NIMH Abandons the DSM-5

DSM-5_3DAndy Coghlan and Sara Reardon write at the New Scientist:

The world’s biggest mental health research institute is abandoning the new version of psychiatry’s “bible” – the Diagnostic and Statistical Manual of Mental Disorders, questioning its validity and stating that “patients with mental disorders deserve better”. This bombshell comes just weeks before the publication of the fifth revision of the manual, called DSM-5.

On 29 April, Thomas Insel, director of the US National Institute of Mental Health (NIMH), advocated a major shift away from categorising diseases such as bipolar disorder and schizophrenia according to a person’s symptoms. Instead, Insel wants mental disorders to be diagnosed more objectively using genetics, brain scans that show abnormal patterns of activity and cognitive testing.

This would mean abandoning the manual published by the American Psychiatric Association that has been the mainstay of psychiatric research for 60 years.

The DSM has been embroiled in controversy for a number of years. Critics have said that it has outlasted its usefulness, has turned complaints that are not truly illnesses into medical conditions, and has been unduly influenced by pharmaceutical companies looking for new markets for their drugs.

There have also been complaints that widened definitions of several disorder have led to over-diagnosis of conditions such as bipolar disorder and attention deficit hyperactivity disorder.

Now, Insel has said in a blog post published by the NIMH that he wants a complete shift to diagnoses based on science not symptoms.

“Unlike our definitions of ischaemic heart disease, lymphoma or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure,” Insel says. “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.”

Insel says that elsewhere in medicine this type of symptom-based diagnosis been abandoned over the past half-century as scientists have learned that symptoms alone seldom indicate the best choice of treatment.

To accelerate the shift to biologically based diagnosis, Insel favours an approach embodied by a programme launched 18 months ago at the NIMH called the Research Domain Criteria project.

The approach is based on the idea that mental disorders are biological problems involving brain circuits that dictate specific patterns of cognition, emotion and behaviour. Concentrating on treating these problems, rather than symptoms is hoped to provide a better outlook for patients.

Read more here.

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  • BuzzCoastin

    > Insel has said in a blog post published by the NIMH that he wants a complete shift to diagnoses based on science not symptoms.

    this is an extremely subtle position
    which on the surface sounds reasonable
    but in reality
    it is a way to increase patients for the system
    without the trouble of them having symptoms
    e.g
    many people without symptoms are diagnosed with & treated for cancer
    they may not feel sick
    but the test says they are sick & need immediate treatment
    who ya gonna believe
    your body or a scientific test?

    I predict a significant increase in Big Pharma treatments
    for people who test insane
    which will likely be people who say things like this

    • Simon Valentine

      ol’Bama never did get its scientistas straight, did?
      nope.
      gotta do it right gotta do it my damn self
      American Federal Technocratic Republic style
      fuck’m
      people round me listen to me more than ol’Bama

      • chinagreenelvis

        Yes, blame the President. Because why the fuck not?

        • Simon Valentine

          i didn’t
          but if you wanna shovel shit
          don’t use a spade

          if you’re so used to assuming on a dime that someone’s this or that in regards to someone
          wheelll
          you must be able to stop on a dime
          so check yourself
          it was humpity dumpity that wrecked itself

          • chinagreenelvis

            I’m sorry, was “ol’Bama” not a reference to Barack Obama?

          • Simon Valentine

            “its” scientistas, plural, so unless you’re going to next say that i’m saying Obama is the prophet anti-christ and has doppelgangers, you’re games up and over. so you call the shot. ask me a legitimate question about Obama or take one of these cookies that say “Obama and Friends tried to clean up a mess and got particular things worked out but there’s going to be a mess remaining come time he, they, or whatever happens out, is out”.

          • chinagreenelvis

            I literally have no idea what you’re talking about at this point.

          • Simon Valentine

            good then i can get back to work, eh? chears mr. elvis

          • Andrew

            Then his rhetorical style is successful.

