{"id":44653,"date":"2014-03-11T00:49:47","date_gmt":"2014-03-11T04:49:47","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=44653"},"modified":"2014-03-11T11:20:40","modified_gmt":"2014-03-11T15:20:40","slug":"a-little-o","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/03\/11\/a-little-o\/","title":{"rendered":"a little “o”…"},"content":{"rendered":"\n
Several years ago, I wrote a ten part series called the dreams of our fathers<\/font><\/strong><\/em> that reviewed the coming of the DSM-III and some of its later history. It starts here<\/a>. It was my attempt to catchup on the history I didn’t know. The short version is that the psychological theories of the analysts had to go, and the group in Saint Louis who wanted to medicalize psychiatry came to the fore. The architect of the system, Dr. Robert Spitzer, wrote:<\/div>\n
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    The approach taken in DSM-III<\/font><\/strong> is atheoretical with regard to etiology or pathophysiological process except for those disorders for which this is well established and therefore included in the definition of the disorder. Undoubtedly, with time, some of the disorders of unknown etiology will be found to have specific biological etiologies, others to have specific psychological causes, and still others to result mainly from a particular interplay of psychological, social, and biological factors…<\/em><\/div>\n
    Robert Spitzer<\/font><\/strong>, in the DSM-III, p 6.<\/em><\/div>\n<\/ol>\n
    The system was based on descriptive criteria and hinged of inter-rater reliability [substituting for the elusive validity every wanted]. It was based on the Research Diagnostic Criteria [RDC<\/font><\/strong>] developed by Spitzer at the NIMH. Besides jettisoning the psychological formulations, it was designed to make communication between clinicians more standardized and to facillitate research in psychiatry. In spite of Dr. Spitzer’s assurances about parsing these diagnoses between disorders of psychological and biological origin, psychiatry became focused on biology, and the that sorting, or even any attempts disappeared. The DSM-5 Task Force began its life in 2002 with the explicit goal of matching the findings of biological research with the diagnostic system, completing the transition to a biology based system, but that enterprise failed – globally. <\/div>\n

    The objections to the clinical diagnostic system were that the psychiatric drugs were not specific for any particular diagnosis. The neuroimaging findings and genetic studies likewise failed to map onto the clinical diagnostic groups. There were no biomarkers of any clinical entity located along the way, nor any biological targets that showed syndrome specificity. We might add that the pharmaceutical industry had run out of clones of the two major classes – SSRIs and Atypical Antipsychotics – and was moving away from CNS drugs after a quarter century feeding frenzy. <\/p>\n

    So on the eve of the launching of the DSM-5, the NIMH announced that it was no longer going to fund research based on the diagnostic entities, but would now focus on it’s own NIMH diagnostic system – not quite yet in existence. [sound familiar?]. It was called the RDoC<\/font><\/strong> [sounds like <\/font><\/strong><\/em>RDC<\/font><\/strong>?]. <\/font><\/strong><\/em>Rather than bring science to the diagnoses, it essentially intends to bring the diagnoses to the known science. Here’s Dr. Insel’s brief view: <\/div>\n
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      NIMH has launched the Research Domain Criteria (RDoC<\/font><\/strong>) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system… This approach began with several assumptions:<\/em><\/div>\n