Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-27T01:11:25.707Z Has data issue: false hasContentIssue false

26 - Should Psychiatry Be Precise? Reduction, Big Data, and Nosological Revision in Mental Health Research

from Section 9

Published online by Cambridge University Press:  02 April 2020

By
Kathryn Tabb
Edited by
Kenneth S. Kendler ,
Josef Parnas  and
Peter Zachar
Kenneth S. Kendler
Affiliation:
Virginia Commonwealth University
Josef Parnas
Affiliation:
University of Copenhagen
Peter Zachar
Affiliation:
Auburn University, Montgomery
Get access

Summary

TThe twenty-first century paradigm of precision medicine can be characterized by its joint commitments to (1) the revision of traditional nosological systems (2) the utilization of transformative new methods of data collection and analysis (“big data”), and (3) the employment of scientific methods able to reduce complex phenomenological, behavioral, and physiological signs and symptoms to underlying biomechanisms. This chapter assesses the value of these commitments for psychiatry, and concludes that they are collectively neither necessary nor sufficient for progress in the explanation of, and intervention upon, mental disorders. Each holds promise and has proved transformative in some areas of psychiatric research and practice, but their appropriateness is better assessed independently and circumstantially. Meanwhile, the value of other traditional psychiatric commitments – such as to the principled demarcation of the pathological from the normal, and the prioritization of research that has clinical application – should not be abandoned amidst the current vogue for precision.

Keywords

Precision MedicinePsychiatryResearch Domains Criteria (RDoC)NIMHNosologyReductionismBig Data
Type
Chapter
Information
Levels of Analysis in Psychopathology
Cross-Disciplinary Perspectives
 , pp. 308 - 334
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amundson, R. (2000). ‘Against Normal Function.’ Studies in History and Philosophy of Science Part C: Biology and Biomedical Science 31(1):33–53.Google Scholar
Andersen, H. (2016) ‘Reduction in the Biomedical Sciences.’ In Solomon, M, Simon, J, and Kincaid, H (eds), Routledge Companion to Philosophy of Medicine. Abingdon, UK: Routledge.Google Scholar
Anderzhanova, E, Kirmeier, T, and Wotjak, CT. (2017) ‘Animal Models in Psychiatric Research: The RDoC System as a New Framework for Endophenotype-Oriented Translational Neuroscience.’ Neurobiology of Stress 7 (December): 47–56.Google Scholar
Bayer, R, and Galea, S. (2015) ‘Public Health in the Precision-Medicine Era.’ New England Journal of Medicine 373 (6): 499–501.CrossRefGoogle ScholarPubMed
Boorse, C. (2011). ‘Concepts of Health and Disease.’ In Gifford, F (ed), Handbook of the Philosophy of Science, Vol. 16: Philosophy of Medicine. Amsterdam, the Netherlands: Elsevier BV.Google Scholar
Borsboom, D, Cramer, A, and Kalis, A. (2018) ‘Brain Disorders? Not Really… Why Network Structures Block Reductionism in Psychopathology Research.’ Behavior and Brain Sciences (Jan 14): 1–54.Google Scholar
Bowker, GC, and Star, SL. (1999) Sorting Things Out: Classification and Its Consequences. Cambridge, MA: MIT Press.Google Scholar
Broome, MR, and Bortolotti, L. (2009) ‘Mental Illness as Mental: In Defence of Psychological Realism.’ Humana Mente 11:25–43.Google Scholar
