When are we going to make the reforms necessary due to an invalid dsm 5?

We're now about 9 years out from when Science 2.0 website announced that Dr. Thomas Insel then Director of NIMH gave the DSM 5 a "KILL SHOT" -----

• It may be slow acting --- BUT it is slowly making its way through the System(s).

      When you have SYSTEMS that are SO DEPENDENT on a particular WAY OF THINKING and that WAY OF THINKING is GREATLY CALLED INTO QUESTION---

• Understanding there is a problem is just the FIRST STEP.

   
       I think the problems associated with the DSM will ultimately be recognized right up there with the Copernican Revolution and Darwinian Evolution.

      BUT both the Copernican Revolution  and Darwinian Evolution went to RELIGION --- the PROBLEMS with the DSM are going to EMPIRICAL SCIENCE and its LIMITS---- especially if DIVORCED from:

• REASON, and 
• HIGHER ORDER MORAL and ETHICAL CONSIDERATIONS

----Once you get RDOC (the National Institute of Mental Health's Research Domain Criteria Program)--- figured out --- we will start MODIFYING --- is not only NOT GOOD ENOUGH --- it's RIDICULOUS when it is not HORRIFIC. 

​May 3, 2013

By Hank Campbell
​
The National Institute of Mental Health (NIMH) is distancing itself from the the American Psychiatric Association and its upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

While they acknowledge that the goal of DSM "is to provide a common language for describing psychopathology" they are no longer convinced that approach has value if we are going to solve 21st century cognitive science problems.

​ It is, paraphrasing the statement  of Thomas R. Insel, M.D., Director of the National Institute of Mental Health, more of a dictionary than a manual.  He uses the term "Bible" instead of 'manual' but I would have used 'glossary' rather than 'dictionary'.

Insel pulls no punches in his statement on why they are not going to fund things based on DSM criteria any more.

"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."

This is a charge leveled at psychology as well, and the field in general, but psychiatry takes the biggest hits, because they are supposed to be the most evidence-based. Unlike psychology, psychiatrists have to be M.D.s first. 

Writing in The New Yorker, Gary Greenberg tries to tackle why cognitive science hasn't kept pace with medicine, much less the physical and life and earth sciences, writing rather nicely that "it’s not entirely clear that psychiatrists want a solution to the problem."

Insel is more blunt. "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."

Basically, he says DSM is stuck in the past.

​Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

Patients with mental disorders deserve better.

NIMH is leaving the past behind. In the past, Insel notes, they would reject a biomarker that did not match a DSM category. Now they instead want to collect how all data - genetic, imaging, physiologic and cognitive - cluster, and not just how symptoms do.  They call it the Research Domain Criteria (RDoC) project.

"That is why NIMH will be re-orienting its research away from DSM categories.," he wrote, and that means funding applicants are going to have to adjust to the 21st century.

The APA may be outraged, and certainly some DSM-5 defenders, but I predict people in cognitive science who want to really do science and get NIMH funding are relieved that they are not going to have to cater to a document everyone seems to know was always flawed.

Read Insel's whole statement, Transforming Diagnosis, and have hope for the future.
Science 2.0