In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.
In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.
This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.
As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:
Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.
As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.
For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.
Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.
It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.
It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.
The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.
The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.
Link to NIMH announcement ‘Transforming Diagnosis’.
Mind Hacks 
Thanks for posting this. I think it’s a courageous step and I tend to agree when Insels says: “patients with mental disorders deserve better”.
This is a fantastic first step and is, essentially, the exact reason I went into research.
Declared conflict of interest: I own the domain Pheromones.com
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This announcement could not make clearer what I’ve been advocating since I first addressed the issues in my most recently published work. My antagonists have exemplified the problem of their ignorance of neuroscience in the context of embodied cognition, psychiatry research, evolutionary psychology, and human ethology.
Excerpts from Kohl (2012)Human pheromones and food odors: epigenetic influences on the socioaffective nature of evolved behaviors. Socioaffective Neuroscience & Psychology
Section Head: The FDA Critical Path Initiative
Given the importance of understanding how food odors and nutrition epigenetically influence individual survival in other mammals, it is not surprising that a reiteration of the ‘FDA Critical Path Initiative’ (Marts & Resnick, 2007) stresses the need to approach the development of human sexual behavior, which is required for our species survival and beneficial to human well-being, by using the same pathway that links food odors and pheromones to the behavior of honeybees and humans.
Including the interactions among the gene, cell, tissue, organ, organ-system pathway (Wizemann & Pardue, 2001) allows sexual differentiation of the brain and behavior to be detailed in the manner that was suggested by Diamond, Binstock, and Kohl (1996) and more recently by McCarthy and Arnold (2011). These details are in obvious accord with what has been neuroscientifically known for several decades about organization and activation of the brain and behavior (Naftolin, 1981).
Section Head:
Integration of olfactory/pheromonal conditioning into clinical psychology: The American Society of Addiction Medicine (ASAM) policy statement
The Public Policy Statement: Definition of Addiction (ASAM, 2011) represents a paradigm shift that may move the current practice of clinical psychology forward. It dictates the adoption and integration of neuroscientific principles that are required in order to understand differences between genetically predisposed brain disease, naturally occurring variations of behavioral development, and choice. These neuroscientific principles include focus on how sensory input influences behavior. The statement specifically mentions food and sex along with drugs and alcohol; each seems to chemically condition changes in hormones and in behavioral responses. Although no link between cause and effect is mentioned by ASAM, these principles could incorporate the GnRH neurophysiological mechanism and levels of LH, which link food odors and pheromones to chemically conditioned behaviors.
See also: G. Zhang et al., “Hypothalamic programming of systemic ageing involving IKK-β, NF-κB and GnRH,” Nature, doi:10.1038/nature12143, 2013.
This reminds me of a classic joke about compensating for dysregulated arousal systems.
There are two brothers, Steve and Barry. Steve asks Barry to to watch his house and cat while he is away on holiday with his girl friend in Florida. After a few days, Steve calls home to see how things are going.
“Hey bro, how are things? House still standing? How’s my cat doing?”
Barry swallows hard, “Well yeah Steve, your house is still standing. Nice neighborhood you have here. Sorry to say, though, but your cat died.”
“What?” gasps Steve. “You just can’t tell someone that their cat is dead. You have to break it to them gently. The first time I call you should say that the cat is on the roof, trying to catch a bird. The second call you should say the cat fell trying to catch the bird as it flew away, and now it’s at the vet. The third call you should be to tell me that the vet says that it’s not looking good for the cat. On the fourth call you let me know that my cat died peacefully in its sleep.”
Barry understood the importance of breaking the bad news slowly.
“So,” Steve continues. “Have you been to see Mom in the nursing home? How’s she doing this week?”
“Well, Mom’s on the roof over there.”
😀
I can’t say that this is surprising, since the DSM is such a mess, but I’m also not sure how useful it is to continue taking the biological reductionism further to focus ever more on symptoms, biomarkers, and endophenotypes. We already ignore the impact of social and cultural factors to a great extent, and this change will move the field even further away from the human experiences that patients have.
