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Translational Medicine Friday

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

3/29/2022

 
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. 
Picture
Picture
​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

Comments are closed.

    Translational Medicine Friday

    We're riffing off NPR's Science Friday to create Translational Medicine Friday.

    We'll be collecting Research Article recommendations for Clinicians with regard to Cognitive Disability.

    ​There is much in the RESEARCH JOURNALS and we'll just be SKIMMING THE SURFACE.

    The POINT is to INCREASE FUNDING for TRANSLATIONAL RESEARCH at the Federal Level for the National Institutes of Health, the Centers for Disease Control, the Nation's Research & Teaching Hospitals and possible collaborations with Medicare and Medicaid providers.

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  • Home
    • About Orchid >
      • Why Orchid?
      • ORCHID'S SYSTEMIC FOCUS & "ROOT CAUSE" ANALYSIS APPROACH TO PROBLEM SOLVING WITH A COMMITMENT TO CREATIVITY & INNOVATION
      • Disclaimers, Limitations and An Invitation
      • Orchid Board
      • Orchid Book Club
      • Conjecture, Science & Translational Research & Medicine
      • Orchid Themes & Symbols
      • The Tipping Point
      • Orchid's Website Advertising Policy
      • Statement for Potential Website Contributors
      • Contact
  • Blogs
    • Val's Blog
    • Val's Blog 2
    • ​TRANSLATIONAL/ ​TRANSITIONAL JUSTICE MONDAY
    • NEURO-DIVERSITY Wednesday
    • Olmstead Law & Order Thursday
    • Translational Medicine Friday
    • Translational Love, Relationships & Neuro-Diversity Saturday
  • Orchid's A-Z Index
    • Crisis Services in CO, the US & Around the World
    • Assertive Community Treatment & Flexible ACT Index
    • Housing & Homelessness Index
    • Criminal Justice
    • Innovation Index
    • For More: See the Main Orchid Index Page
  • US Federal
    • THE IMD RULE & ADMIN. ENFORCEMENT OF DISABILITY CIVIL RIGHTS LAWS
    • Medicaid & Supportive Housing & Housing-Related Services
    • CMS' FAILURE TO COVER HOUSING FOR LTC & THE IMD RULE: WHAT THEY HAVE IN COMMON IS DISCRIMINATION
    • National Take
  • Research & Translational Medicine
    • Immunology & Mental Health >
      • Alcoholism & the Immune System & Mental Health
      • Brain Injury, the Immune System & Mental Health
      • Celiac Disease & Sensitivities, the Immune System & Mental Illness
      • Mental Illness & The Immune System
      • Racial Discrimination & the Immune System & Mental Health
      • Trauma & the Immune System & Mental Health
      • ***Physical Health Issues, the Immune System & Mental Health Index
    • University of Chicago: Institute of Translational Medicine
  • Hot Topics
    • What We Want --- SAMHSA Grant Opportunities Due Jan. 22, 2019
    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
      • Personality Disorders -- Unscientific & Vague -- Must Be Reformed
    • Executive Functioning & "Prison Brain" >
      • Job Accommodation Network on Executive Functioning Deficits
    • Medicaid & Medicare Network Adequacy >
      • OIG: STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE (Sept. 2014)
      • OIG: ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE (Dec. 2014)
      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
      • CMS: Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability (April 2017)
    • Medicaid Mental Health & Substance Use Disorder Parity >
      • CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs [Jan. 17, 2017]
      • Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP [CMS October 11, 2017]
    • Olmstead Disability Rights >
      • Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. (2011)
      • Comprehensive Olmstead Planning
      • the Logical Long Term Consequences of our failure to provide Intensive Community MH Treatment
      • Olmstead Nation ---State Pages: How Far to Comply with Olmstead?
  • Take A Walk Around Orchid's Resource Block
  • Colorado Abuse & Neglect Scandals Involving People with Disabilities
  • Mental Health By The Numbers
  • New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW
  • Olmstead & Homelessness
  • Double V
  • " 'Defund the Police" Means 'Invest in the Resources Our Communities Need' " or Don't Cost Shift to the Police
  • VAGUE OLMSTEAD PLANS, EXPENSIVE LITIGATION
  • Updating & Reforming our Understanding & Treatment of "Anti-Social Personality Disorder" Blog
  • Reform of " Anti-Social Personality Disorder" in Criminal Justice
  • CO HB22-1278
  • New Understandings Matter
  • Mental Health, Ethics & Law
  • CO Olmstead Disability Homeless Law & Policy Project
  • Inflammation, the Immune System, Neuro-Developmental Disorders, Psychiatric Disorders, Substance Use Issues & Chronic Disease
  • Microglia and the Brain's Immune System
  • Substance Issues & the Immune System