
National Institutes of Mental Health Director Rejects DSM V - sehugg
http://blogs.scientificamerican.com/cross-check/2013/05/04/psychiatry-in-crisis-mental-health-director-rejects-psychiatric-bible-and-replaces-with-nothing/
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tokenadult
The blog statement by the director of National Institute of Mental Health

[http://www.nimh.nih.gov/about/director/2013/transforming-
dia...](http://www.nimh.nih.gov/about/director/2013/transforming-
diagnosis.shtml)

is much more informative and balanced on this issue.

I am part of a local "journal club" of psychology researchers and graduate
students in psychology at my alma mater university, and what several of those
researchers are seeking are more reliable diagnostic criteria based on
biological information.

~~~
icegreentea
From what I get from reading around, it seems like pretty much all parties
involved agree that most sound way to diagnose mental disorders is by being
able to actually measure the physiological causes of the disorders, whatever
they might be.

It's just that the group pushing DSM5 believes that we really need an updated
set of definitions to guide diagnosis, that we have no reliable tests to look
for physiological signs of mental disorders, and are unlikely to find and
flesh out any in the near future (as in few years to a decade time frame), so
we may as get DSM5 out for now, which does appear to update the various
definitions and groupings to more accurately reflect our current understanding
of the disorders - for example the groupings for various previously distinct
diagnosis into spectrums.

There are certainly other issues with DSM5, such as exactly what thresholds
are used and what not... but I certainly think that many of the issues (like
omg! big pharma is trying to define everything so they get more sales) won't
go away even with 'reliable' physiological tests.

~~~
pekk
Given that the majority of these disorders do not have any clear etiology, and
may not have any biological reality, requiring measurement of causes would
destroy most of DSM.

Not just pharma but the whole psychiatric establishment has a vested interest
in handing out diagnoses, whether they are understood or not. Prescriptions
are not just convenient for big pharma, they can be given out in a short time
so that a doctor can turn over many more patients per day.

~~~
rubinelli
The current state of psychiatry is like a world in which antibiotics were
discovered before the germ theory of disease. Imagine you go to a doctor and
he diagnoses you as having pneumonia. That's the best he can do, a symptom-
based diagnosis. He tells you to take penicillin for seven days, and to go see
him again after 14 days, to see if the medication is working, or if you'll
have to switch to amoxicillin.

If this hypothetical doctor knew what caused infections, he could test for
specific strains and choose the best medication without this trial and error
phase. He would also know that pneumonia and skin infection, two apparently
completely unrelated diseases, may in some cases be caused by the same
bacteria and treated with the same medicine. Does it mean he should stop
prescribing antibiotics until he knows exactly how they work? Of course not.
Those are saving lives, and there are clinical trials to prove it. What it
does mean is that researchers should work on discovering the underlying
mechanisms, because the payoff would be absolutely tremendous. Assuming, as
you said, that they exist.

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imperio59
Should the pharmaceutical industries reimburse the patients and insurance
companies for having essentially asked for money for treatments not based on
science but on opinion for the last 50 years? It most likely won't happen, but
that's really the question that should be on the table here...

~~~
hga
Sorry, but that's garbage: the time frame you've set includes the wide
adaptation of antipsychotics and biopolar disorder treatments. We _know_ those
work, e.g. in late '50s a while after my mother did the psychiatric ward
portion of her nursing residency she was _amazed_ to see one of those
"hopeless" cases working in a janitorial or orderly role in the same hospital.

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xijuan
I am just glad that theses kind of issues with DSM are being talked about. I
just feel that most people are unaware of these issues

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readme
The DSM has been my main gripe with psychiatry. I always thought it was a
vague way of labeling things that society deems unacceptable, rather than a
way of identifying mental disorders.

~~~
VLM
A quote right outta the old manual: "clinically significant distress or
impairment in social, occupational, or other important areas of functioning"
It boils down to if its not causing distress, leave them alone, which sounds
like a reasonably libertarian outlook on life.

Its also a classification system, not a theory (why it happens) or a treatment
plan system.

The best computer science analogy I can come up with is its something like "a
list of sorting algorithms and how to identify them" rather than a history of
each, or implementation guidelines. So if you see an algorithm that sweeps
thru an array sequentially and swaps adjacent items if they're outta order,
and keeps doin it until it can't find anything outta order anymore, then
you're probably looking at a bubble sort.

Nothing to do with how someone who read Knuth or wikipedia would laugh at you,
or how to avoid 0/1 referenced array bugs (and at the other end, running off
the end of the array) or how to use (or not use) pointer arithmetic, etc.

~~~
readme
>Its also a classification system, not a theory (why it happens) or a
treatment plan system.

This is the exact problem. It provides a means for categorizing what could be
considered normal mental phenomena, and then calls it a disorder.

As far as your quote: '"clinically significant distress or impairment in
social, occupational, or other important areas of functioning" It boils down
to if its not causing distress, leave them alone, which sounds like a
reasonably libertarian outlook on life.'

There are plenty of kids who were diagnosed with ADHD and other disorders via
the coercive force of their parents and teachers who would disagree with the
above statement.

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illuminate
Who calls it the "psychiatric bible" other than well-biased Scientologists who
want to replace it with their own "religious technology"?

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DanBC
"bible" is often used to mean "authoritative work". It has often been used for
programming languages. "The C++ Bible", etc.

Calling the DSM a "bible" just means it's the authoritative, definitive, work
for many professionals.

~~~
illuminate
Makes more sense.

