Around three years ago Andy Field and I, with the help of a number of very valued friends, created a new Experimental Psychopathology journal. Our reasons for doing this were that we thought that experimental psychopathology was being unnecessarily squeezed out of clinical psychology journals, was undervalued as a research approach to understanding mental health problems, and – perhaps rather sadly – was being eclipsed by large-scale biologically-oriented approaches to mental health – particularly many crassly descriptive neuroscience approaches, large-scale, multi-authored psychiatric RCTs based around a small number of privileged clinical research centres, and piece-meal genetic research utilizing a small number of extensive, but probably valuable, databases.

Doing the latter kinds of research is surely important, and allows researchers to publish in a range of primarily psychiatric journals with high impact factors. But experimental psychopathology was getting unnecessarily marginalized – especially because many Psychology Departments were being seduced by the hype of psychiatry, medically-relevant research, genetics, and the high impact value of research that could be published in medically-related journals.

Interestingly, last week I was a discussant in a symposium about perseverative psychopathologies (pathological worrying and depressive rumination) at the Annual Conference of the British Association of Behavioural & Cognitive Psychotherapies (BABCP). I ended up making two particular points:

(1) That it was so nice to see four papers that were looking specifically at the mechanisms of perseverative thought – what were the processes that led someone to begin a worry bout, perseverate that bout, feel increased distress through that bout, and then end it without feeling better? My point was that if you could understand the mechanisms that underlay a single bout of worrying, you would probably understand everything you needed to know in order to begin helping someone who was a pathological worrier. This is not something that I could easily believe that either genetic or neuropsychological approaches would have much to say about in the first instance.

(2) Sadly, those approaches to mental health research that have stayed outside the medical approach have over the last 15-20 years themselves become insular. Not that they don’t have journals to publish in – they have many of them. What is so depressing is that they have ended up creating their own incestuous and confused approach to mental health research. I have to admit that I am not a clinical psychologist – I am an experimental psychologist who for many years now has enjoyed using the various research skills I was trained with to study psychopathology. But I am always dismayed by the fact that clinical researchers continually attempt to re-invent wheels very badly. Much of the information we need to understand how mental health problems develop, are maintained, and can be treated is already there in the core psychological literature – and is entirely ignored by clinical psychology researchers who are happy to create idiosyncratic clinically-experienced based models of psychopathology that would take your average psychologist many decades to comprehend. This incestuous approach is compounded by the fact that clinical psychology journals continue to restrict their scope in ways that mean that clinical psychology researchers will only ever get exposure to the imperfect and insular research perpetuated by these journals.

And as a consequence, experimental psychopathology gets squeezed. But one of the uplifting aspects of our experience of creating and publishing an Experimental Psychopathology journal is that experimental psychopathology is clearly appreciated as an approach to researching mental health problems in a number of countries, especially European countries such as The Netherlands, Belgium, and Germany, and also countries like Australia and Canada. I would hope that we can push forward and convince researchers that experimental psychopathology is a highly valuable methodology for understanding mental health problems in a way which elaborates underlying psychological and cognitive mechanisms, which utilizes core psychological knowledge and which has direct relevance to treatment.

But sadly, we have to create the journals in which to publish this research, we have to make it clear that clinical psychology research is not just about medicine, we have to explain that understanding mental health problems will require us to understand the moment-to-moment processes that operate during psychopathology (and not just the genetics or neuroscience of psychopathology), and we have to convince universities that good mental health research is not simply stuff that is medical, generated by large research consortiums with privileged access to databases or client groups, or is restricted to expensive neuroscience procedures that simply light up bits of brain. We also have to convince a rather large group of clinical psychology researchers that their discipline will neither progress academically nor make inroads into the tight grip that psychiatry has over mental health without them making good use of an existing and well researched core psychology literature.

