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Sunday, March 14, 2021

On Anti-Nuclear Bullshit

Founder and Executive Director

In his widely read essay, “On Bullshit,” the philosopher Harry Frankfurt famously distinguished between liars and bullshitters. Liars, counterintuitively, Frankfurt argued, actually care about the truth, and hence attempt to conceal or distort it. Bullshit, by contrast, serves a social function, not an epistemic one.

I was reminded of Frankfurt’s distinction recently, with the publication of a new paper by Harrison Fell, Alex Gilbert, Jesse Jenkins, and Matteo Mildenberger reanalyzing data from a study published last fall in Nature Energy by Benjamin Sovacool and colleagues at the University of Sussex Energy Group.

Sovacool and his coauthors claimed to demonstrate that deployment of nuclear energy around the world did not reduce carbon emissions. The reanalysis by Fell, et. al. is devastating, showing Sovacool’s data actually shows the opposite. From the abstract: “employing the same data sources and time periods, we find that nuclear power and renewable energy are both associated with lower per capita CO2 emissions with effects of similar magnitude and statistical significance.”

Of course, you don’t really need a complicated regression analysis to figure this out. France and Sweden boast the lowest per capita emissions among major advanced developed economies globally and get 80% and 50% of their electricity, respectively, from nuclear energy. When nations build nuclear plants, emissions reliably fall and when they shut them down, as we’ve witnessed over the last decade in Japan and California, they reliably rise.

But for decades, Sovacool and other prominent anti-nuclear academics have published a slew of dubious studies in peer-reviewed publications purporting to find that closing nuclear plants reduces emissions, that nuclear energy is fossil fuel intensive, uniquely dangerous, and inherently expensive, and that renewable energy alone can meet 100% of the world’s energy needs.

This is the sort of thing that many people would call bullshit. But in Frankfurt’s parlance, ideological academics like Sovacool are actually liars. By that, I am not suggesting that Sovacool and others are literally lying. Nor does any of it rise to the level of academic fraud.

But the history of anti-nuclear scholarship pretty strongly suggests that peer-review is no defense in the face of tenured academics with strong ideological commitments. Motivated cognition is a powerful thing and faced with an inconvenient truth, that nuclear energy, which environmentalists have long viewed as worse than fossil fuels, is actually one of the better options we have for cutting carbon emissions and addressing climate change, researchers like Sovacool are entirely capable of conjuring scholarly falsehoods via the magic of models, regression analyses, and highly selective data.

Bullshit, by contrast, is a different animal. It involves going along to get along, repeating claims that are prima facie ridiculous because everyone else appears to believe them too. If Sovacool and other anti-nuclear academics are liars in Frankfurt’s parlance, the peer reviewers and editors who went along with publishing the whole absurd exercise are bullshitters.

Sure, peer-review is time-consuming and uncompensated. But that can’t remotely explain how Sovacool was able to take a study that he was forced to retract just three years ago, slap a fresh coat of paint on it, and republish it in a more prestigious journal. Or why Mark Jacobson’s now-debunked 100% renewable study was not only published by the Proceedings of the National Academy of Science but received an award as one of the best studies of the year, before its obvious flaws were exposed. Or, for that matter, why decades of coverage of nuclear energy in the mainstream media has so reliably diverged from the overwhelming evidence about nuclear’s remarkable record of safe operations and low emissions.

The actual technological pathways to deeply decarbonizing the entire global economy are few and far between. Nuclear is without question one of them.

Climate and energy bullshit proliferates not based on the strength of empirical claims upon which it is based but because it fits a social narrative that has been around for a very long time and that was mapped over, almost whole cloth, from earlier environmental claims about population, toxic chemicals, and limits to growth.

At bottom, almost all contemporary framings of the climate issue insist that addressing the problem will require a fundamental break from the past. Our actions, our choices, our determination to fundamentally remake the world, right now, shall determine whether we thrive or burn up in a runaway fossil-fueled cataclysm.

And so, in the popular climate discourse, we imagine more marching and protesting and clever climate communications might radically remake the political economy of carbon and energy on a planet with seven billion people, soon to be nine, that is still overwhelmingly dependent on fossil fuels. We argue that political will is all that stands in the way of an international treaty, a global carbon price, or a Green New Deal and that once the political breakthrough materializes, those measures will magically produce some unnamed and unobjectionable technology to do everything that wind and solar energy can’t.

Nuclear energy’s original sin was that it was plug and play with industrial modernity, promising limitless energy to support economic prosperity and a growing population. Even as most today acknowledge that any serious effort to address climate change will need to accommodate both, the popular climate discourse speaks of carbon budgets and temperature targets as if they were real things while barely mentioning nuclear, a real technology with documented success decarbonizing modern economies, because it doesn’t fit the narrative.

When nations build nuclear plants, emissions reliably fall and when they shut them down, as we’ve witnessed over the last decade in Japan and California, they reliably rise.

