America is in a mental health crisis. In 2020 alone, an estimated 1 in 5 people experienced some form of mental illness, and over 12 million seriously contemplated suicide, according to the National Alliance on Mental Illness. There’s no doubt that our nation is struggling with emotional, psychological, cognitive, and behavioral issues. But the real crisis lies in the way people are being diagnosed with mental health disorders like anxiety and depression.
The current standard for making psychiatric diagnoses is based on symptom clusters described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Psychiatrists are the only medical specialists who virtually never look at the organ they treat—the brain—leaving them to make diagnoses of complex cases based only on talking to patients, observing them, and searching for symptom clusters. This is basically the same method that was used to diagnose Abraham Lincoln with melancholia, or depression, over 150 years ago.
According to an explosive study in Psychiatric Research, making psychiatric diagnoses based solely on symptom clusters is scientifically meaningless and disingenuous.
According to an explosive study in Psychiatric Research, making psychiatric diagnoses based solely on symptom clusters is scientifically meaningless and disingenuous. Click To TweetWHAT IS THE DSM AND WHY IS IT INADEQUATE AS A DIAGNOSTIC TOOL?
In 1952 the American Psychiatric Association (APA) released the first version of the DSM, which categorized mental disorders in an attempt to create more objective standards for making diagnoses in a field that struggled with credibility. The DSM, which has since undergone multiple revisions, has had great success. Nearly all mental health professionals in the U.S. and many around the world use it.
Yet, the DSM is not without controversy.
In a 2005 lecture at the annual meeting of the APA, Thomas Insel, one of the most powerful psychiatrists in the world at the time as Director of the National Institutes of Mental Health, caused an uproar when he announced the DSM was 100% valid, meaning if you make a diagnosis with the criteria today for a certain disorder, like depression, you will make it again tomorrow, but 0% valid because it is not based on any underlying neuroscience.
Regarding the DSM-V’s release in 2013, Insel posted a blog in which he wrote:
The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. 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. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are [not] based on . . . any objective laboratory measure. . . . Patients with mental disorders deserve better.
After using a number of the DSM versions on thousands of patients at Amen Clinics over the past 30-plus years, it is clear that it can help psychiatrists categorize illnesses, such as depression, bipolar disorder, schizophrenia, panic disorder, or borderline personality disorder. The problem is that the DSM doesn’t reveal anything about what causes these conditions or how to predict which treatments will work. As Insel said, the DSM is not based on any underlying neuroscience.
THE PROBLEM WITH STANDARD MENTAL ILLNESS DIAGNOSES
The landmark study mentioned above was led by University of Liverpool researchers who focused on a meticulous analysis of 5 chapters in the DSM-5:
Their main findings highlight many of the shortcomings of the current diagnostic paradigm:
- There is a major overlap of symptoms among diagnoses.
- Many diagnoses overlook the role of psychological trauma and head trauma.
- The current approach rarely takes the individual in mind.
This study’s deep dive into the numbers shows just how murky and inconsistent the diagnostic model is. For example, “There are almost 24,000 possible symptom combinations for panic disorder in DSM-5, compared with just one possible combination for social phobia.”
Equally concerning is their finding that “two people could receive the same diagnosis without sharing any common symptoms.” And the sheer number of combinations of symptoms makes the ability to arrive at an accurate diagnosis nearly impossible.
Take this stunning fact, for instance: “In the DSM-5 there are 270 million combinations of symptoms that would meet the criteria for both PTSD and major depressive disorder, and when 5 other commonly made diagnoses are seen alongside these two, this figure rises to one quintillion symptom combinations—more than the number of stars in the Milky Way.”
The researchers conclude that following a different approach may be more effective than remaining committed to what they called a “disingenuous categorical system.”
MENTAL HEALTH AS BRAIN HEALTH: A NEW PATH FORWARD
Based on experience with tens of thousands of patients at Amen Clinics, it is clear that making diagnoses solely based on DSM symptom clusters, such as anxiety, depression, temper outbursts, or a short attention span is inadequate and disrespectful to patients. Symptoms don’t reveal anything about the underlying biology of the problems patients have.