Carpenter, WT. (2016) ‘The RDoC Controversy: Alternate Paradigm or Dominant Paradigm?’ American Journal of Psychiatry 173 (6): 562–63.CrossRefGoogle ScholarPubMed
Chang, H. (2004) Inventing Temperature: Measurement and Scientific Progress. Oxford: Oxford University Press.Google Scholar
Chen, R, Mias, GI, Li-Pook-Than, J, Jiang, L, Lam, HY, Chen, R, Miriami, E, Karczewski, KJ, Hariharan, M, et al. (2012) ‘Personal Omics Profiling Reveals Dynamic Molecular and Medical Phenotypes.’ Cell 148: 1293–307.Google Scholar
Curtis, C, Shah, SP, Chin, SF, Turashvili, G, Rueda, OM, Dunning, MJ, Speed, D, et al. (2012) ‘The Genomic and Transcriptomic Architecture of 2,000 Breast Tumours Reveals Novel Subgroups.’ Nature 486 (7403): 346–52.CrossRefGoogle Scholar
Cuthbert, BN, and Kozak, MJ. (2013) ‘Constructing Constructs for Psychopathology: The NIMH Research Domain Criteria.’ Journal of Abnormal Psychology 122 (3): 928–37.Google Scholar
De Grandis, G, and Halgunset, V. (2016) ‘Conceptual and Terminological Confusion around Personalised Medicine: A Coping Strategy.’ BMC Medical Ethics 17 (1): 1–12.Google Scholar
Eyal, G, Sabatello, S, Tabb, K, Adams, R, Jones, M, Lichtenberg, FL, Nelson, A, et al. (2019) ‘The Physician–Patient Relationship in the Age of Precision Medicine.’ Genetics in Medicine 21 (4): 813–15.CrossRefGoogle ScholarPubMed
Fernandes, BS, Williams, LM, Steiner, J, Leboyer, M, Carvalho, AF, and Berk, M. (2017) ‘The New Field of “Precision Psychiatry.”’ BMC Medicine 15 (1): 1–7.Google Scholar
First, MB, and Westen, D. (2007) ‘Classification for Clinical Practice: How to Make ICD and DSM Better Able to Serve Clinicians.’ International Review of Psychiatry 19 (5): 473–81.CrossRefGoogle ScholarPubMed
Gandal, MJ, Leppa, V, Won, H, Parikshak, NN, and Geschwind, DH. (2016) ‘The Road to Precision Psychiatry: Translating Genetics into Disease Mechanisms.’ Nature Neuroscience 19 (11): 1397–407.Google Scholar
Gillan, CM, and Whelan, R. (2017) ‘What Big Data Can Do for Treatment in Psychiatry.’ Current Opinion in Behavioral Sciences 18 (December): 34–42.CrossRefGoogle Scholar
Gillett, G, and Harré, R. (2014) ‘Discourse and Diseases of the Psyche.’ In Fulford, KWM, Davies, M, Gipps, RGT, Graham, G, Sadler, JZ, Stanghellini, G, and Thornton, T (eds )The Oxford Handbook of Philosophy and Psychiatry. Oxford University Press, 307–20. doi:10.1093/oxfordhb/9780199579563.013.0022Google Scholar
Harper, AR, and Topol, EJ. (2012) ‘Pharmacogenomics in Clinical Practice and Drug Development.’ Nature Biotechnology 30 (11): 1117–24.Google ScholarPubMed
Haendel, MA, Chute, CG, and Robinson, PN. (2018) ‘Classification, Ontology, and Precision Medicine.’ New England Journal of Medicine 379 (15): 1452–62.Google Scholar
Haro, JM, Ayuso-Mateos, JL, Bitter, I, Demotes-Mainard, J, Leboyer, M, Lewis, SW, Linszen, D, et al. (2014) ‘ROAMER: Roadmap for Mental Health Research in Europe.’ International Journal of Methods in Psychiatric Research 23 (S1): 1–14.Google Scholar
Hengartner, MP, and Lehmann, SN. (2017) ‘Why Psychiatric Research Must Abandon Traditional Diagnostic Classification and Adopt a Fully Dimensional Scope: Two Solutions to a Persistent Problem.’ Frontiers in Psychiatry 8 (June): 101.CrossRefGoogle ScholarPubMed
Hey, SP, and Kesselheim, AS. (2016) ‘Countering Imprecision in Precision Medicine.’ Science 353 (6298): 448–49.Google Scholar
Hyman, S. (2010) ‘The Diagnosis of Mental Disorders: The Problem of Reification.’ Annual Review of Clinical Psychology 6: 155–79.Google Scholar
