Clutter is Bad For Your Physical and Mental Health. This Portable Wand Scanner Can Help Get You Organized.

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3 Ways to Harness the Mental Power of Writing

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National Institute of Mental Health abandoning the DSM

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:

Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.

As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.

For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.

Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.

It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.

It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.

The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.

The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.

Link to NIMH announcement ‘Transforming Diagnosis’.

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5 Ways to Overcome Mental Blocks

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Letter from the mental states of America

Alistair Cooke presented the longest running radio show in history. The BBC’s Letter from America was a weekly report, where Cooke reflected on life and news in the United States. It ran for just shy of 58 years.

Despite the massive ‘psychologisation’ of society during the years Cooke was broadcasting, from 1946 to 2004 no less, Cooke rarely addressed matters of the mind and brain directly.

However, he did occasionally touch on these issues and the shows are well worth listening to.

As the BBC has just put almost the complete Letter from America archives online so I’ve collected some of the highlights.

Link: George Gallup (1901-1984) – 9 November 1984
Link: TV Violence – 13 April 1986
Link: Narcotics, interdiction and Colombian drug lords – 08 September 1989
Link: American public schools – 03 January 1992
Link: Aphasia and studying the human brain – 15 October 1993
Link: Timothy Leary (1920 -1996) – 7 June 1996
Link: New York: How are you Doing? – 3 May 2002

I’ve linked to the transcripts, but listen to the linked audio if you have the chance. Cooke had a distinctive voice and a calm style that underscored his often insightful commentary.

Link to Letter from America archives.

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A mental space filled with flowers

An entire psychiatric hospital has been filled with flowers before demolition as part of a beautiful art installation to remember a place “rich with a history of both hope and sadness.”

Art website Colossal has amazing pictures of the sublime artwork.

In 2003 a building housing the Massachusetts Mental Health Center (MMHC) was slated for demolition to make way for updated facilities. The closure was a time for reflection and remembrance as the MMHC had been in operation for over 9 decades and had touched countless thousands of patients and employees alike, and the pending demolition presented a unique problem. How does one memorialize a building impossibly rich with a history of both hope and sadness, and do it in a way that reflects not only the past but also the future? And could this memorial be open to the public, not as a speech, or series of informational plaques, but as an experience worthy of they building’s unique story?

To answer that question artist Anna Schuleit was commissioned to do the impossible. After an initial tour of the facility she was struck not with what she saw but with what she didn’t see: the presence of life and color. While historically a place of healing, the drab interior, worn hallways, and dull paint needed a respectful infusion of hope. With a limited budget and only three months of planning Schuleit and an enormous team of volunteers executed a massive public art installation called Bloom. The concept was simple but absolutely immense in scale. Nearly 28,000 potted flowers would fill almost every square foot of the MMHC including corridors, stairwells, offices and even a swimming pool, all of it brought to life with a sea of blooms.

A beautiful and touching piece.

Link to photos from Colossal (via @sarcastic_f)
Link to artist’s pages on the project.

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The war of the manual of mental illness

Wired covers the battle raging over the next version of the ‘manual of mental illness’ – the American Psychiatric Association’s DSM-5.

The piece discusses how the chief editors of two previous version of the manual, Robert Spitzer and Allen Frances – who edited the DSM-III and DSM-IV, have heavily criticised the proposed new manual for lack of transparency in development (non-disclosure agreements are required) and for ever-widening categories.

We’ve covered the (surprisingly personal ) battle on a couple of occasions but the Wired piece does a great job of getting into the nitty gritty of the arguments.

What the battle over DSM-5 should make clear to all of us—professional and layman alike—is that psychiatric diagnosis will probably always be laden with uncertainty, that the labels doctors give us for our suffering will forever be at least as much the product of negotiations around a conference table as investigations at a lab bench. Regier and Scully are more than willing to acknowledge this.

As Scully puts it, “The DSM will always be provisional; that’s the best we can do.” Regier, for his part, says, “The DSM is not biblical. It’s not on stone tablets.” The real problem is that insurers, juries, and (yes) patients aren’t ready to accept this fact. Nor are psychiatrists ready to lose the authority they derive from seeming to possess scientific certainty about the diseases they treat. After all, the DSM didn’t save the profession, and become a best seller in the bargain, by claiming to be only provisional.

My only gripe with the article is it seems a little star-struck by the idea that mental illness could be validated or even wholly defined by reference to neuroscience, which is a huge category error.

How would we know which aspects of neuroscience to investigate? Clearly, the ones associated with distress and impairment – mental and behavioural concepts that can’t be completely substituted by facts about the function of neurons and neurotransmitters.

That’s not to say that neuroscience isn’t important, essential even, but we can’t define disability purely on a biological basis.

It would be like trying to define poverty purely on how much money you had, without reference to quality of life. We need to know what different amounts of money can do for the people in their real-life situations. Earning $5 a day is not the same in New York and Papua New Guinea.

Not even physical medicine pretends to have completely objective diagnoses, as, by definition, a disorder is defined by the impact it has.

An infectious disease is not solely defined by whether we have certain bacteria or not. First, it must be established that those bacteria cause us problems.

The urge to try and define all mental illnesses in terms of neuroscience is, ironically, more an emotional reaction to criticisms about psychiatry’s vagueness than an achievable scientific aim.

Link to article ‘Inside the Battle to Define Mental Illness’.

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