Instead, we talk of technologies that have never actually existed: gigantic machines that remove carbon directly from the atmosphere or hydrogen-powered aircraft or pumping sulfur particles into the stratosphere. The environmental movement and philanthropy have even been far more open to bolting costly carbon capture technology onto coal and gas plants than reconsidering nuclear energy, probably because the former is a pollution-control technology that would increase the cost of fossil energy and, not incidentally, is probably only feasible in the event that the world either regulates or taxes carbon dioxide.

Nuclear energy is no panacea either. And perhaps we will figure out how to entirely eliminate emissions with carbon capture or clean hydrogen or something else. But the actual technological pathways to deeply decarbonizing the entire global economy are few and far between. Nuclear is without question one of them. It can do things, like providing heat for industrial processes that renewables simply cannot easily, and is still the only low-carbon technology with a demonstrated track record of significantly decarbonizing a modern, industrialized economy.

As impressive as the falling costs of wind and solar energy have been, we aren’t going to power the entire global economy with variable sources of renewable energy alone. We have no experience or proven capability to operate an electrical grid entirely with wind and solar energy, much less the other 80% of the global energy economy that doesn’t run on electricity.

Most serious observers, in the news media, academia, government, and even environmental NGOs actually know this and most credible global decarbonization scenarios and energy systems models find a significant need for nuclear to deeply decarbonize modern economies. But you wouldn’t know that from our zombie climate discourse.

Successful climate action in the actual world won’t look anything like the heroic fantasias that so easily captivate the chattering classes. More likely, insofar as we succeed, we will do so via a series of partial, stumbling, and half-baked measures. Doing so will require things like nuclear energy, natural gas, carbon capture, and big agriculture that don’t, in the popular imagination, sit weightless on the land. It will require big government, big corporations and big infrastructure. It will accommodate itself to industrial modernity, consumption, and consumerism and will require a revolution in neither sentiment nor technology but rather the slow accumulation of knowledge, technological prowess, institutions, and practices.

In the end, everyone knows what Sovacool, Jacobson, and other anti-nuclear academics are up to. They are simply highly credentialed ideologues. It’s the bullshit that I worry more about, because, in its incoherence, overheated conspiracies, breezy utopias, and empty radicalism, it is far harder to interrogate

 

DSM-5

From Wikipedia, the free encyclopedia
 
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5)
DSM-5 Cover.png
AuthorAmerican Psychiatric Association
CountryUnited States
LanguageEnglish
SeriesDiagnostic and Statistical Manual of Mental Disorders
SubjectClassification and diagnosis of mental disorders
PublishedMay 18, 2013
Media typePrint (hardcover, softcover); e-book
Pages947
ISBN978-0-89042-554-1
OCLC830807378
616.89'075
LC ClassRC455.2.C4
Preceded byDSM-IV-TR 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. The DSM-5 is the first DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the first "living document" version of a DSM.

The DSM-5 is not a major revision of the DSM-IV-TR but there are significant differences. Changes in the DSM-5 include the reconceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the "bereavement exclusion" for depressive disorders; the renaming of gender identity disorder to gender dysphoria; the inclusion of binge eating disorder as a discrete eating disorder; the renaming and reconceptualization of paraphilias, now called paraphilic disorders; the removal of the five-axis system; and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders.

Some authorities criticized the fifth edition both before and after it was published. Critics assert, for example, that many DSM-5 revisions or additions lack empirical support; inter-rater reliability is low for many disorders; several sections contain poorly written, confusing, or contradictory information; and the psychiatric drug industry may have unduly influenced the manual's content (many DSM-5 workgroup participants had ties to pharmaceutical companies).

Changes from DSM-IV

The DSM-5 is divided into three Sections, using Roman numerals to designate each Section.

Section I

Section I describes DSM-5 chapter organization, its change from the multiaxial system, and Section III's dimensional assessments. The DSM-5 deleted the chapter that includes "disorders usually first diagnosed in infancy, childhood, or adolescence" opting to list them in other chapters. A note under Anxiety Disorders says that the "sequential order" of at least some DSM-5 chapters has significance that reflects the relationships between diagnoses.

The introductory section describes the process of DSM revision, including field trials, public and professional review, and expert review. It states its goal is to harmonize with the ICD systems and share organizational structures as much as is feasible. Concern about the categorical system of diagnosis is expressed, but the conclusion is the reality that alternative definitions for most disorders are scientifically premature.

DSM-5 replaces the NOS (Not Otherwise Specified) categories with two options: other specified disorder and unspecified disorder to increase the utility to the clinician. The first allows the clinician to specify the reason that the criteria for a specific disorder are not met; the second allows the clinician the option to forgo specification.

DSM-5 has discarded the multiaxial system of diagnosis (formerly Axis I, Axis II, Axis III), listing all disorders in Section II. It has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V (Global Assessment of Functioning, known as GAF). The World Health Organization's (WHO) Disability Assessment Schedule is added to Section III (Emerging measures and models) under Assessment Measures, as a suggested, but not required, method to assess functioning.

