Insell dings DSM but doubles-down on biological perspective of mental disorders

 Thomas Insell wants to re-orient NIMH research away from using DSM categories as the ‘gold standard’. This makes a lot of sense, as the DSM identifies clusters of symptoms, and symptoms are not reliable markers of discrete disease states. As we search for bio-markers of mental illness, then, it will make sense that results will not always align with the DSM.

On the other hand, it is surpising to see Insell state flatly that “Mental disorders are biological disorders”. The NIMH is betting big that this is still likely to be true, organizing massive efforts to collect imaging, genetic, and biological data in the hopes that this will clearly delineate sets of biological disorders. Perhaps this will work. Or, perhaps looking for the biological mechanism of depression is a bit like looking for the atomic mechanisms of a bad spark-plug. Perhaps mental illnesses really are *mental*, in the sense of sharing commonality only in patterns of thought, emotion, and behavior, and can be instantiated in a near infinite-pattern of biological substrates. Guess we’ll see….

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