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Revisionary Reductionism and the Classification of Mental Disorders

Conceptualisations of mental disorders assign different roles to biological genetic or neural factors in the categorisation of these conditions. Syndrome based accounts, that inform many diagnoses in classificatory systems such as the DSM (APA 2013) or the ICD (WHO 1992), categorise mental disorders in terms of symptomatic behaviours and mental states and personality traits. In these accounts, thus, the identity of a certain mental disorder does not depend on its neural or other biological aetiology or correlates. Proposals for biological and neurocognitive (for short biocognitive) based classification of mental disorders aim, instead, at grounding the categorization of mental disorders on genetic, neurological, or neurocomputational mechanisms. The Research Domain Criteria (RDoC) is a notable example of this proposal (see e.g. Insel and Cuthbert 2015 ; Lilienfeld 2014). The network approach to mental disorders is a recent proposal that offers a more nuanced view on the role that biological factors should have in the conceptualisation of mental disorders (Borsboom 2017). The core assumption of this account is that mental disorders should be conceptualised as networks of causally interacting symptoms. Denny Borsboom, and colleagues(Borsboom, Cramer, and Kalis 2018), argue that this approach is incompatible with a reductionist characterisation of mental disorders as “brain disorders” and, more than that, it shows why this type of reductionism is untenable. Although they are keen to assign some explanatory role to biological factors within their account, they think that causal connections between behaviourally individuated symptoms, inferred mental states, and personality traits are fundamental for the classification of mental disorders. In this paper, without considering whether the network approach is correct, we investigate, from a philosophical perspective, the role that biological factors should have in it. Our main line of reasoning is that Borsboom et al. do not recognise that difficulties in the integration of biological and neurological information in the classification of mental disorders, as they are currently conceptualized in DSM 5 or ICD 10, is also due to the heterogeneity of those categories of mental disorders and associated symptoms. It seems that they exclude without reason a significant role that biological factors should have within their proposal. We think that such a role could be spelled out by means of a plausible interpretation of the current biocognitive- based attempts at classification of mental disorders. Borsboom et al. appear to interpret some eminent instances of these attempts (e.g., Insel and Cuthbert 2015) as endorsement of the type of explanatory reductionism that they criticise. However, we think that there are interpretative grounds and, more importantly, theoretical reasons for thinking that these attempts might be underpinned by what we call revisionary reductionism. Revisionary reductionism is the view that current syndrome- based classifications of disorders, as those codified in the diagnoses in DSMs and ICDs, and those involved in the network approach could be revised or partly or completely replaced by individuating, amongst individuals that satisfy them, cognitive, genetic, neurobiological and even behavioural differences that might enable better treatment, prediction and explanation.

Revisionary Reductionism ; RDoC ; Classification of Mental Disorders

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