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NIMH Distances Itself From DSM Categories, Shifts Funding To New Approaches
New submitter Big Nemo '60 writes with news that the National Institute of Mental Health is seeking to modernize the diagnosis of mental illness through the use of neuroscience, genetics, etc. From the article: "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."
More importantly, they are going to be shifting funding to research projects that seek to define new categories of mental illness using modern medical science, ignoring the current DSM categorizations: "The strength of each of the editions of DSM has been 'reliability' .. 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. ... NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. ... It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the 'gold standard.' ... Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data — not just the symptoms — cluster and how these clusters relate to treatment response."
are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.
They could all be Climate Scientists!
Clearly they have a plan, and goals that are not compatible with that of humans.
Our only hope? Super-intelligent space-monkeys.
I had internal infections misdiagnosed as depression for over 4 years before physical symptoms appeared. This is a good thing to avoid these kind of errors in the future. How the hell can a doctor prescribe SSRI without measuring the actual levels first?
Tomorrow is another day...
Psychiatry is not medicine.
The cynic in me thinks that most of psychiatry is concocted to sell pills (often of dubious efficacy), but I appreciate that mental health issues are real.
That being said, I am pretty sure that the vast majority of mental health conditions are caused by lifestyles VASTLY different than the conditions under which our species evolved.
Yes, of course we can't continue to have a well established resource compiled and validated by large numbers of mental health professionals that stigmatizes Differently Challenged people with labels of mental illness. Folks, we need to empower Differently Challenged folks to harness their Different Challenges. Anything less would be cause fatal damage to their Different Self-Esteem model.
Good grief, what are these psycho-cooks who publish this DSM thing thinking? Tom Cruise tells me the DSM is a load of hooey.
We can't have this.
If you want news from today, you have to come back tomorrow.
to redefine "mental illness" broadly so that gun rights can be more easily denied.
So what does Tom Cruise think about this? Apparently, he knows the history of psychiatry.
Will this help Mrs.Frisby and her children, or cause them more hardship?
Were already well known. Considering we don't know too much about the organic causes of most mental disorders I'm curious about what they mean. Is schizophrenia mediated by glutamate or dopamine? We know dopamine antagonists help some people but not too much more.
You feel a certain way, and you have symptom X? Sorry, Citizens, DSM says you have Unavoidable Statism, and now you and your children and your DNA swabs are public property forever.
I want to delete my account but Slashdot doesn't allow it.
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. ...
In the early 1990s, I was prescribed drugs because "there's too much dopamine up there". They didn't measure jack. They just came up with this out of the blue based on how I was behaving.
The absolute lack of measurement was readily apparent to me, even in my state which after decades was most likely undiagnosed autistic spectrum disorder and post traumatic stress from all the crap that happens when spectrum kids get bullied in school.
Dopamine up there? How the hell couuld they know without a measurement.
The other problem with DSM is that it's too normative. Homosexuality is a "disorder", but then when you start treating homosexuals nicely they suddenly become less traumatized, more come out, and you realize that most of them aren't as sick as you thought, and that a lot of the sick ones are like that because you marginalized them in the first place.
First things first though. Come up with something to measure at least before you even pass judgement on it being normal, and then MAYBE you can try to come up with how much deviation from the mean is healthy. Posted AC for obvious reasons...
it's demons that cause psychiatric illnesses, so they will have a hard time finding the science of that, it's the same with the cause of cancer, demons also, so no cure can be found. What is needed is deliverance and healing prayer to fix these problems and there are so few people who do deliverance properly...
Just because I fucking hate the non-science that is Psychiatry, did you guys know that early DSM editions listed homosexuality as a treatable (with drugs) mental illness. I'm not making this shit up... There is not enough money in the world to restitute the hundreds of millions of people who are first-generation guinea pigs for incredibly dangerous drugs which are used to treat "diseases" which are derived from thin air falsely called science.
