"Only in psychiatry is the existence of physical disease determined by APA presidential proclamations, by committee decisions, and even, by a vote of the members of APA, not to mention the courts". - Peter Breggin, Toxic Psychiatry

"Some critics wonder if the multiplication of mental disorders has gone too far, with the realm of abnormal encroaching on areas that were once the province of individual choice, habit, eccentricity or lifestyle." - Erica Goode, "Sick, or Just Quirky?"

"DSM-III represents a bold series of choices based on guess, taste, prejudice, and hope ... few are based on fact or truth." - George Valiant, "A Debate on DSM-III"

DSM-IV: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

Issues in the Use of DSM-IV

Limitations of the Categorical Approach

DSM-IV is a categorical classification that divides mental disorders into types based on criteria sets with defining features. This naming of categories is the traditional method of organizing and transmitting information in everyday life and has been the fundamental approach used in all systems of medical diagnosis. A categorical approach to classification works best when all members of a diagnostic class are homogeneous, when there are clear boundaries between classes, and when the different classes are mutually exclusive. Nonetheless, the limitations of the categorical classification system must be recognized.

In DSM-IV, there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways. The clinician using DSM-IV should therefore consider that individuals sharing a diagnosis are likely to be heterogeneous even in regard to the defining features of the diagnosis and that boundary cases will be difficult to diagnose in any but a probabilistic fashion. This outlook allows greater flexibility in the use of the system, encourages more specific attention to boundary cases, and emphasizes the need to capture additional clinical information that goes beyond diagnosis. In recognition of the heterogeneity of clinical presentations, DSM-IV often includes polythetic criteria sets, in which the individual need only present with a subset of items from a longer list (e.g., the diagnosis of Borderline Personality Disorder requires only five out of nine items).

A major problem with this is the application of modern psychiatric methods consistently leads to different diagnosis and treatments for the same patient by different psychiatrists! Why? First, because the supposed disorders have unclear boundaries, are not discrete entities, and people with the disorders don't necessarily have similarities (in their own words). If botanists began saying things like, "leaves are not that different from stems, and we can't clarify them as different things really; a tree trunk is operationally like a branch which is also structurally like a bud; let's call it a tree if it has 3 of these sub-categories of leaves, buds, branches, roots, and bark..", there would be a very unusual and unworkable subject of botany. Let's be real here. Leaves are leaves and trees are trees! Second, because as a "profession" the psychiatrists tend to occupy the "bottom" of the class of the medical schools judging by grades. They are simply not as bright as other medical professionals, and this compounded with an already very complex diagnostic subject results in divergent opinions, diagnosis and treatments. This subject is very far from being a "science" of any sort. I personally wouldn't place my well-being in the hands of any of them. That's asking for trouble! Psychiatry's failure to do a strict analysis, observation, and categorizing of the functions of a mind has resulted in 1) a failed subject of the mind, 2) absurd theories and practices parading as "modern science", and 3) explanations like the above few paragraphs in the DSM which explain in excruciating detail just WHY they can't and don't need to be strict regarding distinct categories of the mind!

It was suggested that the DSM-IV Classification be organized following a dimensional model rather than the categorical model used in DSM-III-R. A dimensional system classifies clinical presentations based on quantification of attributes rather than the assignment to categories and works best in describing phenomena that are distributed continuously and that do not have clear boundaries. Although dimensional systems increase reliability and communicate more clinical information (because they report clinical attributes that might be subthreshold in a categorical system), they also have serious limitations and thus far have been less useful than categorical systems in clinical practice and in stimulating research. Numerical dimensional descriptions are much less familiar and vivid than are the categorical names for mental disorders. Moreover, there is as yet no agreement on the choice of the optimal dimensions to be used for classification purposes. Nonetheless, it is possible that the increasing research on, and familiarity with, dimensional systems may eventually result in their greater acceptance both as a method of conveying clinical information and as a research tool.

Use of Clinical Judgment

DSM-IV is a classification of mental disorders that was developed for use in clinical, educational, and research settings. The diagnostic categories, criteria, and textual descriptions are meant to be employed by individuals with appropriate clinical training and experience in diagnosis. It is important that DSM-IV not be applied mechanically by untrained individuals. The specific diagnostic criteria included in DSM-IV are meant to serve as guidelines to be informed by clinical judgment and are not meant to be used in a cookbook fashion. For example, the exercise of clinical judgment may justify giving a certain diagnosis to an individual even though the clinical presentation falls just short of meeting the full criteria for the diagnosis as long as the symptoms that are present are persistent and severe On the other hand, lack of familiarity with DSM-IV or excessively flexible and idiosyncratic application of DSM-IV criteria or conventions substantially reduces its utility as a common language for communication.

