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NIMH Distances Itself From DSM Categories, Shifts Funding To New Approaches

Unknown Lamer posted about a year ago | from the diagnose-like-it's-1899 dept.

Medicine 185

New submitter Big Nemo '60 writes with news that the National Institute of Mental Health is seeking to modernize the diagnosis of mental illness through the use of neuroscience, genetics, etc. From the article: "The world's biggest mental health research institute is abandoning the new version of psychiatry's 'bible' — the Diagnostic and Statistical Manual of Mental Disorders — questioning its validity and stating that 'patients with mental disorders deserve better.' This bombshell comes just weeks before the publication of the fifth revision of the manual, called DSM-5." More importantly, they are going to be shifting funding to research projects that seek to define new categories of mental illness using modern medical science, ignoring the current DSM categorizations: "The strength of each of the editions of DSM has been 'reliability' .. 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. ... NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. ... It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data. In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the 'gold standard.' ... Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category. We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data — not just the symptoms — cluster and how these clusters relate to treatment response."

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185 comments

Hey! (5, Funny)

Anonymous Coward | about a year ago | (#43649215)

are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.

They could all be Climate Scientists!

Re:Hey! (1)

ttucker (2884057) | about a year ago | (#43649403)

I would mod this +1

Re:Hey! (-1)

Anonymous Coward | about a year ago | (#43649449)

You have to be careful going against the sanctimonious group think.

See, many of the slashdotters fancy themselves Climate Scientists, never mind it is an invented fields cobbled together from folks too dense to succeed in their original field. In any argument they'll prattle on about this and that, all of which is lifted straight from pro AGW sites and largely irrelevant. For my money ,the average poster here like tapecuter, etc, really don't know shit except for the AGW talking points. Call them on anything and you are automatically an industry shill. Stick with it and then you are a denier, no better than a scum Nazi who says there was no holocaust and even if there was, the damned dirty Jews deserved it.

Re:Hey! (-1)

Anonymous Coward | about a year ago | (#43649487)

there was no holocaust of 6 million. maybe 100,000 jews died from malnutrition in the camps.

Re:Hey! (0)

Anonymous Coward | about a year ago | (#43649523)

Accccccchssshhhhsshmed?

Is that you?

Re:Hey! (0, Flamebait)

Anonymous Coward | about a year ago | (#43649671)

Why is noone talking about the Caananites that were killed by the jews. Ohh that's right they are all dead. And unlike the Nazis who killed jews (and insignificant others) due to racial hatred; God told the Jews to kill the caananites, and therefore the extermination is completely justified.

+1 for political correctness. Mel Gibson can drive drunk, cheat on his wife, denigrate women, and it is cool. Now if he says something against Jews. Well, that can not be tolerated.

Obviously the work of super-intelligent Rats (4, Funny)

Anonymous Coward | about a year ago | (#43649221)

Clearly they have a plan, and goals that are not compatible with that of humans.

Our only hope? Super-intelligent space-monkeys.

About time! (5, Insightful)

gagol (583737) | about a year ago | (#43649235)

I had internal infections misdiagnosed as depression for over 4 years before physical symptoms appeared. This is a good thing to avoid these kind of errors in the future. How the hell can a doctor prescribe SSRI without measuring the actual levels first?

Re:About time! (5, Insightful)

LurkerXXX (667952) | about a year ago | (#43649283)

SSRI's are measured in the blood. Blood levels may or may not reflect the levels in the part of the brain in question for any particular disorder. There's no way to get a 'real' level without a biopsy, which I'm guessing you'd not be real fond of getting.

It's hard enough for physicians to diagnose ailments in other parts of the body when patients present aytpical symptoms, as often happens. When it happens when the brain is involved, where our understanding much less than it is in every other part of the body, misdiagnosis are bound to be common.

Should testing at treatments be better? Yes. Which is why it is good that they are questioning the whole DSMC and rethinking how things should be done in catagorizing and diagnosing issues with the brain.

Re:About time! (4, Insightful)

gagol (583737) | about a year ago | (#43649323)

The less we "try and see what happens" with drugs messing with the brain's chemical balance the better. I am just glad I finally went under the knife, recovered wonderfully and to be back to work. However, I lost a little fortune in time out of work, plus the nightmare that are those drugs when you don't need them.

Re:About time! (2)

Runaway1956 (1322357) | about a year ago | (#43649563)

A slightly paranoid person might buy into the theory that Big Pharma doesn't WANT to cure patients. Instead, they want to hook people on life-long "cures" that prove to be very lucrative.

Re:About time! (0)

Anonymous Coward | about a year ago | (#43649655)

not really that paranoid -- drug companies love things like diabetes which need lifelong treatment. Look how many catheter commercials there are on TV in the last few years for another example

Re:About time! (2, Informative)

Anonymous Coward | about a year ago | (#43649797)

A non slightly paranoid person might realize most of the medical research in biology looking for cures is done by university researchers with grants from the NIH with about at $30 Billion/year budget. Who are not folks trying to hook you on anything.

And that most of the research money the Pharma companies spend is on doing clinical trials to see which ones actually work in humans after the university researchers have found potential candidates testing in cell cultures and animal models.

Re:About time! (4, Informative)

pepty (1976012) | about a year ago | (#43649933)

And that most of the research money the Pharma companies spend is on doing clinical trials to see which ones actually work in humans after the university researchers have found potential candidates testing in cell cultures and animal models.

