National Institutes of Mental Health Director Rejects DSM V

http://blogs.scientificamerican.com/cross-check/2013/05/04/psychiatry-in-crisis-mental-health-director-rejects-psychiatric-bible-and-replaces-with-nothing/

by sehugg • 13 years ago

61 25 13 years ago

blogs.scientificamerican.com

tokenadult• 13 years ago

The blog statement by the director of National Institute of Mental Health

http://www.nimh.nih.gov/about/director/2013/transforming-dia...

is much more informative and balanced on this issue.

I am part of a local "journal club" of psychology researchers and graduate students in psychology at my alma mater university, and what several of those researchers are seeking are more reliable diagnostic criteria based on biological information.

icegreentea• 13 years ago

From what I get from reading around, it seems like pretty much all parties involved agree that most sound way to diagnose mental disorders is by being able to actually measure the physiological causes of the disorders, whatever they might be.

It's just that the group pushing DSM5 believes that we really need an updated set of definitions to guide diagnosis, that we have no reliable tests to look for physiological signs of mental disorders, and are unlikely to find and flesh out any in the near future (as in few years to a decade time frame), so we may as get DSM5 out for now, which does appear to update the various definitions and groupings to more accurately reflect our current understanding of the disorders - for example the groupings for various previously distinct diagnosis into spectrums.

There are certainly other issues with DSM5, such as exactly what thresholds are used and what not... but I certainly think that many of the issues (like omg! big pharma is trying to define everything so they get more sales) won't go away even with 'reliable' physiological tests.

ollysb3• 13 years ago

How do you distinguish between the physiological causes and symptons? Given that it's possible for different thought patterns to produce different physiological effects how can you ever be sure whether physiological state is the cause or effect?

pekk• 13 years ago

Given that the majority of these disorders do not have any clear etiology, and may not have any biological reality, requiring measurement of causes would destroy most of DSM.

Not just pharma but the whole psychiatric establishment has a vested interest in handing out diagnoses, whether they are understood or not. Prescriptions are not just convenient for big pharma, they can be given out in a short time so that a doctor can turn over many more patients per day.

minopret• 13 years ago

Have I understood that correctly as follows? The key is "RDoC, for now, is a research framework, not a clinical tool." The director of NIMH is saying that although DSM is the clinical tool at present, it must remain open to revisions as new evidence is found, particularly etiology. So if we continue to use DSM also as a research framework and a criterion for awarding grants, thereby we restrain ourselves from achieving the needed evidence.

illuminate4• 13 years ago

Who calls it the "psychiatric bible" other than well-biased Scientologists who want to replace it with their own "religious technology"?

derleth• 13 years ago

> Who calls it the "psychiatric bible" other than well-biased Scientologists who want to replace it with their own "religious technology"?

A number of people, actually:

http://minnesota.publicradio.org/display/web/2012/12/18/dail...

http://healthworkscollective.com/michaeldouglas1/98946/gover...

http://www.cbsnews.com/2100-204_162-6193716.html

http://www.scientificamerican.com/article.cfm?id=dsm-5-updat...

http://www.theglobeandmail.com/commentary/editorials/new-psy...

http://www.psychologytoday.com/articles/200906/the-psychiatr...

illuminate4• 13 years ago

Thanks! Is that a pop usage, or do any professionals jokingly refer to it as such?

gruseom• 13 years ago

The critique of modern psychiatry has a long and intellectually serious tradition. Ironically, as your comment shows, the Scientologists have discredited it by association, at least with the ignorant.

illuminate4• 13 years ago

I'm not saying it's "beyond critique".

raverbashing• 13 years ago

The dictionary that comes with Mac OS has this one definition for bible: (bible) informal, any authoritative book.

So yes, it can be 'the bible', like the ICD can be called 'the bible of diseases'

About the critique the article does, I have nothing to add.

DanBC• 13 years ago

"bible" is often used to mean "authoritative work". It has often been used for programming languages. "The C++ Bible", etc.

Calling the DSM a "bible" just means it's the authoritative, definitive, work for many professionals.

illuminate4• 13 years ago

Makes more sense.

imperio59• 13 years ago

Should the pharmaceutical industries reimburse the patients and insurance companies for having essentially asked for money for treatments not based on science but on opinion for the last 50 years? It most likely won't happen, but that's really the question that should be on the table here...

hga• 13 years ago

Sorry, but that's garbage: the time frame you've set includes the wide adaptation of antipsychotics and biopolar disorder treatments. We know those work, e.g. in late '50s a while after my mother did the psychiatric ward portion of her nursing residency she was amazed to see one of those "hopeless" cases working in a janitorial or orderly role in the same hospital.

xijuan• 13 years ago

I am just glad that theses kind of issues with DSM are being talked about. I just feel that most people are unaware of these issues

readme2• 13 years ago

The DSM has been my main gripe with psychiatry. I always thought it was a vague way of labeling things that society deems unacceptable, rather than a way of identifying mental disorders.

VLM• 13 years ago

A quote right outta the old manual: "clinically significant distress or impairment in social, occupational, or other important areas of functioning" It boils down to if its not causing distress, leave them alone, which sounds like a reasonably libertarian outlook on life.

Its also a classification system, not a theory (why it happens) or a treatment plan system.

The best computer science analogy I can come up with is its something like "a list of sorting algorithms and how to identify them" rather than a history of each, or implementation guidelines. So if you see an algorithm that sweeps thru an array sequentially and swaps adjacent items if they're outta order, and keeps doin it until it can't find anything outta order anymore, then you're probably looking at a bubble sort.

Nothing to do with how someone who read Knuth or wikipedia would laugh at you, or how to avoid 0/1 referenced array bugs (and at the other end, running off the end of the array) or how to use (or not use) pointer arithmetic, etc.

readme2• 13 years ago

>Its also a classification system, not a theory (why it happens) or a treatment plan system.

This is the exact problem. It provides a means for categorizing what could be considered normal mental phenomena, and then calls it a disorder.

As far as your quote: '"clinically significant distress or impairment in social, occupational, or other important areas of functioning" It boils down to if its not causing distress, leave them alone, which sounds like a reasonably libertarian outlook on life.'

There are plenty of kids who were diagnosed with ADHD and other disorders via the coercive force of their parents and teachers who would disagree with the above statement.

National Institutes of Mental Health Director Rejects DSM V

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