Use of DSM-IV in Forensic Settings

When the DSM-IV categories, criteria, and textual descriptions are employed for forensic purposes, there are significant risks that diagnostic information will be misused or misunderstood. These dangers arise because of the imperfect fit between the questions of ultimate concern to the law and the information contained in a clinical diagnosis. In most situations, the clinical diagnosis of a DSM-IV mental disorder is not sufficient to establish the existence for legal purposes of a "mental disorder," "mental disability," "mental disease," or "mental defect." In determining whether an individual meets a specified legal standard (e.g., for competence, criminal responsibility, or disability), additional information is usually required beyond that contained in the DSM-IV diagnosis. This might include information about the individual's functional impairments and how these impairments affect the particular abilities in question. It is precisely because impairments, abilities, and disabilities vary widely within each diagnostic category that assignment of a particular diagnosis does not imply a specific level of impairment or disability.

This is very interesting and telling, because it is usual to assume when in a court of law, that the goal is to place the discovery of truth above all else. Psychiatry's standard "bible" on disorders admittedly is incapable of strict application in ascertaining whether a person actually "has" any of these "disorders". The psychiatrist is apparently much more comfortable under a "less stringent" environment where questions of truth and actuality aren't relevant. Also, the law involves responsibility and competence, two subjects admitted again to be out of the realm of psychiatry's relevance. Responsibility and competence are two KEY aspects of any person - qualities usually thought to derive from their basic inner personality or mind. Again, psychiatry leaves this out of their provence. Psychiatry is a field dealing largely in categorizing the problems (what's wrong) with people, their environments and their minds. Psychiatry NEVER deals with observing, initiating, developing or improving responsibility or competence in anyone! Again, this seems very strange to me. A subject dealing with Man and his mind, would and should strive to get familiar with the basic functions and capabilities of Man and his mind, with a goal to discover ways to help assist in expanding and improving these things. It should be very obvious to anyone that measures taken to improve responsibility and competence would have wide ramifications across the entire range of things called by psychiatry to be "mental disorders". In other words, successful methods to achieving increased competence and responsibility would have a natural and necessary side effect of reducing any "mental disorders". "Mental disorders" and "illnesses" are largely a failure to take responsibility and exercise control over one's own mind, emotions, behavior and environment. A valid subject of Man and his mind would involve methods to do these things. Psychiatry does none of these things, and actually initiates "solutions" which act in the opposite direction, to reduce even further responsibility and control of one's own mind, behavior, and environment. First, drugs, shock, lobotomy and involuntary commitment each act to control and exert force on the individual, and reduce clarity of awareness, perception, feelings, and everything needed to be fully responsible and in control. These methods each dull the source of responsibility - the person them self. Second, the entire ideological approach of psychiatry is one of "no-responsibility". How so? 1) "Oh, don't feel bad Bill. In the old days you would have been told your perversions were your own fault, but today we know it's just a mental illness and you aren't to blame. There's nothing you can do about flashing those three children except take your medication. You aren't responsible". 2) "The criminal needs to be understood and not punished. Even murderers and rapists actually are the victims of specific mental disorders. They suffer from a condition just like cancer or arthritis. They can't stop their behavior anymore than someone else could just decide for their cancer to go away. We need to do more research on the chemical imbalance that causes the criminal impulse." Responsibility and control are "mind" functions of the inner personality. These need to be acknowledged, encouraged, and developed through a true understanding of what these are. When they are, people are happier and society is more sane and stable. Modern psychiatry has completely erased these factors from the human equation. Their solution to everything is drugs and shock. In fact, their approach attacks the idea of personal responsibility and control as solutions. The only time you will here the terms responsibility and control out of their mouths is when it involves "responsibility to take your medication" and "controlling your urges to refuse to undergo psychiatric treatment". In fact, they have even created a "mental disease" for those people not wanting to go along with their stupid system and methods - it's called "V15.81 Noncompliance With Treatment". How convenient! And they call this "science". . .

Nonclinical decision makers should also be cautioned that a diagnosis does not carry any necessary implications regarding the causes of the individual's mental disorder or its associated impairments. Inclusion of a disorder in the Classification (as in medicine generally) does not require that there be knowledge about its etiology. Moreover, the fact that an individual's presentation meets the criteria for a DSM-IV diagnosis does not carry any necessary implication regarding the individual's degree of control over the behaviors that may be associated with the disorder. Even when diminished control over one's behavior is a feature of the disorder, having the diagnosis in itself does not demonstrate that a particular individual is (or was) unable to control his or her behavior at a particular time.

