Mapping the Domain of Mental Illness

Abstract

We argue that dominant research approaches concerning mental illness, which are centered on traditional categories of psychiatric classification as codified in the DSM-IV, have serious empirical, conceptual, and foundational problems. These problems have led to a classification scheme and body of research findings that provide a very poor map of the domain of mental illness, a map that, in turn, undermines clinical and research pursuits. We discuss some current efforts to respond to these problems and argue that the DSM-5 revision process is not very promising, whereas the NIMH Research Domain Criteria initiative and some recent research in cognitive neuroscience fares better, although the latter remains potentially compromised by residual influences of the DSM-based approach. We conclude with some lessons and suggestions for the pursuit of alternative research pathways.

Biocognitive Classification of Antisocial Individuals Without Explanatory Reductionism

“…The core of these criticisms is that this type of approach, for the most part, produces categorical structures that have low validity and are defined by polythetic symptoms that are shared across different disorders (i.e., indicate extensive comorbidity). Thus, the ensuing classifications tend to cover widely heterogeneous groups of people that for clinical and research purposes should be kept apart (Lilienfeld, 2014; Lilienfeld et al, 2013; Murphy, 2006; Poland & Von Eckardt, 2013).…”

“…It has to be noted that adding emphasis on biocognitive data in classifying different psychiatric disorders and conditions does not entail excessive medicalization (for discussion, see Bolton, 2013; Poland & Von Eckardt, 2013). In fact, these data might help to design therapies that involve everything from pharmacological to targeted psychotherapy (Insel & Cuthbert, 2015).…”

The mind electric: Challenges to clinical categories from a person‐centred perspective and the possibilities of metaphysics and art for clinician, patient, and treatment

“…Current scholarship has pointed out that in a medicalized, depersonalized approach to research and practice, where mental illnesses are seen as brain diseases and thus as distinct from normal functioning, what gets ignored is that mental illness is partly constituted by normal processes, which are essential to understanding a person's relatively unique form of disorder, and can be recruited in treating the person's problems . This view affirms that part of a person's disorder is a person's normality, and that part accounts for the uniqueness of the disorder and it can also create healing.…”

Psychiatric Progress and the Assumption of Diagnostic Discrimination

“…Such symptomatic heterogeneity is frequently found among diagnostic conspecifics in other fields of medicine, such as cancer or lupus, and is not on its own evidence against discrimination -though it can certainly confound research (Millon and Klerman 1986;Poland and Eckardt 2013). But the lack of compelling confirmations of psychiatry's taxonomic boundaries by genetics, epidimiology, neurophysiology, and other allied sciences is worrying, and raises the question of whether the manual is useful for anything more than identifying phenotypic clusters.…”

“…For the purposes of this discussion, relevant facts are those about the underlying mechanisms causing the signs and symptoms that patients present with, of the sort that biomedical researchers hope to find: genetic signatures, neurological or cognitive dysfunctions, focal brain lesions, etc. Facts, in other words, that contribute to the scientific project of "mapping the domain" of mental illness (Poland and Eckardt 2013).…”