I recently wrote about the editorial by Allen Frances MD, head of DSM-4, criticizing the current process of DSM-5, and now there is a nasty response from the DSM-5 group, authored by Alan Schatzberg MD, James Scully MD, David Kupfer MD, and David Regier MD, that psychiatry blogger Daniel Carlat MD offered to edit for them to make it more respectful. Lol. A blogger offering to help the leaders of academic psychiatry tone down their language. Lol again.

I mean the damn editorial hasn’t even been published yet.

In their response to Frances Kupfer et al make dubious claims that “attorneys” had advised them to have committee members sign confidentiality agreements to protect “intellectual property”. They also charge Frances (as well as Robert Spitzer MD, who founded DSM and has been making the email rounds with criticism of the current process) with greed in wanting to retain royalties from a book he wrote about DSM-4 which would become outdated after the release of DSM-5. I mean anyone in the business knows that book royalties pale in comparison to the hundreds of thousands of dollars to be had doing pharmaceutical industry consulting and speaking. In fact one could even argue that doing things like editing books (which have essentially no revenue, because hardly anyone buys them) is a feather in the cap that helps you get those more lucrative gigs.

One of the diagnoses on the table is Female Sexual Dysfunction (FSD), a “disease” that if accepted would surely drive the drug companies to “identify and treat” these poor lassies with drugs like the testosterone patch (see “Wow A Drug To Have Sex Once More a Month? Sign Me Up!“) or Viagra or whatever psychotropic they could drug out of the medicine cabinet.

Turns out the medicalizing women’s sexuality may not be such a good idea. There is a long and jaded history of evil meddling by medical doctors in this area. The publication of the book Feminine Forever, whose thesis was that post-menopausal women become shriveled asexual crones due to an estrogen deficiency led doctors to put an entire generation of post-menopausal women on hormone replacement therapy (HRT), which in turn was later found to have caused tens of thousands of deaths from heart attack and other problems.

Then there were Masters & Johnson, the famous sex research team who concluded that women had more frequent orgasms than men.

Masters & Johnson on Meet the Press

This “research” however was based on looking through peep holes at brothels, and later their “research sessions” they conducted with each other. Virginia Johnson was Dr. William Masters secretary, and they “partnered” to have sex on a nightly basis for “research” purposes for years. Their report on 67 patients with unwanted homosexuality showing a 70% conversion to heterosexuality using “conversion therapy” was later disclosed as a fraud when noone could find any evidence of the patients. This bizarre “research team” should hardly be taken seriously about women’s orgasms.

Turns out that the DSM-4 has ‘Female Hypoactive Sexual Desire Disorder’ and ‘Female Hypo Orgasmic Disorder’ (I mean did the guy try going down on her?) as well as Dyspaerunia (painful sex). As a recent editorial pointed out, maybe the 43% of women with some type of so-called sexual dysfunction are acting “appropriately”.

I mean, maybe they’re with jerks and don’t feel like doing it?

The American Journal of Psychiatry has been soliciting editorials on the DSM-5 process. Too bad they rejected the editorial by Robert Spitzer MD who founded the DSM, and for FSD they have only this lame piece by a trio of MDs whose pharma disclosures read like a phone book. Lol. Sort of.

Ray Moynihan had a good piece in bmj on FSD (“FSD: The Making of a Disease”) in which he outlines how industry has moved in a serious way to pour cash in the “research and education” of this newly minted disorder, the rife conflicts of interest in the field, and the attempt by drug companies to medicalize female sexuality.

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.

We come in peas to help Shadow Team solve mystey of psychiatric diagnosis.

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.

PTSD doesn't exist cuz I said so. So shut up and sit down.

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.

Bye now.