The new Diagnostic & Statistical Manual (DSM5) is soon due to be published. DSM is the modern ‘bible’ for diagnosis in psychiatry. Yet there is little or no evidence to support the idea that the categories used in DSM are either based on sound science or clinically helpful. So I decided earlier this year that it was time to start a campaign. I’ve called it: ‘No More Psychiatric Labels’. My arguments are mainly empirical, based on a review of the evidence. I thought it was important to demonstrate that it is the science that tells us that the system of psychiatric diagnostic is a bad idea. In summary, my review found that:
• Psychiatric diagnoses are neither reliable nor valid.
• Using psychiatric diagnosis does not aid treatment decisions.
• Long-term prognosis for mental health problems has got worse over the years.
• The use of psychiatric diagnosis increases stigma.
• Psychiatric diagnosis imposes Western beliefs about mental distress on other cultures.
• Alternative evidence-based models for organizing effective mental health care are available.
Psychiatric diagnoses are not reliable.
Validity refers to whether a particular diagnosis has a meaningful correspondence with something that exists objectively in the real, ‘natural’ world. For example, that the term ‘depression’ applies to a psychological and/or physiological process that can actually be identified, and that a similar process occurs in people all over the world afflicted with the condition.
The failure of scientific research to reveal any specific biological abnormality to identify a psychiatric diagnosis – or for that matter any physiological or psychological marker – is well recognised. Unlike the rest of medicine, which has developed diagnostic systems based on testable theories about the causes of illness, psychiatric diagnoses have established themselves simply through the voting rights of boards of psychiatrists who decide amongst themselves when a new diagnostic category is to be created.
In psychiatry, diagnoses are descriptions of sets of behaviours that often go together. By itself, a psychiatric diagnosis cannot tell you about the cause, the meaning, or the best treatment.
[to read the rest of this article, Subscribe]