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Comment by Dr John L Whiting to the DSM-5
Sunday 19 June 2011
Like the invention of the machine gun and its use in WWI - so many wasted peoples' lives. The ones who pulled the trigger never met eye to eye with their so many victims. So easy for the trigger finger and also, so much unimaginable devastation. But what a wonder weapon of war: I believe that CSSD will be much the same as the machine gun to those who have created it. They will never be able to imagine the suffering that their pet ideology will have created, if they do not correct what they are making.
We can think of the definition of CSSD in other terms too: what of the rules that allowed doctors selections at 'train terminals' in various locations in Europe during WWII? Who saw what was really coming when each new law was 'allowed' in Germany prior to the war? The outcome was expedient efficiency, but who foresaw that? To add to each deceit prior to the war, we also saw these train station selections were made to appear so innocent to each group of newcomers, but in truth, they were not. CSSD is like a selection system: so innocent looking but in reality, so potentially dangerous!
The problem with the definition of CSSD is its 'apparent' vagueness. It is a weapon but not everyone sees it as such. We don't like giving guns to babies, but I fear that those who know little about CFS/ME are like these babies. We do not know exactly who these childlike triggermen will be when they have their new toy to play with but we can imagine the consequences of their actions; and we can see the ultimate outcomes of the 'indiscriminate' selections that this CSSD 'definition' permits.
If we knew with certainty that the definition would be used intelligently, by the best, by those who genuinely cared for patients, we might feel more comfortable. And if we knew that if, by chance, an alternative diagnosis to CSSD was found, the diagnosis of CSSD could be removed without long term stigmatization, then perhaps we might feel even a bit more comfortable about CFFD.
But I fear that this will not be the case. When should there be a need to make a diagnosis of CSSD? This is the big question. We know that Holocaust victims somatise more often than say well balanced controls - but so what? Should they be outcasted once again? The reason for this new definition is not to re-stigmatise these unfortunate victims of the past. In today's world, who will profit the most from this new weapon of mass destruction? Medical insurance companies perhaps? Surely, their hit men will enjoy their new found powers of selection. CBT is not the true rationale for diagnosing CSSD. CBT is simply a front. The real purpose for creating CSSD is for the 'liquidation' of CFS patients and similar undesirables. How can we allow such power to pass into the hands of those who are least likely to use it appropriately?
CFS/ME is a medical condition. Some patients with CFS/ME somatise, but so do patients distressed by many other medical conditions. How can this committee overgeneralise by stating that if somatisation is present amongst CFS/ME patients, then the condition as a whole is one of somatisation as well? Moreover, whilst psychiatry is an essential and noble profession, psychiatrists are usually the least qualified to make judgements on matters that are purely medical.
But who is the final arbiter? Who is the final authority to whom the DSM-5 committee for somatoform disorders answerable? If they are only answerable to themselves, heaven forbid!
Dr John L Whiting
The above originally appeared here.
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