Hell no. About 15% of drugs come from academic research, the rest are invented by biotech or pharma companies. For the most part academic labs identify new drug targets. Most of the compounds they develop to test their hypotheses are for the most part useless as actual active pharmaceutical ingredients due to toxicity, bioavailability, and metabolism.

Re:About time! (2)

mad flyer (589291) | about a year ago | (#43650111)

[source needed]

Re:About time! (5, Informative)

Anonymous Coward | about a year ago | (#43650255)

As a researcher I can confirm this, but also the parent.

Traditionally the drug companies have relied on methods equivalent to "brute force" programming, test a library of a few thousand possible drugs and see which works. But this is getting harder, it seems they have run out of low hanging fruit, so instead they take some existing understanding and use that to make the drug. By doing this they get the drug and the profit but only by relying on taxpayer funded research. Remember the drug does not need to have been made by government researchers to be reliant on tax funded research for its existence. The researchers find a target the drug companies take it from there, but increasingly it is the first part that is most expensive.

It may in fact be cheaper for society to do all this on the government dime, there is a lot of waste in the drug industry a lot of it from its very nature as private research. Fixing this would involve the government massively increasing research funding and deliberately killing an industry, not likely in the short run.

Re:About time! (1)

tibit (1762298) | about a year ago | (#43650375)

Now they are out of targets where search space scales linearly with findings. They have an exponential decay in findings to fight with, and you can't with with an exponential by brute force.

Re:About time! (4, Informative)

pepty (1976012) | about a year ago | (#43650333)

[source needed]

Sorry, a couple of years ago I looked at a year's worth of drug approvals and came up with 15%. The actual data (1998-2007) say 24% came from academia:

http://www.nature.com/nrd/journal/v9/n11/full/nrd3251.html [nature.com]

Firewalled, but there is a great discussion at In The Pipeline that breaks out the numbers:

http://pipeline.corante.com/archives/2010/11/04/where_drugs_come_from_the_numbers.php [corante.com]

Of course more and more university research is funded by Pharma these days, especially the efforts that are most likely to lead to new drugs. Which column would you put that drug in?

Re:About time! (1)

pepty (1976012) | about a year ago | (#43649965)

A slightly paranoid person might buy into the theory that Big Pharma doesn't WANT to cure patients. Instead, they want to hook people on life-long "cures" that prove to be very lucrative.

Actual cures would be much more lucrative. If pharmas had a choice, they'd develop a cure rather than a treatment for any serious chronic disease. Unfortunately, for most non-infectious diseases a "cure" would mean making a fundamental and permanent change in how your body operates. Which pretty much means gene therapy, something which we really don't have a handle on yet.

Re:About time! (0)

Anonymous Coward | about a year ago | (#43650311)

Yeah, I hear they're raking in millions on that smallpox cure every year now!

Re:About time! (1)

fluffy99 (870997) | about a year ago | (#43650397)

A slightly paranoid person might buy into the theory that Big Pharma doesn't WANT to cure patients. Instead, they want to hook people on life-long "cures" that prove to be very lucrative.

Actual cures would be much more lucrative. If pharmas had a choice, they'd develop a cure rather than a treatment for any serious chronic disease. Unfortunately, for most non-infectious diseases a "cure" would mean making a fundamental and permanent change in how your body operates. Which pretty much means gene therapy, something which we really don't have a handle on yet.

It would be naive to not understand that like most large businesses, the pharmas are driven financial motives which drives their research and product development cycles. Just look at how they magically have a new drug ready to replace the old one right about the time their patent expires and all the generic manufacturers are set to suck up any profit. It doesn't matter if the old drug was effective and had lower side risks, the company will pour money into advertising to convince people they need the latest and greatest drug. As we've seen that sometimes leads to inadequate testing prior to widespread adoption.

Re:About time! (1)

tibit (1762298) | about a year ago | (#43650355)

Speak for yourself. I'd be the first in line to have such a biopsy done, were it to be routine in differential diagnosis for, say, depression. These days they have the anesthesia/analgesia down pat, one would have to be truly crazy to reject an objective measure just because there's a biopsy involved. I've had my septum straightened out under very local analgesia just to skip school. And I walked to and from the hospital uphill both ways in a blizzard :)

Re:About time! (3, Informative)

fuzzyfuzzyfungus (1223518) | about a year ago | (#43649361)

I had internal infections misdiagnosed as depression for over 4 years before physical symptoms appeared. This is a good thing to avoid these kind of errors in the future. How the hell can a doctor prescribe SSRI without measuring the actual levels first?

Levels of what?

In my experience, it's reasonably common for psychological complaints to get some bloodwork; but mostly for known endocrine issues with fairly blatant psych manifestations. This isn't to say that instances of 'your thyroid is just phoning it in-itis' aren't missed; but that is something that they look for, especially if the SSRI of the month doesn't get results.

Beyond the endocrine markers you can get from a blood draw, though, the invasiveness of sampling goes up fast and the quality of baseline data to compare you against goes down fast.

Re:About time! (1)

gagol (583737) | about a year ago | (#43649421)

It would be nice to have some tests to determine if the problem is related to some chemical imbalance. I know I a, asking for a lot, but I also find the current medicine to be quite easy to diagnose this or that based on few symptoms. Taking SSRI when you dont need them is a very difficult experience to go through, much worse than anything I can think of. It made me either a complete zombie or very violent depending on the drug they tested. A simple echography would have shown the root cause and avoided the whole mess. I may have been victim of crappy doctors, but the taste in my mouth is very sour after all this. It just seems to me that doctors should spend more time in school, and less time on golf courses or cruises with pharma reps.

