Embed Size (px)
Citation preview
11 May 2013 | NewScientist | 5
THE controversies swirling around the imminent new edition of the Diagnostic and Statistical Manual of Mental Disorders, produced by the American Psychiatric Association, have badly hurt confidence in psychiatric diagnosis.
The update, called DSM-5, includes new diagnoses – and reductions in thresholds for old ones – that expand the already stretched boundaries of psychiatry and threaten to turn diagnostic inflation into hyperinflation. Its new disorders are a dream list for researchers, but will be a nightmare for the people who are misdiagnosed and treated unnecessarily. In my opinion, there is no reason to believe that DSM-5 is safe or scientifically sound.
But the research problem in psychiatry goes much deeper than the aberration that is DSM-5. In 1980, when DSM-III was published, there was great optimism that its provision of a reasonably reliable diagnostic system would rapidly lead to a revolution in psychiatric research.
In one way, this did indeed happen – but in another, it did not. Psychiatric research quickly went from stepchild to darling; in most medical schools it is now
just behind internal medicine in attracting external funding. The happy result: an explosive advance in basic neuroscience.
Disappointingly, however, 30 years of advancing knowledge has had no impact whatsoever on psychiatric diagnosis or treatment. Translational research – work that bridges the gap between basic research and clinical application – has been distressingly slow in all of medicine, and is particularly difficult in psychiatry because the brain is so much more complex
than any other organ. We will probably soon have accurate tests for Alzheimer’s disease, but there is nothing in the pipeline for any other psychiatric disorder, and it may take decades before such tests materialise.
It was hoped that DSM-5 would include biological markers that might reflect past research and promote future research. That was a premature and unrealisable ambition. And it has become increasingly clear that the DSM’s descriptive system may be a research dead-end. Its syndromes are too diverse and overlapping to be good research targets.
So the US National Institute of Mental Health has wisely chosen another approach that is more likely to bear fruit: picking simpler targets for study and bringing to bear all of its enormous resources to determine their causal mechanism (see page 8). It makes more sense to study the genesis of hallucinations, for example, than to expect to understand the diverse causes of schizophrenia, which does not present in one uniform way.
The brain is likely to remain frustratingly elusive in providing answers. But simplifying the research questions is our best hope of finding them. n
Don’t count on this manual
EDITORIAL
The future of psychiatric research lies in simpler questions
“VIOLENCE is the last refuge of the incompetent.” So says Salvor Hardin in Isaac Asimov’s celebrated 1951 novel Foundation, which imagines an organisation dedicated to predicting and reshaping the course of human history – in this case, the fate of the Galactic Empire – through the use of a statistical discipline dubbed “psychohistory”.
For more than half a century, psychohistory has been no more than a fantasy. But the power of “big data” makes it conceivable that some modest version of these predictive powers is achievable. For example, researchers hope that a new database of geopolitical events will eventually help them to project how conflicts will play out (see page 19).
Forecasting is one thing. Intervention, or prevention, is quite another. Choosing the appropriate action will be tricky. In Asimov’s book, the cabal of psychohistorians trying to direct events is reined in by hard-headed politico Hardin. It will be interesting to find out if his real life counterparts share his view on the use of force. n
A Foundation for the future
© 2013 Reed Business Information Ltd, England
New Scientist is published weekly by Reed Business Information Ltd. ISSN 0262 4079.
Registered at the Post Office as a newspaper and printed in England by Polestar (Colchester)
LOCATIONSUKLacon House, 84 Theobald’s Road, London WC1X 8NS Tel +44 (0) 20 7611 1200 Fax +44 (0) 20 7611 1250
AUSTrALIATower 2, 475 Victoria Avenue, Chatswood, NSW 2067Tel +61 2 9422 8559 Fax +61 2 9422 8552
USA225 Wyman Street, Waltham, MA 02451Tel +1 781 734 8770 Fax +1 720 356 9217
201 Mission Street, 26th Floor, San Francisco, CA 94105Tel +1 415 908 3348 Fax +1 415 704 3125
SUbSCrIpTION ServICeFor our latest subscription offers, visitnewscientist.com/subscribe
Customer and subscription services are also available by:Telephone +44 (0) 844 543 80 70email [email protected] newscientist.com/subscribepost New Scientist, Rockwood House, Perrymount Road, Haywards Heath, West Sussex RH16 3DH
One year subscription (51 issues) UK £150
CONTACTSContact us newscientist.com/contact
Who’s who newscientist.com/people
General & media enquiriesTel +44 (0) 20 7611 1202 [email protected]
editorial Tel +44 (0) 20 7611 [email protected]@[email protected]
picture desk Tel +44 (0) 20 7611 1268
Display Advertising Tel +44 (0) 20 7611 [email protected]
recruitment Advertising UK Tel +44 (0) 20 8652 [email protected]
UK Newsstand Tel +44 (0) 20 3148 3333Newstrade distributed by Marketforce UK Ltd, The Blue Fin Building, 110 Southwark St, London SE1 OSU
SyndicationTribune Media Services InternationalTel +44 (0) 20 7588 7588
ProfileAllen Frances is a professor emeritus at Duke University, North Carolina, and was chairman of the DSM-IV task force. He is the author of Saving Normal and Essentials of Psychiatric Diagnosis
130511_R_Editorial.indd 5 7/5/13 16:46:49
