Talitha Stevenson’s Book Review in the Financial Times newspaper (“Mind field”, Life & Arts, May 24) shed much need light on the release of the DSM V, and the ensuing national dialogue about psychiatry and its definitions of mental illness. As a Clinical Professor of Psychiatry, practitioner of Whole Psychiatry, and certified Psychopharmacologist, I propose a companion, if not an alternative to the DSM V.
The authors of the DSM V have been searching for clear diagnostic labels to the point of absurdity. I suggest that we psychiatrists abandon this obsession with categorizing every aspect of the human suffering. It is time to discard the unfounded and close-minded assumption that mental and emotional illnesses are primarily caused by abnormal functioning of brain nerve cells, when, for example, we know that the brain has more immune cells than nerve cells. The current outdated concepts perpetuate the excessive reliance on side-effect laden medications as the solution to mental problems. The basic sciences have proven that all brain functions—cognitive, emotional and vegetative functions, like sleep and appetite, are inseparable from a diverse set of bio-psycho-social systems—from the immune and gastro-intestinal systems, to the economy, community and culture. Psychiatrists need to be open to knowledge from fields such as epigenetics which demonstrate that genes are not destiny; rather, we have the power to turn our genes on and off, for better or worse, through lifestyle choices. We must recognize that all the systems which affect mental health, are also at the root of many common chronic physical illnesses. Diabetics, for example, are more likely to also have a psychiatric disorder, such as depression, and visa versa.
Patients would benefit greatly if clinicians and researchers focused on antecedents of chronic illness (e.g., genetics, childhood stress, socio-economics, nutrition), triggers (e.g., job loss, divorce), and the factors that mediate illness (e.g., hormones, cytokines, family systems). Via a thorough history, physical exam, and laboratory testing one can identify the systems involved in maintaining illness, and develop a personalized treatment plan based on hard data. This reduces supposition and medication trials, and replaces the current simplistic belief that diagnostic labels point the way to the treatment.