Caught Being Offensive: DSM-5, Caught Between Mental Illness Stigma and Anti-Psychiatry Prejudice

Jeffrey Lieberman, president-elect of the American Psychiatric Association, wrote an invited commentary for Scientific American's MIND Guest Blog.  Lieberman's commentary is most remarkable for the lack of respect Lieberman apparently has for other professionals and for others with a different perspective than his own about the DSM, which has a profound influence on how we, as a society, treat people who experience emotional and/or behavioral difficulties.  I don't believe that Lieberman is unaware, uninformed or ignorant; however, in this commentary, he attempts to paint professionals and others who are critical of harmful, discriminatory psychiatric practices that are coercive and cause serious iatrogenic impairments; some fatal, as "real people who don’t want to improve mental healthcare."  

It's as if Lieberman believes there is only one way to look at the issues involved; if one's perspective in not aligned with his own, one is unworthy of consideration, possibly mentally ill, and undeserving of respect.  Presumably, Lieberman states, professionals who are "against the diagnosis and treatment of mental illnesses;" i.e. biological based hypotheses firmly believed in by the folks who arrive at the diagnostic criteria and treatment standards a consensus of p subjective opinions. Consensus is the foundation of psychiatry. Lieberman presumes too much about a diverse group of people. He seems to be intentionally misleading readers about the core issues the American Psychiatric Association and it's bible, The  Diagnostic and Statistical Manual are widely criticized for.  The DSM is being boycotted by some concerned professionals. 

a few excerpts from  "DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice" via Scientific American:

"But there’s another type of critique that does not contribute to this goal. These are the groups who are actually proud to identify themselves as “anti-psychiatry.”

"These are real people who don’t want to improve mental healthcare, unlike the dozens of psychiatrists, psychologists, social workers and patient advocates who have labored for years to revise the DSM, rigorously and responsibly. Instead, they are against the diagnosis and treatment of mental illnesses—which improves, and in some cases saves, millions of lives every year—and “against” the very idea of psychiatry, and its practices of psychotherapy and psychopharmacology. They are, to my mind, misguided and misleading ideologues and self-promoters who are spreading scientific anarchy."

"Being “against” psychiatry strikes me as no different than being “against” cardiology or orthopedics or gynecology—which most people, I think, would find absurd. No other medical specialty is targeted by such an “anti” movement."

"This relatively small “anti-psychiatry” movement fuels the much larger segment of the world that is prejudiced against people with disorders of the brain and mind and the professions that treat them. Like most prejudice, this one is largely based on ignorance or fear–no different than racism, or society’s initial reactions to illnesses from leprosy to AIDS. And many people made uncomfortable by mental illness and psychiatry, don’t recognize their feelings as prejudice. But that is what they are." end quote (emphasis mine)

The dubious claim that "mental illness is like any other illness" is (allegedly) used to "fight stigma."  According to grass roots advocates for the seriously mentally ill, who "fight the stigma" by claiming that having a "psychiatric disease" or "mental illness," is like having diabetes, and taking teratogenic drugs is like using insulin to regulate blood sugar...

Let's be real, this comparison is a spurious claim purportedly made to "bust the stigma of mental illness" and encourage people to seek psychiatric diagnosis and treatment.  The depression is caused by a chemical imbalance "metaphor" is a discarded hypothesis, a disproved hypothetical explanation for what was once called "endogenous depression." It was utilized to manipulate patients, and the general public in order to sell the psychiatric diagnosis = brain disease idea. Just as importantly these compaisons were drawn from thin air as part of a mass marketing strategy to sell psychopharmacology as an ethical, evidence based Standard Treatment for EVERY psychiatric diagnosis AS a putative disease. Once the general public in effect believe that any psychiatric diagnosis is evidence a person has a brain disease,  the public supported legislation allowing psychiatrists to have unwilling patients adjudicated as a person with a brain disease requiring psychiatric treatment...

Lieberman uses some sort of pseudo-logical nonsense to assert psychiatry is the like any other medical specialty. In reality, there are glaring exceptions: the primary one being psychiatrists, subjugate both the Police and the Courts, utilizing them as medical instruments to have unwilling patients adjudicated in Courts of Law---No other medical specialty substitutes legal adjudication for a medical diagnosis.  Once a psychiatrist or other designated mental health professional asserts the person has a brain disease, and further attests the alluded to "disease" can be effectively treated with neuroleptic and/or other psychotropic drugs and/or electrical shocks to the brain. 

