Justina Pelletier: The Case Continues

On March 25, Joseph Johnston, Juvenile Court Justice in Boston, Massachusetts, issued a disposition order in the case: Care and protection of Justina Pelletier.  The background to the case is well-known.  Justina is 15 years old.

Judge Johnston did not return Justina to the care of her parents, but instead granted permanent custody to the Massachusetts Department of Children and Families (DCF), with a right to review in June.

In paragraph 4, the disposition order states: 

“At trial there was extensive psychiatric and medical testimony.  Voluminous psychiatric and medical records were entered in evidence.  Based on credible psychiatric and medical evidence this court has found that Justina suffers from a persistent and severe Somatic Symptom Disorder.  On December 20, 2013, this court found the MA DCF sustained its burden by clear and convincing evidence that Justina Pelletier is a child in need of care and protection pursuant to G.L c. 119, §§ 24-26 due to the conduct and inability of her parents, Linda Pelletier and Lou Pelletier, to provide for Justina’s necessary and proper physical, mental, and emotional development.”

This is the substantial finding of the court, and it is noteworthy that there is no mention of the mitochondrial disease which had been Justina’s earlier diagnosis and for which she had been receiving treatment at Tufts Medical Center, Boston. 

The disposition order is somewhat terse and sparing in its tone, but reading between the lines, it seems clear that the court has determined that Justina either does not have mitochondrial disease or that, even if she does have mitochondrial disease, her concern about this matter is inappropriate and excessive.  There is also the suggestion that her parents, Linda and Lou Pelletier, have contributed to Justina’s preoccupations in this regard, and that for this reason, Justina needs to be protected from them.  As in all cases of this kind, a great deal of the information is kept confidential.  So we are inevitably working with incomplete information.

Obviously there are many issues that might be raised, and these are being addressed by others, but I would like to focus here on the “diagnosis” of somatic symptom disorder.

DSM-5 describes somatic symptom disorder as:  “…distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms.”  A “diagnosis” of somatic symptom disorder can be assigned even if the person really does have an actual illness, provided that the person’s response to the symptoms of the illness is excessively distressing and disruptive.

Here are the actual diagnostic criteria as set out on page 311 of DSM-5:

Somatic Symptom Disorder 300.82 Diagnostic Criteria

A.  One or more somatic symptoms that are distressing or result in significant disruption of daily life.
B.  Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:

1.  Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2.  Persistently high level of anxiety about health or symptoms.
3.  Excessive time and energy devoted to these symptoms or health concerns.

C.  Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

Specify if:

With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.

Specify if:

Persistent:  A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).

Specify current severity:

Mild:  Only one of the symptoms specified in Criterion B is fulfilled.
Moderate:  Two or more of the symptoms specified in Criterion B are fulfilled.
Severe:  Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).

CRITERION A

DSM-5 (p 830) defines a symptom as:  “A subjective manifestation of a pathological condition.  Symptoms are reported by the affected individual rather than observed by the examiner.  Compare with SIGN.”  On page 829 they define a sign as:  “An objective manifestation of a pathological condition.  Signs are observed by the examiner rather than reported by the affected individual.  Compare with SYMPTOM.”  This kind of terminology has become standard in general medicine.  A symptom is something reported by the patient (e.g. abdominal pain); a sign is something observed by the examiner (e.g. distended abdomen).  Symptoms and signs are the twin pillars of medical diagnosis.

“Somatic” means bodily or physical, as opposed to mental.

So criterion A requires that the individual reports at least one physical symptom, and that this symptom is distressing and results in significant disruption of daily life.  Distress and significant disruption are vague concepts, the assessment of which is clearly dependent on the psychiatrist’s subjective judgment.

CRITERION B

Here again, we have a great deal of subjectivity.  Words like “excessive” and “disproportionate” are open to individual interpretation, and there are no objective standards by which the accuracy of the diagnostic decision can be assessed.

Ultimately, a person will meet the requirements of criteria A and B if, and because, a psychiatrist says so.  There is no objective reality against which the psychiatrist’s assessment can be checked.  The psychiatrist’s subjective assessment is the only test for a “diagnosis” of somatic symptom disorder.

So when a psychiatrist says that a person “suffers from somatic symptom disorder,” all that this means is:  “In my opinion this individual is excessively preoccupied with physical symptoms and that, also in my opinion, this preoccupation is causing significant disruption in his/her life.”