There are now biomarkers of epigenetic effects of food odors and pheromones (e.g., on the microRNA / messenger RNA balance) that link nutrient stress and social stress to physical and mental disorders via what is known about adaptive evolution. The examples of balanced selection that show up in amino acid substitutions in model organisms from microbes to man should have long before now been considered in the context of vertebrate GnRH secretion and its central role in the hormone-organized and hormone-activated development of the human brain and behavior (a model that has also been exemplified in the hormone-organized and hormone-activated behavior of invertebrates).
Did you just copy and paste all that from an abstract somewhere? If not, I’m impressed 😉
Of course those biomarkers exist; I’m not arguing with that. But biomarkers of epigenetic effects of having supportive family and friends, having a purpose in life and living in accord with that, having ways of dealing with stress like meditation, etc. certainly exist as well. And I’m willing to bet you that the new direction of NIMH-funded research, while certainly worthwhile for entities like schizophrenia, will not result in effective treatments for the vast majority of patients, e.g. those with depression, anxiety, problems coping with stress.
I am rejoicing that the DSM will be less important in both research and clinical practice. I agree that the focus should not only include, but prioritize and emphasize social and cultural factors. We live in a global community and most of my psychiatrists have been foreigners and very anti-american except for their paychecks and suburban homes. In this sense, I hope the wisdom of the DSM is preserved for those who truly are mis-diagnosed.
I agree that this, at the very least, is a step in the right direction.
Yes! I applaud this decision. Patients do deserve research that steps outside the diagnostic world and instead looks to find what creates the problems.
Calm down…It’s not as good as it sounds. As Thomas Szasz would put it: It’s just an attempt to improve the plantation.
Well stated. I smell “law suit” prevention…anything to prevent a malpractice lawsuit. When will researchers learn to put patient “self-reports” first and research and DSM second.
If there is to be a lawsuit at all, the lawsuit should be filed against the Rule of Law, itself.
For the reasons why, see “STEM vs Lawfare.”
l. Presenting Problem. (patient version)
2. Spouse and/or family perception of the problem complete with family history.
3. Treatment plan. Applied
4. Weekly evaluaton of effectiveness of treatment.
This method requires no need of DMS and insures that the actual treatment can be started at once and evaulated periodically.
If improvement is noted, treatment continued only as long as patient and significant others experience resolution of problem.
If improvement is not noted, a different therapist should be considered or a different medicine tried.
Psycritic asked: “Did you just copy and paste all that from an abstract somewhere? If not, I’m impressed ;-)”
I made an integrative statement based on prior published works and prepublication drafts posted to figshare.com while waiting on the second round of peer-review for a follow up submission to “Human pheromones and food odors: epigenetic influences on the socioaffective nature of evolved behaviors.”
See for example: Nutrient-dependent / Pheromone-controlled Adaptive Evolution http://dx.doi.org/10.6084/m9.figshare.155672
Nutrient-dependent / Pheromone-controlled thermodynamics and thermoregulation
http://dx.doi.org/10.6084/m9.figshare.643393
I can’t decide which to write next: Nutrient-dependent / Pheromone-controlled symbiosis or Nutrient-dependent / Pheromone-controlled morphogenesis or Nutrient-dependent / Pheromone-controlled disorders and their treatment. At least one new report each week exemplifies Nutrient-dependent / Pheromone-controlled something. (That’s why I mentioned: G. Zhang et al., “Hypothalamic programming of systemic ageing involving IKK-β, NF-κB and GnRH,” Nature, doi:10.1038/nature12143, 2013.”
Here’s an example of my copy and paste ability:
“…the new direction of NIMH-funded research… will … result in effective treatments for the vast majority of patients, e.g. those with depression, anxiety, problems coping with stress.” — when others realize that the molecular mechanisms of nutrient stress are precisely the same as for social stress.