All other medical professionals look directly at the organs they treat, but psychiatrists are taught to assume what the underlying biological mechanisms are for illnesses, such as depression, ADHD, bipolar disorder, and addiction without ever looking at the brain. This is despite the fact that psychiatric patients are every bit as sick as those with heart disease, diabetes, or cancer.
Reframing the way psychiatrists think about “mental illnesses” by looking at them as brain health issues are more accurate. Psychiatry needs a completely different diagnostic paradigm rooted in neuroscience and hope. A new way forward in psychiatry will require ending the paradigm of mental illness because psychiatric issues really are so much more. Your brain creates your mind. The issues that affect our minds stem from our brains, our bodies, our thoughts, our social and work interactions with others, and our deepest sense of meaning and purpose. It starts by looking at the brain because if you never look, you never really know.
Anxiety, depression, ADHD, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.
It is so sad that for someone to be able to find a great treatment for their disease you need to have money. My son was diagnosed with schizophrenia and addiction and as a mother I would do anything to help him, and I did help
him to get through University and get a job, but the only treatment he is is receiving is some State young adult service that all they do is prescribe meds that on the long run do not really help because I work at a Hospital and see those patients that end up with terrible chronic illnesses part because of their meds. It is like putting a band and in a deep cut that really need stitches.
Since I can’t afford to send him to a good clinic I decided to pray for him and trust the God that gave him life to touch his mind and heal him.
Comment by Nara — May 7, 2022 @ 8:08 AM
My first diagnosis was 1984 “emotionally disturbed” I was 10. Then at 16 came BP diagnosis. This wld be the LABEL that starts a long journey of medications and almost dying in 2012 from valporic acid poisoning. I should have never been on any of those medication. Especially while my brain was still developing. I’m 47 now. The stigma alone of being labeled mentally ill has cost me much.
My last actual psych diagnosis was BPD , SAD, CPTSD, Panic disorder.
Now imagine if any one adult examined the environment I was living in could have saved me years of trauma.
Comment by Di — May 11, 2022 @ 3:11 AM
i hope, Nana, that favorable fate follows you and your son.
Comment by Bruce Miller — May 11, 2022 @ 3:20 AM
I’m 57 and just had my first therapy session and after about 40 minutes, the counselor was more occupied with “labeling” me, in fact insisted, that he “had to label me “, in order to schedule my next visit (1of6). Then he said, that he thought that I have the makings of a “major depressive disorder”. After asking how he came to that conclusion, he flipped a couple of pages and never really gave me a clear answer. We ended the session, with me adamantly, refusing to be labeled and I scheduled my next visit with trepidation. I look forward to sharing this article with my counselor. This article makes perfect sense to me.
Comment by Crystal A Sleker — May 11, 2022 @ 3:58 AM
I absolutely agree with this article! Depression and anxiety run rampant in our family and the way in which treatment is administered only increases the stress because of the horrible side effects relating to medications prescribed! This latest death of Naomi Judd has only put mental health in more of a negative stance! Clearly having money 💰 didn’t help her! Insurance companies need to be willing to pay for better care like what’s being offered at Amen clinics! I believe their brain scanning and follow care makes all the difference
Comment by Mary Wolfe — May 11, 2022 @ 4:08 AM
I absolutely agree with Nara. People that don’t have the advantage financially to seek this type of help are just stuck.My son also needs this kind of help but him nor I are financially able to get it.its heartbreaking.
Comment by Heidi — May 11, 2022 @ 4:52 AM
Interestingly, I’ve been saying this for years. As a mental health therapist and an addiction therapist, I’ve been of the belief that we’ve been shortsighted in our use of the DSM to diagnose people with maladies and labels that will follow them their whole lives. And I’ve struggled to understand how the pharmaceutical companies can create a pill to fix it when we don’t even know what it is.