And I mean it sincerely. Sure, the DSM just categorizes sets of symptoms. But the problem with basing diagnoses on actual conditions is we have little idea what those actual conditions are, and not for lack of research.
... is selling more drugs by defining more and more mental disorders and trapping more and more people by those diagnoses.
Perhaps this is the beginning of the end for treating the symptom instead of the cause.
This won't be an easy effort, but there is so much potential to improve things for so many people.
I have never been able to believe that medication is always the answer- sometimes just understanding is the answer, but that's something the current culture of psychiatry isn't usually able to provide.
We can't all have ADD, and a one size fits all solution can't possible be highly effective for such a broad set of symptoms with some many different possible causalities.
Next step is to try to figure out how to contribute in some way. Still have to get over fear of failure first. Luckily I don't have fear of being ridiculed when posting AC on Slashdot!
Seriously though, try telling a psychiatrist you have trouble starting and completing projects without getting hit with an ADD diagnosis. You can practically see them mentally flipping through DSM pages. "But I'm pretty sure it's anxiety." "Take this stimulant and don't worry about it." You can imagine how well that ended up.
I for one welcome our new personalized mental health treatment overlords.
The New Scientist article -- whoops, guest editorial -- is titled "Psychiatry divided as mental health 'bible' denounced", but 'denounced' is a ridiculous overstatement. NIH/NIMH are simply announcing a new cross-category funding program that will step back and question the field's traditional assumptions.
Either the guest editorialist didn't RTFA, or else is just using the occasion to inject their personal views into public sight.
Or else just trolling.
Sheesh, evil *and* a jerk. -- Jade
Gooooooooooood?
I'm imagining a police interrogator talking to a suspect. "You know, you've really been very good about ensuring that you and your friends all told us the same story. There's only one problem: that story's bullcrap, and we can prove it."
https://en.wikipedia.org/wiki/The_Secret_of_NIMH
I'm really glad this has come about, not because the DSM itself is a useless book but because the attitudes towards it lead to some gross errors of judgement.
The DSM can be useful: if one clinician wants to communicate to another at a fairly high level the symptoms a patient is experiencing, then a DSM-defined disorder can be a reasonably efficient way of doing this. Also, the DSM does group together some symptoms which tend to occur as clusters under labels which can provide cues for looking for related symptoms which might otherwise be missed.
However...
People make the mistake of thinking that because something is listed in the DSM it is somehow a 'real disease'. The Epstein–Barr virus is a real disease: it is caused by a specific virus. Type I Diabetes is a real disease: it is caused by the loss of insulin-producing cells in the pancreas (although there is the more distal cause of the cell loss). Depression is not a real disease, in this sense - at least, not at the moment. It is a cluster of symptoms which when the occur together are referred to as Depression. Nothing more. (That isn't to say a 'disease' will not actually be identified at some point, but I suspect that will be for a specific subtype of depression, not depression as it is currently classified).
On the radio yesterday, I heard an 'aspie' - who under DSM 5 will no longer be an 'aspie' since Aspergers will no longer exist in its current form - talking about how it was great when he was diagnosed because they finally knew what was wrong with him. The problem is this: they didn't and still don't know what's wrong - just that his symptoms fit a commonly observed pattern, and that there are particular interventions to try to address the associated deficits. Having a listing in the DSM doesn't make things any more or less 'real', but some/many people imagine that it does. Just because there isn't a diagnostic criteria for a very shy child (although I imagine one could be found if looking hard enough), that doesn't mean that there aren't programmes to help the child be more comfortable with social interaction.
This becomes most manifestly a problem when conducting genetic, neurobiological, or even treatment research into the causes for 'a disorder'. Because these disorders are symptom clusters, and often have substantial variation in presentation, they are at times artificially grouped for research. This can hinder research into specific subgroups who show more common characteristics. Similarly, if there is a presentation which includes two DSM disorders (e.g. depression and anxiety, which is a very common comorbidity) then these people will tend to be systematically excluded from research because they are defined as 'having comorbidity'. Are both 'disorders' caused by the same underlying cause? Who knows, but being separate DSM disorders means that this group tends to be very underrepresented in research.