Section II: diagnostic criteria and codes

Neurodevelopmental disorders

Schizophrenia spectrum and other psychotic disorders

Bipolar and related disorders

Depressive disorders

Anxiety disorders

  • For the various forms of phobias and anxiety disorders, DSM-5 removes the requirement that the subject (formerly, over 18 years old) "must recognize that their fear and anxiety are excessive or unreasonable". Also, the duration of at least 6 months now applies to everyone (not only to children).
  • Panic attack became a specifier for all DSM-5 disorders.
  • Panic disorder and agoraphobia became two separate disorders.
  • Specific types of phobias became specifiers but are otherwise unchanged.
  • The generalized specifier for social anxiety disorder (formerly, social phobia) changed in favor of a performance only (i.e., public speaking or performance) specifier.
  • Separation anxiety disorder and selective mutism are now classified as anxiety disorders (rather than disorders of early onset).

Obsessive-compulsive and related disorders

Trauma- and stressor-related disorders

  • Post traumatic stress disorder (PTSD) is now included in a new section titled "Trauma- and Stressor-Related Disorders."
  • The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.
  • Separate criteria were added for children six years old or younger.
  • For the diagnosis of acute stress disorder and PTSD, the stressor criteria (Criterion A1 in DSM-IV) was modified to some extent. The requirement for specific subjective emotional reactions (Criterion A2 in DSM-IV) was eliminated because it lacked empirical support for its utility and predictive validity. Previously certain groups, such as military personnel involved in combat, law enforcement officers and other first responders, did not meet criterion A2 in DSM-IV because their training prepared them to not react emotionally to traumatic events.
  • Two new disorders that were formerly subtypes were named: reactive attachment disorder and disinhibited social engagement disorder.
  • Adjustment disorders were moved to this new section and reconceptualized as stress-response syndromes. DSM-IV subtypes for depressed mood, anxious symptoms, and disturbed conduct are unchanged.

Dissociative disorders

Somatic symptom and related disorders

  • Somatoform disorders are now called somatic symptom and related disorders.
  • Patients that present with chronic pain can now be diagnosed with the mental illness somatic symptom disorder with predominant pain; or psychological factors that affect other medical conditions; or with an adjustment disorder.
  • Somatization disorder and undifferentiated somatoform disorder were combined to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms.
  • Somatic symptom and related disorders are defined by positive symptoms, and the use of medically unexplained symptoms is minimized, except in the cases of conversion disorder and pseudocyesis (false pregnancy).
  • A new diagnosis is psychological factors affecting other medical conditions. This was formerly found in the DSM-IV chapter "Other Conditions That May Be a Focus of Clinical Attention".
  • Criteria for conversion disorder (functional neurological symptom disorder) were changed.

Feeding and eating disorders

  • Criteria for pica and rumination disorder were changed and can now refer to people of any age.
  • Binge eating disorder graduated from DSM-IV's "Appendix B -- Criteria Sets and Axes Provided for Further Study" into a proper diagnosis.
  • Requirements for bulimia nervosa and binge eating disorder were changed from "at least twice weekly for 6 months to at least once weekly over the last 3 months".
  • The criteria for anorexia nervosa were changed; there is no longer a requirement of amenorrhea.
  • "Feeding disorder of infancy or early childhood", a rarely used diagnosis in DSM-IV, was renamed to avoidant/restrictive food intake disorder, and criteria were expanded.

Elimination disorders

  • No significant changes.
  • Disorders in this chapter were previously classified under disorders usually first diagnosed in infancy, childhood, or adolescence in DSM-IV. Now it is an independent classification in DSM 5.

Sleep–wake disorders

Sexual dysfunctions

  • DSM-5 has sex-specific sexual dysfunctions.
  • For females, sexual desire and arousal disorders are combined into female sexual interest/arousal disorder.
  • Sexual dysfunctions (except substance-/medication-induced sexual dysfunction) now require a duration of approximately 6 months and more exact severity criteria.
  • A new diagnosis is genito-pelvic pain/penetration disorder which combines vaginismus and dyspareunia from DSM-IV.
  • Sexual aversion disorder was deleted.
  • Subtypes for all disorders include only "lifelong versus acquired" and "generalized versus situational" (one subtype was deleted from DSM-IV).
  • Two subtypes were deleted: "sexual dysfunction due to a general medical condition" and "due to psychological versus combined factors".

Gender dysphoria

  • DSM-IV gender identity disorder is similar to, but not the same as, gender dysphoria in DSM-5. Separate criteria for children, adolescents and adults that are appropriate for varying developmental states are added.
  • Subtypes of gender identity disorder based on sexual orientation were deleted.
  • Among other wording changes, criterion A and criterion B (cross-gender identification, and aversion toward one's gender) were combined. Along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents. The grouping has been moved out of the sexual disorders category and into its own. The name change was made in part due to stigmatization of the term "disorder" and the relatively common use of "gender dysphoria" in the GID literature and among specialists in the area. The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight.