The Rules of Evidence used by the Police and the Courts in any and every other type of legal procedure or process, are not required for these adjudicative procedures. The designated medical professional's claims are a professional opinion proffered in accordance with a political process developed by consensus. Ironically, the lowered standards are seemingly "justified" by widespread acceptance of, and presumably belief in the idea that a psychiatric diagnosis, or a mental illness means one is less than one once was, one is less than "normal;" one is less human. That  a person has a disease is at best, a shared professional opinion that is substituted for "evidence."  Serving in effect, as the evidence, this "fact" becomes the sole justification for mandating psychiatric treatment regardless of any actual benefit or adverse effect experienced by the person who is legally adjudicated and Court Ordered to psychiatric treatment under color of law.  

"tolerable side effects of diagnosis and treatment"

evidence of actual iatrogenic,  
"physician caused" harm

Conveniently,  Lieberman and biological psychiatry practitioners in general minimize the nature of the psychotropic drugs used by psychiatrists, psychopharmacologists develop the treatment standards by consensus. Imagine an oncologist diagnosing and treating cancer using diagnostic criteria and treatment standards derived through a political process, consensus. Imagine the uproar at "treating sick people like that!" The neuroleptic or so-called "anti-psychotic" drugs are only minimally effective for a minority of people with a diagnosis of schizophrenia.  Teratogenic drugs, they cause a myriad of iatrogenic diseases and impairments that are then medically neglected; increasing the risk a person will die an untimely iatrogenic, death.  Common drug-induced impairments specifically drug-induced brain damage, impairs a person's ability to realize they have been harmed, prevent further iatrogenic harm.  

Can there be any doubt medically neglected iatrogenic injuries and impairments have a profound effect on a psychiatric patient, adversely effecting length and quality of life?

The civil commitment laws in the U.S. lower the evidentiary standards used in civil and criminal legal procedure. Court hearings do not follow standard court procedures--- The courts in the U.S. do not require any evidence the person has a disease, to support a psychiatrist's expert opinion.   Psychiatrists need not offer any evidence the recommended treatment will "effectively treat" the person who is being adjudicated.  Psychiatric diagnoses and the treatment protocols used by psychiatry were created using a quasi-democratic political processes; not medical or scientific processes.  When any other medical specialist  testifies in a court of law, they are required to submit empirical evidence of the factual basis of their testimony in compliance with the Rules of Evidence used in Police procedure and Courts of Law. For example, psychiatrists who offer professional opinions in court in person or by affidavit, will attest, "patient x has schizophrenia, a brain disease that requires medical treatment." However, no supporting evidence to substantiate the assertions made is offered, or required. Evidence that psychiatric drugs and/or electroshock will effectively treat the person isn't needed to obtain a Court Order to force treatment upon a person who has been adjudicated.  That unsupported attestations instead of factual evidence can be accepted on faith, then used as a basis to deprive a person of their liberty, is evidence that attorneys assigned to defend people facing adjudication proceedings, are failing to defend their client's Constitutional Rights.

The DSM5 has been much discussed and debated, but it is more than an exaggeration to state the DSM5, "ignited a broad dialogue on mental illness and opened up a conversation about the state of psychiatry and mental healthcare in this country."   While the DSM5 has, and continues to be a catalyst for debate and discussion, it seems to me that the APA and the professionals involved with the DSM5, have stifled debate, and have refused to acknowledge, or respectfully listen to critics.  The fact is, Lieberman like most psychiatrists, is disparaging of people who self-identify as psychiatric survivors, ex-patients, or as "anti-psychiatry;" some of whom have been "discussing the state of psychiatry and mental healthcare in this country" longer then I've been alive...  