On top of this, there is the involvement of vested interests in the development of disorders, there is the interpretation of things as 'wrong' because they are a DSM disorder, etc.
In summary, the DSM can be useful for clinicians to communicate a summary to each other, when accompanied by further detail. It can provide gross groupings for treatment research, but lacks finesse of distinction which could help tailored treatments to individual characteristics rather than the broader presentation. People suddenly seem to think something is 'real' because it appears in the DSM, and so push to have ever more 'disorders' included. This all makes DSM as much of a hindrance as a help to good research and mental health practices.
Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms ... Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category.
Heart attacks are physical events; the muscles in the heart stop contracting, risking death. The patient's experience of it is relatively unimportant, except as an indicator of the physical event. It's the heart attack that needs treatment.
But for mental problems, the patient's perceptual experience often (usually? always?) is the condition that needs treatment. If the patient experiences depression, that is the problem. The physical conditions may be helpful as indicators of the perceptional condition, but it's the depression that needs treatment.
Its about time we brought this field out of the realm of guesswork and into the realm of objectively verifiable science.
Well done!
Asperger's is an excellent example of this, where knowing something about the disorder, what symptoms go together, and what strategies are effective at managing it, is extremely useful. The 'diagnosis' is of enormous practical value.
But it's not a disease in the sense of a specific diagnosis, nor are they even confident that it is a single disorder, and, at least at present, it certainly doesn't point towards a cure or anything beyond management of symptoms.
So it's useful, but definitely not 'diagnosis' in the same sense that, for example, identifying Mycobacterium tuberculosis would diagnose tuberculosis.
On the radio yesterday, I heard an 'aspie' - who under DSM 5 will no longer be an 'aspie' since Aspergers will no longer exist in its current form - talking about how it was great when he was diagnosed because they finally knew what was wrong with him.
SO, he'll be cured when this new version comes out.
Hurray!
There's hope!
Now, if they'll only remove the personality disorder(s) I suffer from.
And "Alcoholism".
No, it's called being a M-A-N; you pussies!
when I saw NIMH I was thinking about Nickel–metal hydride batteries. didn't realise that NIMH stood for National Institute of Mental Health. i learned something new today.
Nerds opining on psychiatric diagnosis...
This should go about as well as psychiatrists opining on monads...
Da Blog
But does this mean that having a female mind and a male reproductive system no longer means that I'm a serial killer who's constructing a woman suit? Does this mean when they scan my brain and find that it's psysiologically more female than male (these things aren't exact) that it just means that I'm a woman, not that I have a mental illness? What would we ever do if not for the DSM V? Thank you DSM V for acknowledging that being a woman is a mental illness! This post brought to you by b33r.
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That's all well and nice, but the practical reality is that it goes:
Symptoms -> Diagnosis -> Treatment
Except for very basic symptom treatments like painkillers if you're in pain you usually need a diagnosis before you get started on treatments, even if it's not entirely correct or the treatment might not work. If my general physician sees I'm under the weather and should stay in bed for a couple of days he still needs to put some kind of general condition on the sick notice like a non-specific virus infection. Until you get a diagnosis you are in many ways in medical limbo, which is why it matter so much.
Live today, because you never know what tomorrow brings
Do these guys have the patent on Nickel Metal Hydride batteries?
And there was a movie called the Secret of NIMH
A further problem with the "if it's listed in the DSM it's a real disease" attitude is the conflation of conditions with disorders. Just because someone has a particular, identifiable pattern of thought and behavior, which may be useful to name and document, does not mean that that person has something wrong with them that they need fixed. I'm thinking in particular here of conditions frequently found in members of the neurodiversity movement, who may very well have some identifiable distinct difference from your typical person, but who would deny vehemently that it is a problem that needs correction.
