{"id":326,"date":"2019-01-09T11:24:14","date_gmt":"2019-01-09T11:24:14","guid":{"rendered":"https:\/\/blogs.sps.ed.ac.uk\/skape\/?p=326"},"modified":"2020-06-26T11:34:44","modified_gmt":"2020-06-26T11:34:44","slug":"beyond-diagnosis-shifting-approaches-in-psychiatry","status":"publish","type":"post","link":"https:\/\/blogs.sps.ed.ac.uk\/skape\/2019\/01\/09\/beyond-diagnosis-shifting-approaches-in-psychiatry\/","title":{"rendered":"Beyond diagnosis? Shifting approaches in psychiatry"},"content":{"rendered":"

A blogpost by\u00a0Martyn Pickersgill<\/a>,\u00a0Centre for Biomedicine, Self and Society at\u00a0The University of Edinburgh<\/h4>\n

@PickersgillM<\/a><\/p>\n

\"\"<\/a>The use of biological ideas and techniques in the study of mental ill-health and the practice of psychiatry is nothing new. But just because it isn\u2019t new doesn\u2019t mean that\u2019s the only thing that\u2019s going on in research and in the clinic: many other notions (psychological, sociological, and so on) interpolate with somatic emphases in psychiatry. One engine powering the late-twentieth century biological turn within US psychiatry was the 1980 launch of the third edition of the American Psychiatric Association (APA)\u2019s Diagnostic and Statistical Manual of Mental Disorders: DSM-III. This texted helped to revivify attention to the bodily aspects of mental ill-health, although of course psychiatrists had to be attentive already to this ontological dimension for such a shift to be propelled. The DSM has come to be a major feature within the landscape of mental health research and practice, and not just in the US. Nevertheless, over the last few years criticism of this text has been growing within psychiatry itself.<\/p>\n

A key locus of critique has been the former Director of the US National Institute of Mental Health (NIMH): Thomas Insel. The NIMH has traditionally been a major supporter of studies conducted using the DSM \u2013 and, indeed, of the production of successive editions of the DSM itself. In 2010, Insel and colleagues launched the NIMH Research Doman Criteria (RDoC) initiative. This was supposed to be a framework for shaping thinking about specific characteristics of what were regarded as psychopathologies, and how these could be better interrogated within laboratory and related settings. The NIMH have called RDoC a \u201clong-term project\u201d that incorporates \u201cgenetics, imaging, cognitive science, and other levels of information to lay the foundation for a new mental disorders classification system\u201d (NIMH, 2013). Through its promotion of RDoC, the NIMH has downplayed the import of the DSM. Insel himself wrote in one widely discussed blog post that: \u201cUnlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure\u201d (Insel, 2013). Consequently, NIMH would \u201cbe re-orientating its research away from DSM categories\u201d (ibid).<\/p>\n

My ongoing research, supported by the Wellcome Trust, is examining epistemological debates such as the ones around RDoC and the DSM so as to generate a sharper image of the ways in which diagnoses are used in research and clinical practice, and with what ontological ramifications. Part of my research has involved interviewing key figures in US and UK psychiatry, and I have explored how they construct the purpose, nature, and implications of the ambiguous RDoC project. My intent is not to provide a broad-brush critique of RDoC as, for instance, biologically reductionist. As my data demonstrates, this is a criticism that psychiatrists themselves are often happy to make. Hence, the sociological focus of any analysis of RDoC needs to be positioned slightly differently. Accordingly, I use discussions about RDoC as a case study in what I have termed the sociology of novelty. In my upcoming SKAPE talk, I will explore how major institutional actors\u2019 accounts of what is new, important, or (un)desirable about RDoC are constituted through institutional context and personal affects. In so doing, I aim to add empirical depth to current understandings about the bio-politics and psy-sociality of contemporary (US) psychiatry, and to contribute to sociological debates about \u2018the new\u2019 in technoscience.<\/p>\n

\n

Further Reading:<\/h4>\n

Cuthbert, B. N. and Insel, T. (2013) \u2018Towards the future of psychiatric diagnosis: the seven pillars of RDoC\u2019, BMC Medicine, 11, 126, https:\/\/bmcmedicine.biomedcentral.com\/articles\/10.1186\/1741-7015-11-126<\/a>.<\/p>\n

Insel, T. (2013) \u2018Transforming Diagnosis\u2019, NIMH Director\u2019s Blog, 29 April 2013, https:\/\/www.nimh.nih.gov\/about\/directors\/thomas-insel\/blog\/2013\/transforming-diagnosis.shtml<\/a>.<\/p>\n

NIMH (2013) \u2018Introduction to RDoC\u2019, NIMH Science Update, 9 August 2013, https:\/\/www.nimh.nih.gov\/news\/science-news\/2013\/introduction-to-rdoc.shtml<\/a>.<\/p>\n

Pickersgill, M. (2013) \u2018The social life of the brain: neuroscience in society\u2019, Current Sociology, 61, 322-340.<\/p>\n

Pickersgill, M. (2014) \u2018Debating DSM-5: diagnosis and the sociology of critique\u2019, Journal of Medical Ethics, 40, 521-525.<\/p>\n

Pickersgill, M. (forthcoming) \u2018Psychiatry and the sociology of novelty: negotiating the US National Institute of Mental Health \u2018Research Domain Criteria\u2019 (RDoC)\u2019.<\/p>\n","protected":false},"excerpt":{"rendered":"

A blogpost by\u00a0Martyn Pickersgill,\u00a0Centre for Biomedicine, Self and Society at\u00a0The University of Edinburgh @PickersgillM The use of biological ideas and techniques in the study of mental ill-health and the practice of psychiatry is nothing new. But just because it isn\u2019t new doesn\u2019t mean that\u2019s the only thing that\u2019s going on in research and in the   …Continue Reading<\/a><\/p>\n","protected":false},"author":260,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"acf":[],"_links":{"self":[{"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/posts\/326"}],"collection":[{"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/users\/260"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/comments?post=326"}],"version-history":[{"count":9,"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/posts\/326\/revisions"}],"predecessor-version":[{"id":455,"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/posts\/326\/revisions\/455"}],"wp:attachment":[{"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/media?parent=326"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/categories?post=326"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.sps.ed.ac.uk\/skape\/wp-json\/wp\/v2\/tags?post=326"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}