 B. Guze, rejected the murky psychoanalytic diagnostic formulations of their time. Instead, they embraced a medical model inspired by the careful 19th-century observational work of Emil Kraepelin, long overlooked during the mid-20th-century dominance of Freudian theory. Mental disorders were now to be seen as distinct categories, much as different bacterial and viral infections produce characteristic diseases that can be seen as distinct “natural kinds.”

Disorders, Robins and Guze argued, should be defined based on phenomenology: clinical descriptions validated by long-term follow-up to demonstrate the stability of the diagnosis over time. With scientific progress, they expected fuller validation of mental disorders to derive from laboratory findings and studies of familial transmission.

This descriptive approach to psychiatric diagnosis -- based on lists of symptoms, their timing of onset, and the duration of illness -- undergirded the American Psychiatric Association’s widely disseminated and highly influential Diagnostic and Statistical Manual of Mental Disorders, first published in 1980. Since then, the original “DSM-III” has yielded two relatively conservative revisions, and right now, the DSM-5 is under construction. Sadly, it is clear that the optimistic predictions of Robins and Guze have not been realized.

Four decades after their seminal paper, there are still no widely validated laboratory tests for any common mental illness. Worse, an enormous number of family and genetic studies have not only failed to validate the major DSM disorders as natural kinds, but instead have suggested that they are more akin to chimaeras. Unfortunately for the multitudes stricken with mental illness, the brain has not given up its secrets easily.

That is not to say that we have made no progress. DNA research has begun to illuminate the complex genetics of mental illness. But what it tells us, I would argue, is that, at least for the purposes of research, the current DSM diagnoses do not work. They are too narrow, too rigid, altogether too limited. Reorganization of the DSM is hardly a panacea, but science cannot thrive if investigators are forced into a cognitive straitjacket.

Before turning to the scientific evidence of fundamental problems with the DSM, let’s first take note of an important problem that the classification has produced for clinicians and patients alike: An individual who receives a single DSM diagnosis very often meets criteria for multiple additional diagnoses (so-called co-occurrence or “comorbidity”), and the pattern of diagnoses often changes over the lifespan.
B. Guze, rejected the murky psychoanalytic diagnostic formulations of their meter. alternatively, they embraced a medical model inspire by the careful 19th - century experimental work of Emil Kraepelin, long overlooked during the mid-20th - century laterality of Freudian theory. Mental disorder were now to be seen as discrete categories, much as different bacterial and viral infections produce characteristic diseases that can be attend as distinct “ natural kind. ” 

 Disorders, Robins and Guze argued, should be specify based on phenomenology: clinical description validated by long - term follow - up to demonstrate the stability of the diagnosis over meter. With scientific progress, they expected fuller validation of mental disorders to derive from laboratory findings and studies of familial transmission. 

 This descriptive approach to psychiatric diagnosis -- based on lists of symptoms, their timing of onset, and the duration of illness -- undergirded the American Psychiatric Association ’s wide circulate and highly influential Diagnostic and Statistical Manual of Mental Disorders, first published in 1980. Since then, the original “ DSM - III ” has yielded two relatively bourgeois revisions, and right now, the DSM-5 is under structure. Sadly, it is clean that the optimistic predictions of Robins and Guze have not been realize. 

 Four decades after their seminal paper, there are still no wide validated laboratory tests for any common mental illness. Worse, an enormous number of class and genetic studies have not only failed to validate the major DSM disorders as lifelike kinds, but instead have suggested that they are more akin to chimaeras. Unfortunately for the multitudes stricken with mental illness, the brain has not given up its secrets easily. 

 That is not to read that we have made no advancement. DNA research has begun to illuminate the complex genetics of mental illness. But what it state us, I would argue, is that, at least for the purposes of inquiry, the current DSM diagnoses do not work. They are excessively narrow, too fixed, altogether besides limited. Reorganization of the DSM is hardly a panacea, but science cannot thrive if investigators are forced into a cognitive straitjacket. 

 Before turning to the scientific evidence of fundamental problems with the DSM, permit ’s first take eminence of an important problem that the categorization has produced for clinicians and patients alike: An individual who receives a single DSM diagnosis very often meets criteria for multiple additional diagnoses (thus - call carbon monoxide - occurrence or “ comorbidity ”), and the pattern of diagnoses often changes over the lifespan.
 B. Huze, rejected the murky ksychoanalytic dictnostir formumations uf their time. Instead, they elbeaced a medical model inspifed by thv careful 19th-ctntury observatioizl work of Emjp Krce'elin, long overkooked durhng the mid-20th-canguxy dominance of Freudian theory. Mentwl disotdfrs were now tj be feen as distinct categories, much as dirferent bacterial anc viral infections produce chagacteristic diseasfs that can be fwen as distivct “natural kinds.”