There's definitely some use in a patient being able to say "I notice that I tend to do this that and the other thing and they're making my life problematic, can you help me change" and being able to put a name to that pattern and apply techniques known to alter it. It's another thing entirely for a doctor to say "I notice you seem to do this that and the other thing, you have a disease and I can treat it and make you better". Identifying and naming the patterns is great. Calling them disorder or diseases or something that implies a defect in need of correction, instead of a perfectly benign difference that doesn't necessarily need treatment, is a problem.
-Forrest Cameranesi, Geek of all Trades
"I am Sam. Sam I am. I do not like trolls, flames, or spam."
I'm curious what percentage (or number) of court cases might bear re-visiting once "the experts" have declared all versions of DSM rubbish (when DSM had been used to reach the verdict).
The neurodiversity movement is a load of wank. It's like claiming your car is otherly-powered when the engine falls out.
Tubal-Cain smokes the white owl.
It's like claiming your car is otherly-powered when the engine falls out.
And yet if the car keeps going, is that an incorrect statement?
The other problem with DSM is that it's too normative. Homosexuality is a "disorder", but then when you start treating homosexuals nicely they suddenly become less traumatized, more come out, and you realize that most of them aren't as sick as you thought, and that a lot of the sick ones are like that because you marginalized them in the first place.
The concept of a mental illness is fundamentally normative. Even if you think homosexuality is perfectly OK, you need to admit that it was removed for purely political reasons. Objectively it is clearly abnormal: perhaps 1%, perhaps 3%, whatever... but TINY.
If you insist on adding the requirement that there be harm, and you want to dismiss the suicide issue as a trauma result, the situation is still pretty clear from numerous viewpoints. In the USA, AIDS is still primarily a homosexual disease. I can even argue this from an atheist viewpoint: if something prevents offspring in the Nth generation, impacting one's evolutionary fitness, then it causes harm. (and we all know what the typical Christian/Muslim/Jew would argue)
Given that we've already found brain differences, this new system seems like it can not avoid bringing back homosexuality as a medically accepted illness. This is not to say it can be treated or that any future treatment would be worthwhile, because the cure can be worse than the disease. Nearly nobody is going to risk surgical and/or genetic brain modification to become heterosexual. Almost certainly it would be considered unethical to even attempt such a risky modification.
BTW, there tend to be differences between the brains of republicans and democrats. Care to declare one of them in need of treatment? (sure, the other team!)
RE: gnoshi sez: The problem is this: they didn't and still don't know what's wrong - just that his symptoms fit a commonly observed pattern, and that there are particular interventions to try to address the associated deficits. [emphasis mine]
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But that's exactly what happened with Parkinson's Disease, and still is happening with Parkinson's Disease. Dr. Parkinson observed a common pattern in a group of patients. These patterns of symptoms and behaviors constituted a syndrome which began to be called "Parkinson's Disease" after Dr. Parkinson died. (I guess he didn't have the ego to name it after himself :>) )
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There are many many possible causes for Parkinson's (even bad drugs can cause it, which is how they found out a lot about it), and it's taken almost two-hundred years to keep learning about it. All of these various causes end up with the same ultimate (theorized) endpoint: that there is not enough dopamine in a particular part of the brain called the substantia nigra (black substance, or black region). The fact that the real cause of Parkinson's is not known or fully understood even today does not mean that Parkinson's is not a disease.
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The fact that something is not in the DSM manual also does not mean it has been disallowed as a disease: it just means that it is not in that particular and specific compendium. And now, the National Institute of Mental Health (NIMH) is saying that the DSM is not the final arbiter of what constitutes a mental disorder or psychiatric disorder. In other words, I also completely agree with your conclusion using different words of my own. :>)
Actually, he won't be "cured". He'll have autism spectrum disorder, rather than asperger syndrome, most likely. I can't see a way someone could have an AS diagnosis under DSM-IV and not be considered ASD under DSM-V.
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Uh, no.