All due respect to Jeffrey Lieberman, his commentary reads like a juvenile justification, proffering lame excuses and abdicating having any personal or professional responsibility while offering no explanation for the lack of scientific basis for his "medical" specialty. The misguided attempt to rewrite history with the strange claim that asylums were, "humane warehouses," and opining that Freudian theory was a "brilliant fiction;" borders on being sci-fi fantasy. The first assertion evinces a bias for the psychiatric disease hypothesis, as well as willful blindness to the grievous harm done to real people in standard psychiatric practice. read  here

Lieberman and the American Psychiatric Association collectively refuse to acknowledge psychiatry's victims; in effect, invalidating an entire class of people. It's utterly despicable and adds insult to injury that the doctors who vehemently defend themselves, and their chosen profession, are willfully blind to those grievously injured by psychiatric treatment.

Psychiatry is failing to perform an ethical medical duty: to HELP those with iatrogenic injuries recover, psychiatry forgets to "First, do no harm..." Lieberman, is not unusual, he abdicates responsibility for the harm caused real people by treatments he vehemently defends as effective and necessary medical treatments.  Lieberman seems to be encouraging a perspective that pretends my son, Isaac, and others with profound, disabling iatrogenic injuries from psychiatric treatment aren't worthy of being respected or having their human rights preserved. Equally important, Lieberman seems unaware of having an ethical duty to the victims, the countless current and former psychiatric patients who are in critical need of medical treatment for their profound iatrogenic injuries and impairments.

I'm biased from the experience of witnessing the horrifying manner psychiatrists have treated, and in reality, mistreated and disabled my son before he was an adult.  My son at the age of 7 had an IQ of 146, and could do triple digit addition in his head, without using his fingers.

Christmas 2011, he used his fingers to count the seven remaining days until Christmas. He is 25 years old and I take care of my precious son, who was disabled by psychiatrists who acted with impunity. It is a bittersweet privilege; it is an honor. Lieberman's attitude seems prejudiced to me, but like I said, I'm biased. I'm a MadMother who knows that my son deserved to be heard, who knows he needed to be helped to process the violence which caused the traumatic injuries he sustained as the victim of violent crime at 3 years old. Instead, he was repeatedly traumatized by mental health professionals, social workers who allowed psychiatrists to inflict the iatrogenic injuries that he will likely die from. 

@href="https://twitter.com/drjlieberman">drjlieberman Your implication that any conceptual critique of psychiatric assumptions must be motivated by ideology or self-promotion is >>
— Sam Thompson (@uilleannair) May 21, 2013

@drjlieberman >> deeply offensive. Many are sceptical of the medical model because they feel it serves distressed people poorly. You may >>
— Sam Thompson (@uilleannair) May 21, 2013

@drjlieberman >> disagree, but to impugn bad faith on behalf of psychiatry's critics is insulting, and unworthy of someone in your position.
— Sam Thompson (@uilleannair) May 21, 2013

. @nasw @apa @unboundradionet Jeffrey Lieberman, incoming president of the APA---> #DoucheCentral twubs.com/DoucheCentral
— SocialWorkUnplugged (@URTRiPiN) May 21, 2013

The DSM 5 Controversy Update

Update April 2, 2013 apparently, Psychiatric Times disabled every link sometime recently. One wonders on their motivation to disable links that had been functional for so long...

Original 8-15-2011 Updated June 14, 2012
I recently read, "Inside the Battle to Define Mental Illness," an interview with Allen Francis, M.D., lead author of the DSM IV, and an outspoken critic of the current effort to update the Diagnostic and Statistical Manual, the DSM 5.  My hat's off to  Dr. Francis for having the professional integrity to assertively state his case.   


via The Psychiatric Times:

A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences


 By Allen Frances, MD | June 26, 2009

Dr Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

"We should begin with full disclosure. As head of the DSM-IV Task Force, I established strict guidelines to ensure that changes from DSM-III-R to DSM-IV would be few and well supported by empirical data. Please keep this history in mind as you read my numerous criticisms of the current DSM-V process. It is reasonable for you to wonder whether I have an inherently conservative bias or am protecting my own DSM-IV baby. I feel sure that I am identifying grave problems in the DSM-V goals, methods, and products, but it is for the reader to judge my objectivity." 

"Much of our effort in developing DSM-IV centered on avoiding possible misuses of the system." here

via Wired Magazine:
Excerpts from The Battle to Define Mental Illness, an interview with Dr. Allen Francis:

"Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.” For the first time in two days, the conversation comes to an awkward halt." 

