Broadcast Retirement Network’s Jeffrey Snyder discusses delivering the best care to patients with Jim Van Os of the University Medical Center Utrecht.
Jeffrey Snyder, Broadcast Retirement Network
Well, Dr. Van Os, it’s so great to see you. Thanks for joining us this morning. Hi, good morning, Jeffrey, thanks.
Yep, thank you so much, and we appreciate, we know there’s a bit of a time difference between the East Coast of the United States and the Netherlands. We appreciate you accommodating our earlier start time. Doctor, you wrote a piece about the DSM manual.
It’s a manual that has been in place for over 70 years. It’s routinely updated, but you made a really important point about delivering the right standard of care. Does that really necessitate updating the manual, and is the manual still relevant, doctor?
Jim Van Os, University Medical Center Utrecht
Yep, thanks. So, you know, a good question. So I collaborated in bringing about the fifth edition of the DSM, and I was closely involved in it, so I know it very well.
And really what we are struggling with is that we really want to have something that helps patients. So diagnosis can be important in psychiatry if your diagnosis predicts what sort of care people need, and what sort of prognosis they will have. And after, say, 50 years of the use of DSM, the modern DSM, DSM 3, 4, and 5, we have discovered scientifically that it does not predict the care needs of the patients, and it does not predict prognosis.
And what’s more, we have not been able to, you know, to find specific causes of these 200-plus diagnoses in the DSM. And we haven’t been able to find specific symptoms or environmental risk factors. So you can ask yourself the question, you know, if we want to help patients, is a new version of the DSM, which is not going to change anything really, it’s just going to be more elaborate, and it’s going to take more time, is that what we really want?
Or do we want to perhaps rethink the whole diagnostic process with regard to mental health? That’s basically the big question.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, and look, I think here in the United States, probably where you are in the Netherlands, in Europe, mental health is a big challenge for many. There are probably a lot of people that are struggling in some way, shape, or form. Figuring out the best, and that’s not to say that what worked in the past won’t work in the future.
It’s about how do you optimize the delivery of care? I think your thesis makes a lot of sense. Maybe after 70 years, it’s trying to maybe think about a new model, a new way, maybe leveraging what we’ve learned in the past, because you don’t want to throw that all away, but maybe trying to create more of a hybrid, if you will.
Jim Van Os, University Medical Center Utrecht
Yeah. So I think, you know, that would be a very good idea because now after 50 years, we also have the voices of patients. And what they’ve been telling us really is that if you have a mental struggle, if you have mental distress, what happens is that you go through some sort of learning process.
You learn how to deal with the experiences in your mind. You deal, you learn how to cope and find your way and reorganize a meaningful life. And this is really the process they ask us to think about in terms of how diagnosis can help.
And perhaps diagnosis can help much more if you have a more like of a hybrid framework that involves both experiential knowledge of patients and practical knowledge from practitioners. And of course, the question is, what is really science in this? And the problem is that scientifically, we haven’t been able to come up with the scientifically valid diagnostic system for mental health.
So perhaps what we should try to do is just ask patients about their unique experiences, how they make sense of them, how they see, you know, the learning process of getting back their lives and try to organize a diagnostic process that helps them with their care needs and, you know, their daily struggles. And we’re a long way from that, frankly.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, you know, I think, you know, the point you’re making is very valid. You know, we live in a very different era than we did even 10 years ago. I wanted to ask you, as you contemplate kind of a new road and you and your colleague contemplated a new road and maybe leveraging the practical as well as maybe some of these diagnoses, this diagnosis manual, where does artificial intelligence and technology, does it play a part in what you’re describing?
Because in the popular press that I read, you know, people were talking, you know, mental health also comes, you know, there’s a lot of talk around chatbots and leveraging some of that technology to help people with some of their mental health. I think the jury’s still out on that, but does the technology in some way, shape or form help in what you’re describing?
Jim Van Os, University Medical Center Utrecht
Well, yes and no, in the sense that many of my patients make use of chatbots or they use ChatGPT or Claude or, you know, comparable programs. And just the other day I talked to a patient and she said, well, I spent like an hour a day talking to ChatGPT and receiving answers. And I asked her, do you really believe it?
And she said, no, but you know, it helps passing time and reorganizing my thoughts so that I’m better prepared, you know, for making decisions the rest of the day. And it also helps with my loneliness. But then the really complicated things like, for example, if you are tormented by hearing voices or you have severe anxiety or you have addiction, that is something that ChatGPT is unlikely to talk you out of because it’s much more complex and you need, you know, the complex human interaction, which is unpredictable and emergent and much more like flexible than ChatGPT can deliver because it is still not sentient, of course. And probably if you want to relieve mental suffering, you need a sentient other being to help you with that.
That said, you know, of course, AI is great in reorganizing and structuring clinical data. And it’s very helpful to us, the practitioners, doing that in our daily work. So definitely it has a role assisting us and it has a role assisting patients with loneliness and with answering practical questions, but still it won’t, I think, replace the therapeutic process.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, I guess my last question for you, doctor, I mean, I think there are a lot of valid points in what you’re talking about. Yours is a community of professionals. You’re part of the American Psychiatric Association.
They kind of have oversight, I think, for the DSM. So how do you take what you’ve described this morning and in your article with your colleague and effect meaningful change? So, you know, you’re not gonna get everything that you wanted, but things in life are very iterative.
So how do you take what you’ve developed and bring it to your community?
Jim Van Os, University Medical Center Utrecht
Yeah, well, exactly. So I agree with you entirely. It’s very iterative.
So what we’ve been doing for the last 15 years really is trying to entice whole regions in the country to enter into a process of transformation where we have a whole different new approach to mental distress. And which involves much more collaboration between social care, medical care, but also, you know, informal care and all kinds of other initiatives. And where we agree to let patients choose, you know, how they want to work with reorganizing their lives given their level of mental distress and how they want to work on reducing painful experiences like hearing voices and anxiety and addiction.
So make it less, you know, a one way traffic of a medical diagnosis and a medical formulation of mental distress and medications, et cetera. They’re still there, but it has become much more flexible allowing people to organize their own learning process. And I know this sounds a bit fake, but we’ve been actually been able to entice six regions in the Netherlands to work in that fashion.
And it’s very interesting that if you give people choice, they start to make use of different avenues and different ways of framing, of diagnosing and tackling mental distress, which can be very helpful. So this is quite different from the linear DSM medical guideline treatment model. It is still there, but only people make much more flexibly use of it and are also using other options.
So that is an enrichment, I think, which I hope we will be able to use in other parts of the world as well. I’ll certainly try to talk to the APA about this, see if we can do similar trials in other countries.
Jeffrey Snyder, Broadcast Retirement Network
Yeah, it certainly starts with maybe smaller, as you say, clinical trials. I’m not a scientist, but it seems like it would start there. But the world is, it’s not the same for all of us, meaning I process information probably a little bit differently than you and maybe other people.
And so maybe you need to add these, what I’m gonna describe as qualitative factors in the diagnosis process. Doctor, we’re gonna have to leave it there. Thanks so much for joining us.
And we look forward to having you back on the program again very soon, sir.
Jim Van Os, University Medical Center Utrecht
Thank you very much, Jeffrey. Thanks for inviting me.