Psychiatry’s Guide Is Out of Touch With Science, Experts Say
New York Times
By PAM BELLUCK and BENEDICT CAREY
May 6, 2013
Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.” The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms. While the Diagnostic and Statistical Manual of Mental Disorders, or DSM, is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research. “As long as the research community takes the DSM to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match DSM criteria, but you know what? Biology never read that book.”
Establishment of Diagnostic Validity in Psychiatric Illness: Its Application to Schizophrenia
BY ELI ROBINS. M.D.AND SAMUEL B. GUZE, M.D.
American Journal of Psychiatry. 1970 126:107-111.
… One of the reasons that diagnostic classification has fallen into disrepute among some psychiatrists is that diagnostic schemes have been largely based upon a priori principles rather than upon systematic studies. Such systematic studies are necessary, although they may be based upon different approaches. We have found that the approach described here facilitates the development of a valid classification in psychiatry…
Dr. Spitzer’s compromises, reliability for validity and atheoretical/descriptive for etiology produced a very long day. The diagnostic system had several revisions, refinements of the DSM-III, and the DSM-IV set a record, lasting 19 years [1994-2013]. In 2002, the future chairs of the DSM-V [as it was then called] announced that Spitzer’s compromise had outlived its usefulness and proposed to move the diagnostic system closer to mainstream medicine by including the biological findings with the diagnoses – a biomedical diagnostic system for psychiatry was on the way. And so we started our day over once again. That same year, Tom Insel took over the NIMH and became a cheerleader for Clinical Neuroscience, his renaming of psychiatry.
We all know what happened. The psychopharmacology bubble burst and clay feet were exposed far and wide – in industry, in academia, just about anywhere anybody looked. The DSM-5 [as it had become] Task Force had to announce that its plans biomedical had been premature, and everything else went equally badly. They were amply warned by their predecessors [Drs. Robert Spitzer and Allen Frances] that they were headed for big trouble, but instead of listening, they resorted to Ad Hominem defenses. It has been a bad version of that same old day, the one that lasted from 2002 until this week. No question about that.
NIMH Won’t Follow Psychiatry ‘Bible’ Anymore
by Emily Underwood
6 May 2013
Although Insel’s blog was reported as a bombshell and potentially seismic, NIMH’s decision to scrap the DSM criteria has been public for several years, says Bruce Cuthbert, director of NIMH’s Division of Adult Translational Research and Treatment Development. In 2010, the agency began to steer researchers away from the traditional categories of DSM by posting new guidance for grant proposals in five broad areas. Rather than grouping disorders such as schizophrenia and depression by symptom, the new categories focus on basic neural circuits and cognitive functions, such as those for reward, arousal, and attachment…