A recent issue of Nature attempts to summarize the latest embarrassment from America’s psychiatrists — their revision of what everyone calls their bible, the Diagnostic and Statistical Manual of Mental Disorders.

This bound bohemoth – its anal insistence on stuffing everything in the world into itself stronger proof of mental disorder than most of the diagnostic descriptions within it – has always attracted ridicule and condemnation, and the next edition will attract even more.

Because this time around the anal fixates of the APA are adding secrecy, hyperactivity, and self-delusion to their practices.

[C]ritics have alleged that the process has been too secretive, and that working groups have been pushed to meet an unrealistic 2012 publication date. Some, including the architects behind the last two editions of the DSM, also complain that project leaders are pushing for the premature inclusion of changes meant to incorporate recent genetic and neurobiological advances, before they are ready for the clinic.

The problem facing the revision
committees is that the manual
is not a bible; it has become a
tower of babel. Picture the
situation in this way and it
begins to make sense:

See how there isn’t any foundation,
and how you’ve got a lot of frenetic
people running around trying to
decide what to do? Only they
can’t decide what to do, because
they’re not living, as Madonna sings,
in a material world:

Rather than relying strictly on categorical diagnoses — one either has depression or does not, for example — they have pushed to add ‘dimensional’ criteria to ascertain to what extent a person is depressed. Such criteria could also address similarities among different disorders, reflecting, for example, neuroimaging studies that suggest multiple anxiety disorders can affect the same region of the brain.

… [A]larmed critics … say the science behind such dimensional assessments is not yet ready to be incorporated into clinical assessments. In March, Duke University psychologist and epidemiologist Jane Costello resigned from the working group on child and adolescent disorders … Adding these assessments would require a great deal of extra research, she says, at a time when working groups were already behind schedule for their 2012 publication deadline. “There just hasn’t been time to do this in an organized way,” she says. “This is a huge job.”

Yes, real science does take time, but psychiatry has never let empirical unreadiness impede it, and the drug companies are getting impatient.

The latest revisions come as financial ties between prominent psychiatrists and pharmaceutical companies are being closely scrutinized. A 2006 analysis of potential conflicts of interest among those who participated in the last revision showed that 56% of panel members had financial links to the pharmaceutical industry.

Chop-chop!