Re:About time! (4, Informative)

fuzzyfuzzyfungus (1223518) | about a year ago | (#43649467)

Oh, I'd be the last to deny that the quality of mental health care is deeply uneven(with the limited exception of scheduled substances, where the DEA may end up knocking on your door) if it's FDA approved, any doctor can prescribe it, so there are a lot of drugs being handed out either by dubiously qualified generalists, or by the wrong flavor of specialist. My point was just that, since our knowledge of the brain is so poor(and our methods for sampling an in-vivo brain so... crude) the list of objective chemical markers dwindles alarmingly swiftly once you get past a relatively short list of endocrine issues.

Re:About time! (4, Insightful)

Runaway1956 (1322357) | about a year ago | (#43649609)

I'm in over my head already - but, it seemed to me that TFS was saying this very thing: "since our knowledge of the brain is so poor(and our methods for sampling an in-vivo brain so... crude) the list of objective chemical markers dwindles alarmingly swiftly once you get past a relatively short list of endocrine issues."

They want to stop being witch doctors, and actually research causes and effects. Guessing at problems, then experimenting with various drugs to see what results they give is little more than witch doctoring.

Yeah, I clicked some of the links, but I get even further over my head with each click. ;^)

Re:About time! (1)

pepty (1976012) | about a year ago | (#43650009)

It would be nice to have some tests to determine if the problem is related to some chemical imbalance.

Give it fifteen years. Your doc will have you snort a dose of a labelling compound up your nose (privileged route past the blood brain barrier) like it was a line of cocaine or inject you with the labelling compound attached to little piece of a rabies protein ( another way to get stuff past the BBB). Then they'll pop you in an MRI machine and generate a 3D map of serotonin concentration in your brain.

Re:About time! (2)

nightcats (1114677) | about a year ago | (#43649417)

It's a start, and something I was merely hoping for when I wrote this [briandonohue.org] :

When it comes to mental health, our science is at an infantile or at best adolescent level of development. Next month, it brings us a new bible of pathology — the DSM-V, which will tell us again how many ways we can be sick, yet with no guide as to what mental health actually is or how it might be strengthened. That, it appears, must become a common effort — crowdsourced, if you will. One of the founding documents of our nation insists that government allow us the “unalienable right” to seek happiness; but no state or institution can actually deliver it.

Re:About time! (1)

icebike (68054) | about a year ago | (#43650305)

I had internal infections misdiagnosed as depression for over 4 years before physical symptoms appeared. This is a good thing to avoid these kind of errors in the future. How the hell can a doctor prescribe SSRI without measuring the actual levels first?

Yes it is about time.
Even those in the profession realized the DSM was a growing embarrassment, stubbornly clung to to avoid admitting the emperor was stark naked.

Psychiatry is not medicine (1)

Anonymous Coward | about a year ago | (#43649255)

Psychiatry is not medicine.

The cynic in me thinks that most of psychiatry is concocted to sell pills (often of dubious efficacy), but I appreciate that mental health issues are real.

That being said, I am pretty sure that the vast majority of mental health conditions are caused by lifestyles VASTLY different than the conditions under which our species evolved.

Re:Psychiatry is not medicine (-1)

Anonymous Coward | about a year ago | (#43649407)

As opposed to good ol' fashion psychology? Aka the "you want to fuck your mother" syndrome. No thanks. I'll take the happy pills. It worked for Neo.

Re:Psychiatry is not medicine (3, Informative)

fuzzyfuzzyfungus (1223518) | about a year ago | (#43649481)

As opposed to good ol' fashion psychology? Aka the "you want to fuck your mother" syndrome. No thanks. I'll take the happy pills. It worked for Neo.

Psychoanalysts have been mostly confined to the English/contemporary lit departments for quite some time now. Talk therapy is still very much a thing; but old-school analysts are pretty thin on the ground these days.

Re:Psychiatry is not medicine (2)

EricTheGreen (223110) | about a year ago | (#43649707)

Psychoanalysis != the entirety of non-pharma clinical psych. therapy. Quite a few approaches still in use, particularly along cognitive/behavioral lines.

Re:Psychiatry is not medicine (1)

Runaway1956 (1322357) | about a year ago | (#43649615)

Excuse me, but Neo rejected the happy pill, and took the reality pill. Had he chosen the happy pill, the story would have ended right there.

Re:Psychiatry is not medicine (1)

fuzzyfuzzyfungus (1223518) | about a year ago | (#43649431)

So are the vast majority of dental health conditions... Psychiatry is what happens when you may have some fancy reason for your mental health condition; but that isn't exactly going to get you out of waking up and punching the clock tomorrow morning... Unless you are independently wealthy, or possess a very indulgent family, the amount of leisure time you have to take off from the daily grind of modernity and nurse your psychological woes is very, very, limited indeed. Plus, being mentally diseased makes you a cost center, just as physical disease does, plus it carries a nontrival social stigma! The efficacy may not be so hot; but there's a reason why the demand for pills that will paper over the problem as quickly and quietly as possible is as large as it is. (Oh, and, um, incidentally, a milligram of clonazepam and a pint of beer reduce anxiety about the same amount; but only one is blatantly obvious on your breath and difficult to take without drawing attention to yourself at work... Just, an, um, theoretical observation).

