So you’ve got the “traditional” psychiatric community on the left that engages, to some degree, in the “talking cure” whereas, on the right you have the neurophysiology that underlies those terms and have a tangible physical existence within the brain. The problem is that gap between the left side and the right side, the concepts, the terminology that explains the lived experience – the phenomenology – on the left and how it is translated into (and how it translates in the other direction) from the phenomenon to the neurophysiology and back. Forget, for a moment, about dopamine and stuff because, bottom line is, I don’t feel dopamine. I feel happy, sad, joyful, sad and so on. Yet we know that the physiology maps to the phenomenon and vice-versa. (next page)
Dr. Parker looks at this issue in his post “Psychiatric Diagnostic Labels: Functional or Static?” There are those within the psych community and its hierarchy, as Parker notes, that are resisting the changes needed to incorporate the latest research and to “map” that research to the categories. As Doc points out, even with 20 plus years of research and peer reviewed and replicated data, there is still an enormous resistance to incorporating these findings into the DSM. What’s needed, as he points out in his conclusion, is “DSM 5 should include biologically available grids that match with office symptoms and evidence.”
There are three issues that need to be dealt with.
1. There is always a tendency for people and institutions to protect their knowledge and with it, the power that comes from that knowledge. “Truth” has nothing to do with it. So we have the traditional community protecting its power (knowledge).
2. We have the alternate community, represented by Doc Parker and others, who are looking beneath the surface to see, what is it that is REALLY going on here and how can we create treatments that deal with the “problems” as they manifest themselves, not as happiness or sadness, but as changing levels of X which are effected by receptors of Y, and so on. How can we help people by dealing with the physiology of the problem.
3. The problem that is being faced, and that needs to be overcome, is how to take the static nature of the diagnostic labels, as Doc points out in the title of the post, and make them functional. But actually, the problem is bigger than that and was hinted at when Doc used the word “grid.” How can we have a gird that brings together the understandings of “1″ above with the findings of “2″ above?
I believe the answer is something like the following: (see next page)
We need the equivalent of three dimensional chess. The bottom most level is, say, the neurophysiological level. The top most level is sadness, happiness. That middle level acts as the transposition layer between the two. It’s the next evolutionary step in the understanding of how mind/brain translates[,] interact[s]. So Doc Parker suggestion of having that grid in DSM 6 [Editor's note: Parker said DSM 5] and having a more open, fluid system that allows for information to change, dynamically, as new information becomes available, would seem to be a vital step forward. You need to have both the current descriptions of ailments – in words, that is – and physiological description of the same to coexist for a time so that ongoing practice and research can refine it over time and help with [the] missing middle level. But as Doc points out, you must allow for more fluid, more dynamic change to the definition and understanding. You probably need a peer-reviewed psychiatric Wikipedia that can be updated with the latest research at any time.