Insel, TR. (2010) ‘Faulty Circuits.’ Scientific American 302 (4): 44–51.Google Scholar
Insel, TR. (2014) ‘The NIMH Research Domain Criteria (RDoC) Project: Precision Medicine for Psychiatry.’ American Journal of Psychiatry 171 (4): 395–97.Google Scholar
Insel, TR, and Quirion, R. (2005) ‘Psychiatry as a Clinical Neuroscience Discipline.’ JAMA 294 (17): 2221–24.Google Scholar
Insel, TR and Cuthbert, B. (2010). ‘The Data of Diagnosis: New Approaches to Psychiatric Classification.’ Psychiatry: Interpersonal and Biological Processes 73 (4): 311–14.Google Scholar
Insel, TR, and Cuthburt, B. (2015) ‘Brain Disorders? Precisely.’ Science 348 (6234): 498–99.Google Scholar
Juengst, E, McGowan, ML, Fishman, JR, and Settersten, RA Jr. (2016) ‘From “Personalized” to “Precision” Medicine: The Ethical and Social Implications of Rhetorical Reform in Genomic Medicine.’ Hastings Center Report 46 (5): 21–33.CrossRefGoogle Scholar
Kaiser, M. (2015) Reductive Explanation in the Biological Sciences. Cham: Springer.Google Scholar
Kendler, KS. (2005) ‘Toward a Philosophical Structure for Psychiatry.’ American Journal of Psychiatry 162 (3): 433–40.Google Scholar
Kendler, KS. (2012) ‘Epistemic Iteration as a Historical Model for Psychiatric Nosology: Promises and Limitations.’ In Kendler, KS and Parnas, J (eds), Philosophical Issues in Psychiatry II: Nosology. Oxford: Oxford University Press.Google Scholar
Khoury, MJ, Iademarco, MF, and Riley, WT. (2016) ‘Precision Public Health for the Era of Precision Medicine.’ American Journal of Preventive Medicine 50 (3): 398–401. doi:10.1016/j.amepre.2015.08.031.CrossRefGoogle ScholarPubMed
Kincaid, H, and Sullivan, JA (eds). (2014) Classifying Psychopathology. Cambridge, MA: MIT Press.Google Scholar
Kotov, R, Krueger, RF, Watson, D, Achenbach, TM, Althoff, RR, Bagby, RM, Brown, TA, et al. (2017) ‘The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional Alternative to Traditional Nosologies.’ Journal of Abnormal Psychology 126 (4): 454–77.Google Scholar
Lemoine, M. (2016) ‘Molecular complexity: Why has psychiatry not been revolutionized by genomics (yet)?’ In Boniolo, G and Nathan, M (eds), Foundational Issues in Molecular Medicine. London: Routledge, 81–99.Google Scholar
Lemoine, M. (2013) ‘Defining Disease beyond Conceptual Analysis: An Analysis of Conceptual Analysis in Philosophy of Medicine.’ Theoretical Medicine and Bioethics 34: 309–25.Google Scholar
Lemoine, M. (2017) ‘Neither From Words, nor From Visions: Understanding P-Medicine From Innovative Treatments. Lato Sensu: Revue de la Société de Philosophie des Sciences 4 (2): 12–23. doi:10.20416/lsrsps.v4i2.793CrossRefGoogle Scholar
Lesko, LJ. (2007) ‘Personalized Medicine: Elusive Dream or Imminent Reality?’ Clinical Pharmacology & Therapeutics 81: 807–16.Google Scholar
Lewis-Fernandez, R, Rotheram-Borus, MJ, Betts, V, Greenman, L, Essock, SM, Escobar, JI, Barch, D, et al. (2016) ‘Rethinking Funding Priorities in Mental Health Research.’ The British Journal of Psychiatry 208 (6): 507–9.CrossRefGoogle ScholarPubMed
Lilienfeld, SO, and Treadway, MT. (2016) ‘Clashing Diagnostic Approaches: DSM-ICD versus RDoC.’ Annual Review of Clinical Psychology 12 (1): 435–63.CrossRefGoogle ScholarPubMed
Maj, M. (2018) ‘Why the Clinical Utility of Diagnostic Categories in Psychiatry Is Intrinsically Limited and How We Can Use New Approaches to Complement Them.’ World Psychiatry 17 (2): 121–22.Google Scholar