"But he recovers quickly, and back in the living room he finishes explaining why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career." read it here.

When I read the APA's response to Allen Francis' criticism in the Psychiatric Times, I was unimpressed.  Francis begins his criticism with the statement, "We should begin with full disclosure."   The APA's rebuttal was signed by four psychiatrists and was a lame attempt to defend the indefensible.  An advertisement  for Abilify was alongside of it:

6-14-2012 When updating this article, I discovered the page with the APA's rebuttal had an even larger advertisement for Latuda, that takes you to another page:

Explore results from Study 3, including the primary and key secondary measures.^1,2

Before I was done updating this article, the advertisement was changed to one for Seroquel...I must say, it is more than a little disconcerting to have so much advertising of the neuroleptic drugs in professional journals.  It is just as disturbing, if not more so, than the amount of direct to consumer marketing of  psychiatric drugs.  It is particularly troubling to see so much reliance on pharmaceutical industry funding for psychiatric journals, and the functioning of the APA itself.  It doesn't seem ethical to have Direct to Professional marketing for psychiatric drugs in "professional literature."  There is no way in hell that these marketing messages do not feed any existent biases a professional may have.

It is no secret that Conflicts of Interest, fraud and corruption have permeated every aspect of psychiatry for some time.  In the real world, some psychiatrists have caused a great deal harm to human beings they meant to help.  The societal damage has wide-ranging effects, and a negative impact on ALL of US.  Why is the APA (and the AACAP) allowing become and it originates with the criminal enterprise that conflicted academic psychopharmacology researchers involved themselves in; intentionally or not.  This criminal enterprise continues to defraud all of us through publicly funded programs, and continues to harm patients.  In spite of this reality, many psychiatrists do not seem to understand that even if they themselves did not perpetrate any  fraud themselves, they have an ethical obligation to have psychiatrists who have, held accountable.  It is obviously in everyone's best interest for professional groups to hold their individual members to high ethical standards.  It seems to me that unethical conduct has not only been accepted; it has been richly rewarded and honored...

My final observation is this:  The APA will conceivably make a great deal of money from the DSM 5.  It is preposterous and disingenuous for it's members to suggest a loss of income is motivating Allen Francis; yet failing to mention the anticipated income expected by the American Psychiatric Association with publication of the DSM 5.  Psychiatrists who are critical of the APA, have been maligned; and have had their careers dramatically altered.  Psychiatrists are punished for being ethical, having integrity and defending their work, i.e. showing all of the data generated, the procedures and parameters used. Such overt ethical integrity is punished in the APA; a person may be forced to defend themselves against malicious attacks and/or ostracized.  APA thugs are not even censured.   

Psychiatrists that are critical of any aspect of this process, that speak out about the harm caused patients; and that question the secretive process and the lack of validity are castigated. The professionals with the integrity to publicly express disagreement or dissent are said to be impaired or lacking insight by "Key Opinion Leaders" of the APA.   The psychopharmachology faithful in the APA have let loose a contagion that has spawned an epidemic of Pharmachosis.  Psychiatrists with Pharmachosis have ansognosia; and don't even know it. When experiencing Pharmachosis, a psychiatrist doesn't know what they have, or what they don't have, and they don't even know if they have or have not... (◔‿◔)  Completely oblivious to a quantifiable reality recognized by anyone without Pharmachosis, i.e. having a modicum of critical thinking skills. 

Alert to the Research Community—Be Prepared to Weigh in on DSM-V

Setting the record straight Schaztberg Scully Kupfer Regier

APA and DSM: Empty Promises Spitzer

A Response to the Charge of Financial Motivation

Criticism vs. Fact William Carpenter

Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion

Advice to DSM-V . . . Change Deadlines and Text, Keep Criteria Stable

Advice to DSM-V: Integrate with ICD-11

B4U-ACT group wants pedophilia to be renamed "minor-attraction"

Via Herald Sun :

Mental health group B4U-Act looks to remove stigma from paedophilia

A GROUP of psychiatrists and other mental health professionals say it is time to change the way society views individuals who have physical attractions to children.

