one was misdiagnosed (over diagnosis is a widely recognized problem ... a story possibly for another day but "ADHD" would be one that would be firmly in the cross hairs) or that one is simply "suffering" from being human and therefore not perfect. Situational unhappiness, temper tantrums, mood swings, acting out and dozens of other behaviours were not "disorders" until a combination of perfectionist seeking society started overreacting to them and modern psychiatry, backed by the profit seeking pharmaceutical industry (and statistics will show that "disorders" sky rocketed after these two linked up about five decades ago), decided - and I do mean decided, see again the vote by a show of hands - that so much of normal human behaviour is an "illness" that can be made to go away by a simple pill (or likely a cocktail of them).

This is an industry that has no clothes. And I see no sign of them acquiring any any time soon.  

[I apologize again for the formatting issues. It all looks normal and the same in my composition box but when I post it, the formatting is all strange - brad]



  2. That psychiatry was ever given any respect is pretty funny actually, since without Edward Bearnaise no-one would have ever heard of Sigmund Freud

    or had much interest in the rest of the nutjob/philosopher's who "started" the trade.

    psychiatry is an offshoot of marketing - and don't take my word for it:

    watch "Century of the Self" on youtube or vimeo or at the library

  3. SocialCritic - thanks for that. I don't need to be convinced. I've seen ample evidence from multiple, multiple academic and other highly reliable sources that say the same thing about the public's concept and belief of psychiatry and the drugs they push; and that is is a picture of it being largely a product of marketing. This is at the consumer level (mass media marketing) and at the "trade show" conventions that the drug companies run for medical doctors and psychiatrists.