A recent article published in European Psychiatry examines the historical context of the National Institute of Mental Health’s new Research Domain Criteria (RDoC) initiative. The authors describe different strands of historical psychiatry, from basing mental illness in the brain to focusing on presenting symptoms or “clinical phenomenology.”
“RDoC eschews disorder definitions altogether, focusing instead on data that can support data-driven revisions to future versions of the DSM and the ICD that include quantitative, empirically-based cutpoints for disorders,” write Drozdstoy Stoyanova, Diogo Telles-Correia, and Bruce N. Cuthbert.
The National Institute of Mental Health’s Research Domain Criteria (RDoC) initiative has received a lot of buzz in psychiatric circles for its aim of grounding an understanding of mental illness in specific brain processes rather than pre-established psychiatric disorders.
Although RDoC might help with folk psychiatry assumptions about psychiatric disorders being “illnesses,” others have argued that the change in research orientation may also double down on medical interventions such as psychiatric drugs. Though it poses itself as a radical new approach based on scientific truth and ground-up biological realities, it may end up reinforcing the medical model approach to dealing with human suffering. Recently, a group of mental health professionals from the Task Force on Diagnostic Alternatives sent an Open Letter to the leaders of several psychiatric initiatives, including the leaders of RDoC.
In the letter, they discuss RDoc and point out that “despite billions of dollars of research investment, no biomarkers, confirmatory physical ‘signs’ or pathognomonic evidence of biological causation have been discovered for the putative pathologies represented by the category labels within these systems.”
The current paper indirectly responds to these criticisms and locates the RDoC initiative within the history of psychiatry’s understanding of psychopathology and issues of the relationship between mind and brain. The authors argue that RDoC is consistent with some strands of classical psychiatry, such as the emphasis on localized areas of brain functioning. However, they caution that RDoC is also concerned with an integrative understanding of the relationship between brain processes and behavior.
“During this same period, the staff at the NIMH also evaluated diagnostic studies emerging from multiple laboratories. Data from neuroimaging, genomics, behavioral science, and other fields increasingly indicated that the results generally failed to align with DSM diagnoses. Perturbations in the same neural systems (associated with fear, reward, cognitive processes, etc.) could be observed across multiple disorders, while not all patients in a given diagnostic category evinced the same response patterns. In other words, DSM categories represented heterogeneous syndromes rather than specific disease entities.”
The authors explain that during the 19th century, psychiatry had already developed conflicting understandings of mental illness. Philippe Pinel, known as the “first psychiatrist,” argued that psychiatry should focus on symptoms and clusters of symptoms. Later, in opposition to that perspective, Carl Wernicke and others championed a neurobiological approach, stating that mental illnesses were “diseases of the brain.”
Wernicke believed that mental illnesses could be traced back to abnormalities in specific regions of the brain, such that “psychopathological symptoms originated from interruption (“sejunction”) of associative connections in the brain.” His work drew on Theodore Meynert’s work, attempting to map connections between neuroanatomy and psychiatric symptoms.
One of Wernicke’s students, Karl Kleist, continued this strand of psychiatric thinking with his emphasis on “localizationalism” of specific brain processes being linked to specific psychological processes. The authors note that many believe Meynert, Wernicke, and Kleist echo modern brain imaging approaches using fMRI and PET scans.
Following these debates, some psychiatrists such as Karl Jaspers argued that there must be an emphasis on the human sciences and clinical phenomenology, or people’s experience, rather than only an emphasis on neuroanatomy.
These and other advances in psychiatry led to a 1978 paper by Spitzer, Endicott, and Robins called the “Research Diagnostic Criteria (RDC),” which attempted to elaborate an a-theoretical, evidence-based approach to psychiatric nosology, in comparison to the psychoanalytic formulations of the Diagnostic and Statistical Manual of Mental Disorders which had been ascendant in the mid-20th century.
The authors situate RDoC within these different lineages, arguing that it proposes an answer not only to the older “indeterminate” school of psychoanalytic psychiatry, but also the most recent formulations of the DSM which are not grounded in leading research initiatives.
RDoC is supposed to represent, not necessarily an alternative diagnostic classification system, but “a framework for psychopathology research, proposing independent variables in experimental designs organized around functional constructs (e.g., fear, working memory, social withdrawal) rather than traditional categories such as schizophrenia or depression.”
The authors note that RDoC has similarities to the Meynert-Wernicke approach in focusing on specific brain localization, but also the Jaspers approach of paying attention to presenting symptoms, so long as those symptoms are understood to fall on a spectrum of differences in localized brain functioning. They state that this approach views all symptoms as existing on a spectrum of abnormal to normal functioning, rather than starting with distinct psychopathological syndromes.
The authors thus argue that RDoC is a blend of “old” and “new.” They state that most RDoC efforts emphasize an integrative approach mixing “multiple measures in analysis.” However, some authors do tend toward biological reductionism, which they justify as an effort to combat overly “mentalistic” approaches in psychiatry. In terms of limitations, they acknowledge issues of reliability and validity in using laboratory tasks to observe functional and behavioral differences between individuals and a resulting need for careful scientific analysis moving forward.
Stoyanov, D., Telles-Correia, D., & Cuthbert, B. N. (2019). The Research Domain Criteria (RDoC) and the historical roots of psychopathology: A viewpoint. European Psychiatry, 57, 58-60. (Link)
It doesn’t sound like RDoC adds much. At some point the truth that psychiatry and psychology are merely two extremes of a systemic child abuse and rape covering up pendulum should be acknowledged.
And all this child abuse and rape covering up is by DSM design.
