ABSTRACT
This chapter will trace the history of diagnosis in psychiatry, an effort marked by often inconsistent and contradictory conceptual models that led us to the DSM-III in 1980 and the DSM-5 in 2013. Unfortunately, the DSM-5 failed to reach the goal of a transcendent diagnostic system based on pathophysiology, despite 60 years of biological research. The lack of a research database is secondary, at least in part, to the faulty diagnostic system itself. DSM spawned the concept that mental disorders are disease entities, with boundaries separating one disorder from another―despite DSM-III clearly stating that the boundaries are vague, as is the separation of mental disorders from normality―a status never defined by the DSM. Despite growing evidence that mental disorders are not separate entities, regulations have required that medications be aimed at specific disorders. It is clear that psychiatric diagnoses should be based on a dimensional system, but that move has met resistance, despite the fact that genetic studies have undermined the model of specificity of disease and treatment. Yet some have found that machine learning involving deep neural networks has discriminated schizophrenia from normal controls. Will big data enable the development of precision medicines for mental disorders?
