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mood.)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain (e.g., a change of more than five pounds of body weight in a month), or decrease or increase in appetite nearly every day.
Insomnia or hypersomnia (sleeping too much) nearly every day.
Psychomotor agitation or retardation nearly every day.
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide.
There are even subtypes of depression such as mild, moderate, and severe, with and without psychotic features, chronic, catatonic, melancholic, atypical, and more outlined in a similar manner.
And there are literally thousands of different distinctions like these made for the major “mental diseases” cataloged in the
DSM-IV
. They include disorders of childhood, delirium, dementia, or cognitive disorders, substance abuse disorders, schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, personality disorders, eating disorders, and sleep disorders.
But this description of depression (and of all the other mental disorders in the
DSM-IV
) is
only
of the symptoms we observe. These descriptions tell us nothing at all about
why
those symptoms occur, or how people with
exactly
the same symptoms may have them for many different underlying reasons and need different and individualized treatment as a result.
At a recent dinner for Research! America (an advocacy group for research and dissemination of research) in Washington, D.C., I sat with the surgeon general and the director of the National Institutes of Mental Health, Thomas Insel, M.D. The discussion around the dinner table focused on the limitations of our current approach of breaking down the body into its component parts to understand how things work.
I asked Dr. Insel what he thought of the
DSM-IV.
He said that it has 100 percent accuracy, but 0 percent validity—that it provides a perfect way to describe symptoms, but has nothing to tell us about the underlying biology for what causes them.
He proposed a new model of psychiatry, called “Clinical Neuroscience,” which would encompass the entire spectrum of things that affect the mind and the brain. We discussed the need for the medical establishment to move beyond its current limited model of diagnosis (both in psychiatry and the rest of medicine). It no longer reflects the science or our understanding of how the body works.
The future of medicine is personalized treatment, not “one size fits all.” The outdated method of naming the disease and then assigning a drug to fix it clearly isn’t working.
Unfortunately, few in the medical industry today seem to understand this. The truth is that medical practice is virtually predicated on the myth of diagnosis.
I want to help you understand how serious this problem is, because it is the basis of everything I am explaining in this book. It is not trivial because it changes
everything
about how we think about disease and what to do about it.
There is a two-volume book medical professionals use called the
ICD-9
(
The International Classification of Diseases
). It is the bible of medical diagnosis. It is the system used by medical insurance companies and Medicare to decide who gets paid. Doctors have to “name” the disease they are treating based on the
ICD-9
to collect their money from these agencies!
The book contains the name of every single disease known. There are more than 12,000 diseases listed. The
ICD-9
gives the impression that all these diseases are separate and distinct.
There is only one problem. They are not.
A very few
Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
Significant weight loss when not dieting or weight gain (e.g., a change of more than five pounds of body weight in a month), or decrease or increase in appetite nearly every day.
Insomnia or hypersomnia (sleeping too much) nearly every day.
Psychomotor agitation or retardation nearly every day.
Fatigue or loss of energy nearly every day.
Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Diminished ability to think or concentrate, or indecisiveness, nearly every day.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt, or a specific plan for committing suicide.
There are even subtypes of depression such as mild, moderate, and severe, with and without psychotic features, chronic, catatonic, melancholic, atypical, and more outlined in a similar manner.
And there are literally thousands of different distinctions like these made for the major “mental diseases” cataloged in the
DSM-IV
. They include disorders of childhood, delirium, dementia, or cognitive disorders, substance abuse disorders, schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, personality disorders, eating disorders, and sleep disorders.
But this description of depression (and of all the other mental disorders in the
DSM-IV
) is
only
of the symptoms we observe. These descriptions tell us nothing at all about
why
those symptoms occur, or how people with
exactly
the same symptoms may have them for many different underlying reasons and need different and individualized treatment as a result.
At a recent dinner for Research! America (an advocacy group for research and dissemination of research) in Washington, D.C., I sat with the surgeon general and the director of the National Institutes of Mental Health, Thomas Insel, M.D. The discussion around the dinner table focused on the limitations of our current approach of breaking down the body into its component parts to understand how things work.
I asked Dr. Insel what he thought of the
DSM-IV.
He said that it has 100 percent accuracy, but 0 percent validity—that it provides a perfect way to describe symptoms, but has nothing to tell us about the underlying biology for what causes them.
He proposed a new model of psychiatry, called “Clinical Neuroscience,” which would encompass the entire spectrum of things that affect the mind and the brain. We discussed the need for the medical establishment to move beyond its current limited model of diagnosis (both in psychiatry and the rest of medicine). It no longer reflects the science or our understanding of how the body works.
The future of medicine is personalized treatment, not “one size fits all.” The outdated method of naming the disease and then assigning a drug to fix it clearly isn’t working.
Unfortunately, few in the medical industry today seem to understand this. The truth is that medical practice is virtually predicated on the myth of diagnosis.
I want to help you understand how serious this problem is, because it is the basis of everything I am explaining in this book. It is not trivial because it changes
everything
about how we think about disease and what to do about it.
There is a two-volume book medical professionals use called the
ICD-9
(
The International Classification of Diseases
). It is the bible of medical diagnosis. It is the system used by medical insurance companies and Medicare to decide who gets paid. Doctors have to “name” the disease they are treating based on the
ICD-9
to collect their money from these agencies!
The book contains the name of every single disease known. There are more than 12,000 diseases listed. The
ICD-9
gives the impression that all these diseases are separate and distinct.
There is only one problem. They are not.
A very few
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