This announcement was greeted with wailing and gnashing of teeth. More money going to basic brain-based research would mean less money going to research on treatments for people with existing diagnoses. The wailers and gnashers also claim that a more scientific approach to mental illness would replace humanistic approaches.

Personally, I think a better understanding of what is happening inside my brain might protect me from the pain and suffering caused by my having been slotted into the wrong symptom silo. The National Alliance on Mental Illness’s Peer to Peer class devotes one session to people identifying their diagnosis. This exercise invariably turns into an accounting of a series of diagnoses, along with a history of medications that were ineffective and/or dangerous. What could be more humane than abandoning a system that isn’t working in favor of a more promising direction?

So, how do we get from a public DSM book-burning to a new, biologically informed system to describe mental illnesses? That’s a long journey, and there are many steps on the way. 

1. How about we start with universal health care? If we don’t need insurance, then we don’t need insurance codes. If we don’t need insurance codes, we can start treating people’s pain instead of their diagnoses.

2. Give the disciplines of psychology and psychiatry each its own diagnoses and treatment protocols. Psychology is primarily a relational discipline and treatment modality. Psychiatry addresses physical processes with technical means, medication and those things they do with electricity and magnetism. Most conditions fall under both fields. As now, these conditions will be treated concurrently, though under different diagnostic schema and with different treatments.

3. Turn the diagnoses of psychology into a narrative-based system, asking the question, What happened to you? The goal will be to heal trauma, develop coping mechanisms for continuing effects, and learn management skills for brain dysfunctions. Current examples include: DBT (dialectical behavioral treatment), CBT (cognitive behavioral treatment), and IPSRT (interpersonal social rhythms therapy).  A branch of NIMH will continue to study which of these and others are “evidence-based,” and how they do indeed remediate certain brain dysfunctions. 

4. Work toward a brain-dysfunction-based diagnostic system for psychiatry. What is actually going on inside the skull, the circuits, the chemistry? Give it new names like Executive Function Dysfunction, Flattened Cortisol Curve, Wonky Wiring… Forget the symptom silos that lump together those with hypersomnia and those with hyposomnia. Forget funding the search for one pill to fix them both. Can TMS (transcranial magnetic stimulation) switch on circuits that don’t currently [sic] work well? How can we best stimulate BDNF (brain-derived neurotrophic factor) and what are the downstream consequences when we do? Where does inflammation come from/what does it do/how can we remediate its deleterious effects?

5. Where do the pills come in? Oh dear, where do the pills come in? Sure – We still need the pill pushers. They will be the psychiatrist/practitioners, applying what the psychiatrist/researchers discover, as the system works now, but presumably with better results that target specific brain issues rather than the current rickety constructs.

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The pushback against my modest proposal will come from DSM IV fans and the folk they can gin up with their hysteria – the same folk who made it impossible for DSM-5 revisers to do their job. Well, they’ll be dead soon.