I met Daniel Amen back in 2000 or 2001 when he was at presenting at a symposium in Cleveland, Ohio. The topic was ADHD and the podium was shared with Russell Barkley. At that time my son was four and I was being told that he had ADHD. We didn’t have access to a pet scan or the like. But I understood then the need, and how I completely missed out as did my whole field on the concept of neuroscience as a viable means to helping people. And I also immediately understood that would be dabbling in a soft science for the rest of my career. It was almost infuriating, but 25 years later, I’ve made do with what I had to work with. Though labeling people with a diagnosis has been a thorn in my side for my entire career. And this article hits the nail on the head. It definitely gives us a reliable means to discuss symptoms and characteristics, but it is hardly valid.
I struggled with giving my son medication for his ADHD-like symptomatology, even though I had family members that were in support of it -as they were from a medical community and background. He was 4! It would be so helpful to understand what was happening in the brain before we start handing out chemicals that only ameliorate some of the symptoms, and more than likely create more issues than not.
So I ask, what’s next? How do we find ways to make brain scanning accessible and affordable? Because I think we’re doing a disservice to continue the way that we currently “treat” mental health.
S.Bernstein, LPC, LICDC, CAADC
Comment by Shari Bernstein — May 11, 2022 @ 4:55 AM
Dr. Amen, I applaud you for your contribution to psychiatric studies. However, I agree with the comment above. Until proper psychiatric care ,such as brain imaging, is made affordable to those who suffer from mental disorders the epidemic will continue. The very people who need this type of care suffer from symptoms that make it hard to keep a job which impacts insurance availability. When will brain imaging be made available to the masses rather than to those who are rich or those who have to make a choice between health care or paying bills?
Comment by Cristina Burns — May 11, 2022 @ 4:56 AM
I agree with Nora’s post about how sad and truly unethical it is to prioritize desperately needed mental treatment and proper diagnoses such as Dr. Amen’s Spect scan technology according to available money! My 44-year-old single mom daughter has suffered for decades with an acute anxiety disorder that has never been even minimally investigated. She began pulling her hair out at age 17, possibly due to abuse & trauma that I’m not aware as well as strong genetic tendencies. She’s worn wigs for 27 years; and since she also pulls the wigs, and is on the poverty scale, I have spent thousands of dollars buying 2-3 wigs a year all those years, on Soc. Sec. the last 10 yrs! I called the Amon clinics in CA a few times in the past year and received information about an Amen approved SPECT scan facility in S. Florida. The situation is dire at this point. I feel like we’re racing the clock with her complete hopelessness in life. But it all comes down to this: MONEY! With the wealth in this country, and I have to believe a good number of generous hearts, Can Amon clinics not establish a foundation with benefactors to help genuinely financially indigent, verifiably so, people like Susie whose lives may now depend on proper diagnosis (SPECT scan) and customized treatment?! I am a praying mother who knows the Bible thoroughly because I was raised internationally by awesome missionary parents. My foundation of faith is solid. But at this point, the miracle healing has not manifested. So perhaps I should use my experience as a published health writer‘s to try to raise awareness for the SPECT scans needed by hundreds of patients like my daughter.
Comment by Carol Bassett — May 11, 2022 @ 5:13 AM
I have argued for years that psychiatrist fail in treating patients who present with mental illness. They fail to FIRST look at physiological causes by taking MRIs. Unfortunately, places like Amen Clinic are unavailable to most people. The cost is prohibitive to the average family. My grandson, with head injuries from football and boxing was diagnosed ten years ago with Schizoid Affective Disorder. Not one doctor thought to look at his brain! It has only gotten worse, no drugs are working, he is constantly hospitalized, has blackouts and STILL none of the mental health facilities in the state of California has done anything to find physiological causes. They simply keep him for a few days and send him on his way. The requirements for psychiatric diagnosis must change to include the elimination of biological or physiological causes.
