What kind of science for psychiatry?

Abstract

Psychiatry has invested its hopes in neuroscience as a path to understanding mental disorders and developing more effective treatments and ultimately cures. Recently, the U.S. NIMH has elaborated this vision through a new framework for mental health research, the Research Domain Criteria (RDoC). This framework aims to orient mental health research toward the discovery of underlying neurobiological and biobehavioral mechanisms of mental disorders that will eventually lead to definitive treatments. In this article we consider the rationale of the RDoC and what it reveals about implicit models of mental disorders. As an overall framework for understanding mental disorders, RDoC is impoverished and conceptually flawed. These limitations are not accidental but stem from disciplinary commitments and interests that are at odds with the larger concerns of psychiatry. A multilevel, ecosocial approach to biobehavioral systems is needed both to guide relevant neuroscience research and insure the inclusion of social processes that may be fundamental contributors to psychopathology and recovery.

Keywords: critical neuroscience; culture; nosology; psychiatric diagnosis; research domain criteria; social context; systems science.

FIGURE 1

The NIMH RDoC framework organized as a 2 × 2 matrix with rows for broad biobehavioral domains that group together specific constructs and columns representing levels of analysis, units, or types of data. Neural circuitry is the central level of analysis on the assumption that behavioral and experiential manifestations of psychopathology can be traced to underlying circuitry which, in turn, can be analyzed in terms of cellular, molecular, and genetic mechanisms. Rows may be further subdivided in terms of specific constructs. A column is reserved for experimental paradigms, which may be specific to domains.