Tuesday, May 7, 2013

Worse than nothing: the single-minded focus on biological psychiatry

Two articles published this week describe NIMH’s recent (and long, long overdue) turn away from the APA’s “Bible,” the DSM: John Horgan’s “Psychiatry in Crisis! Mental Health Director Rejects Psychiatric 'Bible' and Replaces with… Nothing” on his Scientific American blog and Christopher Lane’s “The NIMH Withdraws Support for DSM-5: The latest development is a humiliating blow to the APA” on his blog at Psychology Today.

Horgan reports:
Now, in a move sure to rock psychiatry, psychology and other fields that address mental illness, the director of the National Institutes of Mental Health has announced that the federal agency–which provides grants for research on mental illness–will be “re-orienting its research away from DSM categories.”
Lane also recognizes the importance of the change:
In a humiliating blow to the American Psychiatric Association, Thomas R. Insel, M.D., Director of the NIMH, made clear the agency would no longer fund research projects that rely exclusively on DSM criteria.

…The manual's authority won't end overnight, but, given the implications of the NIMH's decision, it also can't and won't stay as it has.
Both writers also recognize, though, that, while this represents in some ways a needed step forward, characterizing it as a death blow to the status quo isn’t entirely correct. Horgan argues that Insel’s smoke and mirrors can’t hide the fact that NIMH has nothing with which to replace the unscientific DSM:
So the NIMH is replacing the DSM definitions of mental disorders, which virtually everyone agrees are profoundly flawed, with definitions that even he admits don’t exist yet! What more evidence do we need that modern psychiatry is in a profound state of crisis?
He very reasonably argues that this futuristic rhetoric has real consequences for real people and needs to stop:
Since I became a science writer 30 years ago, I have heard countless claims about breakthroughs in our understanding and treatment of mental illness. And yet as the NIMH decision on the DSM indicates, the science of mental illness is still appallingly primitive. Instead of forming fancy new programs and initiatives and alliances, leaders in mental health should perhaps do some humble, honest soul searching before they decide how to proceed.
Lane, similarly, notes that “the alternatives, at least those that the NIMH is presenting, may turn out to be equally problematic and unworkable.” Quoting the same assumptions underlying the NIMH project as I did in my previous post, he points out that “These assumptions spring from assertions and tautologies that have driven American psychiatry since at least the 1970s.” As he makes clear, it’s the “single-minded focus on biological psychiatry as the represented solution” that’s at the heart of the problem. NIMH’s “overwhelming focus is to remain on the brain as the alleged seat and cause of psychiatric suffering,” despite the demonstrated failure and scientific fruitlessness of that project. As these articles recognize, that approach, in practice, is a lot worse than nothing. In an upcoming post I’ll elaborate further on how holding to the genetic science fiction model is irrational and harmful.

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