The need for new ontologies in psychiatry

Abstract

Although researchers in psychiatry have been trying for decades to elucidate the pathophysiology underlying mental disorders, relatively little progress has been made. One explanation for this failure is that diagnostic categories in psychiatry are unlikely to track underlying neurological mechanisms. Because of this, the US National Institutes of Mental Health (NIMH) has recently developed a novel ontology to guide research in biological psychiatry: the Research Domain Criteria (RDoC). In this paper, I argue that while RDoC may lead to better neuroscientific explanations for mental disorders, it is unlikely that this new knowledge will then lead to an improved diagnostic system. I therefore suggest that researchers in psychiatry should work toward the development of two new ontologies: one for research and one for clinical practice.

Keywords:

• cognitive ontology
• pluralism
• RDoC
• taxonomy
• mental health
• psychiatry

Disclosure statement

No potential conflict of interest was reported by the author.

Notes on contributor

Robyn Bluhm is an Associate Professor in the Department of Philosophy and Lyman Briggs College at Michigan State University. Her research focuses on the relationship between ethical and epistemological issues in neuroscience and in medicine. She is a co-editor of Neurofeminism: Issues at the Intersection of Feminist Theory and Cognitive Science (Palgrave Macmillan 2012) and editor of Knowing and Acting in Medicine (Rowman and Littlefield International 2017).

Notes

1. Prior to the DSM-5, the different editions of the manual were distinguished using Roman numerals rather than Arabic numerals. The switch is supposed to make it easier to identify revisions of the new edition (i.e. as 5.1, 5.2, etc.).

2. Both the third and the fourth editions of the DSM were published in a revised form prior to the launch of the following edition, making the DSM-5 the fourth significant revision to the manual since the DSM-III. For a brief history of the DSM, see Shorter (2013). For a discussion of the ways that the DSM-5 revisions have failed to meet the early ambitions of the Task Force in charge of the new edition, see Whooley and Horwitz (2013).

3. Lilienfeld (2014) provides a thorough discussion of the criticisms of the DSM.

4. Anderson (2015) provides a valuable survey of the various approaches to the question of what a new cognitive ontology might look like.

5. In her 2014 paper, Sullivan is even less optimistic, concluding that:

[g]iven the kinds of differences that exist between cognitive neuroscience and cellular and molecular neurobiology, we can anticipate that the project of stabilizing mental disorders or cognitive functions and integrating results into multi-level explanatory models that reveal suitable targets for therapeutic interventions will fail. (Sullivan 2014, 270)

6. Ross notes that it has, in fact, been moved to the category of “substance-related and addictive disorders” in the DSM-5.