The APA, by including this “diagnosis” in their diagnostic manual, assigning it a name and number, and listing the diagnostic criteria, create the impression that this is a real illness, and distract attention from the central fact:  that the only reality here is a psychiatrist’s opinion.

The only justification for the assertion that Justina Pelletier “suffers from a persistent and severe Somatic Symptom Disorder” is a psychiatrist’s subjective opinion.  In fact, the statement “Justina suffers from somatic symptom disorder” means:  “A psychiatrist believes that Justina’s concern about her symptoms is excessive.”  These two statements are absolutely equivalent.  The first statement, despite its appearance of objectivity, contains no additional substance over the second.

CONFLICTS OF INTEREST

This deception is the foundation of modern psychiatry.  But it doesn’t just occur at the point of individual assessment.  It also applies to the invention of these illnesses in the first place.  Somatic symptom disorder, like all psychiatric diagnoses, is considered to be an illness because the APA say so.  And individuals are considered to have a particular psychiatric “illness” because an individual psychiatrist says so.  It’s all based on subjective opinion.  And subjective opinion is notoriously unreliable.

But it is particularly unreliable when there are conflicts of interest.  The notion that all significant problems of thinking, feeling, and/or behaving are illnesses is central to the APA’s survival.  When the day comes – as it surely will – that it is recognized that these problems are not illnesses, then psychiatry will go the way of astrology and phrenology.  It will cease to exist.  Psychiatry’s foundation is an enormous deception, and in my view psychiatrists know this.  But they are fighting for their very existence.  The conflict of interest isn’t just about money; it’s also a matter of their professional identity.  As a group, they are so invested in the notion of psychiatric illness that they have rendered themselves incapable of honestly and objectively addressing the question:  are these problems really illnesses?

In this context, psychiatrists frequently point out that diagnoses in general medicine sometimes involve a physician’s opinion.  This is true, but misses the point.  When a real doctor says: In my opinion, this person’s diagnosis is X, what he’s saying is that he’s not 100% sure what the actual physical etiology is, but his best assessment at that point in time is X.  In psychiatric “diagnosis” there is no reality against which the “diagnosis” can be checked.  There is nothing but the psychiatrist’s opinion.

At the present time, small numbers of individual psychiatrists are seeing the light, and are courageously struggling with these conceptual issues.  But organized psychiatry in the form of the APA is actually doubling down and fighting harder than ever to prop up the deception that is crumbling like a sandcastle in a flowing tide.

And, of course, there is a huge conflict of interest for individual psychiatrists during their initial evaluations.  The psychiatrist’s bill, whether it’s sent to a private insurance carrier, or Medicare, or other reimbursing entity, depends for its legitimacy on the diagnosis.  Without a diagnosis, the psychiatrist doesn’t get paid!

So the situation is this:  the “diagnosis” is based entirely on the psychiatrist’s subjective opinion; and the psychiatrist’s paycheck depends entirely on the diagnosis.  Not surprisingly, psychiatrists manage to “uncover” a great many diagnoses.  In fact, the psychiatric leadership routinely and confidently claim that at any given time about ¼ of the US population has a mental disorder/illness, and that the lifetime prevalence is a staggering 50%.  They remain blind to the fact that these figures are driven by their own interest-invested need to create more “diagnoses” with progressively lower thresholds, and by their members’ equally self-serving need to assign more “diagnoses” in individual cases.

And this is the background against which Judge Johnston felt confident enough to write:

“Based on credible psychiatric and medical evidence this court has found that Justina suffers from a persistent and severe Somatic Symptom Disorder.”

I truly cannot think of any significant field of human endeavor in which such far-reaching decisions would be made on the basis of such poor evidence.  And bear in mind, Justina’s is by no means an isolated case.

If parents are abusing or neglecting their children – and obviously these things do happen – then some kind of intervention is appropriate.  But interventions of this sort should always be based on clear evidence and with due regard to the rights of the parents and the rights of the child.  But a “diagnosis” of somatic symptom disorder, by its very definition can never reach the standard of clear evidence.  

  • Sally Burch

    And of course a genuinely ill person, who is continually told that they are exaggerating their problems and that their “thinking” is at fault, will no doubt become even further frustrated and even more adamant that their illness is REAL!!

    So of course adding further fuel to the “evidence” that the psychiatrists will use to prop up their shaky diagnoses.

    Lose, lose for the patient.

