Do psychiatrists even know what they are doing?

Serious flaws in the way doctors classify psychiatric disorders have sent drug development way off track, two scientists assert in a paper in the British Medical Journal

As seen in this news report one of the scientists puts it this way:

"We need to take all of our copies of the DSM and throw them into the sea," cries Edward Shorter, lead author of the article and a professor of the history of medicine at the University of Toronto in Canada. "There are such fundamental flaws that the whole thing needs to be rethought. We need to have indications that correspond to natural, underlying disease processes."

The research paper has this take on who defines the diseases in the first place:

Who defines psychiatric diagnoses?

Officially, diagnostic decisions are made through scientific consensus by the World Health Organization and the American Psychiatric Association. Small committees of experts decide whether, for example, schizophrenia is one disease or several, and the process of decision making should be transparent and based on good scientific evidence. But sometimes the evidence is poor and influenced heavily by the pharmaceutical industry. The industry exerts a major influence through publication of sponsored supplements to journals, which are often poorly peer reviewed and promote unapproved treatments.8 Such supplements are particularly common for drugs for anxiety and depression as these are the most common treated conditions. Worldwide sales of antidepressants dwarf sales of drugs for all other psychiatric disorders.

Industry is said to prefer the disease based approach of DSM-III to any dimensional approach to illness definition. This is because the separate DSM-style diseases represent tidy diagnostic market niches. Every new diagnosis represents a new licensing opportunity. Companies only have to show the effectiveness of an existing drug over placebo for the new diagnosis in large clinical trials. This is expensive but not difficult if the same methods can be used as for previous studies with the old diagnoses.

But the basic symptom for all this is seen as the lack of speedy development of more drugs, instead to acknowledging the more fundamental problem:

Ultimately, the same original problem returns: deficits in the understanding of the basic science of psychiatric disorders. Both the DSM and drug developers are hampered by the same deficiency. In other words, they don't know what they're doing.

Of course, the news article tries to end on an upbeat note for psychiatry. Almost sounds like whistling in the dark.