Psychiatry’s Guide Is Out of Touch With Science, Experts Say

The New York Times article submitted here is a very good overview of the key issues, well reported with historical and policy context. As I've commented in other submissions on this issue, it's helpful to read the article hand in hand with the National Institute of Mental Health director's blog post "Transforming Diagnosis"

http://www.nimh.nih.gov/about/director/2013/transforming-dia...

for the research background on why the DSM is an unsatisfactory framework for advancing psychiatric research. I am part of a local "journal club" of psychology researchers and graduate students in psychology at my alma mater university, and what several of those researchers are seeking are more reliable diagnostic criteria based on more scientifically replicable criteria than merely the gut reactions of a therapist.

By the way, the several previous Hacker News discussions of this issue over the last week have focused mostly on the issue of medical treatment of psychiatric disorders, with much decrying of "big pharma," but an even worse problem in diagnosis of psychiatric disorders is carry-over of prescientific ideas about human thought and emotion from, for example, Freudian or Jungian psychology. There are whole brands of talk therapy that are demonstrably ineffective, but still sought by some patients, and still paid for by some chump insurance companies. Medical treatment is far from perfect, and diagnosis is far from perfect whether preceding medical therapy or talk therapy, but the problem of needing to seek better, science-based standards of diagnosis and treatment is not confined to medical approaches to treatment.

The DSM takes a pragmatic approach to mental disorders - pragmatic in the sense of the pragmatic maxim:

Consider what effects, that might conceivably have practical bearings, we conceive the object of our conception to have. Then, our conception of these effects is the whole of our conception of the object. -- C.S. Pierce

This should not be surprising. William James, who wrote the book on psychology, was a pragmatist.

The emphasis on chemical and genetic causes will have as its consequence increased use of profitable pharmaceutical drugs and gene therapies and a deprecation of counciling and cognitive therapies. There is a role for drugs, but it is not a one size fits all solution.

Just because we no longer believe schizophrenic behavior is caused by demonic possession, it does not mean that we are currently assigning causality correctly.