    • kowalityjesus

      Scientific diagnoses must necessarily be relative in light of “diseases” that are more or less subjective. However, I think the idea behind the use of science to diagnose is less subtle. For example, a study recently verified that people who have shifty eyes are actually crazy http://ge.tt/3nXdgiQ/v/0 This, of course, is using pre-diagnosed individuals and technologically enhanced tests to determine a ‘symptom pool’ indicative of a disease or disorder, but it’s about as objective as ‘psych’ science can get without using brain-waves (which would probably give us as many “diseases” as there are people).

      I am skeptical of the entire discipline of psychiatry, as I personally never had any meaningful experiences with shrinks (most turned into philosophy lectures, lol). Since they face most gray cases armed with only a prescription pad, they are prone to overprescribe. For example, by one book’s account, obscure or untreated allergies are most frequently misdiagnosed as depression, and prescribed SSRIs which do not mitigate the problem. I spent time at the Museum of Psychiatry in LA and came out with a healthy wariness of the practice, but mostly a first-hand glimpse at the creepiness of Scientology, lol.

  • echar

    This can go both ways. As noted they sometimes treat for the wrong condition and/or over diagnose with the orthodox approach. Calling in Bob Larson , a shaman, and prayer circles may provide a placebo affect. Ultimately diagnostic tools that can show this or that is an improvement, from my perspective.

    • Simon Valentine

      if minds were meant to have orders
      people would actually know what a word means
      instead, people say order when they mean command
      some demand that they don’t have it wrong (that they’re offended by someone telling them that thier idea is wrong except in cases x y z etc.)
      which makes the lying siphons we’re so used to in the states
      whether it be ‘statesmen’ or ‘physicians’, doesn’t matter
      not ethical
      not reasonable
      violates laws

      3 2 1, 1 2 3, 1 3 2, 3 1 2, 2 1 3, 2 3 1
      o r d e r
      “order in the court” – collapse quantum system
      bogus.
      malpractice’s basis is like any other thing
      validity. the inherent lack thereof. the incessant demand that “i have inherent validity” “i am sovereign” and such like, say the slaves.
      Happiness in Slavery

      thing is, orders, and here i’ll say arrangements, cuz that’s what i’m about to do with some mathematical flowers, is like cliques and sets of data points ‘somehow associated’. real easy. real basic. so with so many, it gets ub3r difficult to determine things, so people pop some shit, allude to authority that doesn’t exist, or exhibit something that isn’t a problem any more or less than it’s a solution. thing is, business does it all around, and so do people. it’s all the same. even right here in front of me is a ‘sliding paper calculator’ brochure thingamabob from Goodyear, and it was so rife with bullshit that i couldn’t help but keep it for my garden.

      so it says:
      (t) Actual savings may vary based on when tires are replaced, driving and road conditions, and proper tire maintenance.

      if you notice, that’s exactly the ‘clique’, ‘planar data’, ‘tool’, ‘weapon’ or whatever. the grapheme-morpheme. and it’s the same old story. there are a few knowledgable ethical people in the system who don’t need the shit to do shit right. the rest of them, this is a supression mechanism. fire supression, punny, whatever. turns out it doesn’t only act the way they convince or come-to about it, if they even get aware of it. now. look again at those 3ish variables (may vary based on [sic]). how much of that grapheme-morpheme puts pressure on the corporate, and who if anyone applies the pressure, and is it a matter of voting, and are there psionics. now, again, as always this is more about being aware and polymath to me, so do as you will.

      • echar

        I think get what you are saying. Certainly there is bull crap, variables, and events we may not be able to measure. Having tools that can measure beats one person’s word against a deluge of others. Of course as Buzz noted, it can be flipped around and used to prove insanity or sanity where is none. One Flew Over the Cuckoo’s Nest comes to mind, or Rosemary Kennedy.

