Last week, the National Institute of Mental Health, the largest mental health research organization in the world, announced that it had concerns about the DSM-5 and would begin reorienting its research away from DSM categories. “The weakness is a lack of validity,” NIMH director Thomas Insel wrote in a statement, criticizing the DSM-5 for basing its diagnosis on clinical symptoms rather than on “objective laboratory measures.”
David Kupfer, the DSM-5’s chair, responded to the NIMH’s concerns by arguing that objective measures, like biological and genetic markers, are still too far off to wait for. “In the absence of such major discoveries,” he wrote in a statement, “it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding” of many disorders.
Understanding has been advanced — but not reached. Because even for medical professionals, “fact” is a moving target, a difficult destination. Throughout its history, the DSM has remained a consensus document, says Shorter, ... Psychiatry aspires to scientific status,” but it’s also subject to the political or interdisciplinary nuances of the day.
“People don’t change quickly,” says Frances. “Labels change on a dime. Labels follow fashion. Whenever there’s a sudden jump, it’s not because there’s more pathology, it’s because there’s a difference in labeling it.”
It brings up an essential, philosophical question: Who are we? Are we the same people we’ve always been? Sicker? Healthier? Wounded as ever, but with better terminology? The DSM might relabel our suffering, but does it bring us any closer to understanding the unquiet of our minds?
“We’re very comfortable with what we’ve done,” says James Scully, the APA chief executive, back in his office overlooking the Potomac. “Will there be changes in the future? I hope so. It’s not the word of God. It’s the best science we have currently,” he says.
Scully did not realize how true his off-handed remark is: the DSM is not the Word of God and Christians should not accept it as such. Many of the so-called disorders people suffer have spiritual causes not mentioned in the Bible. And spiritual solutions which are.