Re:Psychiatry is not medicine (1)

Black Parrot (19622) | about a year ago | (#43649503)

The cynic in me thinks that most of psychiatry is concocted to sell therapy sessions

FTFY

What's the hourly rate for a psychiatrist these days?

Re:Psychiatry is not medicine (1)

Livius (318358) | about a year ago | (#43649791)

It doesn't have to be either/or. I think they've figured out there are plenty of both kinds of suckers to exploit.

Re:Psychiatry is not medicine (1)

siride (974284) | about a year ago | (#43650123)

It's generally a lot cheaper than other medical care. Go to a hospital and come back and complain to me about a 40 dollar copay at a psychologist's office.

Re:Psychiatry is not medicine (1)

seebs (15766) | about a year ago | (#43650367)

No, you broke it. It was, if not right, at least coherent before.

Psychiatrists are the ones that are MDs and prescribe medicine. The ones who sell therapy sessions are psychologists and counselors.

Re:Psychiatry is not medicine (2, Informative)

Anonymous Coward | about a year ago | (#43649699)

Psychiatry may not be medicine per se, but yes, they most certainly are medical doctors and they do prescribe a boatload of medications. As someone who met a DSM classification at 18/19 years old and medicated on many of these drugs for 24 years and off of them for 1 year, I do have some facts and opinions on the subject.

I meet the DSM classification for bipolar disorder II to a tee. And the last 5-10 years of taking medications was a complete misery for me. I got hooked up with a doctor that kept giving me more and more medications to "solve" the problems caused by taking so many medications. I was on benzodiazepines for years and was given stronger and stronger versions of them and was having anterograde amnesia. I described this in great detail to my doctor. People would joke at me at work because I could not remember hardly anything. And the doctor put me on meth to counter the drug induced amnesia. In 2 weeks I was absolutely nuts from taking the meth and took myself off. It was not until the doctor left the country and I saw another one that the new one weened me off of the benzos. I then took myself off of the "anti-psychotics" and then took myself off of lithium. My brain and kidneys and liver could not take these medications any more.

Coming off of these drugs was not easy. Especially the lithium after being on it for 24 years. In fact, I lost my job and was "crazy" for many months. I eventually moved in with my parents and stabilized and started a new job after about 7 months after losing my last job. I still have minor mood swings, but no more or less than I did when I was on the medications. I have greatly altered my diet and quit taking all street drugs, tobacco, and drinking of alcohol and I exercise regularly. I'm pretty confident that drugs and alcohol made me bipolar in the first place because I have only been "manic" when coming off of drugs or had manic symptoms being triggered by psychiatric drugs.

I have my ups and downs, but overall I'm more stable and happy and clear thinking without these medications.

More on topic, I think that the DSM is way overrated. One of the symptoms of bipolar disorder is thinking clearly. I will attest that I am not "normal", but I've also read where in "under developed" countries that bipolar people lose like 6 years of functioning life and in "developed" countries they lose 5 years. To me, that is the same degree of impairment, especially when one considers the stigma of being labeled and medicated as "mentally ill", and the cost and commitment towards being on the special med merry-go-round.

For those of you that do not know, there is no panacea with these drugs. You literally keep rotating them around and your symptoms/side effects change over time and it never stops. These drugs are to be taken for a lifetime, and habituation to them makes it very difficult to come off of them, and they have almost caused me to die more than once.

I've never been given anything besides a DSM test for diagnosis. Never a blood test, a genetic test, or anything 100% valid. And until that happens and I function well, I am not ill anymore. Being off of lithium actually helps me in that I can sense what actually triggers my mood swings and I do not feel like I am on emotional training wheels.

The Psycho Docs Are At It Again. (0)

Frosty Piss (770223) | about a year ago | (#43649263)

Yes, of course we can't continue to have a well established resource compiled and validated by large numbers of mental health professionals that stigmatizes Differently Challenged people with labels of mental illness. Folks, we need to empower Differently Challenged folks to harness their Different Challenges. Anything less would be cause fatal damage to their Different Self-Esteem model.

Good grief, what are these psycho-cooks who publish this DSM thing thinking? Tom Cruise tells me the DSM is a load of hooey.

We can't have this.

Re:The Psycho Docs Are At It Again. (0)

Anonymous Coward | about a year ago | (#43649299)

You seem a little "off" yourself.

Re:The Psycho Docs Are At It Again. (-1)

Anonymous Coward | about a year ago | (#43650193)

Did you not even read the summery?

They are not telling doctors to stop using the DSM , they do not in this instance care about stigmatising people at all, this is all about how to target *research*, which in the future will be used to *improve* the DSM not getting rid of the DSM.

They are asking researchers to question outside of the current medical framework because it is a collection of syndromes, which are themselves collections of symptoms. To treat most effectively we want to attack the causes or at least their consequences not the visible effects, this at least will allow us to reduce side effects and find the correct drugs more easily. To do this we need to redefine the categories into diseases with defined causes that can be targeted by specific treatments. For each syndrome I expect the most common diseases that causes it will be given the name of the syndrome, with the more rare variations getting new names, so there will still be the same names around they will just mean something useful when it comes to treatment.

Re:The Psycho Docs Are At It Again. (1)

Aardpig (622459) | about a year ago | (#43650269)

Xenu would like to see you about your overdue audit. Please make an appointment with the receptionclam.