        • Simon Valentine

          hahaha lol well assuming there’s an answer anyway
          false dichotomy, fake question, undefined either way anyway

          Rock, Paper, and Scissor contacted Orange, who told them to ask Tatertot to ask Zales for the latest word on the Key from up the river from down the mountain top. i think i heard Zales say “don’t hold to anything that isn’t already what it is or isn’t unless it is what it is”

          also my direct familiarity, knowledge, experience, with the automotive market combine with computer science and math to yield ideas of what is.

          • echar

            Hmm, well I am no expert. But I had a cousin who had schizophrenia. I remember him telling me how the system worked. He didn’t like his Dr. and he was scared. He killed himself after. Perhaps brain scans and other tools could have pinpointed the meds and treatment he needed. Assuming I understand what you are saying, considering it’s jumbled up.

          • Simon Valentine

            do you remember the Star Trek episode in which they went back in time to retrieve whales? Dr McCoy ran a hand scanner and gave a woman a pill and said dialysis was “dark ages”?

            from that vista, it’s all animal circuits anyway. the patterns of any cluster of animals are a pattern. it is the pattern sought that is enough to repair what detail need repaired, yet, as technology progresses, so to does that which it fixes. new fixes are new breaks. this is not necessarily true but is a pattern that may be seen.

            is not true cure that which is before pattern? to let the pattern occur to fix itself is like friendship. had your cousin had different, more, or particular friends, it would not have been so otherwise. as much as i disdain to, an Aslan quote would fit. something about not knowing what would have been (that which intelligence seeks to disprove, dismember, disassemble, much like taking apart a computer to learn its components). the singularity that occurs after pattern is the same singularity that was before pattern. what has changed? order.

            de facto treatment of variables e.g. persons, animals, … , trash, vehicles, mates, etc. have many-a-same algorithm, algorism, algebra. “throw away mentality”. “eminent domain mentality”. “struggle mentality”. “orthodox mentality”. the point is, there is no list of laws. there is no comprehensive detail of the mind. if there were, there wouldn’t be problems getting, giving, having, being … solutions. your cousin was gifted and anyone who actually comprehended those gifts, as a list, most certainly did not include the doctor. a doctor is an over paid cheeseburger cook. any decent human being can do any damn well thing that they can and it doesn’t require money or titles.

            i plan on never seeing a doctor again and dying in whatever the hell way i am supposed to according to whatever isn’t that ‘thr’ BS.

          • echar

            He was also mentally ill, and needed medicine. I wish I could see a Dr. but no health care. I think that was one of the Star Trek movies, actually. They needed clear aluminum to lift them. Anyhow, I think it’s pretty clear we have differing perspectives on this.

          • Simon Valentine

            doctor:
            diagnosis.
            monopoly on medication.

            why else would one wish to see Dr.

            diagnosis: diagnosis available elsewhere.
            medication: medication may be obtained by court ordered injunction if necessary.

            no such thing as two people not having differing perspectives, yes? so why would it seem so important? obsessive compulsive? ask: if agreeing, a vote, a bit, a state, a quantum register, a sentence, etc. were a single grain of rice, what could ‘merely saying’ that someone is mentally ill do (to them, to others)? could it be a cause of ‘the condition’? a catalyst? a cause for a pre-existing condition that was caused by someone else causing it? keep regressing until it gets to the inevitable: NO ONE HAS THE ANSWER. a problem no one has solved. do yourself a favor and don’t believe anyone. not me, not yourself; no one. life continues. if paranoia is the cue ball, who’s the illegitimate bastard putting English on it? is it the eight ball? which game is it?

          • echar

            Thank for your perspective. My last comment was an attempt to gracefully back out of this conversation. I am being respectful, because I like you. Have a good evening.

          • Simon Valentine

            alright that’s distinct. i wasn’t sure. thank you. i wish well for you. until next time.

          • rtb61

            The principle is, are their any direct physiological causes for those symptoms. For an obvious start, is their a brain tumour present and is that the cause of the psychological problems.
            Other forms of physical damage can also cause a range of symptoms and then there are birth defects, whether genetic or as a result of toxicological exposure during pregnancies.