Look, imagine that we discovered that about 2% of our population were heavily vulnerable to simple trickery, like they were much more enthusiastic about a 10% chance of survival than a 90% chance of mortality, even though they're the same thing. And they were easily manipulated by actors who knew how to show a particular emotion on command. And they had some cool things, like they were unusually good at reading emotions from facial expressions, but overall they had crippling problems that made it hard for them to function like rational adults.
Now, consider: If 98% of people were ASD, and 2% weren't, that would be what we'd have. We'd have a diagnostic criterion for "obsessive social behavior", but some people would argue that these poor overly-socialized kids are actually pretty tolerable once you get used to them, and maybe we should just accept that there's a few people who have this driving need for social interaction and can't focus on work and hobbies like normal people.
Neurodiversity isn't about dysfunction, it's about function that really is different, and not necessarily obviously better or worse.
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But it's not a disease in the sense of a specific diagnosis, nor are they even confident that it is a single disorder, and, at least at present, it certainly doesn't point towards a cure or anything beyond management of symptoms.
1) Maybe you meant spectrum disorder?
2) Who calls Asperger's a disease?
Asperger's is a Syndrome, which is medical speak for "a collection of frequently comorbid symptoms for which we may or may not have found the cause(s)."
Please understand the words you're using and their definitions in a medical context.
Re : I had internal infections misdiagnosed as depression for over 4 years before physical symptoms appeared.[emphasis mine]
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May I respectfully ask how you could expect anyone to diagnose something which had no physical symptoms manifesting for four years? It's not like doctors have magic. They have to base their diagnosis and diagnostic procedures based upon the history and physical: the history and information given by the patient and the physical exam performed to assess the patient's physical well being.
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If no physical symptoms manifest, whether as things that could or could not be tested for by blood tests or by scans of any type, how could anyone predcit or deduce its existence? There's a problem that also occurs when doctors overprescribe or overuse tests: they get trounced on for "overusing or overprescribing tests or scans"!! The doctor can only do things based upon the evidence presented...
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As to the last sentence of your, I sadly have to agree with you about "How the hell can a doctor prescribe SSRI without measuring the actual levels first?"
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The drug companies' pharmaceutical reps (representatives, salesman and saleswomen really) go to doctors and try to persuade them to prescribe certain drugs, the ones that their company makes. Many primary care doctors (such as internists or family physicians) who ought not be prescribing drugs which should be prescribed by specialists such as psychiatrists end up prescribing drugs such as SSRI's because of the marketing and because of the pressure from patients. That part is so sadly true. They ought not do that; I agree with you there. Did you see a specialist or a general practitioner?
Is ADHD a "problem" that needs to be "cured"? How about Aspberger's or the inability to spell words like that? What risks and side effects would be tolerate? Suppose it requires brain surgery or virus-mediated genetic engineering with a 7% risk of death and a 29% risk of survival with disability.
Here we have people who are obviously abnormal (maybe 1% or 3%, whatever), who obviously have brain structure differences, and who are obviously having problems. They are far more likely to commit suicide. In the USA, they are far more likely to get HIV. By any objective measure, we ought to be searching for a cure.
Most of them don't want a cure, or at least won't admit to wanting one. We can save money by not bothering! This reminds me of the sad situation of deaf people who seek to make deaf children (no joke) and who view people who get cochlear implants as being sort of like traitors or sellouts. If most deaf people were this way, we'd never have developed any treatments.
Then it's all downhill from there.
Unfortunately the 'it's number X in the DSM' shortcut thinking means that if clinician A makes a mistake, clinician B is likely to believe clinician A's opinion without critical analysis and just assume that the original diagnosis is correct. Roll on a few more meetings with clinicians and the 'the previous n clinicians could'nt be wrong' mentality means that a diagnosis is likely to stick whether correct or not.
John_Chalisque
What happened to using Lithium?
Don't Panic.
"Mental Illness" has been a central issue in the current debate about firearms. If the government is going to expand restrictions based on a determination of who is "mentally ill" they shouldn't also have the power to make the definitions.
