Psychiatric Diagnoses Are Scientifically Meaningless

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.

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WHAT 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:

• anxiety disorders
• depressive disorders
• trauma-related disorders
• bipolar disorder
• schizophrenia

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.