If DSM diagnosis doesn't inform treatment, what good is it? The answer is one, to facilitate the exchange of money between payers and providers, and two, to create silos for focused research. With the NIMH announcement, scratch number two.
We still have to rely on DSM to diagnose illness, but thanks to Dr. Insel the end of that state of affairs is a step closer. The identification and treatment of mental illness is about to leave the realm of psychiatry and enter the science of neurology.
For what we need to do in mental health research, the DSM approach is not appropriate. Even if it is still the best way to diagnose disorders and deliver treatment and knit the mental health care system together, it must begin to be supplanted by a new science-based framework.
A tragedy like Sandy Hook can tend to solidify people's fears and prejudices about mental illness. So it is of vital importance that we, as a community, re-dedicate ourselves to eliminating the stigma that affects 1 in 4 people in our country.
That there is something inherent in the person to be found there -- in mental illness and addiction -- is received wisdom, not empirical fact. The belief derives from the assumption that these phenomena are medical diseases.
The logic is absolutely clear -- the more guns in private hands, the more people will be shot and killed each year in the US. The more guns in private hands, the greater the number will be of mentally unstable individuals with guns.
Have you heard a word about mental health in the deluge of discussions that populate health reform communications on TV, radio and newspapers? Have you seen any mention in Federal legislative offerings?