In what may well come to be seen as epoch-marking moment, the USA’s National Institute of Mental Health has effectively ditched DSM and its symptom-based approach. As the Director says in his blog, “Patients with mental disorders deserve better.”
As long ago as 2008 The New York Times pointed out that the imprinted brain theory “provides psychiatry with perhaps its grandest working theory since Freud, and one that is founded in work at the forefront of science.” And, anticipating the new stance of the NIMH, The New York Times also noted that “The theory has no use for psychiatry’s many separate categories for disorders, and it would give genetic findings an entirely new dimension.”
And not just genetics, but psychiatry itself. According to the diametric model of the mental illness, mentalism—our innate ability to understand our and other people’s behavior in mental terms such as intention, emotion, and meaning—varies along a continuum stretching from autism to psychosis. Autistic spectrum disorders (ASDs) show symptomatically deficits in mentalism, sometimes with compensations in mechanistic cognition (the ability to understand the physical world epitomized in science, technology, and maths). Psychotic spectrum disorders (PSDs) are the opposite: symptomatically hyper-mentalistic, with endophenotypical deficits in mechanistic cognition. If this is so, then normality and sanity are obviously the outcome of balanced, centralized cognition: enough to understand yourself and other people in mental terms, but not so much as to make you paranoid or so little as to make you autistic.
But another obvious implication is that psychiatry too should be a centralized, mentalistically balanced form of cognition—after all, what is psychiatry if not the scientific epitome of sane understanding? And with the benefit of hindsight, it is now easy to see that in the twentieth century psychiatry never achieved such a balanced, sane state of mind. On the contrary, the first half of the century was dominated by the emergence of psychoanalysis on the one hand and by behaviorism on the other. Described in diametric terms, psychoanalysis looks like institutionalized hyper-mentalism, thanks to its mentalizing of unconscious brain mechanisms and mania for finding meaning in everything from dreams to slips of the tongue—not to mention its erotomanic sexualization of childhood and paranoid portrayal of the family in the Oedipus complex.
Behaviorism, by contrast, institutionalized the hypo-mentalism of autism in its denial of the mind and refusal to countenance mental terminology in scientific explanation. And if behaviorists are implicit autistics, leading authorities pointed out that autistic children are natural behaviorists.
Although many attempts were made during the twentieth century to find some stable center between these extremes, none really succeeded, and even though cognitive behavioral therapy emerged as the best therapeutic technique, it lacked its own distinctive paradigm and remained hopelessly eclectic as far as basic theory was concerned. And no twentieth-century theory ever addressed the really fundamental issue of how DNA, development, and the brain accounted for behavior—let alone mental illness.
But the imprinted brain theory—born, appropriately enough, at the turn of the century—does do this. Indeed, the theory clarifies mental illness as being nothing more than deviation from the normal range of mentalizing, either in the autistic or psychotic direction. And as far as DNA, development, and the brain are concerned, the theory proposes that it is variations in the expression of genes during brain development that explains where a person’s cognitive configuration ends up on the mentalistic continuum, with environmental factors contributing to the extent that they replicate, resemble, or reinforce such effects.
The imprinted brain theory’s own cognitive configuration is strategically centralized to the extent that it distinctively recognizes both mentalism and the mechanism of the mind, and balances ASD against PSD in its diametric model of the mind and of mental illness (below).
Psychiatry has oscillated between the hyper-mentalism of psychoanalysis and the hypo-mentalism of behaviorism for long enough. The time has come for it to settle where the diametric model already sits: strategically in the middle, with the benefits of both and the disabilities of neither thanks to being not only the grandest but also the most balanced working theory since Freud.
(With thanks to Jonas Forare.)