On Monday, David Brooks weighed in on the debate about the merits of the latest edition of the DSM-5, psychiatry’s primary diagnostic manual for mental disorders. As often happens when a columnist parachutes into a complicated scientific subject, he made a muddy topic even muddier with superficial generalizations.
His column, headlined “Heroes of Uncertainty,” is oddly contradictory, beginning with a sweeping attack on psychiatrists’ work and concluding with a sweeping defense of it, both of which are off the mark. Brooks seems to grasp fundamental problems with the DSM-5, but the conclusions he draws from that knowledge betray misunderstandings of the underlying science and scientific process.
He explains, for instance, that, “Mental diseases are not really understood the way, say, liver diseases are understood, as a pathology of the body and its tissues and cells” and that, “What psychiatrists call a disease is usually just a label for a group of symptoms.” True enough. However, these facts lead him to claim that:
The problem is that the behavioral sciences like psychiatry are not really sciences; they are semi-sciences. The underlying reality they describe is just not as regularized as the underlying reality of, say, a solar system.
That’s wrong. Psychiatry is not a semi-science. It’s just a really immature science, and most practitioners are well aware of its limitations. They’re not focusing on symptoms for fun. They’re doing it because, until we have a better understanding of the brain, and better tools to diagnose its afflictions, it’s the best anybody can do, and it’s often effective. Moreover, there is every reason to believe that the “underlying reality” of the mind is just as “regularized” as the solar system, and for the most part, psychiatrists are as eager as anybody to figure out how it all works.
Brooks’s misinterpretation probably resulted from the acrimonious, and often misunderstood, debate within the medical field about the DSM-5’s value and usefulness. A few weeks before its release, Dr. Thomas Insel, the director of the National Institutes of Mental Health, wrote a blog post declaring:
We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data—not just the symptoms—cluster and how these clusters relate to treatment response.
That is why NIMH will be re-orienting its research away from 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.
That system is called Research Domain Criteria (RDoC), and shortly after his post, Insel told The New York Times:
As long as the research community takes the D.S.M. to be a bible, we’ll never make progress. People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.
These comments fostered a few misunderstandings, however. First, there were the inaccurate headlines about the NIMH “abandoning” and “rejecting” the DSM-5, which led Insel to clarify his position. In a joint statement with the president-elect of the American Psychiatric Association, which publishes the DSM, he explained:
[The manual] represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care.
And testifying to the fact that psychiatry is an immature field of science, rather than a “semi-science,” Insel added:
All medical disciplines advance through research progress in characterizing diseases and disorders. DSM-5 and RDoC represent complementary, not competing, frameworks for this goal.
Nonetheless, Insel’s charge that the research community treats the DSM like a “bible” has lingered. Myriad news articles have blindly repeated the assertion, but careful readers might note that reporters never actually quote psychiatrists calling it that. On the contrary, Dr. Richard A. Friedman, a professor of clinical psychiatry at Weill Cornell Medical College, noted in an op-ed for The New York Times, “Most of my colleagues laugh at the notion that the manual is a ‘bible.’”

What a horrible article.
There are profound differences between the hard sciences and the social disciplines including psychiatry, psychology and sociology. We CANNOT just reduce Mind to Matter. Human beings are different that just things.
I might recommend Ernest Becker’s exhaustive writing on the matter.
#1 Posted by Bill Du Bois, CJR on Thu 30 May 2013 at 04:49 PM
How come Psychiatry is not like other "behavioral fields"? Doesn't it deal with behavior? For a more nuanced discussion see Liah Greenfeld's Mind, Modernity, Madness: The Impact of Culture on Human Experience (Harvard University Press). Or, for a quick bite, see here http://www.psychologytoday.com/blog/the-modern-mind/201305/the-real-trouble-dsm-5 and here http://www.psychologytoday.com/blog/the-modern-mind/201305/is-depression-real-disease
#2 Posted by Gil Press, CJR on Thu 30 May 2013 at 06:28 PM
I am appalled that CJR would publish this piece.
Brainard says "reporters never actually quote psychiatrists calling [the DSM the "psychiatrist's bible]." But they do. Allen Frances, the head of the DSM-IV Task Force named two of his books "Am I Okay?: A Layman's Guide to the Psychiatrist's Bible", and "Your Mental Health: a Layman’s Guide to the Psychiatrist’s Bible". Dan Carlat and other psychiatrists refer to it that way, as well.
More laziness: if he'd spent a few moments on the internet, even he would have stumbled upon Marcia Angell's incredible takedown of psychiatry's greed, duplicity, intellectual disingeneousness and near-slavery (albeit well-renumerated) to pharma. She and others--including psychiatrists--note that psychiatry embraced the medical model of illness largely to raise its status, reduce competition with other providers, and be seen as more scientific. In other words, psychiatrists had an inferiority complex.
Also, the DSM isn't the "best anyone can do." Psychiatry, mind health, is so much more than pills, labels, and behavior. if other countries (and non-DSM-focused practitioners in the US) are able to get better, longer-lasting results (as they have, and do) then the DSM's model can't claim primacy..
Finally, even Brainard must know that the shadow and reach of the DSM is long and wide, and often permanent. The labels, discrimination, frequent and permanent damage from the medication, and other burdens are ripple out forever in our culture and lives.
#3 Posted by Angela Ursery, CJR on Thu 30 May 2013 at 11:19 PM
David Brooks profoundly misguided? No, please say you don't that. He's never ever been misguided, confused, self-contradictory, superficial, foolish, or any of those things before, as I've previously written.
http://crosscut.com/2009/09/18/crosscut-blog/19094/David-Brooks-in-Yakima-Im-in-favor-death-panels/
#4 Posted by Harris Meyer, CJR on Fri 31 May 2013 at 04:50 PM
Brooks, who determined Obama's excellent fitness for President based on the crease in his trousers, and Brainard, who attacks semi-science with semi-science.
Two peas from the same pod.
#5 Posted by harkin, CJR on Mon 3 Jun 2013 at 12:54 PM
The DSM exists to ensure that every person, no matter how sane, can be given a psychiatric diagnosis. Without a diagnosis, insurance companies will not pay for treatment.
#6 Posted by Pronghorn, CJR on Mon 3 Jun 2013 at 02:25 PM
Attention editors of RealClearScience:
Please do not ever post anything from this blog or this "review" or this author again.
I never, ever, ever in my life thought I would agree with David Broks on anything.
#7 Posted by Jan Vones, CJR on Mon 3 Jun 2013 at 06:04 PM
It is absolutely ridiculous to have blind faith that psychiatry's labeling/name calling "will improve" given time. It's been 100 years of them slapping labels on people based on pseudoscience. Your mindless faith that understanding the problems of a human life, is the same as understanding how the universe works, is just pathetic. This is one of the worst articles I've seen on this dismal pseudoscience, psychiatry.
I hope I live to never see another thing you write. You are pathetic.
#8 Posted by Your mindless faith, CJR on Tue 4 Jun 2013 at 04:08 AM
There are about seven billion people labeled as humans, by corporations.
The One True Corporate god told his Corporations to have dominion over
all of Earth's Human Resources, Earth's Natural Resources for their profit.
Religion is B.S. a Belief System. Corporations worship their own gods.
In the Beginning, there were no patents. Corporate lawyers were bored.
#9 Posted by Judge Knot, CJR on Thu 13 Jun 2013 at 02:47 PM