          • Simon Valentine

            i think what he was getting at is that that’s what the principle isn’t, wasn’t, and should have been.

            we know the obvious. doctors are supposed to know it too. nonfeasance, the principle, is?

          • http://hormeticminds.blogspot.com/ Chaorder Gradient

            why do we have to believe there is a brain tumor to be completely enchanted by a belief? Is it so scary that some problems could simply be a psychological construct? That anyone could be “insane” but having no way to prove it?

          • Simon Valentine

            heh on a lighter humor side of things
            there’s always Woolooloo

          • Simon Valentine
          • echar

            Scans cannot be used to discover mental illnesses yet, but maybe they can in the near future.

          • Simon Valentine

            it’s not that ‘they can’
            it’s that ‘they will’
            and some will make it lucrative
            and some honest people will fall prey
            again

            what scans will do is locate something that doesn’t quite fit the profile of usual brain construction, chemistry, anatomy, atomics, subatomics, heck, maybe they compute Chi sometime eh?
            the patient has the right to be informed instead of being spoon-fed bullshit
            e.g.
            some artists choose to have states that some doctors quantify as mental illness, while other doctors don’t

            and some public circles wack each other off to the schadenfreude and schadenprahlen, maybe even they portend to ‘a legitimate critic’ or maybe it’s just an entirely other sort of schema
            like psychosis

          • echar

            I try not to perceive in absolutes, especially when it comes to the future. Also, paranoia may cause you and/or others discomfort and/or limit potential.

          • Simon Valentine

            do you see a positive side of things to limiting potential? i guess there’s something we differ on. i tend to think of the future as a block of cheese and no matter which cheese grader the now is, the past it still just cheese. it’s got a fun(ny) value to me more than an “absolutely!” value to me. too many sim-antics with constancy sometimes. pun intended ;)

          • echar

            I prefer you speak clearly, and that you refrain from flip flopping. It appears you are messing with me, and I do not care for such.

          • Simon Valentine

            it’s a legitimate question, if you personally are feeling it approach a fish-out-of-water scenario, to me, that’s math, not messing. /clearly/ and absolutely i’m guessing have something different yet are similar – to me, a word that could possibly be among the difference is “authority”, “command”, “push”, “influence”, “force”, “magnetics”, “gravity”, “Cassimir effect”, “Dedekind cut”, etc.

          • echar

            Limiting may be positive if it leads to destruction. Yet a technology is neutral.

          • Simon Valentine

            i’ve never interpreted the word de-struction this way before. con-structed would be flip-flop. de-structed would be, like, without structure. which can be very peaceful and calm. Shiva technology :)

            first thought was, though, “wait a second, that’s not … when put with the thing you said before it’s … hang on that’s not the only thing to speak of”. second thought “atomic model? what magnification of the fractal? cellular? metaphysical? imaginary?”

          • echar

            I am hopeful this will lead to healing. I take back the word destruction and place harm in it’s place.

            I am finding it difficult to understand you. Which is causing frustration due to the static.

          • Simon Valentine

            i’ve never interpreted the word de-struction this way before. con-structed would be flip-flop. de-structed would be, like, without structure. which can be very peaceful and calm. Shiva technology :)

            first thought was, though, “wait a second, that’s not … when put with the thing you said before it’s … hang on that’s not the only thing to speak of”. second thought “atomic model? what magnification of the fractal? cellular? metaphysical? imaginary?”

          • echar

            I prefer you speak clearly, and that you refrain from flip flopping. It appears you are messing with me, and I do not care for such.

          • Simon Valentine

            do you see a positive side of things to limiting potential? i guess there’s something we differ on. i tend to think of the future as a block of cheese and no matter which cheese grader the now is, the past it still just cheese. it’s got a fun(ny) value to me more than an “absolutely!” value to me. too many sim-antics with constancy sometimes. pun intended ;)

  • Dingbert

    HALLELUJAH!

  • Anarchy Pony

    So wait… what about the super intelligent rats and mice?