Comment by Erin — May 11, 2022 @ 6:23 AM
I am a mental health professional and I agree with this article. Unfortunately, most of my caseload does not have the money to afford the treatment Amen clinic offers. Several thousands dollars out of pocket even using care credit is not a viable option so they are left with less than optimal care because that is the only option. Finding a way that insurance will cover would be optimal.
Comment by Dawn — May 11, 2022 @ 6:47 AM
I was initially diagnosed as bipolar or manic-depressive in 1983 by the U.S. Army psychiatrists & discharged from the military with an honorable discharge. I was followed up by both private psychiatrists and the VA as bipolar. Over the next several years I took Lithium which not only required frequent painful blood tests but it robbed me of my personality. Psychiatrists, who had never taken Lithium, said that was not true. Off & on until 2012 I was prescribed anti-depressants (which are helpful for many people) from every class there was & not one every gave me help. Often the biggest thing they gave me was increased hunger. Finally, anti-psychotics hampered the manic part; however, they also made me wild. Finally, with the help of my parents who paid out of their own bank account, I saw a neurologist who gave me a B.rain E.lectrical A.ctivity M.apping or B.E.A.M.=a neuropsychologist who gave me a Halstead-Reitan Neuropsychological Test Battery (HRNB)=a psychiatrist who did his own testing & all three (3) came to the same separate conclusion. I was NOT bipolar or manic-depressive, I had temporal lobe epilepsy. The psychiatrist took me off that nasty Lithium & the anti-depressant I was taking & placed me on carbamazepine. Within 10 days I felt “normal” for the first time in years. I have taken both Depakote & carbamazepine over the years to successfully help me with my temporal lobe epilepsy. I went to graduate school & I am a Licensed Mental Health Counselor (Hawaii). Had I continued to travel down the manic depression path I would have ended up in a group home (which is where my parents were going to send me when my re-diagnosis came through).
Comment by Michael — May 11, 2022 @ 6:49 AM
I think you have a typo in paragraph three: the DSM is 100% reliable (test retest reliability) but 0% valid (doesn’t measure what it purports to measure
Comment by Martha Pedersen — May 11, 2022 @ 7:03 AM
Yes! I am glad someone is saying this out loud! I have been saying this for years! My brother had schizophrenia with multiple personalities and bipolar. We couldn’t get any help for him because the state we live in goes off of household income and he never qualified for assistance. He died on June 23, 2019 at 43 yrs old. Thank God I lived in a neighboring state when my dual diagnosed son turned 18 and they dropped the parent’s income so we could get him help. (I also had to write my local legistlation). My son has been diagnosed with ODD, Conduct Disorder (though he doesn’t have a criminal history which is a requirement) and Intermittent Exlosive Disorder. We have 5 kids that we raised. We didn’t lower our standards for his special needs but changed our parenting style based on each child’s needs. My son is very well behaved now and refers to those days as his dark days. They tried to diagnose him with schizophrenia when he was 14 but I told them to prove it. He was recently diagnosed with schizophrenia again. We’ll see. I’ve read the dsm and it’s impossible (for someone without a psych degree) to tell the difference between one issue and another. They all sound so similar! When my son was growing up I would have him retested every 2 yrs to make sure we had the correct diagnosis. (Yes, with different doctors)
Comment by DJ — May 11, 2022 @ 7:21 AM
It is a shame insurance won’t cover the SPECT, and also the VA refusing to the SPECT as well. I am both a RN and a veteran. I did pay for the scan and was truly amazed on how much the trained neuropsychologist was able to see things, such as my personality traits, I had no signs of Alzheimer’s, and various other things. Simply amazing, I hope someday psychologist will accept the SPECT someday and throw Away their old outdated way of treating their patients their books of diagnosis. They are really doing as disservice to their patients.
