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| Bill Fulford |
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| Matthew Broome |
There has since been something of a row-back: Bruce Cuthbert, writing with the endorsement of NIMH, notes that Insel’s blog 'was addressed to the research community… rather than to observers of the DSM-5'; and in a joint press release NIMH and the American Psychiatric Association have reaffirmed the importance of the DSM in clinical use. But the principle remains. DSM has failed to deliver on the promise of the neurosciences for patient care. RDoC, Insel claims, will do better.
But will it? RDoC is intended as a stepping stone (no more) to a hoped-for future psychiatric classification that in contrast to the symptom-based DSM will be research+symptom-based. As such RDoC’s open framework of domains/dimensions and ‘units of analysis’ (running from genes and molecules through psychology and behaviour to ‘self reports’) is clearly more hospitable to research findings than DSM’s now several hundred descriptively defined categories. RDoC furthermore, and importantly, is inclusive not exclusive. The success of RDoC, Cuthbert writes, will be measured by the extent to which it sparks innovative research in paradigms that ‘… outstrip the RDoC matrix to move in entirely new directions that transcend the organization of the current system’.
All of which is great. But the concern is that when it comes to translation of research into practice, RDoC offers nothing particularly new. Ideas equivalent to its domains/dimensions and units of analysis, even its ‘open and inclusive framework’ approach, were all there in principle fifty years ago at the corresponding ‘stepping stone’ stage that led, ultimately, to the DSM (see blog post here). Granted, we have new and more powerful neurosciences now than we did then. Granted, too, RDoC provides a new and more powerful organising framework for the findings of the new neurosciences than does DSM. But to these must be added a bridge or conduit for translating research findings into tangible improvements in patient care.
Enter what one of us has called elsewhere ‘computational psychopathology’ - the application of computational methods in the study of the mind to psychopathology. As a potential translational bridge between research and practice, computational psychopathology looks distinctly promising. First, it adds to the many descriptive methods available for studying psychopathology the power of, well, computation. Computational methods have turbo-charged other areas of science (think, here, physics) so why not psychopathology too?
Second, as a way of studying psychopathology, computational psychopathology really is a new kid on the scientific block. Computational methods are well established in the new ‘sciences of the mind’ represented by cognitive science and related areas of the philosophy of the mind. Among these, recent applications of quantum logic to processes of reasoning and decision-making are directly relevant to psychopathology. There are other approaches too that depend on developments in semantic logic that were simply not available fifty years ago: see for example the Erotetic Theory currently being developed in Oxford by Philipp Koralus and Salvador Mascarenhus.
Third, computational psychopathology encompasses, even-handedly, strengths as well as deficiencies in reasoning: the British psychiatrist Gareth Owen’s collaboration with the American mathematician Steve Selesnick covers the cognitive strengths shown by people with schizophrenia as well as their more widely recognized cognitive difficulties. This last feature of computational psychopathology is particularly promising for translation in that it holds out the prospect of a computationally turbo-charged model of recovery based on development of self-management skills.
The potential of computational psychopathology as a bridge between research and practice has still to be tested. This is after all precisely what it means to be a new kid on the scientific block. RDoC’s open framework is nothing if not an opportunity for testing out new kids on the scientific block. So, let’s grasp that opportunity. Let’s do it now!