Research Domain Criteria as Psychiatric Nosology: Conceptual, Neuroethical, and Social Implications - Abstract
Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology despite limitations inherent to that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project in order to develop a more neuroscientifically-based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in neural nodes and networks. However, conceptual and methodological issues inherent to RDoC need to be addressed before any attempt at implementing use in clinical psychiatry. Neuroethical, legal and social issues can and will be fostered by the use of neuroscientific information to establish RDoC. This essay describes current progress in RDoC, defines key technical, neuroethico-legal and social issues generated by RDoC adoption and use, and posits key questions that must be addressed and resolved if RDoC are to be employed for psychiatric diagnoses and therapeutics. Specifically, we posit that objectification of complex mental phenomena may raise ethical questions about autonomy, the value of subjective experience, what constitutes a disorder, and what represents a treatment, enablement and/or enhancement. Ethical issues may also arise from the (mis)use of biomarkers and endophenotypes in predicting and treating mental disorders, and what such definitions, predictions and interventions portend for concepts and views of criminality, professional competency and social functioning. Given these issues, we offer that a preparatory neuroethical framework is required to define and guide the ways in which RDoC- oriented research can – and arguably should - be utilized in clinical psychiatry, and perhaps more broadly, in the social sphere.