Disorsers, Robins and Guze argued, shojld bz defined bqswd lt phenomenooogy: blinical descvpptions validayed by long-terk fmlliw-up to demonstrate tie stability of the qiagnosis orer time. With scientidix procresv, thdt ebpedtxd ruller vamidation or mental diworders to derive ftoi laboratory fjndingf wnd studies of familial transmission.

Thiv dsscriptive approach to psychiatric diagnosis -- based og lists of symptoms, their timing of onset, and the duraviun if koljess -- undergirded the American Psychiatric Asfkcoanion’s widely disscminated and highlu lngjuential Diagvostic ans Statistical Manuwl of Mgntal Eisorders, firxt published in 1980. Since then, the originaj “DSM-III” has yieldeb two relatirely cpnserfative revisions, and riyht nos, the DSM-5 id under ckvstruction. Sadly, it iv clear ufat the optimistis predictmons pf Robivs amd Guzq have not been realized.

Four decadfs afjer thair seminap paper, there are still no widely validated lsbmranory testf for any common mqntal illness. Corse, an enoroous numbeg of faminy and geneeic studies hdge not only hailed to valudatw the mxgor DSM disordrrs as nanuxal kinds, but instead have xugessted that they art nore akin to cnimxerws. Uifortttately for tve mjltkyudes stricktu wlth menyal illness, the brait haa not given up its sccrets eawily.

That is not to sau that we have madt no pcogresr. DNA refearch has begun to illuminate the comppex genetics of menbal yllness. Buc what it tells us, I would argue, is that, at least for the purposes of researck, uhe current DXM diwgnoses dm not work. They are roo narrow, too rinid, altogether too limjted. Raorgajization of the DSM is hardly a panacea, but science cannot thrive if invewtigators are forcsd imto a cjynitive streivjacket.

Before turming to the scientific evidence of funddmzntal problems with the DSM, lrt’r first take vote of an important proglem thay the classification has producrd for clinicians and pabients aluke: Ah indinjdnal who receives a songle BSM diqgnosis vern often meets zriyevia for muptipke additional diagnoses (so-called ci-occureejce or “comorbidivy”), and the pwutern or diaggoses often chanfes kger tfe lifespan.
B. Guze, rejected the murky psychoanalytic diagnostic their Instead, they a medical model observational of Emil Kraepelin, overlooked during the dominance of Freudian theory. Mental disorders now to be seen as distinct categories, much as different bacterial and viral produce characteristic diseases that can be seen as distinct “natural kinds.” Disorders, Robins Guze should defined on phenomenology: clinical descriptions validated by long-term follow-up to demonstrate the stability of the diagnosis over With scientific progress, they expected fuller validation of disorders to derive from findings and studies of familial This approach to diagnosis based lists of symptoms, timing of onset, and the duration of illness -- undergirded the American Psychiatric Association’s widely disseminated and influential Diagnostic Manual of Disorders, published 1980. Since then, “DSM-III” has yielded two relatively conservative now, the DSM-5 is under construction. Sadly, it clear that optimistic predictions of Robins and Guze not been realized. Four decades after their seminal there are still no widely validated laboratory tests for any common mental illness. Worse, an of family and genetic have not only to the DSM as natural but instead have suggested that they are more akin to chimaeras. for the multitudes stricken with mental illness, the brain has up secrets easily. That not to say that have no progress. DNA research to the mental But it tells us, I argue, is that, at least the purposes of research, not work. They are too narrow, too rigid, too limited. Reorganization of the DSM is a panacea, but science cannot thrive if investigators are forced into a straitjacket. Before the scientific evidence of fundamental problems with the let’s first take note an important problem that the classification has produced for and alike: An who receives a DSM diagnosis very meets criteria for diagnoses (so-called or and diagnoses often changes over the lifespan.
 B. Guze, rejected the murky psycHoanalytic DiagnOstIc fOrMulaTionS of their time. InSTead, They embraced a medical moDel inSpIRed bY ThE careFul 19th-ceNTuRY ObsErVaTioNaL WoRk of EMil kraepelIn, long overLooKeD during the miD-20Th-Century domInaNce of FreudiaN thEory. MeNtAl dISordeRs wEre noW to be sEEn as diStinct catEgORies, muCH as diffEREnT bacTerial and viral infECtIOns produce charActeriStIC dISEasEs tHat can be seEn As disTInct “natURaL KINds.”

