Promises and limitations of cognitive neurosciences and genomics in identifying valid mental disorder constructs within the Research Domain Criteria (RDoC) framework
Our PhD student Reinier Schuur has been invited to present a paper at a prestigious and highly competitive conference in Canada later this year: Cognitio 2015.
His paper is entitled: "Promises and limitations of cognitive neurosciences and genomics in identifying valid mental disorder constructs within the Research Domain Criteria (RDoC) framework”.
I wish to give my talk on the promises and limitations of the cognitive neurosciences, genomics, and related sciences, in identifying valid disorder constructs in the context of the new framework for researching mental disorders, the Research Domain Criteria (RDoC). I will argue that the RDoC is necessary for attaining greater validity in disease attribution, but that it is not sufficient. This is because greater validity depends on notions of normativity outside the scope of the cognitive sciences, having to do with philosophically rooted notions of the good life and well-being.
In 2013, Thomas Insel announced that the NIMH would reorient its research framework away from the DSM towards a new framework for research, the RDoC (Insel, 2013). DSM categories are considered to hinder findings from the cognitive neurosciences and genomics from informing disorder classification and treatment because the DSM categories that constrain psychiatric research have low validity by not reflecting distinct disease entities.
The RDoC framework is intended to overcome this problem by providing a dimensional approach to researching mental disorders, providing a matrix of domains of functioning (cognitions, negative/positive valence, etc…) and units of analysis (genetics, physiology, neural circuits, self reports, etc…) that cut across traditional DSM categories. A primary goal of this framework is to elucidate the underlying mechanisms and biomarkers of mental disorders, which is hoped to inform future nosological decisions about disorder categories, thresholds, and sub-groups.
Wakefield argues that a major problem with the RDoC is that it only aims at improving construct validity but that it offers no solution to how to attain greater concept validity for disease categories (Wakefield, 2014). Construct validity is whether or not a mental disorder category picks out a distinct entity, whereas concept validity is whether a mental disorder picks out an actual mental disorder as opposed to a non-disorder. Wakefield argues that these two kinds of validity can be independent, since a disease category can lack construct validity if it categorises several disease entities but can have concept validity if it only picks out real mental disorders, as well as vice versa.
I will argue in this talk that the RDoC, along with other empirical approaches using cognitive neurosciences to identify mental disorders, may indeed succeed in attaining construct validity in elucidating more refined and distinct causal classifications, but that no such approaches so far have offered a viable solution to how to attain concept validity in disease attributions. I will argue that the cognitive sciences cannot in principle provide such a solution because questions of normativity in regards to mental health must ultimately be derived from conceptions of normativity outside the true scope of the cognitive sciences, having to do with philosophical notions of the good life, norms of mental functioning, and well-being. I will not offer a theory of normativity, but make the negative case that the cognitive sciences cannot attain concept validity. If this is the case, the important consequence is that some normative theory, whatever it might turn out to be, is required to inform empirical findings to arrive at a conceptually valid classification of mental disorders.
Insel, T. R. (2013, April 29). Director’s blog: Transforming diagnosis. Retrieved on 14-11-2013
Wakefield, J. C. (2014). Wittgenstein’s nightmare: why the RDoC grid needs a conceptual dimension, 13 (1), World Psychiatry, 38-40.