Makes it easier (0)

Anonymous Coward | about a year ago | (#43649291)

to redefine "mental illness" broadly so that gun rights can be more easily denied.

Re: Makes it easier (1)

Anonymous Coward | about a year ago | (#43649367)

Step 1: If one is so delusionally paranoid that they think they need an AR-15 to protect their suburban home from invasion, they are mentally unfit to own a weapon.

Re: Makes it easier (0)

Anonymous Coward | about a year ago | (#43649447)

You, sir, are absolutely, 100% correct. No one should EVER have an AR-15 for defending a suburban home. That is absurd. All of us here, in the Detroit suburbs, know DAMN WELL you need an M134 minigun at a bare minimum.

Re: Makes it easier (1)

Runaway1956 (1322357) | about a year ago | (#43649635)

I'm comfortable with bolt action carbines. An M-14 is good. Never had any use for an M-15 or -16 - I just don't like them. Miniguns? FFS . . . I guess a real man like Rambo would pick it up and shoot from the hip, right?

Re: Makes it easier (0)

Anonymous Coward | about a year ago | (#43649759)

I'm Rambo and I approve this message

Re: Makes it easier (0)

Anonymous Coward | about a year ago | (#43649831)

Nice red herring. No one mentioned an AR-15.

Re:Makes it easier (0)

Black Parrot (19622) | about a year ago | (#43649521)

Careful there, paranoia is already established as a mental illness.

Re:Makes it easier (0)

Anonymous Coward | about a year ago | (#43649607)

When they come for the the guns of the masses that ever got scrips for Adderal or Prozac, it won't be as funny to those that have records of having taken those in their jackets.

We need a true expert's opinion (0)

Anonymous Coward | about a year ago | (#43649339)

So what does Tom Cruise think about this? Apparently, he knows the history of psychiatry.

Good or bad news? (0)

Anonymous Coward | about a year ago | (#43649355)

Will this help Mrs.Frisby and her children, or cause them more hardship?

these weaknesses (3, Interesting)

WGFCrafty (1062506) | about a year ago | (#43649405)

Were already well known. Considering we don't know too much about the organic causes of most mental disorders I'm curious about what they mean. Is schizophrenia mediated by glutamate or dopamine? We know dopamine antagonists help some people but not too much more.

Re:these weaknesses (0)

Anonymous Coward | about a year ago | (#43649477)

You do have a point. The success of these drugs, such as Clozapine, is limited. Realistically speaking, we're no better off than we were when we used good old shocks or beating the asylum inmates with clubs. And you have to admit, beating and shocking people is WAY more affordable and fun! Instead of being a drain on resources, we could actually turn mental health into a profit center. There's lots of people, myself included, who would pay money to beat or shock an inmate.

Re:these weaknesses (1)

Runaway1956 (1322357) | about a year ago | (#43649661)

You sound as if you should hit the personal ads. There are people who would pay you to administer a good safe beating. Or, if you need the beating, you can hire a nice dominatrix. There's no need to incarcerate people to beat on. There's not even any need to pay or be paid by anyone - it's common for S&M and B&D people to trade services even up.

Re:these weaknesses (1)

Black Parrot (19622) | about a year ago | (#43649535)

Were already well known. Considering we don't know too much about the organic causes of most mental disorders I'm curious about what they mean.

Good point. If they're launching this as a research initiative, we should expect a decade or more before it starts traditional methods.

DSM - the "zero tolerance" of medicine (0)

Gothmolly (148874) | about a year ago | (#43649435)

You feel a certain way, and you have symptom X? Sorry, Citizens, DSM says you have Unavoidable Statism, and now you and your children and your DNA swabs are public property forever.

Wow, it only took them this long (3, Insightful)

Anonymous Coward | about a year ago | (#43649491)

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. ...

In the early 1990s, I was prescribed drugs because "there's too much dopamine up there". They didn't measure jack. They just came up with this out of the blue based on how I was behaving.

The absolute lack of measurement was readily apparent to me, even in my state which after decades was most likely undiagnosed autistic spectrum disorder and post traumatic stress from all the crap that happens when spectrum kids get bullied in school.

Dopamine up there? How the hell couuld they know without a measurement.

The other problem with DSM is that it's too normative. Homosexuality is a "disorder", but then when you start treating homosexuals nicely they suddenly become less traumatized, more come out, and you realize that most of them aren't as sick as you thought, and that a lot of the sick ones are like that because you marginalized them in the first place.

First things first though. Come up with something to measure at least before you even pass judgement on it being normal, and then MAYBE you can try to come up with how much deviation from the mean is healthy. Posted AC for obvious reasons...

Re:Wow, it only took them this long (1)

Omestes (471991) | about a year ago | (#43649799)

"there's too much dopamine up there"... "was most likely undiagnosed autistic spectrum disorder and post traumatic stress from all the crap that happens when spectrum kids get bullied in school."...

So your problem with unscientific psychobabble is that it was the wrong type of unscientific psychobabble?

Re:Wow, it only took them this long (1)

seebs (15766) | about a year ago | (#43650381)

What he said wasn't exactly super formal clinical language, but it certainly fits a pretty well-observed pattern. People do not deal well with autistics.

the DSM was political (1)

r00t (33219) | about a year ago | (#43650347)

The other problem with DSM is that it's too normative. Homosexuality is a "disorder", but then when you start treating homosexuals nicely they suddenly become less traumatized, more come out, and you realize that most of them aren't as sick as you thought, and that a lot of the sick ones are like that because you marginalized them in the first place.

