In a letter on the National Institute of Mental Health website, Director Thomas Insel announced that NIMH will be “re-orienting its research away from DSM categories.” He comments that the DSM has had reliability but not validity:
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.
I had a moment of hope, that perhaps they would be looking beyond reported symptoms to cultural and structural as well as biological factors. Instead, NIMH is launching the Research Domain Criteria (RDoc) project to develop a classification system of its own. NIMH support in the future will be for research that cuts across DSM categories and fits the assumptions of RDoC (the emphasis is mine):
- A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
- Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
- Each level of analysis needs to be understood across a dimension of function,
- Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment
I’m not a doctor and I do believe that many illnesses that we see as “mental disorders” have a basis in chemical imbalances or biological disease. However, this sort of institutional bioreductionism worries me. It seems like a quest for magic bullet solutions rather than an understanding of the complex factors inside and outside the patient that contribute to what he or she is experiencing.