Sunday, May 5, 2013

Psychiatry in Crisis! Mental Health Director Rejects Psychiatric “Bible” and Replaces With… Nothing

Scientific American   What is mental illness? Schizophrenia? Autism? Bipolar disorder? Depression? Since the 1950s, the profession of psychiatry has attempted to provide definitive answers to these questions in the Diagnostic and Statistical Manual of Mental Disorders. Often called The Bible of psychiatry, the DSM serves as the ultimate authority for diagnosis, treatment and insurance coverage of mental illness.

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.” Thomas Insel’s statement comes just weeks before the scheduled publication of the DSM-V, the fifth edition of the Diagnostic and Statistical Manual. Insel writes:

“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. The strength of each of the editions of DSM has been ‘reliability’–each edition has ensured that clinicians use the same terms in the same ways. 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. 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. 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.”[...]


  1. Mazel tov!... It's about time...

    Here's a quote from the guy who wrote the dsm-iv, and has now become a major critic:

    "The common themes in the definition of
    mental disorder are distress, disability, dyscontrol, and dysfunction (Bergner 1997, Klein
    1999, Widiger & Sankis 2000), but these are
    very imprecise and nonspecific markers with lit-
    tle practical value. Ironically, the definition of mental disorder that does have abiding practical meaning is never given formal status because it is tautological and potentially highly self-serving. It would go something like, “Mental disorder is what clinicians treat and researchers research and educators teach and insurance companies pay for” (Maddux et al. 2008). Historically, this is how the individual mental disorders appear to make their way into the system (Kirk 2005) rather than being logically, rationally derived from any particular definition of mental disorder (Wakefield 2001)."

  2. I was having a discussion with someone about whether Hitler was insane (I think he wasn't) and ran into this problem. How do you define insanity?

    1. from Wikipedia- it is a legal defintion

      In United States criminal law, insanity may serve as an affirmative defense to criminal acts and thus does not need to negate an element of the prosecution's case such as general or specific intent.[13] The States differ somewhat in their definition of insanity but most follow the guidelines of the Model Penal Code. All jurisdictions require a sanity evaluation to address the question first of whether or not the defendant has a mental illness.

      Most courts accept a major mental illness such as psychosis but will not accept the diagnosis of a personality disorder for the purposes of an insanity defense. The second question is whether the mental illness interfered with the defendant's ability to distinguish right from wrong. That is, did the defendant know that the alleged behavior was against the law at the time the offense was committed.

      Additionally, some jurisdictions add the question of whether or not the defendant was in control of their behavior at the time of the offense. For example, if the defendant was compelled by some aspect of their mental illness to commit the illegal act, the defendant could be evaluated as not in control of their behavior at the time of the offense.

      The forensic mental health specialists submit their evaluations to the court. Since the question of sanity or insanity is a legal question and not a medical one, the judge and or jury will make the final decision regarding the defendant's status regarding an insanity defense.[14][15]

      In most jurisdictions within the United States, if the insanity plea is accepted, the defendant is committed to a psychiatric institution for at least 60 days for further evaluation, and then reevaluated at least yearly after that.

      Insanity is generally no defense in a civil lawsuit. However, in civil cases, the insanity of the plaintiff can toll the statute of limitations for filing a suit until the plaintiff has recovered from this condition, or until a statute of repose has run.


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