The concept of a mental illness is fundamentally normative. Even if you think homosexuality is perfectly OK, you need to admit that it was removed for purely political reasons. Objectively it is clearly abnormal: perhaps 1%, perhaps 3%, whatever... but TINY.

If you insist on adding the requirement that there be harm, and you want to dismiss the suicide issue as a trauma result, the situation is still pretty clear from numerous viewpoints. In the USA, AIDS is still primarily a homosexual disease. I can even argue this from an atheist viewpoint: if something prevents offspring in the Nth generation, impacting one's evolutionary fitness, then it causes harm. (and we all know what the typical Christian/Muslim/Jew would argue)

Given that we've already found brain differences, this new system seems like it can not avoid bringing back homosexuality as a medically accepted illness. This is not to say it can be treated or that any future treatment would be worthwhile, because the cure can be worse than the disease. Nearly nobody is going to risk surgical and/or genetic brain modification to become heterosexual. Almost certainly it would be considered unethical to even attempt such a risky modification.

BTW, there tend to be differences between the brains of republicans and democrats. Care to declare one of them in need of treatment? (sure, the other team!)

it's demons (0)

Anonymous Coward | about a year ago | (#43649519)

it's demons that cause psychiatric illnesses, so they will have a hard time finding the science of that, it's the same with the cause of cancer, demons also, so no cure can be found. What is needed is deliverance and healing prayer to fix these problems and there are so few people who do deliverance properly...

Wow... (0)

Anonymous Coward | about a year ago | (#43649541)

Just because I fucking hate the non-science that is Psychiatry, did you guys know that early DSM editions listed homosexuality as a treatable (with drugs) mental illness. I'm not making this shit up... There is not enough money in the world to restitute the hundreds of millions of people who are first-generation guinea pigs for incredibly dangerous drugs which are used to treat "diseases" which are derived from thin air falsely called science.

Re:Wow... (0)

Anonymous Coward | about a year ago | (#43649581)

Haven't seen much success on the unicorn or Jesus fronts.... got any other suggestions?

Re:Wow... (1)

femtobyte (710429) | about a year ago | (#43649679)

Not considering homosexuality a "problem" that needs to be "cured"? That's the approach we've used for republicanism --- though perhaps not the best example of "success."

Good luck with that (2)

russotto (537200) | about a year ago | (#43649543)

And I mean it sincerely. Sure, the DSM just categorizes sets of symptoms. But the problem with basing diagnoses on actual conditions is we have little idea what those actual conditions are, and not for lack of research.

What it's really about... (0)

Anonymous Coward | about a year ago | (#43649553)

... is selling more drugs by defining more and more mental disorders and trapping more and more people by those diagnoses.

Treat causes not symptoms (1)

Anonymous Coward | about a year ago | (#43649559)

Perhaps this is the beginning of the end for treating the symptom instead of the cause.
This won't be an easy effort, but there is so much potential to improve things for so many people.
I have never been able to believe that medication is always the answer- sometimes just understanding is the answer, but that's something the current culture of psychiatry isn't usually able to provide.
We can't all have ADD, and a one size fits all solution can't possible be highly effective for such a broad set of symptoms with some many different possible causalities.
Next step is to try to figure out how to contribute in some way. Still have to get over fear of failure first. Luckily I don't have fear of being ridiculed when posting AC on Slashdot!
Seriously though, try telling a psychiatrist you have trouble starting and completing projects without getting hit with an ADD diagnosis. You can practically see them mentally flipping through DSM pages. "But I'm pretty sure it's anxiety." "Take this stimulant and don't worry about it." You can imagine how well that ended up.
I for one welcome our new personalized mental health treatment overlords.

Re:Treat causes not symptoms (0)

Anonymous Coward | about a year ago | (#43649657)

"We can't all have ADD"

No, but we can all have Ritalin prescriptions, which is our God-given right. It's in the Constitution, on page 6. It clearly states "And the right of the people to keep and bear prescriptions for Schedule II controlled substances shall not be infringed, especially if they have Medicaid"

Re:Treat causes not symptoms (0)

Anonymous Coward | about a year ago | (#43649923)

Once upon a time a woman in nowheresville was diagnosed with Multiple Personality Disorder just like 13 other people that year were. After this case became famous there were 60 000 cases the next year. Turns out the patient and doctor were faking the illness. Good old psychiatry looking for a pill to push.

troll article? (4, Insightful)

Black Parrot (19622) | about a year ago | (#43649591)

The New Scientist article -- whoops, guest editorial [newscientist.com] -- is titled "Psychiatry divided as mental health 'bible' denounced", but 'denounced' is a ridiculous overstatement. NIH/NIMH are simply announcing a new cross-category funding program that will step back and question the field's traditional assumptions.

Either the guest editorialist didn't RTFA, or else is just using the occasion to inject their personal views into public sight.

Or else just trolling.

Re:troll article? (0)

Anonymous Coward | about a year ago | (#43650309)

The New Scientist article -- whoops, guest editorial [newscientist.com] -- is titled "Psychiatry divided as mental health 'bible' denounced", but 'denounced' is a ridiculous overstatement. NIH/NIMH are simply announcing a new cross-category funding program that will step back and question the field's traditional assumptions.

Yes. They are finally applying science to the field, as none has been employed before.