We should address the question of whether our society, as a whole, benefits from having multibillion dollar, iatrogenic illness creating, scientific fraud based, primarily child abuse and rape covering up, “mental health” industries at all.
And let’s be realistic, all this systemic child abuse and rape covering up, by our “mental health” workers, does also aid, abet, and empower the child molesters and child sex traffickers. So our society now has enormous pedophilia and child sex trafficking problems.
There comes a time we should admit to the reality that the systems are satanic, thus we should get rid of the systems. We should start arresting the child molesters and human traffickers, instead of systemically neurotoxic poisoning the victims. We should bring about a return to the rule of law.
And we should end the modern day psychiatric holocaust. The psychiatrists are murdering 8 million innocent people a year, via their “invalid” DSM disorders, and with their neurotoxic psychiatric drugs. That’s 400,000,000 psychiatric induced deaths in the past 50 years.
We should put an end to “the dirty little secret of the two original educated professions.”
Well seems like much of the same.
The constant presentations of possibilities, of causes, of identifying, etc etc etc, why would this be if we are looking at a pathology?
All psychiatry keeps doing is arguing about the illness. They seem to be doing just fine as it is.
I guess they become uncomfortable, they feel one day it will bite them in the ass. So they toss ideas around and the ideas are all about diversion. It keeps the public believing that the “real doctors” are looking for something real.
Am I the only one that understands the research to be a diversion, whether intentional or not?
Psychiatry is wasting millions and wasting lives. I hope that there are a few that refuse to DSM their clients, so the clients have a chance in life, the same effin chance a shrink and his offspring are allowed.
“they toss ideas around and the ideas are all about diversion.” It’s like what our mainstream media does all the time, “terror, terror, terror” over 9/11/2001; “fear, fear, fear” over corona virus, etc.
It’s all about diversion from the truth, good point, Sam.
Sam, I agree with this ….
“so the clients have a chance in life, the same effin chance a shrink and his offspring are allowed.”
Yes they get to happily go on with their life of wealth, smug privilege and inflated ego while they leave the client’s life in ruins.
Have you seen a happy psychiatrist Rosalee? 🙂 It seems the only time they laugh is among their colleagues…like a kind of laughter where everyone is in a disguise, hoping they won’t be found out 🙂
Mobsters trying to sound normal to each other, both knowing what each is guilty of.
DSM and ICD categories represents various processes of hidden information memorization, with its subsequent implementation in the form of a diagnosis.
“despite billions of dollars of research investment” … most (if not all) of that money is profit driven in order to approve, market and sell psychotropics. Or did I miss something?
“Adding something to psychiatry” also doesn’t register (with me) as something that would be desirable.
Just another effort to lend pseudo credibility to everybody’s favorite pseudo science.
Why do shrinks even bother? Not like they’ll ever be held accountable by anyone anyhow. Certainly not by their partners in crime. AKA other doctors.
The fault is not with western medicine but the crooks in charge.
After reading the article, the answer is clearly “nothing,” unless by “adding” you mean “providing yet further distractions and justifications for avoiding looking at environmental/social/spiritual causes.” It also appears to avoid looking at ACTUAL physiological causes of emotional distress, such as poor diet, thyroid issues, anemia, sleep problems, etc.
They mention early on something about “issues of the relationship between mind and brain,” and yet the actual research seems to be all brain, all the time. Not one more word about “mind” in the entire article.
In other words, “Meet the new boss, same as the old boss.” Nothing new to see here.
WORD SALAD….that’s basically what the whole article above is, *WORD* *SALAD*….
And does anybody else note that “RDoC” is about *RESEARCH*, and trying to legitimize the current pseudoscience lies of psychiatry, and increase funding for *RESEARCH*?…. One driver of the apparent, so-called “shortage of psychiatrists”, is the fact that psychs are increasingly moving into RESEARCH of various types, and essentially abandoning “clients”….????…. Yup, just more psychiatric WORD SALAD….gnaw, gnaw, gnaw, chew, chew, chew….yummy word salad!….
Yeah, more bullshit. No better word describes this article, besides word salad, and BULLSHIT…..
I think that about MANY articles, especially when they fumble for words to try and make something sound legit.
I like the reference to the “effort to combat overly ‘mentalistic’ approaches in psychiatry.” Like the effort to combat overly ‘computational’ approaches in programming solutions. A computer gamester is unlikely to get far outwitting Zarkon, ruthless ruler of the Galra empire, by removing his computer’s back plate, checking the wiring, and perhaps removing a few banks of RAM.
Actual physiological problems – which can certainly affect mental states, function, and behavior – are the province of neurology or other bona fide medical specialty which deals with medicine’s proper realm: observable, measurable, physiological pathology.
Actual neurological problems WHICH btw neurology usually can’t identify on any kind of “test”,
always get diagnosed as “mental”.
Our present public loves neurology and other “scientific” specialities.
In fact they all love each other because psychiatry is their go to for “absence of disease, or condition”.
They would rarely admit that their science is SO very limited.
Lack of identification of why someone has pain or can’t sleep are then called psychological which of course has no “tests”, except they convinced the public that their opinions are a science.
Of course, cancer is pretty easy to detect and they still only have Chemo, which basically is like a bomb for the body, and if chemo was helpful, in theory it should work for aggressive cancer.
So even if they detect a “neurological” basis for “behaviour”, one first has to make that behaviour an unwanted part of the human, a pathology and the chemical warfare will be the same.
So johnny squirming in class, will still get his “drugs”. Except in cancer, we can opt for chemo or not.
Like cancer specialists, only they and their patients realize truths. The majority of the public tells cancer patients to listen to their doc, take their chemo.