engleski

Reductionism and the biocognitive approach to psychiatric classification

Conceptualisations of mental disorders assign different roles to biological genetic or neural factors in the categorisation of these conditions. Syndrome based accounts, that inform many diagnoses in classificatory systems such as the DSM (American Psychiatric Association 2013) or the ICD (World Health Organization 1993), categorise mental disorders in terms of symptomatic behaviours and mental states and personality traits. In these accounts, thus, the identity of a certain mental disorder does not depend on its neural or other biological aetiology or correlates. Proposals for biological and neurocognitive (for short biocognitive) based classification of mental disorders aim, instead, at grounding the categorization of mental disorders on genetic, neurological, or neurocomputational mechanisms. The Research Domain Criteria (RDoC) is a notable example of this proposal (Insel et al. 2010 ; Insel and Cuthbert 2015 ; Lilienfeld 2014) However, there has been some opposition to biology-based classifications of psychiatric disorders. A significant instance of this resistance is in a recent BBS target paper (2018) by Denny Borsboom, Angélique Kramer and Annemarie Kalis, who argue that the RDoC type approaches are overly reductionist, empirically unsuccessful for advancing psychiatric practice, and theoretically unsound. In this paper, we want to highlight and criticise some of the misgivings that motivate such a resistance to biocognitive based classifications. We argue that most of these doubts derive from a misunderstanding of the commitments that guide the RDoC type approaches. The principal of these misunderstanding is that these approaches involve a reductionist programme. We argue, instead, that they might be considered as involving a plea for revisionary reductionism. We use antisocial personality disorder (from now on ASPD) and psychopathy as a case study to illustrate the notion of revisionary reductionism and support our reasoning. In our discussion ASPD and psychopathy play several roles. First, we use these categories to show that in assessing issue of psychiatric classification we should distinguish between what confers the mental illness status to a condition and the explanatory mechanisms that account for it. Second, they are good example of current psychiatric classification because they capture a genetically and neurobiologically heterogeneous group of people. Given such a heterogeneity, applying RDoC to this type of disorders cannot be straightforwardly reductionistic. Third, and relatedly, the case of ASPD and psychopathy show that nosology in psychiatry might benefit, in accordance with what we call revisionary reductionism, from reconceptualizing mental disorders along their biocognitive dimensions. Fourth, we illustrate how a revision of ASPD or psychopathy that are grounded on biocognitive data and hypotheses promises more effective treatment than the current classification. Finally, we conclude that given that RDoC type of approach can be fruitfully applied in the case of ASPD and psychopathy, then it might be fruitfully applied to other psychiatric categories as well. References (just to the target article) Borsboom, Denny, Angélique Cramer, and Annemarie Kalis. 2018. ‘Brain Disorders? Not Really… Why Network Structures Block Reductionism in Psychopathology Research’. Behavioral and Brain Sciences, January, 1–54. https://doi.org/10.1017/S0140525X17002266.

RDoC ; reductionism ; Classification of Mental Disorders

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