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Since the establishment of the DSM V Shadow Team to track the proceedings of the DSM committee in response to their paranoid decision to keep all of their meetings a secret and not allow anyone to keep notes or talk to the press, we have been quietly reviewing psychiatric nosology and contemplating the architecture of psychiatry. The ongoings of the “mainstream” DSM committee were chronicled in an article in this month’s Time magazine (remember when you used to read that? So do I) called “Redefining Crazy: Researcher Revise the DSM-V” where it made the point that psychiatrists were spending more time arguing than coming to consensus (Hey Dr Hyman, I thought you weren’t supposed to talk to the press? I am gonna have to tattle on you to David).
However several recent articles by journalists who seem to have granted themselves honorary degrees in psychiatry and who quote whatever ridiculous opinion from psychiatrists that happens to cross their desk as if it is, well, worth quoting, have prompted us to speak out.
First off, the New York Times wrote an exceedingly lame editorial regarding the decision of the Department of Defense to not award the Purple Heart (the medal received by soldiers who are wounded in combat) for combat-related posttraumatic stress disorder (PTSD). Here is their lame comment:
PTSD can be difficult to diagnose, with symptoms that can arise later in life, far from the battlefield and are not necessarily linked to any specific actions of an enemy. So the Pentagon contends that it has no choice but to exclude its sufferers from the Purple Heart, given to those whose injuries result from direct and intentional action by the enemy…
The military is, in fact, moving forward merely by mentioning PTSD and the Purple Heart in the same breath. Imagine Gen. George Patton, who so notoriously slapped a quivering enlisted man, learning that his beloved Army was even considering giving medals to those whose combat tours left them mentally shattered.
Frankly I found this letter to be patently offensive, ill informed and incorrect. First off, General Patton was an idiot, and should not be celebrated for physically abusing soldiers. Secondly, PTSD is very much related to combat exposure, is not difficult to diagnose, and is not delayed in onset. The NYT morons go on to opine that “Purple Heart may not be the answer — not until, perhaps, advances in brain science bring full objectivity to the diagnosis of mental injury.” And exactly what “brain science” is that? The same morons who publicized dubious science such as the search for the neural correlates of morality or trumpeted a drug that would preserve marital fidelity are now turning those brain scanners against the recognization that war is hell and can be associated with life long mental wounds?
Next on the journalist role call is an article in Scientific American (“Soldier’s Stress: What Doctors Get Wrong About PTSD“) by David Dobbs. An example of one of his (highlighted) retarded statements is “misdiagnosed soldiers receive the wrong treatments and risk becoming mired in a Veterans Administration system that encourages chronic disability.” Since when does the VA want chronic disability? If anything they are invested in reducing their costs. And who is he to say who is “misdiagnosed”? Not everyone develops PTSD, but for those who do, it is real, believe me, and it doesn’t matter what some pointy headed professors (or journalists) who are seeking attention with provocative statements say.
Dobbs taps into an underbelly of academic psychiatry that looks for approval from others by trying to look like they buck the trend about trauma and PTSD, with the basic message that PTSD is an overblown diagnosis created by a bunch of cry babies. Most of these “detractors” he quotes were authors of articles in a moronic special issue of the Journal of Anxiety Disorders in 2007 on PTSD. These authors purport to be offering important and controversial papers that will undermine the diagnosis of PTSD but instead they just send up a bunch of hot air balloons. Simon Wessely, a psychiatrist from the Institute of Psychiatry in London, writes a convoluted “historical” piece that seems to imply that we should pay attention to the role of secondary gain (e.g. getting disability benefits) in the development of PTSD. Big deal, some people want disability payments, does that mean PTSD is a bullshit diagnosis? I don’t think so. It would have been more interesting if Simon had written a piece telling us about who was the mystery woman at his institute involved in the Sex and Seroquel scandal who said that she needed to be punished by the head of the Seroquel Study Team for reading a paper about Risperdal.
Next in the Journal we have Richard McNally, who gets a lot of mileage out of pointing to his study showing that people who think they were abducted by aliens have psychophysiological responses that look like PTSD as evidence that PTSD is a bs diagnosis (if those aliens did that to my rectum I think I would have PTSD too, wouldn’t you)? He makes the point that if you tightened the criteria for PTSD that there would be fewer veterans classified as having PTSD (based on an article that revised the estimate downward from 14% to 9%). So what? As we pointed out in a letter to Science in 2007 that still would mean 236,000 Vietnam veterans with PTSD 30 years later.
Last time I saw Richard he broke his glasses down the middle during a lecture he was giving and had to hold up one half to read his slides, which he called his “monacle”, which together with his spirited presentation made him look like a mad professor, indeed.
Next we have Paul McHugh, MD, the evil troll who used to second as chairman of psychiatry at Johns Hopkins School of Medicine in Baltimore. Last time I saw him lecture was whining about one of his “case reports” of a woman claiming childhood sexual abuse ”how could that woman have been sexually abused by her father? That family was one of the most prominent families in Baltimore!” as if that made any frigging difference. They write:
PTSD, as presently diagnosed, described, and treated, has failed to improve on what had been standard teaching. It has redefined and overextended the reach of a long-recognized natural human reaction of fear, anxiety, and conditioned emotional reactions to shocks and traumas.
In other words, nothing like the old days, when guys killed Japs and enjoyed it, and gals got raped and if they didn’t stop sniveling you could just give them a good wack to help them get over it.
Robert Spitzer wrote an editorial in this special issue which promised a radical revision, but instead merely recommended requiring that the person be personally exposed to the traumatic event, and dropped a few of the symptom criteria like irritability that were not specific to PTSD. Another editorial was written by the sociologist Allan Young and the epidemiologist Naomi Breslau. Last time I saw Allan he was reading a paper about the Yale Neurosciences PTSD program as an object for study by sociologists with the basic thesis that PTSD is a “social construct”. Frankly when I see a sociologist who studies mental health my instinct is to run in the opposite direction as quickly as I can. For what it’s worth here is the abstract of their paper. Let me know if you can understood it; I sure as hell couldn’t:
As represented in the DSMs, the PTSD syndrome coheres through cause and effect relations among diagnostic features. Research practices routinely ignore this essential characteristic, by atomizing the diagnostic features, especially the role of memory. The failure to confront this contradiction explains the failure of research to fully engage the pathological process that justifies the PTSD diagnostic classification. Several papers in this collection direct readers’ attention to this fundamental problem. We are pessimistic that their insight will lead to positive results.
They don’t sound very optimistic. Does that mean they are not resilient and are vulnerable to PTSD? Don’t worry guys if you get sick I’ll make sure that you do not go on disability and become chronic charges of the government.
What these guys are saying is that PTSD is “not reliable, not accepted” often made up to get victims’ compensation and compare that to “accepted” diagnoses like major depression and bipolar. What’s more their cronies on the mainstream DSM wants to drop Dissociative Disorders as diagnoses all together, for no better reason than because they, well, want to. Well I’ve got news for you guys just because drug companies made billions off of the pedalling of depression (and not PTSD) doesn’t make that disorder somehow more “real”. And the suffering of patients with PTSD and Dissociative Disorders for that matter is very real, thank you very much.
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Films by Doug Bremner & Laughing Cow ProductionsWhen five Italian sisters return to their home in Sicily to divide up the family art and antiques and the vestiges of their ancestral past, all hell breaks loose. From Laughing Cow Productions, Catania! was written and directed by Doug Bremner and filmed in 2012 in Atlanta, GA. Visit the film's facebook page for updates.
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