This is Kind of a Big Deal

The National Institute of Mental Health has withdrawn its support for the DSM-5, the 5^th edition Diagnostic and Statistical Manual of Mental Disorders, the massive update of the American Psychological Association's encyclopedic, and controversial, diagnostic manual:

Just two weeks before DSM-5 is due to appear, the National Institute of Mental Health, the world's largest funding agency for research into mental health, has indicated that it is withdrawing support for the manual.

In a humiliating blow to the American Psychiatric Association, Thomas R. Insel, M.D., Director of the NIMH, made clear the agency would no longer fund research projects that rely exclusively on DSM criteria. Henceforth, the NIMH, which had thrown its weight and funding behind earlier editions of the manual, would be “re-orienting its research away from DSM categories.” "The weakness” of the manual, he explained in a sharply worded statement, “is its lack of validity.” “Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

That consensus is now clearly missing. Whether it ever really existed remains in doubt. As one consultant for DSM-III conceded to the New Yorker magazine about the amount of horsetrading that drove that supposedly "evidenced-based" edition from 1980: “There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, ambiguous.”

According to Insel, too much of that problem remains. As he cautioned of a manual whose precision and reliability has been overstated for decades, “While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each.” And not even a particularly good dictionary, apparently. Of the decision to steer research in mental health away from the manual and its parameters, Insel states: “Patients with mental disorders deserve better.”

I'm wondering how much of this is a generational thing.

The people who have been in charge of the DSM since at least the late 1970s are all roughly of the same age, being in their 40s back then, and being in their ate 1970s now, and as such, advances in genetics, neurochemistry, and imaging allow for a far more quantitative approach to the discipline.