Disruptive, impulse-control, and conduct disorders

Some of these disorders were formerly part of the chapter on early diagnosis, oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified became other specified and unspecified disruptive disorder, impulse-control disorder, and conduct disorders. Intermittent explosive disorder, pyromania, and kleptomania moved to this chapter from the DSM-IV chapter "Impulse-Control Disorders Not Otherwise Specified".

  • Antisocial personality disorder is listed here and in the chapter on personality disorders (but ADHD is listed under neurodevelopmental disorders).
  • Symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. The conduct disorder exclusion is deleted. The criteria were also changed with a note on frequency requirements and a measure of severity.
  • Criteria for conduct disorder are unchanged for the most part from DSM-IV. A specifier was added for people with limited "prosocial emotion", showing callous and unemotional traits.
  • People over the disorder's minimum age of 6 may be diagnosed with intermittent explosive disorder without outbursts of physical aggression. Criteria were added for frequency and to specify "impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences".

Substance-related and addictive disorders

  • Gambling disorder and tobacco use disorder are new.
  • Substance abuse and substance dependence from DSM-IV-TR have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category. "Recurrent legal problems" was deleted and "craving or a strong desire or urge to use a substance" was added to the criteria. The threshold of the number of criteria that must be met was changed and severity from mild to severe is based on the number of criteria endorsed. Criteria for cannabis and caffeine withdrawal were added. New specifiers were added for early and sustained remission along with new specifiers for "in a controlled environment" and "on maintenance therapy".

There are no more polysubstance diagnoses in DSM-5; the substance(s) must be specified.

Neurocognitive disorders

Personality disorders

  • Personality disorder (PD) previously belonged to a different axis than almost all other disorders, but is now in one axis with all mental and other medical diagnoses. However, the same ten types of personality disorder are retained.
  • There is a call for the DSM-5 to provide relevant clinical information that is empirically based to conceptualize personality as well as psychopathology in personalities. The issue(s) of heterogeneity of a PD is problematic as well. For example, when determining the criteria for a PD it is possible for two individuals with the same diagnosis to have completely different symptoms that would not necessarily overlap. There is also concern as to which model is better for the DSM - the diagnostic model favored by psychiatrists or the dimensional model that is favored by psychologists. The diagnostic approach/model is one that follows the diagnostic approach of traditional medicine, is more convenient to use in clinical settings, however, it does not capture the intricacies of normal or abnormal personality. The dimensional approach/model is better at showing varied degrees of personality; it places emphasis on the continuum between normal and abnormal, and abnormal as something beyond a threshold whether in unipolar or bipolar cases.

Paraphilic disorders

  • New specifiers "in a controlled environment" and "in remission" were added to criteria for all paraphilic disorders.
  • A distinction is made between paraphilic behaviors, or paraphilias, and paraphilic disorders. All criteria sets were changed to add the word disorder to all of the paraphilias, for example, pedophilic disorder is listed instead of pedophilia. There is no change in the basic diagnostic structure since DSM-III-R; however, people now must meet both qualitative (criterion A) and negative consequences (criterion B) criteria to be diagnosed with a paraphilic disorder. Otherwise they have a paraphilia (and no diagnosis).

Section III: emerging measures and models

Alternative DSM-5 model for personality disorders

An alternative hybrid dimensional-categorical model for personality disorders is included to stimulate further research on this modified classification system.

Conditions for further study

These conditions and criteria are set forth to encourage future research and are not meant for clinical use.

Development

In 1999, a DSM-5 Research Planning Conference, sponsored jointly by APA and the National Institute of Mental Health (NIMH), was held to set the research priorities. Research Planning Work Groups produced "white papers" on the research needed to inform and shape the DSM-5 and the resulting work and recommendations were reported in an APA monograph and peer-reviewed literature. There were six workgroups, each focusing on a broad topic: Nomenclature, Neuroscience and Genetics, Developmental Issues and Diagnosis, Personality and Relational Disorders, Mental Disorders and Disability, and Cross-Cultural Issues. Three additional white papers were also due by 2004 concerning gender issues, diagnostic issues in the geriatric population, and mental disorders in infants and young children. The white papers have been followed by a series of conferences to produce recommendations relating to specific disorders and issues, with attendance limited to 25 invited researchers.

On July 23, 2007, the APA announced the task force that would oversee the development of DSM-5. The DSM-5 Task Force consisted of 27 members, including a chair and vice chair, who collectively represent research scientists from psychiatry and other disciplines, clinical care providers, and consumer and family advocates. Scientists working on the revision of the DSM had a broad range of experience and interests. The APA Board of Trustees required that all task force nominees disclose any competing interests or potentially conflicting relationships with entities that have an interest in psychiatric diagnoses and treatments as a precondition to appointment to the task force. The APA made all task force members' disclosures available during the announcement of the task force. Several individuals were ruled ineligible for task force appointments due to their competing interests.

