I find it disturbing if people believe objective measures are not possible in psychiatry, due to a lack of biomarkers. There seems no will to understand.
Its worse than that. There is a reason the US government had to do a report on biomarkers - even in the NIH people did not understand what a biomarker was.
ME has no
diagnostic biomarkers. However a biomarker is just a statistically significant biological abnormality. We have thousands. Its just that not every biomarker is unique, nor does every potential patient have the same set of markers. For example, going from comments by Ron Davis, ME has lots of biomarkers in common with sepsis and African sleeping sickness. We probably cannot use any of those diagnostically, though I suspect otherwise, because they are not unique to ME. I suspect otherwise because it would take someone very un-astute to fail to distinguish between sepsis, African sleeping sickness and ME.
Another type is outcome biomarkers. I am increasingly concerned that medical science goes astray when it locks onto some outcome marker prematurely, like blood glucose in diabetes for example. Its an important marker, but may not be the most important marker, especially when considering long term outcomes. For example, I recently became aware that its highly unlikely that insulin resistance has anything to do with inability for cells to take up glucose as a primary problem - that is secondary. The concentration of glucose inside muscle cells in diabetics is so high that if it was a blood concentration they would be dead. Stone cold dead. Yet we often give insulin to force even more glucose into the cells. (I have not seen data on other cell types, but I presume, at this point, it would be similar, though there are probably other critical cell types that need that blood glucose, such as nerve cells.)
So lets take major psychiatric disorders, like depression. There are lots of biological abnormalities in depression. With work they might use those markers to create some kind of assessment of a depressed patient. Other psychiatric disorders might have no markers, or at least nothing we can find. That is because they are not proper medical diagnoses, but are probably part of a psychiatric cultural phenomena. Like the attempt, which I think failed, to make PMS a psychiatric disorder. They could not find anything other than the known biological mechanisms. What is or is not a psychiatric diagnosis is a limited consensus decision, not an objective reality.
ME has oodles of markers. They are not useful diagnostically, though at least a couple of markers are under current investigation. My understanding of many so called functional disorders, like IBS for example, there are also a great many biological abnormalities. We just don't understand the mechanisms fully.
Once we have a good understanding of mechanisms in any specific diagnosis I suggest we will have diagnostic biomarkers. However once we do that then the psychiatric component of a functional disorder is done with. It becomes a biological dysfunction, not a psychiatric one. I have yet to see any proof, ANY proof, that even one psychiatric disorder is not biological. That is an assumption based on a lack of evidence of biological causation, just as with the old views of diabetes, asthma, heart disease and cancer. Do we put those patients under only psychiatric care these days?
Patients with what we currently call psychiatric disorders deserve better science than they are getting.