Thus, the biomarkers that reflect changes in the nutrient-dependent microRNA / messenger RNA balance can be used as indicators of nutrient stress and/or social stress. Effective treatments can then specifically address cause and effect at the required levels (gene, cell, tissue, organ, organ system).
Until now, we’ve had people looking at cause and effect that’s so far removed from what is neuroscientifically known that few molecular biologists ever bother to educate those from other disciplines. Many of the outsiders (and some of the insiders) think in terms of “mutations theory” and cannot grasp the dynamics of how the epigenetic landscape becomes the physical landscape of DNA, via olfactory/pheromonal input in species from microbes to man. For many people, ecological, social, neurogenic, and socio-cognitive niche construction just somehow randomly occurs.
Bravo, NIMH! The APA deserves to be shunned for their complete disregard for science and quality of care for those with mental disorders. Given the American Counseling Association also is not going to require immediate use of the DSM 5, the APA ought to seriously consider a revision before it hits the shelves.
Bravo! Mental health is a lot more than, scales and diagnostic tables.
What a refreshing development. The tyranny of the DSM is weakened. I will look forward to the vector from the NIMH.
Hoping research will look at overcoming trauma as healing and not a mh diagnosis.
Thank you for looking at the bigger picture – I think a mix between the two approaches would bring the way we diagnose into balance … Sometimes there is a need to be disease specific and other times, there is a need to stand back and look across the disorder spectrum… I find taking black and white approaches oftentimes do us a disservice in that we need to be able to zoom into and out of our knowledge base.
This work of Fiction, The DSM, has been presented as Fact for far too long and far too many people have suffered greatly as a result.
Dependence on their work of fiction causes docs to prescribe for the long term, medications that have been ‘tested’ only in short running trials. That the results of these short lived trials are many times falsified is not seen as important to the welfare of the patients who are ultimately prescribed the medications for supposed “brain chemical imbalance” and told they “need the drugs like a diabetic needs insulin.”
The docs themselves admit that there is no test to determine ‘brain chemical imbalance’ and yet they insist on throwing toxic chemicals (“medications”) into patients and expecting a good outcome. When patients develop a host of side effects from these toxic chemicals the resulting ‘side effects’ are then treated with additional ‘medications’ – all of which have their own sets of side effects.
A special kind of Choreographed Insanity is caused by the benzodiazepine class of drugs. Benzos are tranquilizers, and everyone knows tranquilizers are addictive! Addiction to tranquilizers sometimes begins to look like insanity after a patient has been on them for a time, as the patient begins to experience inter-dose withdrawal and to occasionally behave erratically as a result. Some benzo addicts even begin to experience hallucinations – which are then treated by pDocs with anti-psychotics when all the patient REALLY NEEDS is to be taken OFF of the offending drug.
For the life of me I will never understand how adding iatrogenic addiction to a deadly drug – for an already existing medical problem – helps matters any, especially since addiction is, in and of itself, considered a “medical problem”. Though the drug is quite difficult to O.D. on, many people have died when cold turkeyed from benzos, as a cold turkey from benzos can cause seizures, and coma – leading to death.
Worse yet, there seems to be growing evidence that benzos cause permanent brain damage. There is no other way to say this, except that it is abuse and torture. Sometimes it’s even court ordered.
Imagine that. The pDocs use a work of fiction to justify chemically abusing/torturing patients.
It’s far past the time to announce to the world that their gig is up.
The root causes of many emotional and mood disorders are also works of fiction.
Bureaucracies and governing authorities routinely fabricate a lot of shreklisch situations that can drive pretty much anyone meshugenah.
Unbelievable! Just today I thought and even posted on GRASP forum my lamentation re lost cathegory (and it seems the DSM5 affected me much deeper in this way: to lose the identity!)- and a sudden dramatic turn!
The Mayans were right, the world we knew has gone. They just got the year wrong.
I love it. The little APA should have fired the DSM5 committee years ago.
