“Psychiatry in Crisis! Mental Health Director Rejects Psychiatric “Bible” and Replaces With… Nothing”

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John Horgan of Scientific American writes that “in a move sure to rock psychiatry, psychology and other fields that address mental illness, the director of the National Institutes of Mental Health has announced that the federal agency–which provides grants for research on mental illness–will be “re-orienting its research away from DSM categories.”

(14 months ago Horgan wrote, in “Are Psychiatric Medications Making Us Sicker?“, that Anatomy of an Epidemic is “one of the most disturbing, consequential works of investigative journalism I’ve read in a long time. Perhaps ever.”)

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5 COMMENTS

  1. I agree Duane. I commented on the original news post on MIA but maybe more commenting is necessary.

    Drawing from Wiki, let us tease out a bit more what Dr. Insel about the DSM not being Valid. Why does the DSM’s lack of Validity matter? What is Validity anyway?
    Validity:

    “In science and statistics, validity is the extent to which a concept, conclusion or measurement is well-founded and corresponds accurately to the real world. The word “valid” is derived from the Latin validus, meaning strong. The validity of a measurement tool (for example, a test in education) is considered to be the degree to which the tool measures what it claims to measure.

    In clinical fields, the assessment of validity of a diagnosis and various diagnostic tests are extremely important. As diagnosis augments treatments, medications, and the patient’s life, it is extremely important to know that when running diagnostic tests that clinicians are truly testing what they intend to test.

    It is generally accepted that the concept of scientific validity addresses the nature of reality and as such is an epistemological and philosophical issue as well as a question of measurement. The use of the term in logic is narrower, relating to the truth of inferences made from premises.

    Validity is important because it can help determine what types of tests to use, and help to make sure researchers are using methods that are not only ethical, and cost-effective, but also a method that truly measures the idea or construct in question.”

    Wiki also supplies a nice graphic for those, like me, who enjoy a visual. Remember, Dr. Insel stated that while the DSM has reliability (consistency) it lacks validity. So when you look at the diagram below (not sure if will show up here), you will see that the DSM quite literally “misses the mark”.

    The admission by Dr. Insel can’t be understated in my opinion. He’s lifted the curtain and exposed the sham underpinnings of our so-called mental health system. I do wonder and worry about what might rush in to fill the vacuum. Will something else fill the vacuum with this admission? Is this not the opportunity folks at MIA, Mindfreedom, NEC and others have been waiting for? A chance to say, “There’s a better way. A more human, caring way.”

    • “Is this not the opportunity folks at MIA, Mindfreedom, NEC and others have been waiting for?”

      I completely agree. I’ve had a couple of days digesting the news. It’s even more meaningful than I originally thought. Tom Insel’s statement, despite its political correctness, is very strongly worded. I have gone many times over this paragraph in particular,

      “The weakness is its lack of validity. 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.”

      If that isn’t an official adoption of Thomas Szasz’s “The Myth of Mental Illness” talking points, then what is it?

      It is a very explicit acknowledgment that DSM criteria are nothing more than “opinions” about behavioral patters that deviate from “normal”, whatever “normal” is. If so, what makes the DSM labeling different from Inquisition sanctioned labeling as “heretic”?

      What I find surprising is that the statement is dated April 29th. It only showed up in MIA, and other news outlets, 4 days later. Why did it take so long? And more importantly, isn’t this a great starting point for demolishing the current psychiatric establishment?

  2. Official Response to Insel from the APA:

    FOR IMMEDIATE RELEASE
    Erin Connors, 703-907 8562 May 3, 2013
    [email protected]

    Tamara Moore, 202-745-5114
    [email protected]

    Statement by David Kupfer, MD
    Chair of DSM-5 Task Force Discusses Future of Mental Health Research

    The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting. In the absence of such major discoveries, it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding of disorders such as autism spectrum disorder, bipolar disorder, and schizophrenia.

    This progress will soon be recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The new manual, due for release later this month, represents the strongest system currently available for classifying disorders. It reflects the progress that we have made in several important areas.
    – A revised chapter organization signals how disorders may relate to each other based on underlying vulnerabilities or symptom characteristics.
    – Disorders are framed in the context of age, gender, and cultural expectations, in addition to being organized along a valuable developmental lifespan within each chapter.
    – Key disorders were combined or reorganized because the relationships among categories clearly placed them along a single continuum, such as substance use disorder and autism spectrum disorder.
    – A new section introduces emerging measures, models and cultural guidance to assist clinicians in their evaluation of patients. For the first time, self-assessment tools are included to directly engage patients in their diagnosis and care.

    DSM, at its core, is a guidebook to help clinicians describe and diagnose the behaviors and symptoms of their patients. It provides clinicians with a common language to deliver the best patient care possible. And through content such as the new Section III, the next manual also aims to encourage future directions in research.

    Efforts like the National Institute of Mental Health’s Research Domain Criteria (RDoC) are vital to the continued progress of our collective understanding of mental disorders. But they cannot serve us in the here and now, and they cannot supplant DSM-5. RDoC is a complementary endeavor to move us forward, and its results may someday culminate in the genetic and neuroscience breakthroughs that will revolutionize our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime? Every day, we are dealing with impairment or tangible suffering, and we must respond. Our patients deserve no less.