  • Anonymous

    Sally, to your point, the most controversial aspect of “Somatic Symptom Disorder” is that it can be assigned to a “genuinely ill person.” Even if Justina Pelletier’s physical symptoms are caused by mitochondrial disease, if she thinks a lot about them or is anxious about them to an extent that is excessive (determined entirely via subjective judgment as Phil noted), she has Somatic Symptom Disorder. This is patently absurd; it not only has no scientific basis, but it violates common sense. Critics of this diagnosis have primarily focused on its unfair pathologizing of people whose medically explained but distressing symptoms are legitimate cause for concern. But I don’t recall critics even imagining that Somatic Symptom Disorder could case a medically ill child to be taken away from her parents. The Pelletier’s experience is unconscionable.

  • Anonymous

    The Judge believes in such a thing as “credible psychiatric evidence”. Think of how many MILLIONS of human beings have lost the right to own their own body, as a result of government believing there is something “credible” about the quackery psychiatry calls its “evidence”.

    The disorderists literally see civil and human rights as absurd, inconvenient barriers to them imposing their ideology on any and all other human beings by force. It is illegal to not believe psychiatry’s pseudoscientific name-calling is “credible”.

    With another Fort Hood shooting, the media is all about how the shooter’s “psychiatric issues” are the “cause”. Again… why are these issues considered “psychiatric”. Solely because the profession of psychiatry has an ill-gotten monopoly on defining these issues. Why are these “psychiatric issues” the “cause”? The same circular reasoning that runs through all of psychiatry… the shooter did the shooting because he had “psychiatric issues”, why does the shooter have “psychiatric issues”? Because he did the shooting.

    There is of course new/ever-present calls to scapegoat, round up, disarm, forcibly drug, all of those labeled “ill” by the wizards of neurochemistry that don’t examine anybody’s neurochemistry….

    But two salient points need to inform any reading of the latest Ford Hood shooting:

    1) The shooter was already a label believing adherent of the Church of Psychiatry, that is to say, the shooter is said to have been “in treatment”, by those who believe name calling of never-examined bodies and the guesswork drugging of such bodies constitutes a “medical treatment”. The Shooter was such a label believing adherent that he was said to have been willingly imbibing the Church of Psychiatry’s Holy Eucharists by the bottle-full already, so I guess, he was a living, breathing example of psychiatry’s finest work.

    2) The second fact that is salient to the latest Ford Hood shooting is as follows. Simple, blunt, and to the point: The last Ford Hood shooter was a psychiatrist.

    Otherwise rendered as “50% of Ford Hood Shooters are Psychiatrists”, or “100% of Ford Hood Shooters believe life is a brain disease”, or “100% of Psychiatrists who commit gun massacres start out small, by carrying out forced drugging attacks before graduating to gunning people down”.

    And after the 2009 massacre by a psychiatrist, at Ford Hood, who quickly the adherents of the Church of fake brain disease P$ychiatry were to label one of their own a brain disease. Hasan had managed to balance a belief in biological determinism drug & label psychiatry with militant Islamism, when these two faiths clashed, his professional colleagues (the other Ford Hood psychiatrists, not Al-Awlaki), were quick to denounce their colleague as a steaming pile of jittery neurotransmitters gone awry.

    But I thought lie-chiatrists were “experts” at “predicting violence”? (knowing the future)… working in such close quarters with Hasan all that time, being able to diagnose faulty “brain circuits” by an amazingly high-tech skill set of neuro-investigative biologically advanced cutting edge science of “asking the person questions”, “writing down on a piece of paper whether the person looks disheveled”, “observing behavior”, and the like… why didn’t these “colleagues”, fresh from giving “credible court evidence” that strangers are “a danger to self or others”, pick up on their colleague Major Hasan? Weren’t his frayed dopamine pathways and overexcited serotoninergic flows picked up on their “brain scans” that everyone knows psychiatry has because, well, “here’s a link from BBC, CNN, Fox News that says psychiatry has brain scans”….???

    (Note: there’s another Anonymous in the hen house, the one below is not me).

    Happens from time to time. A common name, like John Smith.

  • Sally Burch

    Yup… totally what I was thinking.

  • Anonymous

    Believing You’re a Real Doctor Disorder 666.82 Diagnostic Criteria

    A. Qualifications in psychiatry along with one or more bullshit beliefs about the unproven somatic etiology of DSM labels, resulting in distressing torture for those you initiate violence against and call ‘involuntary patients’, causing significant disruption of daily life to thousands of people you dupe into blaming their brains for their problems throughout your career.

