Monday, May 27, 2013

Mental "Disorders" or "Illness" Isn't Medical At All; There Are No Biological Markers


Excerpts:

"The reason there is so much controversy about DSM-5 is that psychiatric diagnosis has become, if anything, too important — not only in clinical decisions but also in school services, disability and in the courtroom. There's a tremendous amount at stake," says Frances, of Coronado, Calif., a professor emeritus at Duke University in Durham, N.C.
Because the DSM contains a detailed list of psychiatric disorders, it's a guidebook for the U.S. health care system and insurance coverage...

Psychotherapist Gary Greenberg, of New London, Conn., has written about the DSM for more than a decade and says the DSM disorders are "simply collections of symptoms that some experts agree constitute mental illnesses. There's not a single diagnosis in DSM that lives up to the standards of medical diseases."
"If I as a therapist tell you (that) you have a mental disorder, it's not the same thing as my telling you you have diabetes or cancer because diabetes and cancer are diseases that can be confirmed through biochemical findings. They meet the requirements for a disease in the way we generally think of a disease. There is not a single disorder in DSM-5 or any DSM that does that," says Greenberg, author of The Book of Woe: The DSM and the Unmaking of Psychiatry, out earlier this month.
"The whole disease model that underlies the DSM has been an utter scientific failure," says Stuart Kirk, a professor emeritus of social welfare at UCLA, who has been tracking DSM for decades. "There's not a single biological marker for any of the 300-plus disorders. What we do instead is descriptive. This describing is creating a disorder and pretending it's a medical illness rather than just human behavior."...
Psychiatrist Michael Taylor, of Ann Arbor, Mich., author of Hippocrates Cried: The Decline of American Psychiatry, out last month, says psychiatry has to go back to the medical model for disease.
"The reason why so many of the syndromes don't work out when they do field trials is that they don't exist in biological reality," he says. "They only exist in the DSM."
The focus on biomarkers and away from symptoms got attention just weeks ago when a blog post by Thomas Insel, director of the National Institute of Mental Health, said the DSM is "at best, a dictionary, creating a set of labels and defining each" and that "its weakness is its lack of validity." He says NIMH will reorient its research away from the manual because "DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

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