Meigs, JB, Shrader, P, Sullivan, LM, McAteer, JB, Fox, CS, Dupuis, J, Manning, AK, Florez, JC Wilson, PW, SrD’agostino, RB, and Cupples, LA. (2008) ‘Genotype Score in Addition to Common Risk Factors for Prediction of Type 2 Diabetes.’ New England Journal of Medicine 359: 2208–19.CrossRefGoogle ScholarPubMed
Miller, GA. (2010) ‘Mistreating Psychology in the Decades of the Brain.’ Perspectives on Psychological Science 5 (6): 716–43. doi:10.1177/1745691610388774.Google Scholar
Mishara, AL, and Schwartz, MA. (2013) ‘What Does Phenomology Contribute to the Debate about DSM-5?’ In Paris, J and Philips, J (eds), Making the DSM-5: Concepts and Controversies. New York: Springer, 125–42.Google Scholar
Monteith, S, Glenn, T, Geddes, J, and Bauer, M. (2015) ‘Big Data Are Coming to Psychiatry: A General Introduction.’ International Journal of Bipolar Disorders 3 (1): 21.CrossRefGoogle ScholarPubMed
Morris, S, and Cuthbert, B. (2012) ‘Research Domain Criteria: Cognitive Systems, Neural Circuits, and Dimensions of Behavior.’ Dialogues in Clinical Neuroscience 14 (1): 29.Google Scholar
Murphy, D. (2014) ‘Natural Kinds in Folk Psychology and in Psychiatry.’ In Kincaid, H and Sullivan, JA (eds), Classifying Psychopathology: Mental Kinds and Natural Kinds. Cambridge, MA: MIT Press, 105–22.Google Scholar
Murphy, D. (2015) ‘Concepts of Disease and Health.’ In Zalta, EN (ed), The Stanford Encyclopedia of Philosophy (Spring 2015 Edition). https://plato.stanford.edu/archives/spr2015/entries/health-disease/.Google Scholar
Nature Editorial Board. (2012) ‘Therapy Deficit.’ Nature 489: 473–74.Google Scholar
National Research Council (US) Committee on a Framework for Developing a New Taxonomy of Disease. (2011) ‘Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease.’ Washington, DC: National Academies Press (US).Google Scholar
Need, AC, and Goldstein, DB. (2016) ‘Neuropsychiatric Genomics in Precision Medicine: Diagnostics, Gene Discovery, and Translation.’ Dialogues in Clinical Neuroscience 18 (3): 237–52.CrossRefGoogle ScholarPubMed
Olbert, CM, Gala, GJ, and Tupler, LA. (2014) ‘Quantifying Heterogeneity Attributable to Polythetic Diagnostic Criteria: Theoretical Framework and Empirical Application.’ Journal of Abnormal Psychology 123(2): 452–62.CrossRefGoogle ScholarPubMed
Paranjape, SM, and Mogayzel, PJ. (2018) ‘Cystic Fibrosis in the Era of Precision Medicine.’ Paediatric Respiratory Reviews 25 (January): 64–72.Google Scholar
Parnas, J, and Sass, LA. (2008) ‘Varieties of ‘Phenomenology.’ In Kendler, KS and Parnas, J (eds), Philosophical Issues in Psychiatry: Explanation, Phenomenology, and Nosology. Cambridge, UK: Cambridge University Press, 239–77.Google Scholar
Parnas, J, and Henriksen, MG. (2014) ‘Disordered Self in the Schizophrenia Spectrum: A Clinical and Research Perspective.’ Harvard Review of Psychiatry 22 (5): 251–65.Google Scholar
Paulus, MP. (2015) ‘Pragmatism Instead of Mechanism.’ JAMA Psychiatry 72 (7): 631–32.CrossRefGoogle ScholarPubMed
Petrovski, S, Shashi, V, Petrou, S, Schoch, K, McSweeney, KM, Dhindsa, RS, Krueger, B, Crimian, R, Case, LE, Khalid, R, El-Dairi, MA, Jiang, YH, Mikati, MA, Goldstein, DB. (2015) ‘Exome Sequencing Results in Successful Riboflavin Treatment of a Rapidly Progressive Neurological Condition.’ Cold Spring Harbor Molecular Case Studies 1 (1):a000257. doi:10.1101/mcs.a000257CrossRefGoogle ScholarPubMed
Phillips, MR. (2014) ‘Will RDoC Hasten the Decline of America’s Global Leadership Role in Mental Health?’ World Psychiatry 13 (1): 40–41.Google Scholar
