Springfield, VA, USA. The Diagnostic and Statistical Manual of Mental Disorders (DSM IV), like The Bible, is a disparate compilation of many different types of books and methods of varying validity and applicability. Not all the books and methodologies carry the same message. Some have little use or relationship to the physical world of neurobiological science other than as intellectual curiosities. Some diagnostic conclusions are dead wrong and scientifically inaccurate. The DSM can be thought of as an interesting collection of myth, sociological history, moral and religious views, and semi-scientific conjecture and outright speculation of varying value to the universe at large.

 

The DSM purports to be a hand book for mental health professionals that lists multiple categories of psychological disorders and the criteria for identifying those disorders. Used worldwide by clinicians and researchers — as well as insurance and pharmaceutical companies and various policy makers — the DSM is published by the American Psychiatric Association (APA).

 

The basis and root foundation of the DSM is firmly entrenched in nineteenth and twentieth century psychiatric psychology. The mind and its workings are seen as distinct and separate from the brain and body. Disorders are established and described based on the weight of philosophical arguments and the proponent’s gravitas rather than neuroscience. DSM descriptions and diagnoses are not informed by the findings of neurobiology.

 

The need to collect statistical information served as a catalyst for developing a classification system for what was termed mental disorders. A rudimentary classification was established in 1840 with a single category, idiocy/insanity. Either you were, or you were not.

 

By 1880 there were seven: dementia, disomania, epilepsy, mania, melancholia, monomania, and paresis. By the time the APA began to develop its guide for mental hospitals in 1917, there were twenty-two diagnoses. Since then, the number of diagnoses has grown exponentially.

 

All of the diagnoses were based on the observation of patient behavior rather than empirical scientific research on the root biology behind the behavior.

 

The ensuing accumulation of descriptive diagnoses and classifications of mental disorders by the members of the APA parallels the rampant explosion of bird taxonomy as ornithologists and amateur bird enthusiasts identified thousands of new bird species based on minimal differences in plumage that had little significance, if any, in the molecular, fossil, or anatomical evidence. Lack of scientific underpinning did not stop either the DSM diagnoses or explosive bird speciation from playing prominent and diverse roles in folklore and urban myths, religion and popular culture.

 

As The Bible is viewed as inerrant by Christian theologians, so too has the DSM grown more powerful with the APA serving as both Pope and priest. With continued research by the hard sciences, especially neurobiology and genomics, the view of the DSM as inerrant diagnostic prescripture is shared by fewer and fewer scientists even as the APA circles the wagons and continues its helter-skelter expansion of the DSM’s diagnostic criteria.

 

A new generation of researchers is emerging, however, to challenge the intellectual assumptions of their predecessors. The neuropsychologists are exploring the physical causes of what the DSM has thought of as mind and behavior. The mind is a bi-product of the physical brain. Disruptions in the development of the fetal genome and neurobiology and later, the brain’s neural connections appear to be the root causes of much of what the DSM has traditionally classified as a “mental disorder.” Much of what has passed as authoritative psychiatric diagnosis is becoming seen as the “just so” stories of a previous, less than rigorously scientific generation.

 

Perhaps the time for the DSM has passed. Without a major restructuring of its basic assumptions and organization, the DSM is rapidly becoming a quaint reminder of a bygone era. Without a major infusion of the neurosciences, the DSM will become a footnote in the Victorian worldview with as much relevancy as a bustle in a world of iPODS and neurotechnology.

Neuroscience, a biological science, focuses on the scientific study and research of the nervous system. It encompasses the biochemistry, development, evolutionary history, function, genetics and genomics, informatics, pathology, pharmacology, and physiology of the nervous system. Cognitive and neuropsychology, computational biology, computer science, molecular biology, statistics, physics, and medicine are among the analytical disciplines that are brought to bear.

 

Neuroscientists employ empirical methodologies from the biochemical and genetic analysis of the dynamics of individual nerve cells and their molecular components to the neuro-imaging of the perceptual and motor tasks inside of the brain. They explore the basic questions of how psychological and cognitive functions are produced by the neural circuitry within the physical brain.

 

The DSM has none of this. APA members, for the most part, are not trained scientists. The various psychological conjectures contained in the DSM were not developed using rigorous scientific methods and research. They approach “the mind” as if it were a separate entity that is distinct from the physical structure of the brain that produces it and independent of the body in which it resides.

 

In many ways the APA and the DSM are the last proponents of one of the oldest philosophical and religious question: who is this “I” that resides inside this body. Plato contended that the soul was distinct from the body as do many religions. Aristotle felt that body and soul are two aspects of the same underlying substance (form and matter) as do most neuroscientists.

 

The DSM will always have fundamentalist true believers. There will always be psychiatric gurus willing to be its priests.

 

But the DSM is not science. It never has been. The DSM is philosophical conjecture and secular religious dogma masquerading as empirical evidence and diagnosis. Its rooms are populated with the stale, unpleasant smell of a smoldering cigar in a world of non-smokers.

 

It’s time to put the DSM out and clear the air for some actual science.

 

 

 

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