Months ago, I learned that major drug companies had stopped research on psychotropic drugs. Previously hidden research results had found their way out of the shadows, results that indicated that in clinical trials the drugs had not proven to be more effective than placebos.
Now, on a blog post dated April 29, 2013, Thomas Insel, the director of the NIMH (National Institute of Mental Health), announced that the NIMH wants to transition research away from DSM categories. This will require re-categorizing disorders. He writes,
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. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness 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. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
“The weakness [of the DSM] is its lack of validity.” If the weakness of a dictionary is that the definitions are invalid, what good is the dictionary?
What Insel’s statement indicates is that psychiatrists have been medicating people (and billing insurance companies) based on invalid diagnoses. Clients (whom they call “patients,” a label which implies that they are medically sick) have spent hundreds of thousands of hours and dollars seeing psychiatrists and psychologists based on diagnoses that even the industry leaders do not consider credible. What if the director of the American Medical Association announced that its major medical manual lacked validity?
There is no “objective laboratory measure.” What if your doctor said likewise? “I haven’t really diagnosed your cancer, your kidney disease, your____ with objective laboratory measurements. And the manual isn’t valid. But I’m going to continue to treat you as if it is.” Thousands of people have been diagnosed with mental “illnesses” without legitimate evidence. Psychology and psychiatry have been presented to the public as sciences, yet this announcement demonstrates that they are not.
How can psychiatry be believed? Psychiatry’s self-therapy to become more scientific might be laudable. But since in the past psychiatrists claimed to authoritatively define disorders while actually not objectively or accurately defining problems in living, why should we believe that their next diagnostic manual will be objective and accurate?
How well would a dictionary with invalid definitions sell? Therein is the crux of the matter. The driving force for this new approach is commercial. An article by Forbes on the NIMH announcement noted that drug companies like GlaxoSmithKline and others have stopped inventing new drugs for psychiatric use. Other companies, like Merck and Pfizer, have shifted their focus elsewhere. The move of the NIMH will bring about an increased market demand. Kurt Grady, pharmacist, author, and professor explains how:
If research can establish a connection between a biomarker and a drug for several of what psychiatry calls disorders or diseases, they would have a drug with “multiple indications right out of the chute and the biological basis to support it…this would, as they say in the [Forbes] article, jump start [sic] the pharma research machine…which is nearly dead at this time.”
Insurance companies do not care how NIMH allocates research dollars. There will be no immediate impact on billing as it will, for the foreseeable future, continue to be based on the DSM. When the time arrives for a significant impact on insurance companies, “we will see the people at the APA pivot and turn to embrace the new classification system in their publication…They did it [pivoted] in 1973 with the definition of homosexuality, and again in 1980 with the DSM III (early biological basis foundation).” (Kurt Grady by private email)
Apparently, people are biochemical machines. The April 29 NIMH blog says,
NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system…This approach began with several assumptions:
- A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,
- Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
- Each level of analysis needs to be understood across a dimension of function,
- Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.
There it is: “Mental disorders are biological disorders…” This is an underlying assumption that I refuted in my book, Parenting the Difficult Child, including a discussion of the faults of very kind of behavioral research that is being proposed. Psychiatry wants to play doctor even though the problems they treat are not medical. If psychiatry assumes that problems in living are biological, then it presumes that people are biochemical machines. Apply a chemical tool to tweak the circuitry. Add a few years of therapy to enhance the effect. Continue for years as necessary. Hopefully, the circuits will be rewired and the machine will function like we want. Now if research discovers that the problem is a genetic chemical imbalance, Pfizer will be happy to supply your drugs for a lifetime.
Lest it be thought that I am against medications, let me add that I believe that some emotional and behavioral problems have physiological bases. These are medical conditions with medical diagnoses requiring medical treatment by a doctor. Biblical counseling can teach how to rightly handle the suffering that accompanies a medical condition.
Mental health problems are not primarily biological problems. That is why psychiatry does not hold the solutions and has to keep reinventing and redefining “diseases” and “disorders.” People are not biochemical machines. That is why all of their research will never discover the solutions they want.
People are humans, created by God with an intangible spirit/heart generating our desires, thoughts, intentions, doubts, and beliefs. We have emotional and relational problems in living because we have a basic sin nature in that heart that causes us to mishandle problems and reap unpleasant consequences. Sin problems require God’s solutions.
As psychiatry’s major revamp demonstrates, man’s categories and diagnoses of emotional problems is fickle. Man’s views cannot be trusted. But God’s Word can. It abides forever and always achieves what it claims. It provides effective solutions to the causes underlying every human non-physiological emotional, behavioral, and relational problem, and it never changes. It is absolutely true and reliable.