NIMH Wants to “Fail Better” than the DSM-5 Did

07 May NIMH Wants to “Fail Better” than the DSM-5 Did

May 6, 2013

I wonder why no major media outlet is covering this story—the National Institute of Mental Health (NIMH) announced on April 29, 2013 that it won’t be using the Diagnostic and Statistical Manual of Mental Disorders (DSM) anymore. (The story is all over the blogosphere, which is how I found out about it.)

But don’t put this into the category of “Good News” just yet.

Yes, the rejection by NIMH “delivers a kill shot to DSM-5,” in the words of  blogger Hank Campbell. What killed it is its lack of validity—something tens of thousands of professionals and consumers have pointed out in petitions, books, articles, TV and radio interviews, forums and blogs over the past eighteen months. Most of the protest surrounding the DSM-5 attributes its invalidity to its mischaracterization of mental distress as brain disease and its medicalized study and treatment. The sloppy data collection and field trials, not to mention psychiatry’s collusion with pharmaceutical companies, have also been widely exposed. Some, like myself, locate all the above in the broader political-philosophical issues of “What are emotions?” and “Why diagnosis?” (Search my blog for DSM-5.)

But for the NIMH, the DSM-5’s invalidity stems from the fact that, unlike the rest of medicine, it is symptom-based. So, far from killing the DSM-5 because it’s too tied to the medical model and the medical industries, NIMH is abandoning it because it finds it to be bad medicine. (I do agree with that.)

According to NIMH director Thomas Insel, MD, in “Transforming Diagnosis” (his NIMH blog entry announcing the change),

“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.”

As NIMH sees it, diagnosis in mental health “must not be constrained by the current DSM categories” but rather needs to include the biology along with the symptoms. The government agency is launching its own work to map “the cognitive, circuit, and genetic aspects of mental disorders.”

So the break with the DSM-5 actually takes us even further down the biological path. And it’s based in more assumptions than even the abyssmal DSM-5. I liked how one blogger put it in the post, “Paradigms lost: NIMH, McGorry & DSM-5’s failure”:

“Such assumptions [about biology, the brain and mental helath/illness] are little more than speculative, yet they are presented as conclusive. They serve to close off avenues of research that fall outside their boundaries rather than open them up. They point to the imperviousness of the dominant biological paradigm to evidence that contradicts it. In the words of Samuel Beckett, “Try again. Fail again. Fail better.” 

The blogger goes on—and I think he points to some of the reason these scientists and bureaucrats continue to “fail better”:

Because psychiatry, like the rest of medicine, is deeply imbued with scientific positivism (that real science is free of social values) and methodological individualism (that social processes are merely the aggregate outcome of individual behaviours), it cannot fully grasp that all health and illness — mental and physical — is both socially embedded and socially constructed. Therefore it cannot critically reflect on its own social nature, its own ideologies and practices that are inextricably bound up with wider social conflicts in their historical contexts…A new paradigm that doesn’t simply repeat those flaws cannot be built from above, not by DSM committees nor NIMH directors. It can only be built through the struggles of patients and clinicians for a mental health system driven by quite different social priorities. (my emphasis)

I couldn’t agree more.