Anti-gun extremists regularly disparage firearms owners as being "crazy" or "nuts" simply because they happen to own firearms. If someone suggests that the U.S. government is devolving into a tyranny (with good evidence), they inevitably earn the label "paranoid".
If new restrictions on civil liberties are applied to people who are "mentally ill" and government gets to make these decisions, they will just keep expanding their definition of "mental illness" to cover whomever they want to disarm. Sort of like they're doing with "terrorist".
People make the mistake of thinking that because something is listed in the DSM it is somehow a 'real disease'. The Epsteinâ"Barr virus is a real disease: it is caused by a specific virus.
Not to be pedantic, but if you consider EBV to be a "disease," then depression would fall under the same category. EBV is a virus, yes, but the other important thing is that it's also the cause of mononucleosis, Burkitt's lymphoma, and nasopharyngeal carcinoma. The same applies to HIV and its later manifestation, AIDS.
Depression is a disease, but everything involving the brain is just so complicated that we don't fully understand why it occurs. That shouldn't minimize the significance (and clinical manifestations) of depression.
I hear the problem with the research is that the rats gain intelligence and escape the laboratory at NIMH. It's a secret, so you may not have heard about it.
Actually, he'll be classified as "High Functioning Autism Spectrum Disorder." This is where many Aspies (myself included) are up in arms about the new DSM. While we recognize that Asperger's Syndrome is part of the Autism Spectrum, calling it "high functioning" makes it sound like you don't need any help. Just like when you say a child is "gifted" and people assume that means he or she will get straight A's with no effort whatsoever. My son (a Aspie) needs a lot of help with social situations. He doesn't understand them the way neurotypical people do and it makes him nervous. When he gets nervous, his anxieties flare and he acts out (talking nonstop, writing on himself, running around, making inappropriate remarks). He can have a series of good days where you might not even realize that he's on the spectrum and then BAM! a horrible day happens. We need teacher/school staff support to help him make it through his days without disrupting his and everyone else's education. Calling him "high functioning" might make it sound like he doesn't need any help at all and might make it harder to obtain that help from school districts eager to trim their budgets by reducing supports for special needs children.
My sci-fi novel, Ghost Thief, is now available from Amazon.com.
They'd have to learn to adjust them up or down to achieve their end goal. And don't forget making some up altogether via extrapolation. And they have to do all this with less knowledge of statistics than an undergrad.
Hell yeah! I really dislike the DSM and frankly psychiatry/psychology in general because of these categories and the wanton drug prescriptions to "treat" them. BUT I gotta say, I'm proud of these guys! (Not that anyone gives a damn :) or they're my kids, etc. etc.) This is a good move!
Asperger's is a lot more than being a "very shy child". There are sensory issues, prosopagnosia(the inability to recognize faces), and obsessiveness.
And the "shyness" you described comes not from normal apprehensiveness or from past social failure but from a (sometimes complete) lack of social understanding, or a complete lack of social intuition. It's not that people with Asperger's or Autism want to be sociable and am just afraid to, or that they want to be sociable and don't know how. Sometimes autistic people don't understand that they're expected to interact in particular ways, or don't understand that they're supposed to interact at all. I can't explain how shocking it is every time I find out that other people have been interacting in ways that I had never conceived of.
If only it was shyness, that would make things so much easier. It's not. Saying that Asperger's Syndrome is just being very shy is exactly the thing you're complaining about, identifying a symptom but missing its cause.
Homosexuality was removed from the DSM because in this modern day and age, being immoral is not abnormal.
I only look human.
My mother is a halfling and my dad is an ogre, so that makes me an Ogreling
And I meant it was sincerely. Sure, the DSM does not categorizes sets of symptoms. But the problem with basing diagnoses on actual conditions are we had little ideas what those actual conditions were, and not for lack of researches.
alarmas
I'm really glad this has come about, not because the DSM itself is a useless book but because the attitudes towards it lead to some gross errors of judgement.