The DSM-5 field trials included test-retest reliability which involved different clinicians doing independent evaluations of the same patient—a common approach to the study of diagnostic reliability.

About 68% of DSM-5 task-force members and 56% of panel members reported having ties to the pharmaceutical industry, such as holding stock in pharmaceutical companies, serving as consultants to industry, or serving on company boards.

Revisions and updates

Beginning with the fifth edition, it is intended that diagnostic guideline revisions will be added incrementally. The DSM-5 is identified with Arabic rather than Roman numerals, marking a change in how future updates will be created. Incremental updates will be identified with decimals (DSM-5.1, DSM-5.2, etc.), until a new edition is written. The change reflects the intent of the APA to respond more quickly when a preponderance of research supports a specific change in the manual. The research base of mental disorders is evolving at different rates for different disorders.

Criticism

General

Robert Spitzer, the head of the DSM-III task force, publicly criticized the APA for mandating that DSM-5 task force members sign a nondisclosure agreement, effectively conducting the whole process in secret: "When I first heard about this agreement, I just went bonkers. Transparency is necessary if the document is to have credibility, and, in time, you're going to have people complaining all over the place that they didn't have the opportunity to challenge anything." Allen Frances, chair of the DSM-IV task force, expressed a similar concern.

Although the APA has since instituted a disclosure policy for DSM-5 task force members, many still believe the association has not gone far enough in its efforts to be transparent and to protect against industry influence. In a 2009 Point/Counterpoint article, Lisa Cosgrove, PhD and Harold J. Bursztajn, MD noted that "the fact that 70% of the task force members have reported direct industry ties—an increase of almost 14% over the percentage of DSM-IV task force members who had industry ties—shows that disclosure policies alone, especially those that rely on an honor system, are not enough and that more specific safeguards are needed".

David Kupfer, chair of the DSM-5 task force, and Darrel A. Regier, MD, MPH, vice chair of the task force, whose industry ties are disclosed with those of the task force, countered that "collaborative relationships among government, academia, and industry are vital to the current and future development of pharmacological treatments for mental disorders". They asserted that the development of DSM-5 is the "most inclusive and transparent developmental process in the 60-year history of DSM". The developments to this new version can be viewed on the APA website. Public input was requested for the first time in the history of the manual. During periods of public comment, members of the public could sign up at the DSM-5 website and provide feedback on the various proposed changes.

In June 2009, Allen Frances issued strongly worded criticisms of the processes leading to DSM-5 and the risk of "serious, subtle, (...) ubiquitous" and "dangerous" unintended consequences such as new "false 'epidemics'". He writes that "the work on DSM-V has displayed the most unhappy combination of soaring ambition and weak methodology" and is concerned about the task force's "inexplicably closed and secretive process". His and Spitzer's concerns about the contract that the APA drew up for consultants to sign, agreeing not to discuss drafts of the fifth edition beyond the task force and committees, have also been aired and debated.

The appointment, in May 2008, of two of the taskforce members, Kenneth Zucker and Ray Blanchard, led to an internet petition to remove them. According to MSNBC, "The petition accuses Zucker of having engaged in 'junk science' and promoting 'hurtful theories' during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their gender identity, can be treated by encouraging gender expression in line with their anatomy." According to The Gay City News, "Dr. Ray Blanchard, a psychiatry professor at the University of Toronto, is deemed offensive for his theories that some types of transsexuality are paraphilias, or sexual urges. In this model, transsexuality is not an essential aspect of the individual, but a misdirected sexual impulse." Blanchard responded, "Naturally, it's very disappointing to me there seems to be so much misinformation about me on the Internet. [They didn't distort] my views, they completely reversed my views." Zucker "rejects the junk-science charge, saying there 'has to be an empirical basis to modify anything' in the DSM. As for hurting people, 'in my own career, my primary motivation in working with children, adolescents and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.'"

In 2011, psychologist Brent Robbins co-authored a national letter for the Society for Humanistic Psychology that brought thousands into the public debate about the DSM. Approximately 13,000 individuals and mental health professionals signed a petition in support of the letter. Thirteen other American Psychological Association divisions endorsed the petition. In a November 2011 article about the debate in the San Francisco Chronicle, Robbins notes that under the new guidelines, certain responses to grief could be labeled as pathological disorders, instead of being recognized as being normal human experiences. In 2012, a footnote was added to the draft text which explains the distinction between grief and depression.

The DSM-5 has been criticized for purportedly saying nothing about the biological underpinnings of mental disorders. A book-long appraisal of the DSM-5, with contributions from philosophers, historians and anthropologists, was published in 2015.

