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Psychiatry and the Epistemology and Ethics of Precision by Kathryn Tabb, PhD, Assistant Professor, Department of Philosophy, Bard College.

Abstract: Over the first decade of the 21st century, the United States government’s institute for psychiatric research, the National Institute of Mental Health, broke from tradition by beginning to actively discourage the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM had long been the consensus document not only for psychiatric clinicians but also researchers, so this shift was dramatic. The rationale was that the DSM, whatever its utility for practice, had not been constructed with biomedical research in mind – indeed, most of its categories were determined on the basis of clinical observation long before the advent of neuroscience or behavioral genetics. The NIMH’s contention was that the categories were not designed to help isolate causal mechanisms, and were in fact retarding scientific progress by focusing researchers’ attention on heterogenous groupings of cases. In its place the NIMH introduced an alternative classification tool, not for patients but for research targets: the Research Domain Criteria matrix, which allows scientists to present their projects in terms of the biomechanisms they target, rather than a specific patient population. Epistemically speaking RDoC constitutes an enormous shift, wherein psychopathology no longer explicitly demarcates the subject-matter of psychiatric research. After demonstrating how this is so, I will turn my attention to the epistemic and ethical challenges that result. In so far as medicine has as its aim the alleviation of suffering and the maintenance of health, medicine has become a distal, rather than proximate, goal for the NIMH. While it may be ethically sound to turn attention away from the traditional goals of psychiatry in the short run to be successful at them in the long run in this manner, the case defending this sort of revisionist view of psychiatry’s project has not yet been made. Instead, the shift in priorities has been implicitly justified by an assumption about psychiatric taxonomy: that the true essences of its categories will lie at the level of the biomechanism. This assumption is no doubt question-begging; I conclude by considering whether it is also wrong.

Bio: Kathryn Tabb is an assistant professor of philosophy at Bard College. She completed a PhD in History and Philosophy of Science and a MA in Bioethics and Health Law at the University of Pittsburgh, and also holds an MPhil in History and Philosophy of Science from the University of Cambridge. Her work focuses on the history and philosophy of psychopathology, focusing on the early modern period as well as contemporary issues in psychiatric classification and explanation. She serves as a steering committee member for Columbia University's Center for Excellence in ELSI Research and has published her work in diverse venues including Philosophy of Science, Nature Human Behavior, Theoretical Medicine and Bioethics, Behavior Genetics, and Synthese. She is currently completing a monograph on John Locke's account of psychopathology.