I teach abnormal psyc, and will not teach DSM-5 criteria. I’ve already prepped lectures along the guidelines laid out by NIMH.
Speaking as an outside observer (not a member of the APA, not even a resident of the US), I’m curious about the resulting practical considerations and the real motivations behind this change.
I don’t see how DSM vs. RDoC vs. X is a legitimate metric for determining the merit of a research proposal, nor do I understand the implied mutual exclusivity between a diagnostic matrix and a taxonomy. I’ve only glanced at the RDoC mission statement, but there seems to be an assumption that the DSM is actively preventing the study of shared causative factors across multiple axes. Is that an actual common problem? I understand that treatment research isn’t necessarily about determining etiology, but I thought DSM was concerned with diagnosis and treatment rather than causation.
Perhaps I’m overly naive about the relationship between research and clinical practice. I assumed that the utility of the DSM for the researcher is to act as a source of assumptions to be questioned and improved-upon, and certainly not in isolation. Is it the intent of the NIMH to quash any use of DSM in their studies, or just to limit its use and require more causative research?
While it sounds good, my worry is that it will make manipulation of clinical trials even more widespread – adjusting criteria so that the results will be more favourable.
YES!!!!!!!!!!!! the changes to autism are so dumb!!!!!!!!!!
sign this if you’re against the DSM’s dumb changes to autism: http://www.change.org/petitions/dsm-5-committee-dont-reduce-the-criteria-for-an-autism-spectrum-condition-in-the-dsm-5
Wonderful! And about time! Good for NIMH and, more importantly, good for the future of psychiatry. (Now at least there is one.)
((Can’t believe Jim Kohl is ranting here too with his pheromones… 😉 ))
@occaminpartaveitsi
What part of what I wrote do you consider to be a rant? The reason I mentioned G. Zhang et al., “Hypothalamic programming of systemic ageing involving IKK-β, NF-κB and GnRH,” Nature, doi:10.1038/nature12143, 2013.” is because it links epigenetic effects of sensory input directly to the neuroendocrine and neuroimmune systems via olfaction and pheromones in species from microbes to man.
Do you consider that published work to also be a rant? They appear to consider it to be proof of concept. “…we conceived that the hypothalamus, which is known to have fundamental roles in growth, development, reproduction and metabolism, is also responsible for systemic ageing and thus lifespan control.” Would it not be odd if that conceptualization had nothing to do with mental health?
I can’t believe that anyone would make that type of inference here by referring to my input as ranting. Perhaps you merely took what I wrote out of context. Do you know anything about hypothalamic programming by olfactory/pheromonal input?
I’m 58. All my unproductive life I and most around me thought me just strange, head up as.. Was anxious and depressed, didn’t know it. Glad I was diagnosed/treated. Even tried meditating, nutrition, god, pma, taking my head out, …. Something wrong physically chemically mentally? You had to be there.
Hopefully this will go some distance toward freeing psychiatrists and psychologists from at least some of the constraints imposed by the rigid categorization characteristic of DSM. For example, it wasn’t until DSM-4 that Asperger’s syndrome was recognized by DSM–and even then it was lumped in with autistic-spectrum disorders. Prior to its inclusion, my brother, who is in his 60s, had been diagnosed with a wide array of other disorders and medicated with an assortment of drugs, none of which helped. As a “high functioning” Aspergian, he is now active with groups who are advocating a wider and less constrictive approach to the diagnosis of his condition, including the removal of it from the list of autistic-spectrum disorders.
In my opinion this a good move on behalf of interest of clinical research and patients. The criteria are at best helpful mostly for billing
APA is mixed up and does not keep interest of patients or psychiatric members and is money minded. I am glad Nimh took such step
Do phenomenologic syndromal approaches necessarily conflict with RDoC? They don’t strike me as exclusionary but topics in need of parallel clarification.
Deconstructing the DSM: http://www.psychologytoday.com/blog/feeling-relating-existing/201204/deconstructing-psychiatrys-ever-expanding-bible
What does it all mean for issues like PAS (or PA now)?
