Atypical Minds: the Cognitive Science of Difference and Potentialities
Cognitio 2015
Young researchers conference in cognitive science
Montréal, June 8th, 9th and 10th 2015
RDoC’s Special Kind of Reductionism and its Possible Impact on Clinical Psychiatry
Simon Goyer & Luc Faucher.
In 2008, the National Institute of Mental Health (NIMH) launched the Research Domain Criteria (RDoC) project. RDoC is an explicit effort to break free from the constraints of current diagnostic DSM categories and to rebuild psychiatric taxonomy on new (biological) grounds.
RDoC’s conception of mental disorder is that they are, as Thomas Insel says, “biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior” (Insel 2013). Commenting on a previous and similar claim made by Insel, the philosopher Ian Gold (2009) proposes that the only charitable way to understand this kind of claim is to postulate that Insel means that psychological sciences are to be “relegated to the status of mere placeholder sciences awaiting replacement by neuroscience and molecular biology” (507). If such is the case, RDoC would be a form of what Matthew Broome has called “eliminative mindless psychiatry” (2006, 304). For our purpose we can understand eliminative mindless psychiatry as being endorsing three claims:
1) An epistemological claim: Mental disorders are essentially and preferentially explainable in the theoretical framework of the behavioral neurosciences (especially neurobiology). Explanations framed in the language of higher level of explanation are at best heuristic tools, and at worst, otiose.
2) A semantic claim: Actual diagnostic categories will not find a confortable niche in a future mindless psychiatry. They will have to be revised substantially or eliminated because they will be shown not to have any referent in reality (as defined by neuroscience).
3) A clinical claim: all mental disorders should be treated systematically and without exceptions with biological technologies, that is to say, for example, with medications and brain stimulation.
In this presentation, we will not talk about (2), but will focus our attention on claims (1) and (3). Concerning claim (1), we will argue that RDoC is in fact better conceived of as a non-reductionist, multi-level, and integrative enterprise in which the proper level of explanation cannot be decided in an a priori manner. After having showing this, we will focus on claim (3) and will argue that mindless psychiatry does not necessarily follows from RDoC. Indeed, depending on how one interprets RDoC, RDoC could enrich clinical psychiatry or impoverish it. If RDoC intrinsic epistemic pluralism is respected, than clinical psychiatry will be enriched. Indeed, by uncovering the biological mechanisms that are responsible for patients’ dysfunctions, we think RDoC could furthers therapists’ understanding of the disorders they encounter in clinics. Moreover, RDoC’s research program could enrich clinical psychiatry by helping clinicians to understand more precisely the effects of psychotherapy on their patients’ brain organisation.
However, if RDoC is interpreted in a reductionist epistemic manner, than clinical psychiatry could be impoverished. Indeed, if the neural activities in the brain of the mentally ill are judged to be the only causes of their mental condition, then one must treat their brains and, preferably, directly with biological therapies. This is problematic, because, as we will show, not every mental disorder should be treated with medications. Moreover, the adoption of a strictly neurobiological framework and the systematic medicalization of mental health problems are also problematic because of their effects on patients’ self-concept (and the conception of their mental problems). Indeed, neurobiological ways of representing oneself, firstly, has the potential to be disempowering and, secondly, could contribute to the maintenance of dysfunctional environment and to the production of false beliefs in the patient’s minds.
Gold, I. 2009. Reduction in Psychiatry. Canadian Journal of Psychiatry/Revue canadienne de psychiatrie, 54(8), 506-512.
Insel T. R. 2013. Director’s Blog: Transforming Diagnosis. NIMH website. URL: http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml. Retrieved October 27, 2013.
Broome, M. 2006. Taxonomy and Ontology in Psychiatry: A Survey of Recent Literature. Philosophy, Psychiatry & Psychology, 13: 4, 303-319.