The subjective nature of psychiatric diagnosis

Medicalising natural and normal responses to life experiences is a dangerous game.

This may be the year that makes you mad. A new psychiatrist’s bible will be published in May and already it’s mired in controversy. Many see it as a pretext for scandalous over-diagnosis and drug-pushing.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, has enormous influence in shaping the way mental health research is carried out worldwide. It was first published in 1952 and the most recent edition appeared in 2000. It has taken over 12 years to agree on the contents of the fifth edition, DSM5.

One problem that people have with DSM5is that it will be oldfashioned: it will make no attempt to link behaviour or feelings to what is known about the physical states of the brain, in an era when neuroscience has made enormous advances in relating physiological issues with behavioural issues.

Take grief. Functional magnetic resonance imaging (fMRI) studies show that grieving people have higher activity in various regions of the brain, including the cerebellum and the posterior brainstem. We’ve all seen the results of this in ourselves or others: low mood, low motivation, loss of appetite.

Here’s the next problem: DSM5 will make it easier to medicalise natural human experience. After the new manual is published, psychiatrists will be able to diagnose people who have had two continuous weeks of this as suffering from depression, even if they are recently bereaved. What was normal behaviour last year will become a medical crisis.

The British Psychological Society and the American Psychological Association are among the mental health organisations that have raised concerns about such moves. Medicalising natural and normal responses to life experiences is a dangerous game. So far, more than 14,000 people have signed an open letter to the team drafting DSM5, expressing concern about some of the proposed changes “that have no basis in the scientific literature”. The letter argues that the changes “pose substantial risks to patients/clients, practitioners and the mental health professions in general”.

The pharma says

Particularly vulnerable, they argue, are children and the elderly. That’s because they are most at risk of having pharmaceutical solutions – many of which can have severe adverse side effects – foisted on them. And there’ll be more people and more conditions for which to prescribe drugs. DSM5 will lower the threshold of what it takes to get diagnosed with a disorder and will offer some new disorders, such as “disruptive mood dysregulation disorder”, a diagnosis for children who exhibit temper tantrums and get upset out of proportion to a situation.

Each positive diagnosis will be a candidate for drug treatment, which makes it particularly worrying that a study published in March last year identified strong ties between the pharmaceutical industry and those drafting DSM5.

The subjective nature of the psychiatric diagnosis has always been a problem. Freud knew this but his 1895 attempt at a “project for a scientific psychology” failed miserably. Back then, science had told us very little about the physiology and function of the brain. In 2013, it has revealed a lot more but there are still far too many gaps to claim that subjective analysis is redundant. Neuroscience is advancing fast; let’s hope we won’t need DSM6.

Michael Brooks’s “The Secret Anarchy of Science” is published by Profile Books (£8.99)

The new psychiatrist's bible is seen by many as a pretext for drug-pushing. Photograph: Getty Images

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 07 January 2013 issue of the New Statesman, 2013: the year the cuts finally bite

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Can Trident be hacked?

A former defence secretary has warned that Trident is vulnerable to cyber attacks. Is it?

What if, in the event of a destructive nuclear war, the prime minister goes to press the red button and it just doesn't work? 

This was the question raised by Des Browne, a former defence secretary, in an interview witht the Guardian this week. His argument, based on a report from the defence science board of the US Department of Defense, is that the UK's Trident nuclear weapons could be vulnerable to cyberattacks, and therefore rendered useless if hacked. 

Browne called for an "end-to-end" assessment of the system's cybersecurity: 

 The government ... have an obligation to assure parliament that all of the systems of the nuclear deterrent have been assessed end-to-end against cyber attacks to understand possible weak spots and that those weak spots are protected against a high-tier cyber threat. If they are unable to do that then there is no guarantee that we will have a reliable deterrent or the prime minister will be able to use this system when he needs to reach for it.

Is he right? Should we really be worried about Trident's potential cyber weaknesses?

Tangled webs 

The first, crucial thing to note is that Trident is not connected to the "internet" we use every day. Sure, it's connected to the main Ministry of Defence network, but this operates totally independently of the network that you visit Facebook through. In cyber-security terms, this means the network is "air-gapped" - it's isolated from other systems that could be less secure. 

In our minds, Trident is old and needs replacing (the submarines began patrolling in the 1990s), but any strike would be ordered and co-ordinated from Northwood, a military bunker 100m underground which would use the same modern networks as the rest of the MoD. Trident is basically as secure as the rest of the MoD. 

What the MoD said

I asked the Ministry of Defence for a statement on Trident's security, and while it obviously can't offer much information about how it all actually works, a spokesperson confirmed that the system is air-gapped and added: 

We wouldn't comment on the detail of our security arrangements for the nuclear deterrent but we can and do safeguard it from all threats including cyber.

What security experts said

Security experts agree that an air-gapped system tends to be more secure than one connected to the internet. Sean Sullivan, a security adviser at F-secure, told Infosecurity magazine that while some hackers have been able to "jump" air-gaps using code, this would cause "interference" at most and a major attack of this kind is still "a long way off". 

Franklin Miller, a former White House defence policy offer, told the Guardian that the original report cited by Browne was actually formulated in response to suggestions that some US defence networks should be connected to the internet. In that case, it actually represents an argument in favour of the type of air-gapped system used by the MoD. 

So... can it be hacked?

The answer is really that any system could be hacked, but a specialised, independent defence network is very, very unlikely to be. If a successful hack did happen, it would likely affect all aspects of defence, not just Trident. That doesn't mean that every effort shouldn't be made to make sure the MoD is using the most secure system possible, but it also means that scaremongering in the context of other, unrelated cybersecurity scares is a little unjustified. 

Barbara Speed is a technology and digital culture writer at the New Statesman and a staff writer at CityMetric.