Comment by Monica Thomas — May 11, 2022 @ 7:31 AM
I’m so sorry to hear about your son. It is sad that quality treatment is so expensive. My nephew also has schizophrenia but the brain scan didn’t catch it. Someone correct me if I’m wrong, but schizophrenia is one of the few conditions a brain scan can’t see. It was incredibly difficult to get him to comply with the injection and stuff required to do the scan. After all, paranoia is usually part of the condition. I’m just glad that Dr. Amen is contributing so much new info to the field with conditions that can be clearly seen! Amazing that brain scans are even possible! I think with the cost will come down in the future as the technology is advanced. Hopefully your son can receive better treatment in the future.
Comment by Joy Elizabeth — May 11, 2022 @ 7:59 AM
I am praying with you. Please also pray for my grandsons. At least 2 of them…
Comment by Dian — May 11, 2022 @ 8:02 AM
I whole-heartedly agree with the critique of this post and highly recommend that those who are concerned about the flaws in American psychiatry read the book; Mad In America by Robert Whitaker for some invaluable context about the practice of psychitry and mental health .
Comment by Paul Ruchames — May 11, 2022 @ 8:04 AM
The medicine for many of the various diagnoses can be similar. It’s about finding the right medicine that works best with that patient. Even if a brain scan is done you are still left with the similar challenge of seeing (through trial and error) which meds or combo of meds works best for each patient. Spending thousands of dollars to Dr a brain scan (that isn’t new, innovative technology but instead the same that’s been done for decades)to help determine a diagnosis doesn’t really solve the problem either! You then are out several thousands of dollars with the same question, how do you then treat the patient with which meds. It doesn’t really solve the root problem. Considering that Amen takes no insurance and is an “out of network” provider makes it assessable to very few people. Most “out of network” plans in todays day have $10,000 or higher deductibles to reach before paying anything. Why have all of these good doctors and supposable solutions that is not available to most? Why not have the scan covered by insurance and have the Dr been private pay so that it’s serving more of the population?
Comment by Susan — May 11, 2022 @ 8:06 AM
The incredibly important work the Amen Clinic is doing must be shared with all. I hope that your organization has an entire team working to convince Medi-Cal Medicare and Medicaid nationwide to cover these
Comment by Holly Jeske — May 11, 2022 @ 8:20 AM
I’m also praying for the wisdom and open doors Four amen clinics do you have opportunities toward including training in medical schools and psychiatric hospitals to bring the entire industry into a more scientific approach to care. I work in a mental hospital as a chaplain and see good work and outcomes, but far too many return and far too many suffered terribly even after they are stabilized.
Comment by Holly Jeske — May 11, 2022 @ 8:24 AM
I, too found Amen Clinic refreshing with their diagnosis. Dr told me he did NOT know what I had but all of my white and gray matter was effected. This was much better to hear than being told by multiple doctors that it was psychosomatic. Final accurate diagnosis was Lyme disease and Bartonella as a brain infection that the right antibiotics cured. I’m the lucky one, as so many neurological symptoms as body jerking, head tremors, labored speech, difficulty walking, mental functioning compromised, etc. I knew I was sick and that it was not in my head so to speak, and Amen Clinic was the first to support me. BTW, my Lyme test was negative until I had adequate treatment.
Comment by Sandy W — May 11, 2022 @ 8:41 AM
Conversion reaction was my psychiatric diagnoses made by many drs, and believed by many. Amen Clinic showed my entire brain was effected, later diagnosed as Lyme Disease and Bartonella as brain infection. At the time, this helped my family understand it was not just depression or conversion reaction before receiving an accurate diagnosis years later.
Comment by Sandy W — May 11, 2022 @ 8:58 AM
As I sit here reading all these comments, I ask why? Why is good mental health treatment only for the wealthy? Why, when most of the crimes, a mental health issue, untreated? Mental Health professionals are frustrated. They know they can do more, but the lack of insurance or inadequate insurance stops at medications. I started…..”as I sit here” Anxiety, depression, pre- dementia, menopause, old age, or whatever society wants to label me. Mental Health is important to me. I am always questioning, why?
