Abstract
In the United States, the National Institute of Mental Health (NIMH) is seeking to encourage researchers to move away from diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders (the DSM). A key mechanism for this is the “Research Domain Criteria” (RDoC) initiative, closely associated with former NIMH Director Thomas Insel. This article examines how key figures in US (and UK) psychiatry construct the purpose, nature, and implications of the ambiguous RDoC project; that is, how its novelty is constituted through discourse. In this paper, I explore and analyze these actors’ accounts of what is new, important, or (un)desirable about RDoC, demonstrating how they are constituted through institutional context and personal affects. In my interviews with mental health opinion leaders, RDoC is presented as overly reliant on neurobiological epistemologies, distant from clinical imaginaries and imperatives, and introduced in a top-down manner inconsistent with the professional norms of scientific research. Ultimately, the article aims to add empirical depth to current understandings about the epistemological and ontological politics of contemporary (US) psychiatry and to contribute to science and technology studies (STS) debates about “the new” in technoscience. Accordingly, I use discussions about RDoC as a case study in the sociology of novelty.
Highlights
As Keating and Cambrosio (2004, 357) have reflected, the “idea of reducing pathology to biology has an extensive history.” In psychiatry, many have supported the application of biological approaches to comprehending and treating mental ill-health
It is perhaps more commonly regarded as a neurobiological initiative aiming “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” (Akram and Giordano 2017, 592)
When the National Institutes of Health (NIH) and its subinstitutes elect to move their operations forward in particular ways, and perhaps especially when those are characterized as “new,” those they fund need to orientate their work in alignment
Summary
What is RDoC? it is a kind of epistemic infrastructure providing a framework for (new kinds of) research. Insel (2013) described in his aforementioned blog post that the NIMH was “committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.” Through such public-facing statements, Insel has contributed to structuring the NIMH as a promissory organization (Pollock and Williams 2010) that defines epistemic requirements and generates expectations that these will be provided for He and other senior NIMH figures consolidate their own authority and that of their organization This can be read as part of a broader strategy for limiting symbolic and material divestment in (biological) psychiatry and (re)invigorating support for mental health research and development. NIMH endeavors like the NRGR reinscribe molecular ways of thinking within psychiatry (Rose 2001) And practically, they gradually dilute the singular salience of the DSM to psychiatric knowledge production. The extent to which the DSM adequately captures reality has long been debated (Pickersgill 2014), it is noteworthy that rejecting its facticity and utility is increasingly legitimate within biomedicine
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