Vaughan Bell (of the terrific blog, Mind Hacks) has posted a couple of fascinating articles highlighting recent evidence from genetics that is challenging the field of psychiatry to rethink how it views diagnosis. In a post published in The Guardian, Bell frames psychiatry’s current diagnostic dilemma as follows:
[Do] different diagnoses such as schizophrenia, bipolar or depression represent distinct disorders that have specific causes or [are these] just convenient and perhaps improvised ways of dividing up human distress for the purposes of treatment?
Bells reminds us that the diagnosis debate is typically framed in terms of two opposing models, a medical model that views psychiatric disorders in terms of diagnosis, medication and biomedical science, and a social model that stresses individual experience, psychotherapy and social interventions. This debate has been heated and politicized, and now it may be further complicated (or elucidated) by evidence from medical genetics that suggests that psychiatric diagnoses do not, in fact, represent distinct disorders, but rather they represent a variety of possible problematic outcomes each stemming from a similar genetic starting point that has been uniquely shaped by an individual’s life experiences.
Dr. Owen and his colleagues gathered and analyzed a great deal of evidence showing that certain genetic differences raise the chances of developing a whole range of psychiatric problems – from epilepsy to schizophrenia to ADHD – rather than these differences being linked to a specific psychiatric disorder. Asked to expound on what the current categories of psychiatry diagnosis (i.e. per the DSM) represent, Owen said:
They are broad groupings of patients based upon the clinical presentation, especially the most prominent symptoms and other factors such as age at onset, and course of illness. In other words they describe syndromes (clinically recognizable features that tend to occur together) rather than distinct diseases. They are clinically useful in so far as they group patients in regard to potential treatments and likely outcome. The problem is that many doctors and scientists have come to assume that they do in fact represent distinct diseases with separate causes and distinct mechanisms. In fact the evidence, not just from molecular genetics, suggests that there is no clear demarcation between diagnostic categories in symptoms or causes (genetic or environmental).
Interesting stuff! I’ll keep my ear to the ground for any new developments.