Tuesday, 7 May 2013

From DSM-5 to RDoC - From bad to worse?

A personal crisis can remind us of our frailty and increase the wish for a sense of order and meaning; consequently, it can be reassuring when a doctor frames our difficult-to-define experiences in a clear and organised way by using familiar diagnostic criteria - usually beginning with "You are suffering from ..."

Though we may welcome some semblance of order during mental or emotional distress, it is not reassuring to know that the producers of DSM-5 have failed to come up with the scientific evidence to support the diagnostic categories that form the basis of this code book. In truth, these are simply just one way of trying to understand our personal struggles and crises (I write more about this here). Furthermore, the limits and risks of the DSM-5 have been loudly trumpeted by many people, including Dr Allen Frances, such as here in the New Scientist.

With the precise timing akin to an experienced actor entering the stage, Dr Insel (Director of the National Institute of Mental Health – NIMI) has announced that they (NIMI) have the answer. They are developing another new classification system (the Research Domain Criteria, RDoC) that will, he asserts, be far superior and have a more robust scientific basis. And with reference to DSM-5, Dr Insel concludes: “The weakness is its lack of validity”.

When I read Dr Insel’s report, some things didn’t ring true. I mention just one: he explains that the research for this new classification system “began with several assumptions”, including the one that “mental disorders are biological disorders involving brain circuits”.

It’s elementary, isn’t it - if science is an open and unbiased (as far as possible) quest for knowledge (and truth) - research cannot be based on narrow and rigidly predetermined assumptions without prejudicing the outcome. Dr Insel is in effect saying “we have decided mental disorders are biological disorders involving brain circuits, and on this basis we will introduce a new diagnostic approach and treatments to match.” It’s certainly wilful, but I don’t see this as science. As Dr Insel says of DSM-5, here again with RDoC the same applies: “the weakness is its lack of validity”. [...]