Soltando el chaleco de fuerza cognitivo de los diagnósticos psiquiátricos

Slipping the 'Cognitive Straitjacket' of Psychiatric Diagnosis

Psychiatry's diagnostic bible meets the awkward facts of genetics

By Steven E. Hyman 

It can fairly be said that modern psychiatric diagnosis was “born” in a 1970 paper on schizophrenia.

The authors, Washington University psychiatry professors Eli Robins and Samuel B. Guze, rejected the murky psychoanalytic diagnostic formulations of their time. Instead, they embraced a medical model inspired by the careful 19th-century observational work of Emil Kraepelin, long overlooked during the mid-20th-century dominance of Freudian theory. Mental disorders were now to be seen as distinct categories, much as different bacterial and viral infections produce characteristic diseases that can be seen as distinct “natural kinds.”

Disorders, Robins and Guze argued, should be defined based on phenomenology: clinical descriptions validated by long-term follow-up to demonstrate the stability of the diagnosis over time. With scientific progress, they expected fuller validation of mental disorders to derive from laboratory findings and studies of familial transmission.

This descriptive approach to psychiatric diagnosis -- based on lists of symptoms, their timing of onset, and the duration of illness -- undergirded the American Psychiatric Association’s widely disseminated and highly influential Diagnostic and Statistical Manual of Mental Disorders, first published in 1980. Since then, the original “DSM-III” has yielded two relatively conservative revisions, and right now, the DSM-5 is under construction. Sadly, it is clear that the optimistic predictions of Robins and Guze have not been realized.

Four decades after their seminal paper, there are still no widely validated laboratory tests for any common mental illness. Worse, an enormous number of family and genetic studies have not only failed to validate the major DSM disorders as natural kinds, but instead have suggested that they are more akin to chimaeras.  

link al artículo completo

Steven E. Hyman, a neurobiologist and former director of the U.S. National Institute of Mental Health, has been Provost of Harvard University for nearly a decade. He plans to step down in June and spend a sabbatical year at the Broad Institute of Harvard and MIT to focus on the genetics of major mental illness. Member of the DSM-5 task force.