The financial association of DSM-5 panel members with industry continues to be a concern for financial conflict of interest. Of the DSM-5 task force members, 69% report having ties to the pharmaceutical industry, an increase from the 57% of DSM-IV task force members.

A 2015 essay from an Australian university criticized the DSM-5 for having poor cultural diversity, stating that recent work done in cognitive sciences and cognitive anthropology is still only accepting western psychology as the norm.

However, DSM-5 does now include a section on how to conduct a ‘cultural formulation interview’. Published in 2013, the cultural formulation interview gives information. about how a persons cultural identity may be affecting expression of signs and symptoms. This helps clinicians to make a much more valid diagnosis for disorders subject to significant cultural variation.

Borderline personality disorder controversy

In 2003, the Treatment and Research Advancements National Association for Personality Disorders (TARA-APD) campaigned to change the name and designation of borderline personality disorder in DSM-5. The paper How Advocacy is Bringing BPD into the Light reported that "the name BPD is confusing, imparts no relevant or descriptive information, and reinforces existing stigma." Instead, it proposed the name "emotional regulation disorder" or "emotional dysregulation disorder." There was also discussion about changing borderline personality disorder, an Axis II diagnosis (personality disorders and mental retardation), to an Axis I diagnosis (clinical disorders).

The TARA-APD recommendations do not appear to have affected the American Psychiatric Association, the publisher of the DSM. As noted above, the DSM-5 does not employ a multi-axial diagnostic scheme, therefore the distinction between Axis I and II disorders no longer exists in the DSM nosology. The name, the diagnostic criteria for, and description of, borderline personality disorder remain largely unchanged from DSM-IV-TR.

British Psychological Society response

The British Psychological Society stated in its June 2011 response to DSM-5 draft versions, that it had "more concerns than plaudits". It criticized proposed diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements... not value-free, but rather reflect[ing] current normative social expectations", noting doubts over the reliability, validity, and value of existing criteria, that personality disorders were not normed on the general population, and that "not otherwise specified" categories covered a "huge" 30% of all personality disorders.

It also expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences... which demand helping responses, but which do not reflect illnesses so much as normal individual variation".

The Society suggested as its primary specific recommendation, a change from using "diagnostic frameworks" to a description based on an individual's specific experienced problems, and that mental disorders are better explored as part of a spectrum shared with normality:

[We recommend] a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or 'symptoms' or 'complaints'... We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of anxiety etc.)? These would be more helpful too in terms of epidemiology. While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of 'schizophrenia' or 'personality disorder' may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person's real problems would suffice. Moncrieff and others have shown that diagnostic labels are less useful than a description of a person's problems for predicting treatment response, so again diagnoses seem positively unhelpful compared to the alternatives. - British Psychological Society June 2011 response

National Institute of Mental Health

National Institute of Mental Health director Thomas R. Insel, MD, wrote in an April 29, 2013 blog post about the DSM-5:

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a "Bible" for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been "reliability" – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity ... Patients with mental disorders deserve better.

Insel also discussed an NIMH effort to develop a new classification system, Research Domain Criteria (RDoC), currently for research purposes only. Insel's post sparked a flurry of reaction, some of which might be termed sensationalistic, with headlines such as "Goodbye to the DSM-V", "Federal institute for mental health abandons controversial 'bible' of psychiatry", "National Institute of Mental Health abandoning the DSM", and "Psychiatry divided as mental health 'bible' denounced". Other responses provided a more nuanced analysis of the NIMH Director's post.

In May 2013, Insel, on behalf of NIMH, issued a joint statement with Jeffrey A. Lieberman, MD, president of the American Psychiatric Association, that emphasized that DSM-5 "... represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5." Insel and Lieberman say that DSM-5 and RDoC "represent complementary, not competing, frameworks" for characterizing diseases and disorders. However, epistemologists of psychiatry tend to see the RDoC project as a putative revolutionary system that in the long run will try to replace the DSM, its expected early effect being a liberalization of the research criteria, with an increasing number of research centers adopting the RDoC definitions.

Biological immortality

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Biological immortality (sometimes referred to as bio-indefinite mortality) is a state in which the rate of mortality from senescence is stable or decreasing, thus decoupling it from chronological age. Various unicellular and multicellular species, including some vertebrates, achieve this state either throughout their existence or after living long enough. A biologically immortal living being can still die from means other than senescence, such as through injury, disease, or lack of available resources.

This definition of immortality has been challenged in the Handbook of the Biology of Aging, because the increase in rate of mortality as a function of chronological age may be negligible at extremely old ages, an idea referred to as the late-life mortality plateau. The rate of mortality may cease to increase in old age, but in most cases that rate is typically very high.

The term is also used by biologists to describe cells that are not subject to the Hayflick limit on how many times they can divide.

Cell lines

Biologists chose the word "immortal" to designate cells that are not subject to the Hayflick limit, the point at which cells can no longer divide due to DNA damage or shortened telomeres. Prior to Leonard Hayflick's theory, Alexis Carrel hypothesized that all normal somatic cells were immortal.