I’ve just spent the last six months researching and writing the second edition of my Psychopathology text book – and I’ll probably be doing this for the next six months as well. I’ve included DSM-5 diagnostic criteria in the book – if I didn’t then it almost certainly wouldn’t be in the slightest bit competitive in the “Abnormal Psychology” textbook market. But I’ve attempted to be critically evaluative of DSM-5 wherever I can, and included a section specifically devoted to criticisms of the DSM developmental processes itself.

However, this led me to thinking about the value of current psychiatric diagnostic criteria. I got my copy of DSM-5 within days of it being published (all £88-11p of it). I was struck immediately by how similar it looked to DSM-IV-TR – except for the fact that they’d used an Arabic instead of a Roman suffix – very contemporary, and highly likely to be attractive to the youngsters. First, I couldn’t help but be impressed by how easily I could mistakenly pick up DSM-IV-TR and believe it to be DSM-5. How long did DSM-5 take to develop, and how much money did it cost?

Anyway, that’s not the point of this piece. It’s about whether research on diagnostic criteria are converging or diverging. That’s important because there is currently a desire to prioritize harmonization of ICD-11 and DSM-5. Let’s not forget that DSM-5 as published is still very much an arbitrary set of diagnostic criteria only very loosely based on biological and psychological evidence – that is clearly reflected in the move in DSM-5 to spectrum-based disorders. Writing an “abnormal psych” textbook is very instructive, because you’re not only writing about diagnostic criteria you’re also reviewing all the evidence on etiology as well – and very often the two just don’t match up!

Almost all Abnormal Psychology textbooks have etiology sections that cover biological, psychology and, sometimes, sociological explanations of almost every psychopathology. Yet trying to reconcile these different etiological approaches with the simplistic diagnostic criteria in DSM-5 is almost impossible. Given the (supposedly) lucrative market for Abnormal Psychology textbooks, there has been a frenzy to align these books with DSM-5. The 12th edition of Wiley’s Kring et al. Abnormal Psychology textbook even preceded DSM-5 and attempted to predict what the new diagnostic criteria would be!

But the more I research the etiology of individual psychopathologies for the second edition of Psychopathology, the more I realize that DSM-5 is a fabrication that is entirely remote from the diverse research being undertaken on all psychological disorders. Schizophrenia spectrum disorders is a good example. There is a growing wealth of knowledge about the neuropsychology of schizophrenia as a diagnostic category. There is also a growing wealth of knowledge about the psychological processes that give rise to cognitive biases contributing to psychotic symptoms. None of this is apparent in any of the words I read in DSM-5. I would hesitate to say this, but I think I would have a better idea of being able to spot and understand a “schizophrenia”-related disability from reading the literature on schizophrenia etiology research than I would ever have from reading the DSM-5 diagnostic criteria.

There is no doubt that DSM-5 is a poor guide to “understanding” psychiatric disorders – anyone who reads it will get very little insight into what it is like to experience a mental health problem and even less insight into what causes that problem. So is DSM-5 simply a load of very eminent psychiatrists exercising their intellectual muscle to force us all to fit into rather simplistic mental health boxes (and also an attempt by them to impress their more traditional medical compatriots)? And for who’s benefit? Well, as I understand it, much of this is for the benefit of the US health insurance market. So is this why we should have a deliberate convergence of diagnostic mental health criteria when such criteria are currently sketchy and arbitrary?

Don’t get me wrong. It’s important that researchers and practitioners collaborate to further knowledge and diagnostic criteria. But to believe that we are already at a point where we can begin to converge different worldwide diagnostic criteria is frighteningly premature. The development of diagnostic criteria for mental health problems has been a process that has been overseen by medics for far too long – not just in the APA but also in the World Health Organization. Mental health problems are not simply medical problems, many of them are problems stemming as much from ways of thinking and from socio-economic status as they are from medical dysfunction. Yet there is an alarming desire to align DSM with neuroscience – and not with psychology and nor with the socio-economic factors that give rise to many common mental health problems. Wouldn’t it be interesting at this stage in our knowledge development to see different attempts to consolidate diagnostic criteria take their own independent routes rather than deliberately converge as a matter of international medical policy?