The Director of the U.S. National Institute of Mental Health (NIMH), Thomas Insel, has written a blog post on the NIMH website pointing out the lack of scientific validity of the American Phychiatric Association’s (AMA) Diagnostic and Statistical Manual of Mental Disorders (DSM). 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.
This is a pretty big deal. New Scientist comments that Insel is effectively calling for
abandoning the manual published by the American Psychiatric Association that has been the mainstay of psychiatric research for 60 years.
But we shouldn’t get our hopes up for any changes to occur in the practice of psychiatry anytime soon. Check out the cognitive dissonance:
“It’s potentially game-changing, but needs to be based on underlying science that is reliable,” says Simon Wessely of the Institute of Psychiatry at King’s College London. “It’s for the future, rather than for now, but anything that improves understanding of the etiology and genetics of disease is going to be better [than symptom-based diagnosis].”
Notice that Wessely is acknowledging that the field of psychiatry is unscientific in its approach to medicine, but has no problem with business continuing as usual for the time being. New Scientist continues:
Michael Owen of the University of Cardiff, who was on the psychosis working group for DSM-5, agrees. “Research needs to break out of the straitjacket of current diagnosis categories,” he says. But like Wessely, he says it is too early to throw away the existing categories.
“These are incredibly complicated disorders,” says Owen. “To understand the neuroscience in sufficient depth and detail to build a diagnosis process will take a long time, but in the meantime, clinicians still have to do their work.”
Notice that Owen is acknowledging that psychiatry has no understanding of neuroscience to the sufficient depth required to build a diagnosis process, but in the meantime, clinicians must still go on diagnosing the “incredibly complicated disorders” he presumes actually exist despite not having any actual scientific basis for making that claim.
Nonprofit Quarterly notes that:
The DSM is used not only by practitioners to diagnose conditions, but also by insurance companies to determine treatments to be covered, so it is a socially powerful document. Insel, however, believes that the DSM is less than scientific….
One point of discomfort about the new edition of the DSM has to do with the large increase of perceived conflicts of interest among those working on its committees. Critics of the DSM-5 point out that 70% of people serving on its committees for the definition of specific diagnoses have financial ties to pharmaceutical companies. In the previous edition, the proportion was 57%.
No industry based on such widespread fraud could ever operate in a free market. This requires the corruption of government and the power bureaucrats and regulators wield. It requires the Food and Drug Administration (FDA) and other agencies lending their stamps of approval both to unscientific medical practices and the drugs prescribed to treat the ever-increasing alphabet soup of “disorders” invented to be able to profit by selling them.
Marcia Angell offered some insights into this elaborate medical fraud and corruption in a June 2011 New York Review of Books article, “The Epidemic of Mental Illness: Why?” Some excerpts:
It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it….
Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs….
[T]he dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs….
What is going on here? …[A]re we simply expanding the criteria for mental illness so that nearly everyone has one?
For example, because Thorazine was found to lower dopamine levels in the brain, it was postulated that psychoses like schizophrenia are caused by too much dopamine. Or later, because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like Prozac or Celexa, are called selective serotonin reuptake inhibitors (SSRIs) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug.
That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As Carlat puts it, “By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.” Or similarly, one could argue that fevers are caused by too little aspirin.
But the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed. All three authors document the failure of scientists to find good evidence in its favor….
For obvious reasons, drug companies make very sure that their positive studies are published in medical journals and doctors know about them, while the negative ones often languish unseen within the FDA, which regards them as proprietary and therefore confidential. This practice greatly biases the medical literature, medical education, and treatment decisions.
Furthermore, the psychotropic drugs prescribed ostensibly to treat mental “disorders” often cause the very symptoms they are supposed to relieve:
With long-term use of psychoactive drugs, the result is, in the words of Steve Hyman, a former director of the NIMH and until recently provost of Harvard University, “substantial and long-lasting alterations in neural function.” As quoted by Whitaker, the brain, Hyman wrote, begins to function in a manner “qualitatively as well as quantitatively different from the normal state.” After several weeks on psychoactive drugs, the brain’s compensatory efforts begin to fail, and side effects emerge that reflect the mechanism of action of the drugs. For example, the SSRIs may cause episodes of mania, because of the excess of serotonin. Antipsychotics cause side effects that resemble Parkinson’s disease, because of the depletion of dopamine (which is also depleted in Parkinson’s disease). As side effects emerge, they are often treated by other drugs, and many patients end up on a cocktail of psychoactive drugs prescribed for a cocktail of diagnoses. The episodes of mania caused by antidepressants may lead to a new diagnosis of “bipolar disorder” and treatment with a “mood stabilizer,” such as Depokote (an anticonvulsant) plus one of the newer antipsychotic drugs. And so on.
That the foundations of this industry of massive fraud and corruption are cracking is a good sign, but it will take more than Insel’s blog post to stop this behemoth and the harm it causes.