    B. Excessive thoughts, feelings, or behaviors related to believing you’re a real doctor. Constant use of terminology such as “patient”, “diagnosis”, “prognosis”, “hospital”, “medication”, “treatment”, yet you haven’t seen inside the human body since anatomy class 20 years ago.

    symptoms or associated believing you’re a real doctor as manifested by at least one of the following:

    1. Disproportionate and persistent thoughts about the seriousness of one’s standing as a real doctor, fixed, unassailable belief you are a real doctor.

    2. Persistently high level of confidence that you’re in a position to be talking about health or symptoms even though you don’t examine the human body at all in coming to your quackery based conclusions.

    3. Excessive time and energy devoted to believing you’re a real doctor.

    C. Although any one believing you’re a real doctor symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 30 years punctuated by brief Eli Lily funded dinners and conferences).

    Specify if:

    With predominant brain blaming: This specifier is for individuals whose belief in somatic symptoms predominantly involve phenomena that science has never successfully reduced to biology.

    Specify if:

    Persistent: A persistent course is characterized by severe symptoms, marked impairment of thousands of individuals who make the mistake of also believing you’re a real doctor.

    Specify current severity:

    Mild: Only one of the symptoms specified in Criterion B is fulfilled.

    Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.

    Severe: Two or more of the symptoms specified in Criterion B are
    fulfilled, plus there are thousands of victims whose lives you’ve destroyed.

    Prognosis: Psychiatry dangerous to self or others, must be treated, does not have any insight into need for treatment.

  • Francesca Allan

    It’s incredibly distressing to me how the legal system is so willing to put its critical thinking skills aside and just swallow what they’re being fed by psychiatrists. The only way this Judge found that the evidence swung in favour of the authorities is because there was an inordinate amount of weight given to that side’s evidence.

    I note what you say about psychiatry’s financial interests but up here we have public health care and the system is much the same. I think it’s not so much money driving these doctors as a kind of an almost fascist do-goodism. Personally, that’s what I found so terrifying. They actually think they are providing a valuable service.

  • Phil_Hickey

    Sally,

    Good point. There’s a lot of that kind of thinking in psychiatry.

  • Phil_Hickey

    Anonymous,

    The irony here is that the psychiatrist’s diagnosis is literally irrefutable – as long as he doesn’t change his opinion or get over-ruled by a more senior psychiatrist. So they have a kind of infallibility built in. Real doctors, on the other hand, have to contend with the real world – they might actually have misdiagnosed a situation.

    Is it any wonder that our friend Dr. Biederman was able to say that he is outranked only by God?

    With regards to the latest Ft. Hood shooting, it will be interesting to see how quickly the reports that the shooter had been taking pills go off the radar.

    Best wishes.

  • Phil_Hickey

    Francesca,

    Yes, they are true believers – but they are also protecting their status, their perceived respectability, and their salaries.

    Have you seen Michael Cornwall’s post from yesterday on Mad in America?

    Best wishes.

  • Phil_Hickey

    Anonymous,

    Nice!

  • ssenerch

    I haven’t read the body of this comment yet, but I know it’s going to be funny with a title like that. Love it.

  • ssenerch

    There IS, though, isn’t there? If you weren’t crazy to begin with, they sure will make you so!

  • ssenerch

    This is brilliant, Anonymous. Can I share it?

  • Francesca Allan

    Hi, Phil. No, I’m a bit behind on my reading so I had missed it. Just read the piece now, though, and it’s a good one. I’d really like to see our efforts and energy be directed towards a practical reform strategy (as Cornwall suggests), rather than our current hodge podge of voices that just aren’t being heard. Thanks for the link.

  • Anonymous

    Can do.

  • Anonymous writes:

    “…Critics of this diagnosis have primarily focused on its unfair pathologizing of people whose medically explained but distressing symptoms are legitimate cause for concern. But I don’t recall critics even imagining that Somatic Symptom Disorder could case a medically ill child to be taken away from her parents. The Pelletier’s experience is
    unconscionable.”

    Critics have been extremely concerned about the dangers of an application of a diagnosis of SSD applied to children, or to the carers of a child or young person with any chronic illness.

    It has been known since the second draft DSM-5 review and comment period that SSD is intended to be applied to children or parents/carers, despite the lack of research to support this new construct’s validity and safety in children.

