Complaints about a new diagnostic manual show that psychiatry has a long way to go before being considered a legitimate science. That hope might never be fulfilled.
The occasion for scientific scrutiny on psychiatry is the publication this month of DSM-5, the latest upgrade to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. This 60-year old “bible” to psychiatrists has had a long history of problems. In New Scientist, Peter Aldhous, Andy Coghlan and Sara Reardon hope that a “scientific DSM will transform psychiatry.” That implies that it is not scientific now.
An article on Evolution News & Views recounts the many ways that psychiatry fails as a science. In the future, New Scientist predicts, things will be different. “It will be based on science, and will look nothing like today’s Diagnostic and Statistical Manual of Mental Disorders.” As we reported earlier (5/18/12, 4/24/13), the DSM-5 has come under fire for removing some categories of mental illness and added many new controversial ones, such as “Hypersexual Disorder” and “Binge Eating.” Many practitioners dispute the method of clustering symptoms and giving them names by consensus. Others have accused the APA for being influenced by pharmaceutical companies.
Leading the charge to dump the DSM and work toward evidence-based psychiatry is Thomas Insel, head of the U.S. National Institute of Mental Health. His blunt comments to the APA have been cheered by many psychiatrists. But how soon can psychiatry earn scientific credentials?
Still, don’t expect the landscape of mental illness to change any time soon. Insel accepts that it will take at least a decade to conduct the research necessary to devise a new approach to diagnosis. In the meantime, patients’ illnesses will continue to be diagnosed using the DSM’s symptom-based categories.
Evidence-based psychiatric diagnosis would require mapping genes, neural abnormalities and other “biomarkers” to mental illnesses, providing biological underpinning for conditions like depression, schizophrenia or bipolar disorder. David Kupfer, who led the DSM-5 revisions, had this to say: “We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.” About those biomarkers, Kupfer said they “may someday culminate in the genetic and neuroscience breakthroughs that will revolutionise our field. In the meantime, should we merely hand patients another promissory note that something may happen sometime?”
Other psychiatrists contacted by New Scientist agreed that the idea of biologically-based diagnosis is ideal, but had their doubts it will come anytime soon—or is even possible. “These are incredibly complicated disorders,” said one. Some worry that a focus on physical causes (neurons, genes) might overlook psychological causes. Brain damage, we know, can cause behavioral problems. So can impacted wisdom teeth. But those are not mental illnesses. If psychiatry needs to anchor its science in the psyche (Gr., soul), though, is that a proper realm for science? How do you scan a soul with an MRI?
It appears that psychiatry (long thought to be superior to psychology because it required a medical degree), is poised for collapse. It cannot float on promissory notes forever. Kupfer said that they’ve been waiting for biomarkers to undergird their diagnoses for decades. DSM-5 is a highly controversial placeholder, but many practitioners with “physics envy,” who desire scientific empiricism to validate their claims, are tired of waiting for the legitimacy that never comes.
The ENV article pointed out that many of the causes of psychiatry’s crisis have parallels to the situation with Darwinism. If something as long-respected as psychiatry can collapse, it may be a matter of time for the Darwin Party, guilty of many of the same sins, falls. We’d like to see the Darwin Party accuse the APA of being pseudoscientific. Then the APA should respond by calling the Darwinists mentally ill. They should fight over this and fall down together, but perhaps this is just a delusion.