Context and DSM
"The genetics of psychological suffering is the genetics of being human, and in particular our capacity to react with feeling to the environment."
— Jim van Os
What is DSM?
The DSM stands for Diagnostic and Statistical Manual of Mental Disorders. It is a classification system used in psychiatry to describe mental disorders.
See also the Wikipedia article: Diagnostic and Statistical Manual of Mental Disorders.
Origin
The DSM finds its origin in the American military and statistics. There was a need for reliable and uniform diagnostics to screen and treat soldiers.
Descriptive, not explanatory
The DSM is a descriptive model:
- it notes what someone experiences (symptoms),
- but does not explain why someone has those complaints.
A “diagnosis” like appendicitis is explanatory and clear. A DSM classification, on the other hand, is a tentative classification of symptoms.
- two weeks of depressed mood
- fatigue
- loss of interest in activities
- sleep problems
- feeling of worthlessness
According to the DSM-5, this meets the criteria for a depressive disorder (DSM-5 criteria, NCBI).
The classification hereby describes the symptoms, but says nothing about the cause.
The underlying reason can be very different:
- loss of work
- relationship problems
- physical illness
- context-blindness or difficulty with complex thinking
Purpose of the DSM
According to psychiatrist Jim van Os:
- There was a proliferation of diagnoses in psychiatry.
- Clear criteria were needed to arrive at a diagnosis.
- This was also necessary to enable validated reimbursement by health insurance.
What it is not?
The DSM is not scientific evidence that these entities truly exist. Sometimes there are attempts to "prove" this afterwards with brain research or biomarkers, but that is a form of reverse engineering. After 50 years of research, no conclusive evidence has been found that the DSM classifications are real diseases like in somatic medicine.
What does genetics say?
The only field that provided insights is genetics. It shows that every person has thousands of genetic variants that are involved in psychological suffering. These variants occur in autism, depression, borderline, schizophrenia, bipolar disorder, ... and are largely overlapping (about 70%). Conclusion: the genetics of psychological suffering is in fact the genetics of being human, and more specifically our capacity to react with feeling to the environment.
Spectrum thinking
Terms like autism, schizophrenia, depression, borderline are not diseases in themselves, but descriptions. Therefore, people are increasingly talking about a spectrum or “characteristics of”. This is also evident in personality disorders: a person can at a certain moment meet the criteria for borderline, later for narcissism, and then not again.
Listen further
Podcast by Jim van Os about the DSM and psychic classification: Listen on Spotify (NL)