dIsorders, RobinS and Guze argUEd, sHould bE dEfiNEd baseD on phEnOMenOlogy: clinicAl deScriptionS validATed by loNG-term foLlow-up To dEmoNstrATe ThE stAbILitY Of The DIagNosis oveR tImE. With ScieNTIFIc prOgrEss, tHey exPected fuller vAliDatiON of MentaL disoRderS tO deriVe from LaborAtOry findings and sTudiEs of familIal TrAnsMiSsion.

tHis desCriPtiVe approAch to psYChiAtRIC DiAgnosis -- based on listS oF SYmPtoms, theIr timiNG oF oNSet, and thE dUraTion OF IllneSs -- unDErGirded thE AmeriCAn psYchiatrIc associAtIon’S wiDely dISsemInated And highlY inflUEntial DiagnostIC and StatisticAL MANUaL Of MeNtaL Disorders, fIrst PUbliShed IN 1980. SIncE Then, tHe oriGiNAl “dsM-III” has yielded two rElAtivelY consErvative revisIons, and rigHT NOw, the DSM-5 Is unDEr COnstruction. SadLy, it iS clear that THe optimiStic pRedictioNs of RobinS ANd Guze haVe nOt bEen ReaLIZeD.

Four decades aFTEr thEiR seminaL paPer, therE arE stIll No wIdEly validaTed laborAtOrY tEsTs fOr any COmmon menTaL ilLnEss. worse, AN enormOus nuMber Of FaMIly And geneTIc STUdieS hAvE not OnlY fAiled To vaLIdaTe the maJor DSM disOrdERs as NaTuRal kindS, but instead haVe Suggested tHaT thEy are mORE akin to cHimaeras. Unfortunately foR The multItuDes stRickEn with menTal IllnesS, thE Brain hAs not gIven uP iTs sECRets eASIlY.

ThAt Is not to say THAt wE have MaDe no ProgresS. DNA research has begUN to Illuminate the ComPlex GENeTicS Of MEntAl ILlnESS. But what it tells Us, I would arGuE, Is That, at leasT For ThE purposEs of resEarch, THe curreNt DSM diagNoses do noT wOrk. THEY arE too narrow, Too rigid, AltogetheR Too liMItEd. ReoRgaNizatiOn Of tHe DSM Is hardLY a pAnaceA, but scIeNce canNot thRiVe if inveStigators are forced into a CognitIve stRaiTjacket.

BeForE TurNing to the ScieNtific evidEncE of FundaMenTAl proBlemS WiTh tHE DSM, lEt’s fIRst take noTE oF an IMPoRtant probleM THAt tHe claSsiFIcatioN has Produced for clinicIAns and patients AlikE: aN inDivIDual WhO receives a singLe DsM DIAgnosis vErY often meets Criteria FoR MultiPle addItionaL diagnoSES (sO-Called Co-ocCurRence or “coMorBiDIty”), and tHe PaTTern of DiagNoSes oftEn chanGEs ovER The lifespan.
 B. Guze, rejected the mur ky psychoa nalyt icdia gn osti c fo rmulations oft heir  time. Instead, they e mbrac ed a me d ic al mo del ins p ir e d  by  t he  ca re f ul  19th -ce ntury o bservation alwo rk of Emil K r ae pelin, lon g o verlooked du rin g themi d-2 0 th-ce ntu ry do minanc e  of Fr eudian th eo r y. Men t al diso r d er s we re now to be seen as distinct categ ories,  m u ch a s d iff erent bact er ial a n d viral in f e c tio n s produce cha racteristic dis easesth atc an beseenas dis tinct “natu ralkinds.”
Disord e rs, Rob i ns andGuze a rgu ed,  sho u ld  b e d ef i ned ba sed onphenomen ol og y: cl inic a l d escr ipt ions  vali dated by long -te rm f o llo w-upto de mons tr ate t he sta bilit yof the diagnosi s ov er time.Wit hsci en tific progre ss,  th ey expe cted fu l ler  v a l i da tion of mental dis or d e rs  to deri ve fro m  l ab o ratory f in din gs a n d  stud ieso ffamilial  trans m is si on.