The DSM can be useful: if one clinician wants to communicate to another at a fairly high level the symptoms a patient is experiencing, then a DSM-defined disorder can be a reasonably efficient way of doing this. Also, the DSM does group together some symptoms which tend to occur as clusters under labels which can provide cues for looking for related symptoms which might otherwise be missed.
However... People make the mistake of thinking that because something is listed in the DSM it is somehow a 'real disease'. The Epstein–Barr virus is a real disease: it is caused by a specific virus. Type I Diabetes is a real disease: it is caused by the loss of insulin-producing cells in the pancreas (although there is the more distal cause of the cell loss). Depression is not a real disease, in this sense - at least, not at the moment. It is a cluster of symptoms which when the occur together are referred to as Depression. Nothing more. (That isn't to say a 'disease' will not actually be identified at some point, but I suspect that will be for a specific subtype of depression, not depression as it is currently classified).
On the radio yesterday, I heard an 'aspie' - who under DSM 5 will no longer be an 'aspie' since Aspergers will no longer exist in its current form - talking about how it was great when he was diagnosed because they finally knew what was wrong with him. The problem is this: they didn't and still don't know what's wrong - just that his symptoms fit a commonly observed pattern, and that there are particular interventions to try to address the associated deficits. Having a listing in the DSM doesn't make things any more or less 'real', but some/many people imagine that it does. Just because there isn't a diagnostic criteria for a very shy child (although I imagine one could be found if looking hard enough), that doesn't mean that there aren't programmes to help the child be more comfortable with social interaction. This becomes most manifestly a problem when conducting genetic, neurobiological, or even treatment research into the causes for 'a disorder'. Because these disorders are symptom clusters, and often have substantial variation in presentation, they are at times artificially grouped for research. This can hinder research into specific subgroups who show more common characteristics. Similarly, if there is a presentation which includes two DSM disorders (e.g. depression and anxiety, which is a very common comorbidity) then these people will tend to be systematically excluded from research because they are defined as 'having comorbidity'. Are both 'disorders' caused by the same underlying cause? Who knows, but being separate DSM disorders means that this group tends to be very underrepresented in research.
On top of this, there is the involvement of vested interests in the development of disorders, there is the interpretation of things as 'wrong' because they are a DSM disorder, etc.
In summary, the DSM can be useful for clinicians to communicate a summary to each other, when accompanied by further detail. It can provide gross groupings for treatment research, but lacks finesse of distinction which could help tailored treatments to individual characteristics rather than the broader presentation. People suddenly seem to think something is 'real' because it appears in the DSM, and so push to have ever more 'disorders' included. This all makes DSM as much of a hindrance as a help to good research and mental health practices.
I agree with most of what you say, but you make it sound like the purpose of the DSM is to allow clearer communications between doctors, and that isn't really the case in practice. That may originally have been one of the goals, but the plain fact is that nowadays the DSM exists primarily to facilitate billing and insurance claims. The big
If they don't change his GAF score, and people change their handling of him significantly, then people are doing something wrong.
That said, I am pretty unhappy with the "high functioning" label these days; the idea that if you are mostly functional that means you don't need help is a great way to make people stop being functional.
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I've long suspected that the way the DSM is constructed how mental illness is diagnosed has been manipulated by political, social and financial interests (medical insurance companies for instance). Our definition of what is and isn't a mental illness shifts over time. If those shifts were the result of ongoing research, it would be understandable, but as this article suggests, it's based on other factors. It will be refreshing to see a more scientific approach applied, assuming objectivity can be maintained and the causes and indicators of mental illnesses can be reasonably defined and observed.
Dude, Such Mess!
Epilepsy categories are even worse! Most of them are incomprehensibly--and tautalogically--named after some long dead scientist or some one single mostly diagnostically useless symptom. Theyve absolutely no semantic value, and of course, no mapping to biomarkers.