Tectonic Shift Towards “Precision” Psychiatry or Away from Scientific Credibility?

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On Critical Psychiatry, Duncan Double discusses a recent article by National Institute of Mental Health Director Thomas Insel about a “tectonic shift” towards “precision” psychiatry. Double suggests the article “should make american psychiatry fearful about the scientific credibility of its NIMH director.”

Psychiatric research folly (Critical Psychiatry, May 12, 2015)

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4 COMMENTS

  1. I don’t know if this is true or not:

    “For example, in his article Disruptive insights in psychiatry: Transforming a clinical discipline, he says aspects of schizophrenia can be mapped onto dysfunction of dorsolateral prefrontal circuits that mediate executive function; depression appears to involve dysfunction in a region of the midline infragenual prefrontal cortex important for regulation of mood; OCD (obsessive-compulsive disorder) involves dysfunction in the orbitofrontal prefrontal cortex via its role in perseverative behaviours; and posttraumatic stress disorder (PTSD) can now be mapped to dysfunction in prefrontal circuits required for the extinction of fear.”

    But as Robert Whitaker points out, the ADHD drugs and antidepressants cause the “bipolar” symptoms, including psychosis. And the neuroleptic drugs cause the positive and negative symptoms of “schizophrenia:”

    “Neuroleptic induced deficit syndrome is principally characterized by the same symptoms that constitute the negative symptoms of schizophrenia—emotional blunting, apathy, hypobulia, difficulty in thinking, difficulty or total inability in concentrating, attention deficits, and desocialization. This can easily lead to misdiagnosis and mistreatment. Instead of decreasing the antipsychotic, the doctor may increase their dose to try to “improve” what he perceives to be negative symptoms of schizophrenia, rather than antipsychotic side effects.”

    “neuroleptics … may result in … the anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures.”

    So I think the psychiatric industry should stop creating mental illnesses in people with their drugs for profit, because that is unacceptable human behavior.

  2. “should make american psychiatry fearful about the scientific credibility of its NIMH director.”

    Wrong assumption: they don’t care about that. RDoC will be the same as DSM in being unscientific and ridiculous (since it can’t be anything else given the state of our knowledge about nervous systems – not only human but even such complex organisms as earthworm) but it will be used as a trick to convince people that psychiatry has put it’s dark past behind it and now they have reliable diagnosis and safe and effective treatments (I promise you, it’s for real this time). And people will buy it for a time and then it’s going to get even worse and they will re-brand again.

  3. Precision brain damage is what you get from this type of thinking. Thomas Insel has long harbored a belief in some burgeoning revolution in understanding the brain. Thing is, this revolution isn’t happening so much in reality, although there have been rumors that we’re on the brink of such a revolution for the past well over 100 years. Thomas Insel makes some kind of progressive sounding pronouncement denouncing the DSM, and a few people think some kind of a seismic paradigm shift has occurred. No such luck. This is merely the result of a power play between the NIMH and the APA for technical supremacy. The NIMH knows they’ve got the APA as far as the science is concerned. The only kind of “medical condition” that is voted into existence by experts with over active imaginations is mental disorder. Beyond that, they’re sharing notes. This is the same Thomas Insel who defended Charles Nemerof when he was caught concealing drug company kick back info. The same Charles Nemerof who has no problem presenting at a pharmaceutical company funded APA annual convention. Apparently, there are not enough elephants in the room to make meat of that one, except for maybe the little pink ones flying in favor of the chemical fix.