These lines (in red) admit no understanding or dealing with actual causes. The psychiatric field spends the majority of it's time 1) investigating what's wrong with people and their minds, 2) categorizing these results, and 3) prescribing drugs. There is no serious research to discover what causes these situations and problems from a viewpoint of "mind" or "mental". All research is directed at convincing the "profession" and public that the various "conditions" are due to purely physiological causes such as genetics and chemical imbalances in the brain. The research is largely funded by groups and associations with direct ties to the major drug companies who require acceptance of the notion that all mental illness is due to biochemical causes (which they offer the solution to in the form of drugs).

It must be noted that DSM-IV reflects a consensus about the classification and diagnosis of mental disorders derived at the time of its initial publication. New knowledge generated by research or clinical experience will undoubtedly lead to an increased understanding of the disorders included in DSM-IV, to the identification of new disorders, and to the removal of some disorders in future classifications. The text and criteria sets included in DSM-IV will require reconsideration in light of evolving new information.

The "consensus" is presented as a professional agreement based upon incredibly scientific methods and modern advanced understanding. This is simply hogwash. The "consensus" is largely the current agreement among practicing psychiatrists of their own bias, miseducation, faulty logic and invalid basic postulates of the subject of Man, his mind, and life.

he use of DSM-IV in forensic settings should be informed by an awareness of the risks and limitations discussed above. When used appropriately, diagnoses and diagnostic information can assist decision makers in their determinations. For example, when the presence of a mental disorder is the predicate for a subsequent legal determination (e.g., involuntary civil commitment), the use of an established system of diagnosis enhances the value and reliability of the determination. By providing a compendium based on a review of the pertinent clinical and research literature, DSM-IV may facilitate the legal decision makers' understanding of the relevant characteristics of mental disorders. The literature related to diagnoses also serves as a check on ungrounded speculation about mental disorders and about the functioning of a particular individual. Finally, diagnostic information regarding longitudinal course may improve decision making when the legal issue concerns an individual's mental functioning at a past or future point in time.

Ethnic and Cultural Considerations

Special efforts have been made in the preparation of DSM-IV to incorporate an awareness that the manual is used in culturally diverse populations in the United States and internationally. Clinicians are called on to evaluate individuals from numerous different ethnic groups and cultural backgrounds (including many who are recent immigrants). Diagnostic assessment can be especially challenging when a clinician from one ethnic or cultural group uses the DSM-IV Classification to evaluate an individual from a different ethnic or cultural group. A clinician who is unfamiliar with the nuances of an individual's cultural frame of reference may incorrectly judge as psychopathology those normal variations in behavior, belief, or experience that are particular to the individual's culture. For example, certain religious practices or beliefs (e.g., hearing or seeing a deceased relative during bereavement) may be misdiagnosed as manifestations of a Psychotic Disorder. Applying Personality Disorder criteria across cultural settings may be especially difficult because of the wide cultural variation in concepts of self, styles of communication, and coping mechanisms.

This is an excellent example of the absurdity of psychiatric classification and diagnosis; in their own words no less! A person who hears or sees a dead relative is NOT considered to have a "mental disease" in one culture, because the culture accepts this phenomena. whereas in a culture that doesn't accept the phenomena, the person is labeled with "psychosis". More importantly, what if he really is hearing or seeing the dead! It makes no difference to the psychiatrists. The index for deciding is what does the culture consider normal and acceptable? This basically says that whenever a society alters its general attitude about any topic that any persons who falls outside of the rigidly "normal" average of social acceptance will be labeled as "mentally ill". This is not an oversimplification; this is exactly how psychiatry operates. This entire approach involves enforcing conformity of thought and behavior. Fit in, think and behave how you are supposed to or submit to drugs or electric shock treatments. The key point is that the same exact "mental" attitude in two different cultures gets two different diagnosis. I can guarantee that if a person has cancer in America they will also have it in South Africa! The same for any real physical disease. The psychiatric "diseases" are a sham. See them for what they are and refuse to contribute to the delusion. Read on for more psychiatric shenanigans.

The provision of a culture-specific section in the DSM-IV text, the inclusion of a glossary of culture-bound syndromes, and the provision of an outline for cultural formulation are designed to enhance the cross-cultural applicability of DSM-IV. It is hoped that these new features will increase sensitivity to variations in how mental disorders may be expressed in different cultures and will reduce the possible effect of unintended bias stemming from the clinician's own cultural background.

