DSM 6: A New Strategy for Deceit

     A group of psychiatrists is currently huddled together in a conference room with their yellow legal pads and Cross pens trying to come up with a plan for DSM 6 that would “meaningfully change the way clinicians think.” This Biomarkers and Biological Factors Subcommittee has the goal of developing a precision psychiatry that can reveal the specific biological aberration behind any mental illness.

     The only problem is that there has never been any strictly biological cause found behind any mental illness. No chemical imbalance, no odd biomarker, no gene, no cell or DNA oddity behind a mental condition.
But there could be, the committee asserts.

     They are convinced it is “imperative” — their word – to shift the psychiatric model from one looking at the social, psychological, socioeconomic and environmental causes of mental illness to a model that shows that the cause of any mental illness is biological, just like with any other “disease.”

     Then psychiatrists could be seen as real doctors. 

     Just like Captain Queeg, with his obsession of finding the missing quart of frozen strawberries and the existence of a duplicate key for them, this subcommittee is hell bent on finding that one biomarker they need to make them real doctors. For them, even though there is absolutely no evidence that there is such a biological cause, there’s a “plausibility” that there could be.

     That’s the wobbly foundation upon which they’re writing their new DSM…a plausibility. That’s the same trick a fiction writer uses to convince a reader of the “truth” of the fictional world he’s creating because of its plausibility, its verisimilitude. But it’s still fiction.

     These DSM 6 psychiatrists are now going to focus on what they call “candidate biomarkers” to base their biological model on. These are the biomarkers that have so far failed to have been verified as biological causes of any mental illness, but they can still be seen – by  this DSM subcommittee of psychiatrists anyway — as “plausible” candidates upon which psychiatrists can pass themselves off as real doctors by pointing to a biological cause of mental illness.

     There could be such things, right?

     Couldn’t there?

     Only a psychotic Captain Queeg would know. His final words, spoken so convincingly by by Humphrey Bogart? “They laughed at me and made jokes, but I proved beyond the shadow of a doubt…that a duplicate key…did exist!”

     Except that it didn’t.