    The Disorder Descriptions document, published by the SSD Work Group in association with the second draft review, dated March 18, 2011, had stated, “In the young child, the “B criteria” may be principally expressed by the parent.”

    DSM-5, page 313 states:

    “The parents’ response to the symptom is important, as this may determine the level of associated distress. It is the parent who may determine the interpretation of symptoms and the associated time off school and medical help seeking.”

    In May 2012, in “Somatic Symptom Disorder could capture millions more under mental health diagnosis,” ( http://wp.me/pKrrB-29B ) I wrote:

    “Proposals allow for the application of a diagnosis of Somatic Symptom Disorder where a parent is considered excessively concerned with a child’s symptoms [3]. Families caring for children with any chronic illness may be placed at increased risk of wrongful accusation of “over-involvement” with a child’s symptomatology.

    “Where a parent is perceived as encouraging maintenance of “sick role behaviour” in a child, this may provoke social services investigation or court intervention for removal of a sick child out of the home environment and into foster care or enforced in-patient “rehabilitation.” This is already happening in families with a child or young person with chronic illness, notably with Chronic fatigue syndrome or ME. It may happen more frequently with a diagnosis of a chronic childhood illness + SSD.”

    It has been happening in the UK for years and it’s still happening. The transcript for Matthew Hill’s disturbing 1999 BBC Panorama report “Sick and Tired” is still available on the BBC website:

    http://news.bbc.co.uk/1/hi/programmes/panorama/archive/506549.stm

    http://news.bbc.co.uk/hi/english/static/audio_video/programmes/panorama/transcripts/transcript_08_11_99.txt

    The UK children and young person’s organization, TYMES Trust, has advocated in over a 100 cases where a child has been taken out of the home, or threatened with removal or placed on the “at risk” register.

    See also this letter by retired pediatrician Dr Nigel Speight to the English Children’s Minister ‘Re Harassment, Neglect and Abuse of young people with ME/CFS, and their
    families’.

    https://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1403a&L=co-cure&F=&S=&P=14630

    There has been considerable concern amongst the ME patient and carer community and ME organizations around SSD and its potential application in children and young people.

    At the September NCHS/CMS ICD-10-CM/PCS Coordination and Maintenance Committee meeting there was a proposal on the Agenda for addition of SSD, as an inclusion term to existing code F45.1, to the ICD-10-CM Tabular List and Index. At the March meeting, there was a repeat proposal for the addition of SSD, coded to F45.1, in the Index. Letters of opposition to this proposal need to be submitted to NCHS by the June 20th deadline. Comments to nchsicd9CM@cdc.gov

    Implementation of ICD-10-CM has been kicked further down the road to
    October 1, 2015. Bill H.R. 4302, known as the PAM Act (Protecting Access to Medicare Act) was signed into law by President Obama on April 1, 2014. This
    means that the U.S. won’t now transition from ICD-9-CM to ICD-10-CM until October 1, 2015.

    Please do not let this delay discourage the voicing of opposition to the inclusion of SSD in ICD-10-CM. If NCHS rubber stamps the addition of Somatic Symptom Disorder to ICD-10-CM it could leverage the future replacement of the existing Somatoform disorders categories with this new, poorly validated single SSD diagnostic construct, bringing ICD-10-CM in line with DSM-5.

    There are implications for ICD-11, too. Once SSD is inserted into ICD-10-CM, the presence of this term within the U.S. adaptation of ICD-10 may make it easier for ICD-11 Revision Steering Group to justify proposals to replace the existing ICD-10 Somatoform disorders categories with a single, new ICD construct contrived to incorporate SSD-like characteristics and facilitate harmonization between ICD-11 and DSM-5 disorder terms and diagnostic criteria.

    Professionals, patients, carers and patient groups need to be opposing the addition of SSD to the forthcoming ICD-10-CM.

    Suzy Chapman, Dx Revision Watch

  • For the second public review of DSM-5 draft proposals, the SSD Work Group had proposed a “Complex SSD” (which required one or more somatic symptoms; at least two cognitions to be met from the “B type” criteria; and a chronicity of typically at least 6 months) and a “Simple or Abridged SSD” (requiring one or more somatic symptoms but only one from the “B type” criteria and a shorter chronicity – a symptom duration of at least 1 month).

    For Simple or Abridged SSD, there was also a proposed specifier where a single symptom predominated, e.g. “SSSD Pain.”

