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Sensationalist headline story in yesterday’s Sunday Times, makes unsubstantiated and unscientific claim that one third of South Africas are mentally ill or mad.—most-won-t-get-any-help

Though Sigmund Freud was a trained neurologist, he never liked the idea of other doctors practising psychoanalysis. In a paper written in 1927, he explained that a medical degree was a disadvantage to the aspiring analyst because it would leave his head full of ideas “of which he can never make use”. There was even a “danger of its diverting his interest and his whole mode of thought from the understanding of psychical phenomena”, which ought instead to be informed by “psychology, the social sciences, the history of civilisation and sociology”. Psychoanalysis was not – not on Freud’s watch – to be “swallowed by medicine”.
It is lucky he didn’t see what happened next. Today the most widely accepted method for understanding “psychical phenomena” is one practised by doctors and dependent on concepts derived from the study of physical disease. Pre-eminent in the field is a medical institution, the American Psychiatric Association (APA), whose latest taxonomy of human suffering is published this month.

Just two weeks before DSM-5 is due to appear, the National Institute of Mental Health, the world’s largest funding agency for research into mental health, has indicated that it is withdrawing support for the manual.

In a humiliating blow to the American Psychiatric Association, Thomas R. Insel, M.D., Director of the NIMH, made clear the agency would no longer fund research projects that rely exclusively on DSM criteria. Henceforth, the NIMH, which had thrown its weight and funding behind earlier editions of the manual, would be “re-orienting its research away from DSM categories.” “The weakness” of the manual, he explained in a sharply worded statement, “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.”

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In a surprising move, the US government institute responsible for overseeing mental health research is distancing itself from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. The DSM has, for several decades, been perceived as the “bible” that delegates how psychiatric illnesses are defined, diagnosed, and treated.

The National Institute of Mental Health (NIMH) — which funds more research into mental illness than any other agency in the world — this week announced a plan to re-orient its investigations “away from DSM categories.” The move comes mere weeks before the publication of the DSM-5, an update to the manual that’s been mired in controversybecause of several contentious changes to existing diagnostic criteria.


“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,” reads the announcement from NIMH director Thomas Insel. “The weakness is its lack of validity.” In particular, Insel notes, diagnostic criteria in the DSM are based on symptom clusters, rather than any objective measures. As experts continue to broaden their understanding of genetics and cognitive science, for instance, Insel anticipates the possibility of more rigorous diagnoses. “Patients with mental disorders deserve better,” he added.

To promote those rigorous diagnoses, the NIMH will now focus on funding research that digs into these underlying biological mechanisms. The eventual goal, Insel writes, is to collect “the genetic, imaging, physiologic, and cognitive data to see how all the data — not just the symptoms — cluster and how these clusters relate to treatment response.”

Of course, it’ll be decades before these new research programs inform diagnoses or yield new treatments for mental disorders. But for now, the move — and its timing — suggests that the “bible” of mental health might not merit that moniker for much longer.