The DSM: A “Dictionary,” Not a “Bible”
(May 7, 2013) NIMH Director Thomas Insel set the mental health world abuzz last week when he blogged that the National Institute of Mental Health will be “re-orienting its research away from DSM categories.” A new edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) is due to be released later this month.
“While DSM has been described as a ‘Bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each (psychopathology),” said Insel in “Transforming diagnosis” (Director’s Blog, April 29). He said that people “with mental disorders deserve better” than a menu of diagnoses that ensures clinicians use the same terms in the same ways but lacks scientific basis.
“(Y)ou know what?” he told the New York Times. “Biology never read that book” (“Psychiatry’s guide is out of touch with science,” May 6).
Insel said psychiatric diseases need to be defined by their biology, genetics and neuroscience – their causes – not by their symptoms.
“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,” he blogged. “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 said an 18-month-old NIMH project is underway “to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.“
As supporters and partners in scientific study of severe mental illness, the Treatment Advocacy Center applauds the NIMH’s direction. As long as psychiatric disease is described in behavioral terms, it will be treated as a behavior, not a disease.
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