Frances's concerns definitely aren't wrong on the whole, but I feel like he's not seeing the forest for the trees. This ultimately isn't just a question of whether this or that DSM revision is helpful. The patterns of the mental health establishment of the 21st century are oddly reminiscent of where physics and chemistry stood ca. the mid-19th century. Legitimate advances are being made, but most of the tools are sti…
> It's not a great situation, and I don't see many signs that it's improving. I think this is a little too pessimistic on the one hand, and very accurate on the other. On the accurate side: this discipline took one of the most significant hits from the replication crisis, and was one of the most resistant to acknowledging and changing practices. Everyone should keep pushing for open science and preregistered studies…
That definitely does happen, but so far it happens glacially, I assume because doing groundbreaking neuropsychiatric research is considerably harder and more expensive work than "evergreening" existing drugs or reading stuff like Meditations and Walden Two [1] while sipping expensive wine and then pulling an allegedly-modern psychosocial theory out of one's nether regions. My current favorite reference point is anti-NMDA-receptor encephalitis, a (class of?) autoimmune condition that was only definitively identified ca. 2007. One must assume that there are centuries of breathless accounts of "demonic possession" or "latent schizophrenia" or people who were "on drugs" (colloquially often referring to effects of heavy doses of ketamine, PCP, and other potent deliriant/dissociative agents, which tend to be NMDA antagonists) that are probably explained by this condition. And who can say what percentage of today's "schizophrenics" have arrived at a similar place along an as-yet-unidentified path?
[1] Not to say those works aren't worth reading; they're iconic for legitimate reasons. I'm just saying that context and proportionality matter in ways that are often conveniently ignored.