Mental illness affects one in four adults, which should make The Diagnostic and Statistical Manual of Mental Disorders (DSM) one of the most well-thumbed medical texts in the world. The handbook, produced by the American Psychiatric Association (APA), lists symptoms for all known conditions and aims to steer psychiatrists, doctors and others towards a correct diagnosis. But in a field that struggles to connect people's inner experiences to measurable changes in their brains and bodies, the DSM is a lightning rod for criticism. It does not delve into the possible causes of mental illness, for example, or acknowledge that sociocultural and environmental factors could be important. Last week, the APA responded to that criticism by publishing a series of articles in The American Journal of Psychiatry, describing the strategy for the future of the DSM. It remains unclear when a new version will supersede the current DSM-5, released in 2013. 'We want to know how to continue to raise the bar for diagnoses for mental health and substance-use disorder, and, of course, we do that really staying very grounded to the science,' Marketa Wills, chief executive and medical director of the APA, based in Washington DC, told a press conference....

Rutter had lived with the condition off and on for years, but the burden had grown since the death of his mother in 2011, followed by a relationship break-up and a car accident the year after. It felt as if his brain was stuck on what he describes as “an automatic circuit”, repeating the same negative thoughts like a mantra: “‘Everything I do turns to crap.’ I actually believed that,” he recalls. The visit to Hammersmith was a preview. He would be returning the next day to participate in a study, taking a powerful hallucinogen under the guidance of Robin Carhart-Harris, a psychologist and neuroscientist at Imperial College London. Years of talking therapy and a variety of anti-anxiety medications had failed to improve Rutter’s condition, qualifying him for the trial. “Everyone was super nice, like really lovely, and especially Robin,” Rutter recalls. Carhart-Harris led him to a room with a magnetic resonance imaging (MRI) machine, so researchers could acquire a baseline of his brain activity. Then he showed Rutter where he would spend his time while on the drug. Carhart-Harris asked him to lie down and played him some of the music that would accompany the session. He explained that he would have on hand a drug that could neutralize the hallucinogen, if necessary. Then the two practised a grounding technique, to help calm Rutter in the event that he became overwhelmed. Without warning, Rutter burst into tears....

With telemedicine likely to expand in the post-Covid world, health care providers will need to work though some fundamental questions. How can we best scale telecare to the broad population? How will it change the way we gather and analyze health care data? And what new models of care will emerge? Specialties like psychiatry, where the use of telecare has been encompassing more than 40% of patient encounters, can help point the way forward....