The organisation, which calls itself B4U-Act, is lobbying for changes to the Diagnostic and Statistical Manual of Mental Disorders, or DSM, the guideline of standards on mental health that is put together by the American Psychiatric Association, FOXNews.com said.

The group says its mission is to help paedophiles before they create a crisis, and to do so by offering a less critical view of the disorder.

"Stigmatising and stereotyping minor-attracted people inflames the fears of minor-attracted people, mental health professionals and the public, without contributing to an understanding of minor-attracted people or the issue of child sexual abuse," reads the organisation's website.

B4U-Act said that 38 individuals attended a symposium in Baltimore last week, including researchers from Harvard University, Johns Hopkins University and the universities of Illinois and Louisville. According to the group, which was said to not endorse every point of view expressed, the speakers in attendance concluded that "minor-attracted" individuals are largely misunderstood and should not be criminalised even as their actions should be discouraged.

Speakers also argued that people who are sexually attracted to children should have input into the decision about how paedophilia is defined in the DSM, which they said is supposed to be a guide to promote "mental health vs social control". (emphasis mine)

The American Psychiatric Association did not participate in the conference, and evidently does not condone the group's message. read here.

Let's be clear here: whatever the hell goes on in someone's mind, is one thing; ACTING on the impulse or "desire" to have a sexual relationship, or any type of overt or covert sexual contact with a minor is sexual exploitation and sexual abuse; it is wrong, period.  This group's attempt to "de-stigmatize" pedophilia is driven by the mistaken notion the stigmatization of pedophilia is unwarranted, and a source of discrimination.  It is not an issue of discrimination; it is an issue of aberrant sexual conditioning and impulses that if acted upon are  criminal acts.  To redefine this perversion as being, "minor-attracted" is an attempt to make something aberrant and truly harmful to victims, acceptable.  Pedophilia is stigmatized because it is not acceptable behavior. (regardless of the reasons or excuses used by the perpetrators to justify the pedophile behavior)  The fact that pedophilia is illegal is not in itself a deterrent.  The fact is, there is a stigma attached to pedophilia  because most people know it to be wrong and criminal---and I for one, do not believe psychiatry has done any of us any favors by classifying it as a "mental disease."  Undesirable behavior regardless of who exhibits it, is simply behavior; when the behavior is against the law, it is criminal behavior.  Period.


This is where the wisdom of Thomas Szasz is needed: 

via reason.com

Sins of the Fathers

Is child molestation a sickness or a crime?

a few excerpts:

"Crimes are acts we commit. Diseases are biological processes that happen to our bodies. Mixing these two concepts by defining behaviors we disapprove of as diseases is a bottomless source of confusion and corruption."


"Conversely, psychiatric diagnoses affect moral judgments. Fred Berlin, founder of the Johns Hopkins Sexual Disorders Clinic and a professor of psychiatry at the Johns Hopkins School of Medicine, declares: "Some research suggests that some genetic and hormonal abnormalities may play a role [in pedophilia]....We now recognize that it's not just a moral issue, and that nobody chooses to be sexually attracted to young people." Yet an action that affects other people is always, by definition, a moral issue, regardless of whether the actor chooses the proclivity to engage in it."


"Berlin misleadingly talks about the involuntariness of being "sexually attracted to young people." The issue is not sexual attraction; it is sexual action. A healthy 20-year-old male with heterosexual interests is likely to be powerfully attracted to every halfway pretty woman he sees. This does not mean that he has, or attempts to have, sexual congress with these women, especially against their will. The entire psychiatric literature on what used to be called "sexual perversions" is permeated by the unfounded idea -- always implied, sometimes asserted -- that "abnormal" sexual impulses are harder to resist than "normal" ones."

"The acceptance of this notion helps explain the widespread belief that sex offenders are more likely than other criminals to commit new crimes, an assumption that is not supported by the evidence. Tracking a sample of state prisoners who were released in 1983, the Bureau of Justice Statistics found that 52 percent of rapists and 48 percent of other sex offenders were arrested for a new crime within three years, compared to 60 percent of all violent offenders. The recidivism rates for nonviolent crimes were even higher: 70 percent for burglary and 78 percent for car theft, for example." read here.

After HHS says children are 'sexual beings', psychologists push to decriminalize pedophilia