I wrote these comments in another thread:
Decades after the rest of the world accepted MS as physical it is still being treated by some as partially psychosomatic. Given the recent trend to claim that many disorders are physical but have a psychosomatic comorbid disorder, a dual diagnosis, they are positioned to keep going.
Rituximab results give us something to work with as advocates, but advocacy will still be required.
Here is something that is an open secret in psychiatry. Very few psychiatric diagnoses are stable, have cures, or are even established disease/disorder states. They are all manufactured categories. Psychiatry is the most problematic of all medical disciplines, and I would argue that most psychiatry does not deserve to be considered medicine but should be considered alternative medicine. It does not belong in a discipline that needs to be based on science.
So psychiatry has a history of diagnoses disappearing, morphing, blending and separating from each other, and, yes, becoming non psychiatric. So it will not be a surprise to any well informed psychiatrist that a diagnosis is changed or dropped. What most find surprising is how diagnostic categories are created.
Based mostly on subjective interpretation of clinical history and studies using subjective methods, small panels decide amongst themselves what is what, and, hey presto, we have a new or revised or dropped diagnostic category.
So do they test these for scientific validity? Nope. How would they do that? Most of this is subjective interpretation. Sure they can use statistics to back them up, but that is just numbers if not properly used.
But, I hear some saying, the APA for example does extensive validity testing! They sure do. They test for diagnostic reproducibility. That is, how often psychs will get the new diagnoses consistently the same. Note this is about repeatability of diagnoses, not scientific validity of diagnosis. If anyone doubts me, please show me a scientific paper, with objective markers, on a range of axis 1 disorders in DSM5, that validates these disorders as discrete clinical entities.
Psychiatry is trying to become more scientific. So far its largely failing. Psychology at least tries to get things right. Sociologists are at least aware of the risks in their methodologies and try to make allowances. Psychiatry however embraces concepts like lying to the patient if they think its in the patient's interest. They inflate, conflate and outright lie. There is much in psychiatry that is appropriate, or effective (at management) and in some cases scientific, but much of it deserves the term devised in the 1970s - psychobabble.
It will be interesting to see how psychiatry embraces the evolving science on ME and CFS. So far they have not done well. From comments over the years a number of advocates have suspected they are repositioning themselves. They could see what was coming. Yet, rather than discuss diagnostic and research uncertainty (unless its other people's research) they kept insisting they were right. So there!
I find it very interesting that it took two oncologists who appear to have what I would call the spirit of inquiry, to make a big leap in ME and CFS treatment and understanding.