"Reliability" - now there's a euphemism (0)

Anonymous Coward | about a year ago | (#43649603)

"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."

I'm imagining a police interrogator talking to a suspect. "You know, you've really been very good about ensuring that you and your friends all told us the same story. There's only one problem: that story's bullcrap, and we can prove it."

DSM can be useful, but not useful enough to keep (5, Insightful)

gnoshi (314933) | about a year ago | (#43649685)

I'm really glad this has come about, not because the DSM itself is a useless book but because the attitudes towards it lead to some gross errors of judgement.

The DSM can be useful: if one clinician wants to communicate to another at a fairly high level the symptoms a patient is experiencing, then a DSM-defined disorder can be a reasonably efficient way of doing this. Also, the DSM does group together some symptoms which tend to occur as clusters under labels which can provide cues for looking for related symptoms which might otherwise be missed.

However...
People make the mistake of thinking that because something is listed in the DSM it is somehow a 'real disease'. The Epstein–Barr virus is a real disease: it is caused by a specific virus. Type I Diabetes is a real disease: it is caused by the loss of insulin-producing cells in the pancreas (although there is the more distal cause of the cell loss). Depression is not a real disease, in this sense - at least, not at the moment. It is a cluster of symptoms which when the occur together are referred to as Depression. Nothing more. (That isn't to say a 'disease' will not actually be identified at some point, but I suspect that will be for a specific subtype of depression, not depression as it is currently classified).

On the radio yesterday, I heard an 'aspie' - who under DSM 5 will no longer be an 'aspie' since Aspergers will no longer exist in its current form - talking about how it was great when he was diagnosed because they finally knew what was wrong with him. The problem is this: they didn't and still don't know what's wrong - just that his symptoms fit a commonly observed pattern, and that there are particular interventions to try to address the associated deficits. Having a listing in the DSM doesn't make things any more or less 'real', but some/many people imagine that it does. Just because there isn't a diagnostic criteria for a very shy child (although I imagine one could be found if looking hard enough), that doesn't mean that there aren't programmes to help the child be more comfortable with social interaction.
This becomes most manifestly a problem when conducting genetic, neurobiological, or even treatment research into the causes for 'a disorder'. Because these disorders are symptom clusters, and often have substantial variation in presentation, they are at times artificially grouped for research. This can hinder research into specific subgroups who show more common characteristics. Similarly, if there is a presentation which includes two DSM disorders (e.g. depression and anxiety, which is a very common comorbidity) then these people will tend to be systematically excluded from research because they are defined as 'having comorbidity'. Are both 'disorders' caused by the same underlying cause? Who knows, but being separate DSM disorders means that this group tends to be very underrepresented in research.

On top of this, there is the involvement of vested interests in the development of disorders, there is the interpretation of things as 'wrong' because they are a DSM disorder, etc.

In summary, the DSM can be useful for clinicians to communicate a summary to each other, when accompanied by further detail. It can provide gross groupings for treatment research, but lacks finesse of distinction which could help tailored treatments to individual characteristics rather than the broader presentation. People suddenly seem to think something is 'real' because it appears in the DSM, and so push to have ever more 'disorders' included. This all makes DSM as much of a hindrance as a help to good research and mental health practices.

Re:DSM can be useful, but not useful enough to kee (2)

Livius (318358) | about a year ago | (#43649769)

Asperger's is an excellent example of this, where knowing something about the disorder, what symptoms go together, and what strategies are effective at managing it, is extremely useful. The 'diagnosis' is of enormous practical value.

But it's not a disease in the sense of a specific diagnosis, nor are they even confident that it is a single disorder, and, at least at present, it certainly doesn't point towards a cure or anything beyond management of symptoms.

So it's useful, but definitely not 'diagnosis' in the same sense that, for example, identifying Mycobacterium tuberculosis would diagnose tuberculosis.

Re:DSM can be useful, but not useful enough to kee (2, Funny)

Anonymous Coward | about a year ago | (#43649801)

On the radio yesterday, I heard an 'aspie' - who under DSM 5 will no longer be an 'aspie' since Aspergers will no longer exist in its current form - talking about how it was great when he was diagnosed because they finally knew what was wrong with him.

SO, he'll be cured when this new version comes out.

Hurray!

There's hope!

Now, if they'll only remove the personality disorder(s) I suffer from.

And "Alcoholism".

No, it's called being a M-A-N; you pussies!

Re:DSM can be useful, but not useful enough to kee (1)

seebs (15766) | about a year ago | (#43650389)

Actually, he won't be "cured". He'll have autism spectrum disorder, rather than asperger syndrome, most likely. I can't see a way someone could have an AS diagnosis under DSM-IV and not be considered ASD under DSM-V.

Re:DSM can be useful, but not useful enough to kee (1)

Kjella (173770) | about a year ago | (#43649957)

That's all well and nice, but the practical reality is that it goes:
Symptoms -> Diagnosis -> Treatment

Except for very basic symptom treatments like painkillers if you're in pain you usually need a diagnosis before you get started on treatments, even if it's not entirely correct or the treatment might not work. If my general physician sees I'm under the weather and should stay in bed for a couple of days he still needs to put some kind of general condition on the sick notice like a non-specific virus infection. Until you get a diagnosis you are in many ways in medical limbo, which is why it matter so much.