DSMs have done a good service to the world’s paychiatry but a phenological-only approach no longer is sustainable. This approach should be integrated with the biological and psychodynamic ones.
If moving away from DSM also implies taking into consideration cultural influence in the diagnosis of mental illness then it is a welcomed development. Maybe a look back at the paper by Ebigbo, P.O & Ihezue U.H titled: Uncertainty in the use of western diagnostic illness categories for labelling mental illness. Published in Psychopathologie africaine (1982, will help illuminate this point.
The DSM and any diagnostic criteria should look beyond the medical models of treatment and recovery. Yes,’patients’ deserve better – but ‘patients’ deserve more than just better.
@James Kohl
This is an article about NIMH abandoning the DSM…your lengthy posts about the “epigenetic effects of sensory input” are tangentially related at best to the subject of NIMH changing its approach to studying mental health. Not that what you’re talking about isn’t interesting – there’s just a time and a place for everything…
@aarongilliland
Some great questions here. I’d love to hear some answers to this too.
Thanks, Andy.
In a series of published works in: Hormones and Behavior; Neuroendocrinology Letters, Journal of Psychology and Human Sexuality, and in Socioaffective Neuroscience and Psychology, I have thoroughly detailed the link from the sensory environment to the molecular mechanisms of adaptively evolved development of the brain and behavior. My model addresses every aspect of the NIMH Research Domain Criteria (RDoC)in the context of environmental effects on genes in cells of hormone-secreting nerve cell tissue of the brain. Where do you think that things like this can be discussed?
(RDoC) 1. Environmental aspects. “The central nervous system is exquisitely sensitive to interactions with various elements of its environment virtually from the moment of conception.”
See for example: From Fertilization to Adult Sexual Behavior (vertebrates; a mammalian model).
(RDoC) 2. Environmental aspects. “The social and physical environment comprises sources of both risk and protection for many different disorders occurring at all points along the life span, and methods for studying such phenomena as gene expression, neural plasticity, and various types of learning are rapidly advancing.”
See for example: Organizational and activational effects of hormones on insect behavior (invertebrates; the honeybee model organism)
Conclusion: While the insect literature contains numerous examples of hormone activation, explicit use of the organization concept provides a window into the developmental origins of phenotypic variation in behavior. It also broadens the time course over which hormonal actions on insect behavior are considered, from egg to adult.’
(RDoC) 3. Environmental aspects. “As with developmental aspects, environmental influences may thus be considered as another critical dimension of the RDoC matrix. The effects of a particular interaction with the environment, e.g., the effects of early child abuse, may pose risk for a wide variety of disorders. As another example, illicit drug use may cause sensitization of mesolimbic dopamine circuits that generalizes to other drugs of abuse and addictive behaviors. Thus, it is hoped that a research program organized around the relevant circuit-based dimensions that are affected, independent of a particular disorder, will accelerate knowledge regarding such environmental influences along the entire range of analysis from genes to behavior.”
See for example: Human pheromones: integrating neuroendocrinology and ethology
My comments on this section (paragraphs 1-3) of RDoC:
In mammals, circuit-based dimensions that are epigenetically effected by sensory input from the social environment in species from microbes to man include the nutrient-dependent pheromone-controlled epigenetic effects on hypothalamic gondadotropin releasing hormone (GnRH). The epigenetic effects of olfactory/pheromonal input link a direct effect from nutrient stress and social stress to gene activation in hormone-secreting nerve cells of tissue in an organ (i.e., the brain), which is adaptively evolved to control organ systems via the feedback loops of multisensory integration, which are responsible for behavior. The central role of vertebrate GnRH is conserved across 400 million years of adaptive evolution. Its receptor diversifies and enables ecological and social niche construction, which results in neurogenic niche construction and socio-cognitive niche construction as is required for the adaptive evolution of embodied cognition. My model eliminates the mind/body dichotomy.