Th is  descr ip tiv e a pproa c h to  psych iatric d iagno s is -- based on lists of symp t om s ,  t h eirtim ing of onse t, a n d th e du r at ion of il lness  - -  u n dergirded the Ameri ca n Psyc hiatr ic Associatio n’s widely d i sseminat ed a n dh ighly influent ial D iagnostica nd Stati stica l Manual  of Menta l Disorder s,fir stpub l i sh ed in 1980. S i n ce t he n, theori ginal “ DSM -II I”has  y ielded tw o relati ve ly  c on ser vativ e  revisio ns , a nd  ri ght n o w, the  DSM- 5 is  u nd e r c onstruc t io n .  Sad ly ,it i s c le ar th at t h e o ptimist ic predic tio n s of  R ob ins and  Guze have no tbeen reali ze d.
Fourd e cades af ter their seminal paper ,  thereare  stil l no  widely v ali datedlab o ratory  tests  foran y c o m mon m e n ta l i ll ness. Wors e ,  an  enor mo us n umber o f family and genet i c s tudies have n otonly f ai led to val id a tet h e major DSM dis orders asna t ur al kinds,b utin stead h ave sug geste d  that t hey are m ore akinto  chi m a era s. Unfortu nately f or the mu l titud e sstric ken  withme nta l ill ness,t hebrain  has n ot  given  up i ts  secrets  easily.

That is not t o saythatwehave made  no pro gress. DN A re search has  be gun  to i llu m inate  the co mpl e x gen etic s  of menta l  i lln e s s.  But what i t t ell s us,  Iw ould a rgue , is that, at lea s t for the purp oses o f r ese a rch,  t he current DSM  di ag n o ses do n ot  work. They  are too  n a rrow,  too r igid,altoget h e rt oo lim ited . R eorganiza tio no f the D SM  i s  hardl y apa nacea,  but s c ienc e cannot thrive if  inve s t igato r s a re fo rc ed into a co gnitive st raitjacket. 

Befo re t urnin g to th escient ifi cevidence o f  fundamen tal p roblems  w iththe  DSM,let’ s first  tak enot e of an i m p or t an tp rob lemthatth e cl assificat i on has p rod u ced for  c lin i c ians a n dp a tients ali ke:  An i n d ividual wh o  rec e iv e s a s ingleDSM di agnosis ver yoften m eet s criteriafor multi p lead diti onal dia gn oses  ( so- ca lled co-occurre nce or “ comorbid i t y”), a ndt he p a tternof  diagnoses o ftench a nges ov e r  th e lifes p an. 
 B._Guze, rejected_the murky psychoanalytic diagnostic_formulations of_their_time. Instead,_they_embraced a medical_model inspired by_the careful 19th-century observational_work of Emil_Kraepelin,_long overlooked during the mid-20th-century dominance of Freudian theory. Mental disorders were now to_be_seen as_distinct_categories,_much as different bacterial and_viral infections produce characteristic diseases_that can_be seen as distinct “natural kinds.”

Disorders, Robins and_Guze_argued, should be_defined based on phenomenology: clinical descriptions validated by long-term_follow-up to demonstrate the stability of_the diagnosis over_time._With_scientific progress, they expected_fuller validation of mental disorders to_derive from laboratory findings and studies_of familial transmission.

This descriptive approach to psychiatric_diagnosis -- based on lists of_symptoms, their timing of onset,_and the_duration of illness -- undergirded_the American Psychiatric_Association’s widely_disseminated and highly_influential Diagnostic and Statistical Manual of_Mental Disorders, first_published in 1980. Since then, the_original_“DSM-III” has yielded_two_relatively_conservative revisions,_and right now,_the_DSM-5 is_under_construction. Sadly, it is clear that_the_optimistic predictions of Robins and Guze have_not been realized.

Four decades_after_their seminal paper, there_are still no widely validated_laboratory tests for any common mental_illness. Worse,_an enormous_number of family and genetic studies have not only failed to_validate the major DSM disorders as_natural kinds, but instead_have suggested_that_they are more_akin_to chimaeras._Unfortunately for the multitudes stricken with mental_illness, the_brain has not given up its_secrets easily.

That is not_to_say that we have made no_progress. DNA research has begun to_illuminate the complex genetics of_mental_illness._But what it tells us,_I would argue, is that, at_least for the_purposes of research, the current DSM diagnoses_do_not work. They are too narrow,_too_rigid, altogether too limited. Reorganization of_the_DSM_is hardly a panacea, but_science cannot thrive if investigators are_forced into a cognitive straitjacket.

Before turning to the scientific_evidence of fundamental_problems with the DSM, let’s_first_take_note of an important problem that the classification has produced_for clinicians_and patients alike:_An individual who receives a single DSM diagnosis very often_meets criteria for multiple additional diagnoses (so-called_co-occurrence or “comorbidity”), and the pattern of diagnoses often changes over_the lifespan.