by John Freedom, CEHP
The International Society for Ethical Psychology and Psychiatry's (ISEPP) has denounced the upcoming DSM-5. Thomas Insel, 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." Thomas Insel's statement comes just weeks before the scheduled publication of the DSM-V, the fifth edition of the Diagnostic and Statistical Manual.
"While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been 'reliability'– each edition has ensured that clinicians use the same terms in the same ways. 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. Patients with mental disorders deserve better."
Insel said that the NIMH will be replacing the DSM with the "Research Domain Criteria (RDoC)," which define mental disorders based not just on vague symptomology but on more specific genetic, neural and cognitive data. But then, immediately after making this dramatic announcement, Insel added that "we cannot design a system based on biomarkers or cognitive performance because we lack the data."
Insel's statement is also an implicit admission that there is no real theoretical basis for drug treatments for mental illness.
John Freedom, CEHP, is the Chair of the ACEP Research Committee. For more information visit: EnergyPsych.org