Thursday, September 12, 2013

Stop thinking about DSM-6

Collection of psychiatrists' views about DSM-5, including those of Charles Nemeroff (see previous post) and Simon Wessely (see another previous post), have been published by BMC Medicine.

Nemeroff and Daniel Weinberger suggest the motivation for DSM-5 was (1) unrealistic anticipations of being able to include genetic markers for mental disorders following the sequencing of the human genome, and (2) unrealistic enthusiasm that brain imaging studies would produce pathognomonic findings about the neurobiology of mental disorders. Their wishful thinking means that only in retrospect do they find this surprising, blaming the complexity of the brain. Actually, it's not just the complexity of the brain that's the issue, but their naivety that the brain-mind problem could be solved. We need to move on from the biomedical paradigm (see previous post).

Nor, as they imply, did the explicit criteria of DSM-III solve the subjectivity and uncertainty of psychiatric diagnosis, which is actually intrinsic to its nature. There needs to be a change of thinking about psychiatric classification. As I said in my previous post in relation to Simon Wessely, please stop talking about DSM-6, at least until there's a proper conceptual understanding of the nature of mental illness. Nemeroff and Weinberger's unrealistic hopes are an insufficient basis on which to proceed.


Cem Atbasoglu said...

Indeed. And since, as you correctly point out, the methodologic problem is inherent in the nature of mental/behavioral phenomena, psychiatric diagnoses will never be better than impressions articulated in standard language –well, “informed impressions” at best.

Thus, genome-wide hunting to leave the rest of the work to expensive informatics is not only boring compared to hypothesis testing and case/cohort reporting, but it’s also pointless as long as the “phenotype” is a personal impression.

Abot wishful thinking: I think the only source of error cannot be naive wishful thinking. Many of the methods and medications previously approved by the health authorities for the treatment of official psychiatric diagnoses are very expensive, i.e. an offical diagnosis is a lot of money i.e. bad science does have financial value.

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