Use of DSM-IV in Treatment Planning

Making a DSM-IV diagnosis is only the first step in a comprehensive evaluation. To formulate an adequate treatment plan, the clinician will invariably require considerable additional information about the person being evaluated beyond that required to make a DSM-IV diagnosis.

What adequate treatment plan? This makes it sound like the psychiatrist will spend time evaluating many possible alternatives for the disorder. This is a complete joke. The psychiatrist has only one or two solutions to offer. It's either drugs or electric shock. The drug companies state clearly with their drug literature which drugs are for what DSM-IV determined "illnesses". A psychiatrist is trained to believe that you and your mind are 100% biochemical in nature, and to apply drugs or shock as the ONLY solutions to whatever diagnosis you get labeled with. A psychotherapist or counselor might attempt to deal with the mental and emotional problems directly, working to increase personal responsibility and control, but not a psychiatrist. Never! The psychiatrist is trained completely and solely into a medical viewpoint of "mental disorders". This is what they are and what they do. Don't look to find or expect anything else.

Distinction Between Mental Disorder and General Medical Condition

The terms mental disorder and general medical condition are used throughout this manual. The term mental disorder is explained above. The term general medical condition is used merely as a convenient shorthand to refer to conditions and disorders that are listed outside the "Mental and Behavioral Disorders" chapter of ICD. It should be recognized that these are merely terms of convenience and should not be taken to imply that there is any fundamental distinction between mental disorders and general medical conditions, that mental disorders are unrelated to physical or biological factors or processes, or that general medical conditions are unrelated to behavioral or psychosocial factors or processes.

This is a required and necessary fundamental tenant of the modern 20th century religion known as psychiatry. It is an orthodox belief system, largely false and misguided, parading as science. There are major distinctions between mental conditions and physical conditions. There are relationships between a mind, the body, behavior and social factors. The authors of the DSM-IV labeled the notion of distinct mental and physical causes as "a reductionistic anachronism of mind/body dualism". The true reductionistic phenomena is psychiatry's persistent demand that the mind doesn't exist as anything unique of itself, and instead that it completely falls under the headings "physical", "chemical" and "biological" as far as any theories or methods are concerned. The above section (in red) must be repeatedly promoted and put forward as "truth" and "fact" by the psychiatric, medical and pharmaceutical fields in a constant attempt to maintain the "party line" and elicit strong public agreement. The current psychiatric drug "solution" would be impossible without this agreement. Again, it is meaningless whether this is done out of careful planning and intentional design, or whether it's the result of stupidity, a collapsed educational system, miseducation and carelessness. Either way it's happening, and the individual pays with personal mental and spiritual deterioration, while society as a whole pays with increasing crime, immorality, violence and a sabotaged educational system. Read first hand for yourself and discover the true nature of psychiatry as a very complicated modern mythology masquerading as "true science". Where else would one find "coffee drinking" (292.9 Caffeine-Related Disorder) turned into a mental illness! Smoking is now classified as a mental illness also! You'll find it under category 305.10 Nicotine Dependence, and 292.0 Nicotine Withdrawal. Yes, smoking does have an addictive aspect. No, drug addiction is not a mental illness! It's simply drug addiction - the reaction physically and mentally to drug taking. "Withdrawal" is a physiological reaction to stopping the taking of a drug. It is not a mental illness either! Of course, more mental illnesses in the catalog (DSM-IV) justifies more psychiatrists, government involvement, drugging of the public, electric shock, brain surgery and involuntary commitment. It truly is a self perpetuating leviathan. More "disorders" gives us more psychiatrists and increased funding of psychiatry, which then gives us more "disorders", and round and round it goes.

Say NO To Psychiatry!

Book Links

DSM-IV published by the American Psychiatric Association

They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal by Paula J. Caplan, Ph.D.

Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders by Herb Kutchins, Stuart A. Kirk

The Myth of Mental Illness: Foundations of a Theory of Personal Conduct by Thomas S. Szasz, M.D., Professor

Law, Liberty, and Psychiatry : An Inquiry into the Social Uses of Mental Health Practices by Thomas S. Szasz, M.D., Professor

DSM-IV Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders by Robert L. Spitzer, Miriam Gibbon, Andrew E. Skodol, Michael B. First

DSM-IV Made Easy: The Clinician's Guide to Diagnosis by James Morrison

Diagnostic Criteria from DSM-IV (4th Ed) by John S. McIntyre

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©Gene Zimmer 1999 ALL RIGHTS RESERVED