    For the third draft and for the finalized criteria set, the Work Group rejected its earlier proposals and merged CSSD and SSSD, renaming to a single “SSD” category.

    The CSSD chronicity of at least 6 months was retained for SSD, but the number of “B type” cognitions required to meet the diagnosis was reduced for the third draft from two from the “B type” to just one – making it even easier for patients with chronic symptoms to fall under this new SSD diagnosis.

    When DSM-5 published, in May 2013, it included another category (DSM-5 Page 327) “Other Specified Somatic Symptom and Related Disorder 300.89 (F45.8)” which had not been discussed in the disorder descriptions that accompanied the second and third drafts.

    “Other Specified Somatic Symptom and Related Disorder 300.89 (F45.8): This category applies to presentations in which symptoms characteristic of a somatic symptom and related disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the somatic symptom and related disorders diagnostic class.

    “Examples of presentations that can be specified using the ‘other specified’ designation include the following:

    1. Brief somatic symptom disorder: Duration of symptoms is less than 6 months.

    2. Brief illness anxiety disorder: Duration of symptoms is less than 6 months.

    etc.”

    So, just one distressing or impairing bodily symptom (for example, pain, or gastrointestinal complaints), with a duration of less than 6 months, could land you a mental health diagnosis under DSM-5’s OSSS and RD 300.89 (F45.8).

    With a chronicity of less than 6 months, “OSSS and RD” has even looser criteria than DSM-IV’s “Undifferentiated somatoform disorder”, which are set out here:

    http://wps.prenhall.com/wps/media/objects/5097/5219346/tools/diag_crit_undiff_somataform_disorder.pdf

    According to review paper “Emerging themes in the revision of the classification of somatoform disorders” (Creed, Gureje, 2012), which also presents emerging recommendations for ICD-11’s proposed replacement for ICD-10’s Somatoform disorders section:

    “In patients attending primary care, prevalence rates for any ICD-10 somatoform disorder as high as 36% have been recorded (Creed et al., 2011a; Toft et al., 2005); the rate for DSM-IV undifferentiated somatoform disorder was 79% in one study (Lynch et al., 1999). In summary, the threshold for somatoform disorders needs much greater attention and improved specificity…”

    But Francis Creed, as a member of the DSM-5 SSD Work Group, had signed off on an already lose criteria set that had been even further reduced in its requirements between the second and third draft, and had also signed off on the introduction for the final criteria sets of an “OSSS and RD” category even less specific than DSM-IV’s Undifferentiated somatoform disorder, which SSD replaces.

    ICD-10’s existing Somatoform disorders are currently under review and revision for the core and primary care versions of ICD-11, now due in 2017.

    The Gureje led “ICD-11 Expert Working Group on Somatic Distress and Dissociative Disorders (S3DWG)” advisory group has proposed an essentially SSD-like construct called “Bodily distress disorder (BDD)”. You can read its current proposed “ICD-11 Short Definition” here:

    http://apps.who.int/classifications/icd11/browse/f/en#/http://id.who.int/icd/entity/767044268

    the text of which is drawn from paper [1].

    WHO and APA have committed, as far as possible “To facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria”, with the objective that, “The WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

    The development of ICD-11 isn’t being carried out by a few WHO staffers in Geneva – it’s a global effort with a heavy U.S. input.

    There are U.S. clinicians and researchers on the ICD-11 advisory groups, sub working groups and ICD-11 Revision Steering Group, which is chaired by Mayo’s Christopher Chute. The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders is chaired by Steven Hyman, MD, Harvard, former Director of the National Institute of Mental Health (NIMH) and former DSM-5 Task Force Member. The U.S. and Canadian WHO Collaborating Centers are feeding into the development process. Stanford University Biomedical Informatics and semantic web technologists are heavily involved in the development process.

    Mental health professionals, non mental health professionals and patient organizations in the U.S. and globally who share concerns for the looseness of DSM-5’s SSD and Related Disorders need to obtain a copy of this paper, monitor the ICD-11 Beta drafting platform and register for participation in the ICD-11 development process.

    There is significant potential for ICD-11 adopting an SSD-like construct.

    1. Creed F, Gureje O. Emerging themes in the revision of the classification
    of somatoform disorders. Int Rev Psychiatry. 2012 Dec;24(6):556-67. [PMID 23244611]

    And as I’ve said in my previous comment, SSD is being proposed for addition as an inclusion term to ICD-10-CM’s F45.1 Undifferentiated somatoform disorder – so please get your comments in opposition to this proposal to NCHS by June 20th deadline.

