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Allen Frances on the DSM and NIMH

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Allen Frances, chairman of the DSM-IV and a strong critic of the forthcoming DSM-V, has this strong editorial regarding the recent decision by NIMH to abandon the DSM.  Dr. Frances states:

The flat out rejection of DSM-5 by National Institute of Mental Health is a sad moment for mental health and an unsafe one for our patients. The APA and NIMH are both letting us down, failing to be safe custodians for the mental health needs of our country.

DSM-5 certainly deserves rejecting. It offers a reckless hodgepodge of new diagnoses that will misidentify normals and subject them to unnecessary treatment and stigma.

The NIMH director may have hammered the nail in the DSM-5 coffin when he so harshly criticized its lack of validity.

This is misleading and dangerous stuff that is bad for the patients both institutions are meant to serve.

NIMH has gone wrong now in the very same way that DSM-5 has gone wrong in the past -- making impossible to keep promises. The new NIMH research agenda is necessary and highly desirable -- it makes sense to target simpler symptoms rather than complex DSM syndromes, especially since so far we have come up empty. And the new plan will further, and be furthered, by the big, new Obama investment in brain research. But the likely payoff is being wildly oversold. There is no easy solution to what is in fact an almost impossibly complex research problem.

Isaac Newton said it best almost 250 years ago; 'I can calculate the motions of the heavens, but not the madness of men." Figuring out how the universe works is simple stuff compared to figuring out what causes schizophrenia. The ineffable complexity of brain functioning has defeated past DSM hopes and will frustrate even the best NIMH efforts.

Progress in understanding mental disorders will necessarily be slow, retail, and painstaking -- with no grand slam home runs, just occasional singles, no walks, and lots of strikeouts. No sweeping explanations -- no Newtons, or Darwins, or Einsteins.

Experience teaches that there is very little low hanging fruit when you try to translate the results of exciting basic science into meaningful clinical advances. This is true in all of medicine, not just psychiatry. We have been fighting the war on cancer for 40 years and are still losing most of the battles.


Good stuff and it's worth reading the whole thing as they say, but I'd also read Neuroskeptic's always insightful post on the issue.  This may not really be a seismic shift after all and what may replace the DSM at NIMH may be just as bad.  


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