See for example: The Mind’s Eyes: Human pheromones, neuroscience, and male sexual preferences and the comment on my model by Simon Le Vay in Gay, Straight, and the Reason Why: The Science of Sexual Orientation. p. 210 ‘This model is attractive in that it solves the “binding problem” of sexual attraction. By that I mean the problem of why all the different features of men or women (visual appearance and feel of face, body, and genitals; voice quality, smell; personality and behavior, etc.) attract people as a more or less coherent package representing one sex, rather than as an arbitrary collage of male and female characteristics. If all these characteristics come to be attractive because they were experienced in association with a male- or female-specific pheromone, then they will naturally go together even in the absence of complex genetically coded instructions.”
And now, Simon’s caveat: “Still, even in fruit flies, other sensory input besides pheromones — acoustic, tactile, and visual stimuli — play a role in sexual attraction, and sex specific responses to these stimuli appear to be innate rather than learned by association [36.]. We simply don’t know where the boundary between prespecified attraction and learned association lie in our own species, nor do we have compelling evidence for the primacy of one sense over another.”
There is overwhelming evidence for the primacy of olfaction and pheromones in the nutrient-dependent pheromone-controlled development of behavior in species from microbes to man. Responses to olfactory/pheromonal input (e.g., nutrients that metabolize to pheromones) are innate. Species-specific responses to acoustic, tactile, and visual stimuli are learned via association with olfactory/pheromonal input. Model organisms: yeast, nematodes, flies, ants, honeybees, mice, rats, sheep et al., exemplify nutrient-dependent pheromone-controlled development of behavior associated with single amino acid substitutions and genes of large effect. These genes are clearly responsible for species diversity that include nutrient-dependent sexually-selected phenotypic diversity in a human population that arose during the past ~30,000 years (Kohl, submitted).
See for example: Human pheromones and food odors: epigenetic influences on the socioaffective nature of evolved behaviors. “”The concept that is extended is the epigenetic tweaking of immense gene networks in ‘superorganisms’ (Lockett, Kucharski, & Maleszka, 2012) that ‘solve problems through the exchange and the selective cancellation and modification of signals (Bear, 2004, p. 330)’. It is now clearer how an environmental drive probably evolved from that of food ingestion in unicellular organisms to that of socialization in insects. It is also clear that, in mammals, food odors and pheromones cause changes in hormones such as LH, which has developmental affects on sexual behavior in nutrient-dependent, reproductively fit individuals across species of vertebrates.”
What remains to be seen is whether my model will ever be incorporated into study designs based on the NIMH Research Domain Criteria (RDoC).
If it is not, I think we can expect progress to be slow in attempts to understand more about Nutrient-dependent / Pheromone-controlled Adaptive Evolution; Nutrient-dependent / Pheromone-controlled thermodynamics and thermoregulation; Nutrient-dependent / Pheromone-controlled symbiosis; Nutrient-dependent / Pheromone-controlled morphogenesis; Nutrient-dependent / Pheromone-controlled epistasis; Nutrient-dependent / Pheromone-controlled embodied cognition; or mammalian nutrient-dependent pheromone-controlled Hypothalamic programming of systemic ageing involving IKK-b,NF-kB and GnRH.
With the caveat of me not being Andy, I might suggest that the answer to your question, “Where do you think that things like this can be discussed?”, would be something that is more specifically related to the more specific factors you spend most of your time discussing.
Even if you might have some interesting points, your posts of ever-increasing length have so much that would be more appreciated in another discussion that it’s harder to dig through everything to find those points of interest for this discussion and easier to just move on to the next comment.
Regardless of how important your research may be, this isn’t the forum for discussing nutrient-dependent/pheromone-controlled anything, really.
Jeremy,
What I hear you echoing is that you would rather not discuss the molecular mechanisms of cause and effect that the NIMH Rdoc criteria will require to be addressed in future grant applications. Is there a reason you would rather not discuss these things here?
