The American Psychiatric Association is releasing the new, extremely controversial, edition of its Diagnostic and Statistical Manual, DSM-V. This increasingly bloated, subjective, unreliable, drug sales manual seems finally to have crossed some sort of b.s. threshold that is making the neuroscience community fire back. On April 29, NIMH Director Thomas Insel announced the NIMH will no longer be using DSM diagnoses in its research projects.
Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.NIHM has launched its own initiative to create a replacement diagnostic system based exclusively on objectively measurable parameters -- the Research Domain Criteria (RDoC)
...RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.” The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories. Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.Translation: Psychiatric junk science based on subjective "diagnoses" represents a form of medicine that went out in the 20th century in every other part of medicine. Neurosciences have advanced to the point where we can now examine brain function at levels from the genome to the neural circuit, and should base mental diagnosis on physical tests and measurements as is done in the rest of medicine. But the DSM prejudges what that science-based "nosology" (classification of diseases) will look like, with its rubbish categories (based, increasingly, on what will sell more drugs). So NIMH is throwing DSM into the trash can, and starting over from scratch.
That is why NIMH will be re-orienting its research away from DSM categories.
Predictably, establishment psychiatrists are upset. Dr. Allen Frances, former Chair of psychiatry at Duke University, now Emeritus, writes at HuffPo that this is "a sad moment":
DSM-5 certainly deserves rejecting. It offers a reckless hodgepodge of new diagnoses that will misidentify normals and subject them to unnecessary treatment and stigma.But, despite the fact that DSM is rubbish that deserves rejection:
The NIMH director may have hammered the nail in the DSM-5 coffin when he so harshly criticized its lack of validity.
Don't lose faith in psychiatry, but don't accept psychiatric diagnosis or treatment on faith -- particularly if it is given after a brief visit with someone who barely knows you. Be informed. Ask lots of questions. Expect reasonable answers. If you don't get them, seek second, third, even fourth opinions until you do.I.e. have faith in psychiatric diagnosis, my children, but pay lots of pyschiatrists until you find one who tells you what you want to hear.