NIMH and Thomas Insel: Futurist? Maybe. Realist? Maybe not.

WASHINGTON- May 10, 2013 — “The Diagnostic and Statistical Manual for mental health is the best current diagnostic criteria science has to offer in a post-industrial world.”-Sanjay Paul, psychology instructor at several universities.

Dr. Thomas Insel, director of the National Institute on Mental Health (NIMH) set off a firestorm of controversy by wholly criticizing the new Diagnostic and Statistical Manual 5th edition (DSM 5) by claiming “Unlike our definitions of ischemic heart disease, lymphoma or AIDS, the DSM diagnosis are based on a consensus about clusters of clinical symptoms.”

NIMH has outlined a new diagnostic system called Research Domain Criteria that may be very useful in the future. There is no doubt of Insel’s brilliance, unfortunately, there are issues with Insel’s approach to current mental health psychometrics which gives one pause.

Insel is forwarding his field of neurobiology as a centerpiece for diagnostics, implying a disorder should be verifiable on an imaging device such as PET, MRI or fMRI to be authentic and current diagnostic measures are unacceptable to him. Nevermind many of the world’s leading mental health experts spent 13 years developing the new DSM with input from multiple cultures, multiple fields of science and a plethora of hard data.

As an M.D., Insel must adhere to the edicts of the American Medical Association which lists over 200 so-called ‘syndromes’ that have no source that can be identified by neuro-imaging, instrument or blood work.

Syndromes such as neuralgia, restless leg, Guillian-Barre, pelvic, metabolic, and so many others are determined in the same manner as many psychological disorders-presentations of symptoms. Yet, Insel wishes to hold the field of mental health to a much higher and currently unavailable standard.

Psychometrics is the study of theory and technique of psychological measurement determining capabilities, knowledge, personality traits, attitudes, judgment, and beliefs among other measures, none of which will currently reveal on a brain scan. Behaviors stemming from cognition, executive level thinking, socio/economic conditions and learned behavior will currently not light up an imaging device and these aspects of mental health are critical for diagnosis and treatment.

‘Real world’ clinicians who are on the front lines of diagnosis and treatment fully understand the new DSM 5 that now includes post-industrial disorders stemming from rapidly changing technologies that affect humanity and in particular, impressionable youth who can become addicted to such technologies.

Many children today are victims of parents who engaged in drug abuse during gestation, environmentally induced illnesses, households of angry parents having been severely affected by the economy, a divorce rate of 50 percent and live in sound bites, bullying social sites and public education systems that are barely able to assist children on an individual basis. These psychometrics will currently not glow on neuro-imaging.

Insel’s concepts and theories will help mental health professionals most likely as adjunctive diagnostic tools, but by his own admission, are not applicable to diagnostics and treatments in today’s world.

Psychology is not an exact science, nor is physical medicine. As medical doctors prescribe different medications and approaches to suit one’s individualities, so do mental health professionals. Science does not always provide exact answers. Science does provide the best explanation.

Perhaps Insel would have been wise to announce the NIMH research for the future and not be so summarily critical and dismissive of the efforts of millions of mental health professionals around the globe. The DSM 5 is the best criteria to date and the future is not now.


Paul Mountjoy is a Virginia based writer and a member of the American Psychological Association and the Association for Psychological Science.


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