Today is officially Mental Health Day. The American Psychological Association (APA) has asked all of us who blog on mental health related issues to participate by publishing a blog that relates to mental health. According to the APA, Congress designated May as Mental Health Month in 1949 to raise public awareness of the issues.
So, what exactly should I write about? I am a researcher, not a clinician, so the topic that immediately came to mind was the controversy over the soon-to-be-published and much anticipated DSM 5. I’ve written elsewhere about this topic here.
All editions of the DSM have provoked their share of controversies. Are we over-diagnosing conditions and pathologizing normal behaviors? Or are we under-diagnosing conditions and preventing people from obtaining the treatment they need? This edition has its share–do we need a category for “attenuated psychosis syndrome” or will this result in the use of antipsychotic medications with all of their substantial side effects by normal people? Should we worry about the fact that the number of participants in the DSM process with financial ties to the pharmaceutical industry has jumped from 14% to 70% from DSM IV to DSM 5? Is the price of the DSM 5 ($199) too steep?
For me, the biggest news is the rejection of the DSM 5 as a source for researchers by non other than the National Institute of Mental Health (NIMH). Thomas Insel, director of NIMH, had this to say: “…the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” Instead, the NIMH has launched its own “Research Domain Criteria Project” (RDoC) to move away from a symptoms-based approach, like that of the DSM, to a more causal approach emphasizing similarities in genetics, brain circuits, and cognitive processes among different types of psychological disorders.
It seems to me that this apparent rejection of the DSM 5 by NIMH really caught the attention of the American Psychiatric Association (another APA), which publishes the DSM and depends on the sales of the book for the majority of its income. On May 13, NIMH issued a press release that seemed more conciliatory. The press release says “DSM-5 and RDoC represent complementary, not competing, frameworks for this goal.”
Another player in this mix is the World Health Organization’s ICD system, which is also in the process of a revision slated for publication in 2015. Unlike the DSM, the ICD system is freely distributed. While the ICD is promoted to a worldwide audience, the DSM is used primarily in the United States. In recent revisions, the DSM and ICD committees have worked more closely together to work out inconsistencies.
It will be interesting to watch as these diagnostic systems go into effect. As a researcher and a neuroscientist, I’m already liking what I’m reading about RDoC. When we find that the candidate genes associated with bipolar disorder and schizophrenia are quite similar, it makes no sense to have one disorder described in one place in the DSM and the other in a completely different section in the manual.
Hopefully, the end result of the discussion about classification systems will be improved care for the people with the disorders. I personally think we have a very long way to go in this direction, and I welcome any efforts that lead to less stigma and better outcomes.