The term "immortalization" was first applied to cancer cells that expressed the telomere-lengthening enzyme telomerase, and thereby avoided apoptosis—i.e. cell death caused by intracellular mechanisms. Among the most commonly used cell lines are HeLa and Jurkat, both of which are immortalized cancer cell lines. HeLa cells originated from a sample of cervical cancer taken from Henrietta Lacks in 1951. These cells have been and still are widely used in biological research such as creation of the polio vaccine, sex hormone steroid research, and cell metabolism. Embryonic stem cells and germ cells have also been described as immortal.

Immortal cell lines of cancer cells can be created by induction of oncogenes or loss of tumor suppressor genes. One way to induce immortality is through viral-mediated induction of the large T‑antigen, commonly introduced through simian virus 40 (SV-40).

Organisms

According to the Animal Aging and Longevity Database, the list of animals with negligible aging (along with estimated longevity in the wild) includes:

In 2018, scientists working for Calico, a company owned by Alphabet, published a paper in the journal eLife which presents possible evidence that Heterocephalus glaber (Naked mole rat) do not face increased mortality risk due to aging.

Bacteria and some yeast

Many unicellular organisms age: as time passes, they divide more slowly and ultimately die. Asymmetrically dividing bacteria and yeast also age. However, symmetrically dividing bacteria and yeast can be biologically immortal under ideal growing conditions. In these conditions, when a cell splits symmetrically to produce two daughter cells, the process of cell division can restore the cell to a youthful state. However, if the parent asymmetrically buds off a daughter only the daughter is reset to the youthful state—the parent isn't restored and will go on to age and die. In a similar manner stem cells and gametes can be regarded as "immortal".

Hydra

Hydra

Hydras are a genus of the Cnidaria phylum. All cnidarians can regenerate, allowing them to recover from injury and to reproduce asexually. Hydras are simple, freshwater animals possessing radial symmetry and contain post-mitotic cells(cells that will never go divide again) only in the extremities.

All hydra cells continually divide. It has been suggested that hydras do not undergo senescence, and, as such, are biologically immortal. In a four-year study, 3 cohorts of hydra did not show an increase in mortality with age. It is possible that these animals live much longer, considering that they reach maturity in 5 to 10 days. However, this does not explain how hydras are consequently able to maintain telomere lengths.

Jellyfish

Turritopsis dohrnii, or Turritopsis nutricula, is a small (5 millimeters (0.20 in)) species of jellyfish that uses transdifferentiation to replenish cells after sexual reproduction. This cycle can repeat indefinitely, potentially rendering it biologically immortal. This organism originated in the Caribbean sea, but has now spread around the world. Similar cases include hydrozoan Laodicea undulata and scyphozoan Aurelia sp.1.

Lobsters

Research suggests that lobsters may not slow down, weaken, or lose fertility with age, and that older lobsters may be more fertile than younger lobsters. This does not however make them immortal in the traditional sense, as they are significantly more likely to die at a shell moult the older they get (as detailed below).

Their longevity may be due to telomerase, an enzyme that repairs long repetitive sections of DNA sequences at the ends of chromosomes, referred to as telomeres. Telomerase is expressed by most vertebrates during embryonic stages but is generally absent from adult stages of life. However, unlike vertebrates, lobsters express telomerase as adults through most tissue, which has been suggested to be related to their longevity. Contrary to popular belief, lobsters are not immortal. Lobsters grow by moulting which requires a lot of energy, and the larger the shell the more energy is required. Eventually, the lobster will die from exhaustion during a moult. Older lobsters are also known to stop moulting, which means that the shell will eventually become damaged, infected, or fall apart and they die. The European lobster has an average life span of 31 years for males and 54 years for females.

Planarian flatworms

Polycelis felina, a freshwater planarian

Planarian flatworms have both sexually and asexually reproducing types. Studies on genus Schmidtea mediterranea suggest these planarians appear to regenerate (i.e. heal) indefinitely, and asexual individuals have an "apparently limitless [telomere] regenerative capacity fueled by a population of highly proliferative adult stem cells". "Both asexual and sexual animals display age-related decline in telomere length; however, asexual animals are able to maintain telomere lengths somatically (i.e. during reproduction by fission or when regeneration is induced by amputation), whereas sexual animals restore telomeres by extension during sexual reproduction or during embryogenesis like other sexual species. Homeostatic telomerase activity observed in both asexual and sexual animals is not sufficient to maintain telomere length, whereas the increased activity in regenerating asexuals is sufficient to renew telomere length... "

For sexually reproducing planaria: "the lifespan of individual planarian can be as long as 3 years, likely due to the ability of neoblasts to constantly replace aging cells". Whereas for asexually reproducing planaria: "individual animals in clonal lines of some planarian species replicating by fission have been maintained for over 15 years".