Re:DSM can be useful, but not useful enough to kee (2)

Pfhorrest (545131) | about a year ago | (#43650101)

A further problem with the "if it's listed in the DSM it's a real disease" attitude is the conflation of conditions with disorders. Just because someone has a particular, identifiable pattern of thought and behavior, which may be useful to name and document, does not mean that that person has something wrong with them that they need fixed. I'm thinking in particular here of conditions frequently found in members of the neurodiversity movement, who may very well have some identifiable distinct difference from your typical person, but who would deny vehemently that it is a problem that needs correction.

There's definitely some use in a patient being able to say "I notice that I tend to do this that and the other thing and they're making my life problematic, can you help me change" and being able to put a name to that pattern and apply techniques known to alter it. It's another thing entirely for a doctor to say "I notice you seem to do this that and the other thing, you have a disease and I can treat it and make you better". Identifying and naming the patterns is great. Calling them disorder or diseases or something that implies a defect in need of correction, instead of a perfectly benign difference that doesn't necessarily need treatment, is a problem.

Re:DSM can be useful, but not useful enough to kee (2)

Aardpig (622459) | about a year ago | (#43650283)

The neurodiversity movement is a load of wank. It's like claiming your car is otherly-powered when the engine falls out.

Re:DSM can be useful, but not useful enough to kee (0)

Anonymous Coward | about a year ago | (#43650343)

It's like claiming your car is otherly-powered when the engine falls out.

And yet if the car keeps going, is that an incorrect statement?

Re: commonly observed pattern... (1)

girlinatrainingbra (2738457) | about a year ago | (#43650385)

RE: gnoshi sez: The problem is this: they didn't and still don't know what's wrong - just that his symptoms fit a commonly observed pattern, and that there are particular interventions to try to address the associated deficits. [emphasis mine]
.

But that's exactly what happened with Parkinson's Disease [wikipedia.org] , and still is happening with Parkinson's Disease. Dr. Parkinson observed a common pattern in a group of patients. These patterns of symptoms and behaviors constituted a syndrome which began to be called "Parkinson's Disease" after Dr. Parkinson died. (I guess he didn't have the ego to name it after himself :>) )
.

There are many many possible causes for Parkinson's (even bad drugs can cause it, which is how they found out a lot about it), and it's taken almost two-hundred years to keep learning about it. All of these various causes end up with the same ultimate (theorized) endpoint: that there is not enough dopamine in a particular part of the brain called the substantia nigra [wikipedia.org] (black substance, or black region). The fact that the real cause of Parkinson's is not known or fully understood even today does not mean that Parkinson's is not a disease.
.

The fact that something is not in the DSM manual also does not mean it has been disallowed as a disease: it just means that it is not in that particular and specific compendium. And now, the National Institute of Mental Health (NIMH) is saying that the DSM is not the final arbiter of what constitutes a mental disorder or psychiatric disorder. In other words, I also completely agree with your conclusion using different words of my own. :>)

But the experience is the condition (1)

guanxi (216397) | about a year ago | (#43649719)

Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms ... Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category.

Heart attacks are physical events; the muscles in the heart stop contracting, risking death. The patient's experience of it is relatively unimportant, except as an indicator of the physical event. It's the heart attack that needs treatment.

But for mental problems, the patient's perceptual experience often (usually? always?) is the condition that needs treatment. If the patient experiences depression, that is the problem. The physical conditions may be helpful as indicators of the perceptional condition, but it's the depression that needs treatment.

Re:But the experience is the condition (1)

pepty (1976012) | about a year ago | (#43650045)

In the rest of medicine when a group of symptoms tend to travel together without any observable root cause/latent variable they call it a syndrome.

Re:But the experience is the condition (1)

PhamNguyen (2695929) | about a year ago | (#43650125)

The problem with your critique is that the DSM classifications are themselves clusters of symtoms. So what is being proposed is to shift from "cluster symtoms, then try to find things associated with these clusters" to "cluster symtoms, along with genetic, imaging, physiologic, and cognitive data".

Awesome! (0)

Anonymous Coward | about a year ago | (#43649731)

Its about time we brought this field out of the realm of guesswork and into the realm of objectively verifiable science.

Well done!

NIMH is not a rechargable battery (0)

Anonymous Coward | about a year ago | (#43649849)

when I saw NIMH I was thinking about Nickel–metal hydride batteries. didn't realise that NIMH stood for National Institute of Mental Health. i learned something new today.

This Should Go Well (5, Insightful)

meehawl (73285) | about a year ago | (#43649861)

Nerds opining on psychiatric diagnosis...

This should go about as well as psychiatrists opining on monads...

But does this mean... (1)

Velex (120469) | about a year ago | (#43649949)

But does this mean that having a female mind and a male reproductive system no longer means that I'm a serial killer who's constructing a woman suit? Does this mean when they scan my brain and find that it's psysiologically more female than male (these things aren't exact) that it just means that I'm a woman, not that I have a mental illness? What would we ever do if not for the DSM V? Thank you DSM V for acknowledging that being a woman is a mental illness! This post brought to you by b33r.

Rechargeable batteries? (2)

rossdee (243626) | about a year ago | (#43650025)

Do these guys have the patent on Nickel Metal Hydride batteries?

And there was a movie called the Secret of NIMH

Legal Consequences? (0)

Anonymous Coward | about a year ago | (#43650179)

I'm curious what percentage (or number) of court cases might bear re-visiting once "the experts" have declared all versions of DSM rubbish (when DSM had been used to reach the verdict).

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