Comment by Dannette Larsh — May 11, 2022 @ 9:36 AM
Not to be rude, but not is not acceptable for a clinic of your caliber to not accept health insurance, like Medicare. Many folks with mental health issues simply cannot afford $200-400 for consultations, several thousands for brain scans/testing and on top of that the costs of the medicines and supplements necessary for treatment. It may have changed since my last visit. If so, I apologize. Something has change Doctor. I know it is not your fault but you all are awesome and more of the afflicted need to have access to your breakthroughs in brain science.
Good luck with getting this done and take care
– Jeff
Comment by Jeff — May 11, 2022 @ 10:23 AM
My son has been in several mental health hospitals within the past year. One gave him controlled substances sent him home didn’t prescribe any. When I complained they told me I had to bring him back every seven days for a refill. Mind you that is An hour and a half away. On top of that he did not see the doctor but the hospital manager. The last saga is one hospital kept him two weeks. Then sent him home. Still hallucinating and all. Said that was the best they could. Between morons in a Texas hospital that let him run around in the hospital hallucinating the local ambulance services that refuse to take him to a hospital that can help. These morons vape in the back of the ambulance and refuse to tie him done so he could jump right out and kill himself and others. Another time I had to take him from the local hospital to another county and have someone call 911 along the way. As this hospital said he did not qualify for help. Not a dang one of these institutions have done any brain test. Nor do they care. I am beside myself. No lawyers will touch this not even state or federal folks. So I wish you have better luck then me.
Comment by Jay — May 11, 2022 @ 11:02 AM
I have read this and the comments and want to add that whether a person has a scan or not or drugs or not it is wasting time and money and will not bring intented changes and improvements if the person doesn’t have the 4 pillars of wellbeing (4 legs of a chair) supported and make changes to support these all and this is per Dr. Amen’s teachings in his 30 day happiness challenge-which is great by the way. So one has to build up and do the biological (great food, etc./psychological (our thoughts & much more)/social support (relationships and more)/spirituality (purpose, faith, etc.) parts of ones life along with any if needed tests, scans and meds. Dr. Amen’s free and very helpful 30 day happiness/health challenge online takes a deep dive into describing these 4 pillars of wellbeing. I think everyone needs to read and use these to have a full, healthier and happier life. It has given me a framework to see what needs attention day to day and week to week. Best wishes everyone. I feel these struggles as major mental health issues were in my family of origin. 3 did ECT treatments without results and i believe these 4 pillars were very weak in each of them. Also one needs EMDR or TMS and won’t do it and chose to be estranged from me.
Comment by Lisa Graham Brott — May 11, 2022 @ 11:25 AM
I agree with you on so many levels, but one of the main reasons that we have diagnosis is because insurance requires it. It is so frustrating to have to put a label on somebody because of insurance.
Comment by susan smith — May 11, 2022 @ 3:30 PM
Totally agreed with the blog! Mental illness affect our daily and social life. Anxiety and depression not only make our lives worse but it also affects our career by not able to concentrate on work. In this COVID era, i also got affected with this serious illness and got rid out of it by getting on-time treatment from psychiatrist Girish Subramanyan , his clinic not only treated me well but also provide insurance plans for your well-being.
Comment by Derek Jones — May 24, 2022 @ 9:33 PM
Doc, I do enjoy watching you on TT and hearing you speak on stuff, however here’s my 2 cents about the post: body systems don’t work separately! I remembered a neurologist saying the brain and the gut are sisters… low and behold, The Gut Brain Axis Link. So though your scans are great, it is connected to the rest of the body systems. We are not body parts either—body parts don’t work separately. So when we start to really understand that, then ppl can really get answers. People need to be treated as a WHOLE person bc the basis of the body is to maintain BALANCE—when imbalance occurs, those are signs and symptoms NOT THE ROOT PROBLEM. Find the root problem, ppl can actually heal.
Comment by Angel — June 10, 2022 @ 4:48 PM