Mental health is an area that has been foisted off on MDs through psychotropic drug prescriptions by Big Pharma using the DSM as an insurance billing guide, all in a sly move to push their “legal” drugs for profit and not the benefit of or actual help of the individual.

Further, the APA as gone so far away from the original Freudian theory, which Freud said himself was far from complete. The only reason the APA is still functioning is due to the false claims of the DSM being based upon scientific fact – although they do say in their own DSM manual that it does not – but it is promoted verbally otherwise. And the APA gets their funding through government programs and Big Pharma and insurance companies that are mandated by law to pay claims, which by the way is also orchestrated by the APA and Big Pharma.

When you base an entire subject and “profession” such as the APA on lies, nothing that is discussed in regards to them will be logical nor can it be reasoned to agreement. Hence this blog.

The APA and DSM will not be with us much longer from all indications and statistics.

All we should look at are facts and not opinion. But one would have to set aside personal profit and special interest to see the truth, unfortunately hardly ever seen nowadays.

-JS

Why is the science of psychometrics being ignored in this debate? A valid elevated 2 scale on the MMPI-2 which reflects several dozen questions is clearly more reliable and valid than having a GP ask about sleep or mood.

I am surprised psychology hasn’t been more vocal about this.

NIMH is correct that DSM lacks validity. Dr. Frances went a step further and called it what most of us would after a few beers.

However, NIMH is WAY ahead of itself in promoting biological markers because few reliable ones exist. This is as much an infant science as psychodynamics was in Freud’s day. In fact, if you want a reliable predictive marker for the course of a mental disorder, you look at statistical factors including psychometrics, which Paul Meehl and others have solidly proved since the 1950s.

Most of what we see in the office is Axis 2 (dimensional) crashing into Axis 4. Both NIMH and DSM fail to recognize this.

Like I said, do a thought experiment. Imagine insurance companies and school districts paid for Axis 2 and 4, many of the Axis 1 diagnoses would go away.

It still blows my mind that a question about sleep or mood asked by a GP counts as evidence of major depression, but >65 MMPI-2 two scale which includes dozens of questions and corrections for validity counts for nothing diagnostically, even though the latter is clearly more reliable and valid. My hope is that the other APA (psychologists) offers a competing manual to DSM-5. Or even better yet, that a disciple of Meehl who really understands taxonomy/scientific method/statistics/falsifiability writes one on his/her own.

Sorry, I really don’t care if I alienate more colleagues than not in this next comment: psychiatrists think with their prescription pads until proven otherwise these past 10 or more years at least, and I know in my heart that almost half do not make any effort to ask about upbringing issues in some form in the first evaluation visit.

Not that I am a big fan of Freudian concepts as a whole, but the man must be rolling in his grave if he could see what his profession has degraded to in the past couple of decades alone.

Oh, by the way, big Pharma is pretty much abandoning psychiatry, just look at what Lilly is doing with their Psychopharm division as of July. This from one of the biggest “contributors” of impact psychotropics for almost 25 years, starting with Prozac and ending with Cymbalta.

I would love to see the hypocrisy and plain denial that will be going on in San Francisco next week, but, I have better things to do with my time and money then. The question is, why do members not know better by now?

Just like the Democrats in Federal Government are circling the wagons in preparation of the Benghazi hearing tomorrow. Denial, rationalization, minimization, and projection will rain like a monsoon by tomorrow night.

Funny, basically what will happen in SF after the opening ceremony at the APA conference for DSM5.

“Do you hear laughter Ramesses, yes, it is the laughter of slaves (the public).” Judgment is coming, believers of the APA, and it will not be a happy ending for the organization, if truth prevails. Just my opinion!

We’ve been studying biomarkers for decades. The failure to find biomarkers is attributed to the failure of the current diagnostic system.

But an equally valid conclusion is that there are no biomarkers for what are largely socially-constructed and -defined disorders. I don’t know and I don’t have any answers, except to throw it out there… that mental illness has always been a biopsychosocial phenomenon. Throwing out two components of that — the psychosocial — and focusing on the “bio” seems like tunnel-vision to me. And goes against all the research demonstrating the effectiveness of psychosocial treatments (like psychotherapy).

