In 2013 the NIMH's then-director, Thomas Insel, called the field out in the starkest of terms. Thirty years after the biological psychiatrists declared victory, he noted, all of psychiatry's diagnostic categories were still based, not on any biological markers of disease, but merely "on a consensus about clusters of clinical symptoms." In the rest of medicine, he said scathingly, this would be "equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever."