“Dr. Insel’s Blog is not big News… It’s an Affirmation of Something That has Been in the Works for a Long Time.”


1 Boring Old Man incisively analyzes NIMH director Thomas Insel’s disavowal of the DSM, saying “it’s not likely to be a shock to the APA or the DSM-5 Task Force… In 2002, the DSM-V leaders published a book with a grandiose plan [A Research Agenda for DSM-V] to rebuild our diagnostic system on a new footing, the biological findings of mental illnesses rather than the descriptive system used for the DSM-III and DSM-IV. They held a number of research seminars over the ensuing years in pursuit of this goal. They said that they realized that they weren’t going to be able to do that in the course of these conferences, but they didn’t tell us until 2011 in the article mentioned above. In that article, they discussed the NIMH’s RDoC Project as the heir to their grand design.

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  1. I guess I have a slightly different take than 1boring.
    I don’t think it’s been clearly said, prior to the Insel blog that someone at Insel’s level of leadership views the DSM as not valid (meaning not true, untrue, false, off the mark, inaccurate). It may have been said in cloistered meetings but the general public and “system” were largely unaware.

    Second, I have to wonder about the collusion of the APA and NIMH when Insel makes this announcement so close to the DSM 5 launch. Is his announcement likely to increase or decrease sales? It’s one of the APA’s top money makers, so the timely doesn’t seem ideal if massive sales are in view.

    Finally, Insel doesn’t claim the new direction of classification will be ready for use anytime some. A decade or more for practical applications. I’ve read another account (NY Times) where Insel walks back his initial comments by saying the DSM system (even though it’s not valid) is the best we have and we should keep using it until something better comes along. I found that very disappointing if not surprising. How can we say the best we have is something that isn’t valid? How can untruth be the best we can do? Don’t we all deserve better?

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