    Suzy Chapman, Dx Revision Watch

  • Phil_Hickey

    Anonymous,

    Thanks for coming back, and for alerting us to this matter.

  • colleen10001

    At this point I am just praying for Justina and family….. and anyone
    in the system or Political to do the right thing and get Justina HOME
    with HER PARENTS and family. Put to the side any fears they have of
    stepping on the wrong toes. This child is much much much more
    important then anyones job for now, or career aspirations within MA,
    DCF,BCH, etc. PRAYERS and PRAYERS……. This is just the basics,
    still have to get the correct medical treatment to daughter Justina.
    JUST Plain shocking and beyond unacceptable.

  • pat

    it so healthy to bring up this subject. The DSM can get most of us. I love to pray lots of rosaries. in the DSM that could actually be called a compulsive disorder. what if one is seen making 300 cookies, even if with a plan for them, they can just hung up on word three hundred, and slap compulsive disorder. within families their are divisions. young adult children with issues against their parents and the old ways of morality. they can find in DSM a disorder to name on their parents. we need many to really tear apart the statements made in the DSM

  • Phil_Hickey

    Pat,

    Thanks for your comment. Yes. For psychiatry, any problem can become a mental illness. And yes, we need to critique DSM and psychiatry relentlessly.

    Best wishes.

  • call me roy

    There is a young person held captive in Massachusetts today who is not allowed to participate in religious ceremonies, or visit family without government agents watching. No, it’s not the accused Boston Marathon bomber Dzhokhar Tsarnaev. It’s 15-year-old mitochondrial disease patient and non-terrorist Justina Pelletier. U.S. District Court Judge George O’Toole Jr. ruled Wednesday that the now-20-year-old charged with four deaths and injuring of more than 260 people should be able to see his sisters without an FBI agent present.
    “Can you believe it?” That was Jennifer Pelletier’s response when she was told about the ruling. She’s Justina’s older sister — and every visit she has with her wheelchair-bound sister is held under the watchful eye of agents from both the state’s Department of Children and Families and — since the story went national — armed state police! The family is only allowed one visit a week, for one hour a week, with their own sick daughter. “It’s hard for me to say this,” Justina’s father Lou told me Wednesday, “but a terrorist is getting better treatment in Massachusetts right now than a sick teenager who’s done nothing wrong.” And that’s the source of rage among Justina’s supporters. She’s the one who’s suffering and all she did was come down
    with an illness.
    Please America, call Massachusetts Governor Deval Patrick at (617) 725-4005. He has the executive power to pardon convicted criminals with the stroke of a pen, yet ignores the plight of an innocent, sick adolescent in state care. It’s a dereliction of duty that Governor Patrick has not taken action to free Justina into the loving arms of her family,” commented Rev. Patrick Mahoney a spokesperson for the Pelletier Family. It is tragic that every young person in the Wayside Youth Facility was able to spend time with their family and celebrate Easter except one. That is
    Justina Pelletier. It appears that DCF is punishing Justina and the Pelletier family rather than trying to reunite them, which is their stated purpose.
    And all of you Americans think you live in a free country? Think again! How does this horrible Dr. Eli Newberger, have such enormous and unchecked power? This Juvenile Court Judge Joseph Johnson is even worse, he should be thrown off the bench. Is something involving illegal medical testing is going on at that hospital? Apparently, something illegal is going on?
    Let them all lose their jobs and their reputations for this unbelievable disdain for justice. By the way folks, why isn’t this news story on the main stream media (ABC, CBS, NBS, MSNBC, CNN, PBS, NPR, the Los Angeles Times, the New York Times?
    What are they hiding?
    A bill in the Massachusetts Legislature which would overrule the judge and free Justina immediately, HD 4212, written by MassResistance and filed on April 4, continues to be blocked by the Democratic leadership in the House, despite national outrage and a flood of calls and emails from across the country. I thought the Democratic Party was for the people? Apparently not!
    Justice is coming Justina. Hang on.

  • Phil_Hickey

    call me roy,

    Thanks for your comment. This is truly a miscarriage of justice. The fact is that psychiatry has been getting away with this sort of thing for a long time, and their theories and practices are accepted as valid within the political and legal systems. Now that they’ve been challenged, they have dug in their heels, because to admit that they were wrong would expose the whole sham to scrutiny. We need to maintain the pressure to right this wrong.