(RDoC) 1. Environmental aspects. “The central nervous system is exquisitely sensitive to interactions with various elements of its environment virtually from the moment of conception.”
(RDoC) 2. Environmental aspects. “The social and physical environment comprises sources of both risk and protection for many different disorders occurring at all points along the life span, and methods for studying such phenomena as gene expression, neural plasticity, and various types of learning are rapidly advancing.”
(RDoC) 3. Environmental aspects. “As with developmental aspects, environmental influences may thus be considered as another critical dimension of the RDoC matrix. The effects of a particular interaction with the environment, e.g., the effects of early child abuse, may pose risk for a wide variety of disorders. As another example, illicit drug use may cause sensitization of mesolimbic dopamine circuits that generalizes to other drugs of abuse and addictive behaviors. Thus, it is hoped that a research program organized around the relevant circuit-based dimensions that are affected, independent of a particular disorder, will accelerate knowledge regarding such environmental influences along the entire range of analysis from genes to behavior.”
We’ve now seen a lot of cheers for the NIMH with no substance. What do you think should happen next? I can predict what will happen next if grant applications don’t incorporate what’s currently known about ecological, social, neurogenic, and socio-cognitive niche construction. How much more loss of funding can psychology withstand?
@ James:
“How much more loss of funding can psychology withstand?”
“Psychology” is losing funding? In what way?
Psychiatry could lose MOST of ‘its’ funding and the world would be a much better place. Their current model of just simply dumping people full of powerful and toxic drugs which have no basis in science as they have not / can not be tested as legitimate medications replacing so called ‘brain chemical imbalances’ – since there is no way possible to test for these chemicals in the brain. So what the docs usually do is throw the medications at patients until they (quoting the docs themselves) “find one that works.” or, the “Right combination of drugs that work.”
The sad thing is, NONE of them work. I don’t doubt that a so-called med that “works” is simply a patient’s body’s response to “toxic chemical fatigue” and that the body is so tired of fighting all these toxic chemicals that it just gives up and begins to shut down. The patient feels different and the docs think they have finally found the ‘right’ medication for that individual.
Not so. How can an addictive and toxic drug be the right medication? Addiction doesn’t fix anything – all it does is add addiction to an already existing problem, along with ‘side effects’ of the toxic drug.
There are no ‘right’ medications for brain chemical imbalance because brain chemical imbalance does not exist.
Modern psychiatric drugs are nothing more than “snake oil” treatment. Only thing is … is that Snake Oil is actually good for you. These drugs are not. Snake oil contains Omega 3 fatty acids. These drugs are just toxic chemicals.
But we can sell toxic chemicals to unsuspecting people using government sanctioned technobabble – just as we can terrify them for fun and entertainment using technical language.
Ever hear of the Dihydrogen Monoxide hoax?
http://en.wikipedia.org/wiki/Dihydrogen_monoxide_hoax
It’s not “abandoning”.
The contents of posting is excellent, but its title is mischoice and confusing people.
In reality, only DSM criteria will determine payment for most practitioners, whether medical or psychological practitioners. It will be a decade (or decades) before there is really any change to diagnosis, and diagnosis is fraught with problems, complicated by the social structure of the DSM. For those of us who want change, we might focus on the distant future; if we want an accurate and fair system, the current structure doesn’t serve us.
… focus on the distant future?
*NOW* IS THE TIME TO CUT THE ABUSERS AND TORTURERS OFF AT THE KNEES! (before there are too many more victims!)
It should have been done years ago!
DSM is a WORK OF FICTION. And “they” use this fiction to chemically exterminate – annihilate us. It’s got to stop.
The root causes of many emotional and mood disorders are also works of fiction.
Bureaucracies and governing authorities routinely fabricate a lot of shreklisch situations that can drive pretty much anyone meshugenah to the point of utter despair.
But the “Nepenthe Treatment” is not for everyone.