I can’t think of any other area of medicine where something like psychotherapy could be shown to cure a disease.

Maybe the emphasis on biomarkers will result in something new a few decades from now. Who knows? But that’s decades from now… nothing that’s going to impact yours or my life this year, much less tomorrow.

The breathlessness in which some mainstream media outlets are reporting on this shift, however, is entirely unwarranted. For some time, the NIMH has not been the driving force in mental illness research. Their desire and hope to take a big chunk of that $100 million committed is simply being reflected here. You certainly couldn’t hope to compete for $100M in research funding by saying the status quo was fine, right?

2. The (lack of) validity of the DSM is no secret. Any researcher in this space knows that, given the hundreds of studies conducted on the validity of DSM diagnoses over the past 30 years. For the director of the NIMH to state a fact already known to scientists and researchers isn’t really news — except to people not in the field.

But it’s a broad, sweeping generalization — and like most generalizations, isn’t very helpful. Some diagnoses have good validity; others have poor validity. To condemn the entire book as though it were one entity is to simply over-simplify and over-generalize.

3. Is it? The NIMH has never said it was relying on the DSM exclusively for diagnoses in the first place. It’s just the common language of researchers and clinicians. If they want to expand on that common vocabulary by pursuing an agenda that independent researchers have been pursuing for decades, well, that’s their prerogative… but it’s not an enormous or significant change. If you’re a researcher and looking for an NIMH grant, you’ll still get funded if you use DSM diagnostic categories.

4. The NIMH is welcomed to “soften” it’s support of a diagnostic system it believes doesn’t capture yet-to-be-identified biomarkers, but it’s hardly a “kill shot” or “withdrawal” of support across the entire agency. As I noted in my entry, this is only one part of the large NIMH bureaucracy — the other parts of the NIMH are still supporting the DSM 100 percent.

Interesting how media reports are missing that point.

Also, the claim that the DSM-5 lacks “validity” because it is not anchored in biology (e.g., there are no verified “biomarkers” for the diagnostic categories)is vastly oversimplified. Biomarkers help define one type of diagnostic validity, usually called “etiological validity.” But there are many other kinds of validity in science, such as convergent validity, discriminant validity, and
predictive validity.

For some DSM diagnoses, these types of validity are supported; e.g., one study found the DSM-III-R and ICD-10 diagnoses of schizophrenia had high predictive validity for long-term outcome, and both provide relatively stable diagnoses.
[Mason et al, Br J Psychiatry. 1997 Apr;170:321-7.]

To be sure: we can do much better than the DSM system, in my view, but we could also do worse!

Best regards,
Ron Pies MD

1. You ignore the crucial timing of the announcement, which is literally within days of the release of DSM-5, completely undermining that release.

2. You gloss (but don’t quote) the key statement by Insel that set all this off: “The weakness of the manual is its lack of validity.” That’s completely unambiguous. “Lack of validity” is extremely damning, esp. considering the NIMH’s previous support for DSM-III and -IV. Why didn’t you quote it?

3. You ignore the crucial fact in Insel’s statement that the NIMH will no longer rely exclusively on the DSM in future research. That *does* represent a significant shift in policy.

4. You write, “The NIMH is simply saying (in my opinion), ‘Look, we’re unhappy with the validity of the DSM and its lack of support for biomedical markers for mental disorders.’” Glad you acknowledge that this is indeed merely your opinion, but, no, given the full statement and its timing and what it actually says the NIMH will do, this is way too mild a reading, especially in light of Insel’s follow-up remarks in the NY Times. The statement *does* indicate a move away from DSM criteria and a marked softening of support for the manual–as lots of media are indeed reporting correctly.

This is being debated over at http://www.1boringoldman.com, and my comment at today’s post is harsh, but, so is the DSM 5. It is time to ignore or marginalize the same lame rhetoric by alleged leaders in psychiatry who are, as Dr Mickey is noting, just doing the APA version of Groundhog Day.

I would love to watch some faces get slapped, if you recall the scene from the movie!