Attempts to engineer biological immortality in humans

Although the premise that biological aging can be halted or reversed by foreseeable technology remains controversial, research into developing possible therapeutic interventions is underway. Among the principal drivers of international collaboration in such research is the SENS Research Foundation, a non-profit organization that advocates a number of what it claims are plausible research pathways that might lead to engineered negligible senescence in humans.

In 2015, Elizabeth Parrish, CEO of BioViva, treated herself using gene therapy with the goal of not just halting, but reversing aging. This effort was widely criticized.

For several decades, researchers have also pursued various forms of suspended animation as a means by which to indefinitely extend mammalian lifespan. Some scientists have voiced support for the feasibility of the cryopreservation of humans, known as cryonics. Cryonics is predicated on the concept that some people considered clinically dead by today's medico-legal standards are not actually dead according to information-theoretic death and can, in principle, be resuscitated given sufficient technological advances. The goal of current cryonics procedures is tissue vitrification, a technique first used to reversibly cryopreserve a viable whole organ in 2005.

Similar proposals involving suspended animation include chemical brain preservation. The non-profit Brain Preservation Foundation offers a cash prize valued at over $100,000 for demonstrations of techniques that would allow for high-fidelity, long-term storage of a mammalian brain.

In 2016, scientists at the Buck Institute for Research on Aging and the Mayo Clinic employed genetic and pharmacological approaches to ablate pro-aging senescent cells, extending healthy lifespan of mice by over 25%. The startup Unity Biotechnology is further developing this strategy in human clinical trials.

In early 2017, Harvard scientists headed by biologist David Sinclair announced they have tested a metabolic precursor that increases NAD+ levels in mice and have successfully reversed the cellular aging process and can protect the DNA from future damage. "The old mouse and young mouse cells are indistinguishable", Sinclair said. Human trials were planned to begin shortly in what the team expect is 6 months at Brigham and Women's Hospital, in Boston.

In a September 2019 article, a group of scientists reported successfully reversing the epigenetic aging in humans.

In November, 2019, the first telomere-lengthening gene therapy clinical trial has started, which aims to reverse aging by at least 20 years. This trial was criticised as being dangerous and unethical due to the usage of genetically modified viruses from an unknown source.

In April, 2020, a group of researchers made a breakthrough in halting the premature aging of cells due to the telomere disease, called dyskeratosis congenita. While directly this is for curing diseases, in the longterm, it can be a base for longevity treatments.

In May, 2020, there was a successful experiment to reduce aging in mice by an average of 54%, with the transfusion of young blood plasma.

In November, 2020, a group of scientists at Tel Aviv University and the Shamir Medical Center have been successfully reversed ageing in human blood cells by applying hyperbaric oxygen treatment (HBOT) on a group of patients for 90 days. The patients' blood cells became 25 years younger, their telomeres were lengthened by 38% and the number of senescent cells decreased by 37%.  Some physicians have voiced their concerns that this therapy can cause health problems and some are skeptical about that ageing could be reversed by just one treatment, that we do not know if removing senescent cells will reverse ageing and some warned, that lengthened telomeres are also present in cancer diseases and advised great caution.

In December, 2020 a group of scientists proposed a new possible cause for ageing: the accumulation of epigenetic noise. They have successfully reprogrammed a group of nerve cells which resulted in restoring the epigenetic information and vision in mice.

Criticism

To achieve the more limited goal of halting the increase in mortality rate with age, a solution must be found to the fact that any intervention to remove senescent cells that creates competition among cells will increase age-related mortality from cancer.

Immortalism and immortality as a movement

In 2012 in Russia, and then in the United States, Israel, and the Netherlands, pro-immortality transhumanist political parties were launched. They aim to provide political support to anti-aging and radical life extension research and technologies and want to ensure the fastest possible—and at the same time, the least disruptive—societal transition to radical life extension, life without aging, and ultimately, immortality. They aim to make it possible to provide access to such technologies to the majority of people alive today.

Future medicine, life extension and "swallowing the doctor"

Future advances in nanomedicine could give rise to life extension through the repair of many processes thought to be responsible for aging. K. Eric Drexler, one of the founders of nanotechnology, postulated cell repair devices, including ones operating within cells and using as yet hypothetical molecular machines, in his 1986 book Engines of Creation. Raymond Kurzweil, a futurist and transhumanist, stated in his 2005 book The Singularity Is Near that he believes that advanced medical nanorobotics could completely remedy the effects of aging by 2030. According to Richard Feynman, it was his former graduate student and collaborator Albert Hibbs who originally suggested to him in around 1959 the idea of a medical use for Feynman's theoretical micromachines. Hibbs suggested that certain repair machines might one day be reduced in size to the point that it would, in theory, be possible to (as Feynman put it) "swallow the doctor". The idea was incorporated into Feynman's 1959 essay There's Plenty of Room at the Bottom.

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