    • http://www.ContraControl.com/ Zenc

      I know.

      I hope they get the new Standards established before the spring plowing. Timothy’s too sick to survive a move right now.

  • Reasor

    As someone who’s actively pursuing a Psychology degree, I welcome any refinement of diagnostic technique intended to help keep up with our growing understanding of the brain’s complexity. The DSM is, at best, a manual for insurance companies to determine whether or not someone’s mental anguish is something they have to cover. Kudos to Insel and NIMH, and here’s hoping they stick to their guns when the pharmaceuticals lobby turns its sights toward them.

    • Rhoid Rager

      As a sociologist, it strikes me as strange that someone can be diagnosed with a physical or mental ailment, as though it developed inside of them sui generis. Sociology has benefited most from the ecological point of view in recent years, since the social nature of humans was accepted as a basic assumption, unlike many other fields. It only seems natural that a social environment, including that projected through media, has an indelible effect on one’s world view. This isn’t an affront on free will, but one which accepts that when humans quash their own curiosity about the world around them and go on ‘autopilot’, cultural norms and roles become the rudder.

      This change towards ‘objectivity’ in diagnosis seems to move further in that direction. I don’t view this as positive, because it helps to reinforce a diagnostic monopoly held by a scientific elite. There may be dismissals of this term ‘elite’, but having wandered the innards of academia for almost a decade, what’s larger than a professor’s ego is his (purposely sexed here) pay cheque. God help us if a technology is ‘invented’ that gives instant, genetic confirmation of the prevalence level of mental illness, circumventing hours and hours of one-on-one sessions by an involved care worker.

      • Monkey See Monkey Do

        “There are periods of history when the visions of madmen and dope fiends are a better guide to reality than the common-sense interpretation of data available to the so-called normal mind. This is one such period, if you haven’t noticed already.” – R.A.W.

        • Rhoid Rager

          Great quote.

      • http://hormeticminds.blogspot.com/ Chaorder Gradient

        Spoke well to my uneasiness of this news.

        Unfortunately… this is a thing now. Had a few friends that did it and I could respond with nothing but a facepalm.
        http://www.gtldna.com/HealthTesting/DNA-Predisposition-Testing.htm

        I expect mental disorders to already be tested for, or at least to be added in the near future

      • DeepCough

        Psychologist David Rosenhan conducted an interesting experiment on whether or not it was possible to definitely distinguish between the
        sane and the insane.

        Being Sane in Insane Places


        David Rosenhan: Being Sane in Insane Places Interview

        • Rhoid Rager

          That clip brought me to this one.

          R.D. Laing influenced my thinking, and Adam Curtis doesn’t nearly give him as much exposure in his documentary as he deserved.

          https://www.youtube.com/watch?v=PKFq43KHw0M

          • DeepCough

            For some reason, Disinfo has not given nearly enough exposure to Adam Curtis, the Cronenberg of journalism.

  • DeepCough

    The Diagnostic and Statistical Manual of Mental Illness (DSM) certainly is a “Bible” of Psychiatry: psychologists and psychiatrists take every word written in it as literal truth without any context genuinely applicable to the real world, and they will even use the law to enforce it. Nice to see some progress here in the 21st century.

  • chinagreenelvis

    In other news, people fear change.

  • http://www.facebook.com/D.Hotkiss Douglas Hotchkiss

    i worked in the field for 20 years , and now am on the ssi end of the stick , got locked down for 72 hrs..supposedly depressed, ptsd, mood disorder..they dispensed the pills, mandated me to outpatient groups..ka-ching..then i looked up board notes and see the police dept. was welcomed to a cozy spot with the mental health provider..a cot plan is now ” streamlined and you dont go before a judge- two phd witch doctors from pakistan can lock you up .

    • Simon Valentine

      hmm i know some people ‘would be interested in hearing this
      i’ll carry in spirit
      makes me more appreciative of some history

      that deal sounds like one that violates a few laws
      stay shrewd~
      good luck

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