Poland, J, and Tekin, S (eds). (2017) Extraordinary Science and Psychiatry: Responses to the Crisis in Mental Health Research. Cambridge, MA: MIT Press.Google Scholar
Prainsack, B. (2015) ‘Through Thick and Big: Data-Rich Medicine in the Era of Personalisation.’ In Vollman, J, Sandow, V, Wäscher, S, and Schildmann, J (eds), The Ethics of Personalised Medicine. Farnham: Ashgate, 161–72.Google Scholar
Radden, J. (2003) ‘Is This Dame Melancholy?: Equating Today’s Depression and Past Melancholia.’ Philosophy Psychiatry and Psychology 10 (1): 37–52.Google Scholar
Schwartz, SJ, Lilienfeld, SO, Meca, A, and Sauvigné, KC. (2016) ‘The Role of Neuroscience within Psychology: A Call for Inclusiveness over Exclusiveness.’ The American Psychologist 71 (1): 52–70.Google Scholar
Sekar, A, Bialas, AR, de Rivera, H, Davis, A, Hammond, TR, Kamitaki, N, Tooley, K, et al. (2016) ‘Schizophrenia Risk from Complex Variation of Complement Component 4.’ Nature 530 (7589): 177–83.Google Scholar
Senn, S. (2001) ‘Individual Therapy: New Dawn or False Dawn?’ Drug Information Journal 35: 1479–94.Google Scholar
Senn, S. (2018) ‘Statistical Pitfalls of Personalized Medicine.’ Nature 563 (7733): 619–21.CrossRefGoogle ScholarPubMed
Snyder, M. (2012) ‘Q & A: The Snyderome.’ Genome Biology 13(3): 147.Google Scholar
Sonuga-Barke, EJS. (2014) ‘Editorial: ‘What’s Up, (R)DoC?’ – Can Identifying Core Dimensions of Early Functioning Help Us Understand, and Then Reduce, Developmental Risk for Mental Disorders?’ Journal of Child Psychology and Psychiatry 55 (8): 849–51. doi:10.1111/jcpp.12293.Google Scholar
Sullivan, PF, Agrawal, A, Bulik, CM, Andreassen, OA, Børglum, AD, Breen, G, Cichon, S, Edenberg, H, et al. (2017) ‘Psychiatric Genomics: An Update and an Agenda.’ American Journal of Psychiatry 175 (1): 15–27.Google Scholar
Tabb, K. (2015) ‘Psychiatric Progress and the Assumption of Diagnostic Discrimination.’ Philosophy of Science 82 (5): 1047–58.Google Scholar
Teachman, BA, McKay, D, Barch, DM, Prinstein, MJ, Hollon, SD, and Chambless, DL. (2019) ‘How Psychosocial Research Can Help the National Institute of Mental Health Achieve Its Grand Challenge to Reduce the Burden of Mental Illnesses and Psychological Disorders.’ The American Psychologist 74 (4): 415–31.Google Scholar
Topol, EJ. (2014) ‘Individualized Medicine from Prewomb to Tomb.’ Cell 157 (1): 241–53.Google Scholar
Wakefield, JC. (2014) ‘Wittgenstein’s Nightmare: Why the RDoC Grid Needs a Conceptual Dimension.’ World Psychiatry 13 (1): 38–40.Google Scholar
Wanders, RBK, van Loo, HM, Vermunt, JK, Meijer, RR, Hartman, CA, Schoevers, RA, Wardenaar, KJ, and de Jonge, P. (2016) ‘Casting Wider Nets for Anxiety and Depression: Disability-Driven Cross-Diagnostic Subtypes in a Large Cohort.’ Psychological Medicine 46 (16): 3371–82.CrossRefGoogle ScholarPubMed
Whooley, O. (2010) ‘Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders.’ Sociology of Health & Fitness 32 (3): 452–69.Google Scholar
van Loo, H, Romeijn, JW, de Jonge, P, and Schoevers, R. (2013) ‘Psychiatric Comorbidity and Causal Disease Models.’ Preventive Medicine 57 (6): 748–52.Google Scholar
Zuberi, SM, and Brunklaus, A. (2018) ‘Epilepsy in 2017: Precision Medicine Drives Epilepsy Classification and Therapy.’ Nature Reviews Neurology 14 (2): 67–68. doi:10.1038/nrneurol.2017.190.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×