The separation of nosology from etiology in DSM-III in 1980 was to boost reliability in psychiatric diagnosis. But it came at the expense of validity. Thus 30+ years later it is all unraveling for the APA. Unfortunately psychiatry has suffered around the world from going down this blind alley. It is welcome to see the NIMH break ranks. However I fear the NIMH is still too stuck on the “bio” part of the biopsychosocial spectrum.
For a (somewhat humorous) clinical perspective on this – I had an article in the Medical Journal of Australia some years ago – “Cough Disorder: an allegory on the DSM-IV”
https://www.mja.com.au/journal/2009/191/11/cough-disorder-allegory-dsm-iv?0=ip_login_no_cache%3D7c4d1fc7f3563ea24367e0d86e8ecb70
But my article has a serious undertone – the consequences of a reified superficial psychiatric nosology in DSM in an era of pharmaceutical industry dominance have been serious and deleterious.
It’s not clear to me how deconstructing the circuits in the brain will help solve the basic problem.
If you want to get to the otherwise unknown “etiology” or cause of emotional disturbances manifesting as anhedonia, depression, or mood disorders, it hardly matters exactly how these conditions are reflected in the way the brain captures, stores, or processes life’s large and little misadventures, vexations, and intractable ethical dilemmas.
I have copious evidence that not all mental disorders have organic roots. Consider that the opposite of “order” is “chaos.” We happen to live in chaotic times. Indeed, Harold Bloom has expressly identified the current age of literature as the Chaotic Age.
If the function of the mind is to construct mental models of the world in which we find ourselves embedded, then it follows that we are obliged to harbor mental models of dysfunctional and chaotic systems.
Having studied Chaos Theory, I happen to know how to do that. Most people, however, don’t.
DSM-5 is gonna have a hell of time diagnosing the mishugas that arises when people are living in chaotic times.
See “To Hell with DSM-5” on Moulton Lava …
http://moultonlava.blogspot.com/2013/05/to-hell-with-dsm-5.html
About time! So-called mental disorders are physical i.e. in the brain and the rest of the body. The mind is merely a term to describe an individual’s response to the internal and external environment. DSM serves to perpetuate the myth of the mind as a separate entity derived from religious ideas about “the soul.
That is precisely why occupational therapist work with Autistic people and children so well!!! I can tell every time my daughter sees her Ot at school ! She gets aroma therapy and deep pressure on joints, listening program she’s great! It really helps autistics! Just ask Temple Grandin.
Deb,
Is there a model for that? My antagonists here seem to think that olfactory/pheromonal input and epigenetic effects on the hypothalamic secretion of gondatropin releasing hormone is not appropriate for discussion here.
Ask Temple Grandin what?
@James,
I do not recall any statements seriously controverting the science behind what you put forth. Perhaps I can add some clarity to my perspective about your statements and how I perceive the comments of your “antagonists” with two statements and a question:
Up until now, your statements have been nowhere near as concise as this most recent comment. This is far easier to digest and your point is clearer rather than buried in citations and highly technical terms (I, however, actually understand most – not all – of what you’ve said). Which leads to the question…
How many people here have the expertise necessary to confidently and meaningfully discuss the phenomena you speak of — have you considered your audience?
Understanding your audience is KEY in the kind of discussion you seem to want. For example would you make the statements (verbatim) in your comment of May 7, 2013 at 12:09 pm to someone whose expertise is far different from yours? Or would you, as you have just apparently done, make a similarly technical statement to a presumable layperson (my apologies, Deb K, if I misrepresent you).
You can’t have a meaningful discussion if people don’t understand you or get lost along the way, regardless of how relevant you think your subject matter is.
Insofar as the Diagnostic and Statistical Manual of Mental Disorders is at best no more than a set of suggestions about how the marketing and selling of mental health services might possibly be undertaken, and because it has nearly no relationship whatsoever to the technology of mental health and healing, the NIMH is totally correct in no longer attempting to relate scientific research and practice to that promotional manual.