The Revolution Has Begun

Written by craig

When I found it, my hands began to tremble a little, and my eyes moistened. It took a few seconds to accept that the words said what they did, and a few minutes to finally believe in my heart that what they promised was true.

I'd been trolling through JAMA (the Journal of the American Medical Association) hunting for more research tidbits, nothing in particular, when I ran across a commentary by Insel and Wang entitled, "Rethinking Mental Illness."

 They talked about how, in the first issue of Nature this year, the editor referred to the next decade as the "decade for psychiatric disorders." Folks, they didn't mean we're going to have an epidemic of schizophrenia and bipolar disorders. No, what they discussed was the fact that research has finally  been making wholesale inroads into the actual causes of what we call mental illness. 'Fact is, what the researchers are finding just doesn't fit what we've been doing. Please allow me a lenghty quote here:

Two noteworthy points are emerging from systems neuroscience. First, there seem to be emerging relationships between genetic variation  and development of neural circuits that mediate complex cognition and behavior, from reward to emotion regulation. Second, the current diagnostic categories, based on clinical characteristics, do not seem to align well with findings from genetics and neuroscience.   [emphasis added]

'Interesting, but no big deal. I'd seen this argument before. The authors then mentioned a project very recently begun by the NIMH (National Institute for Mental Health), a government agency that controls considerable funding in mental health research. I read the blurb on the project from the commentary, and my hands trembled slightly. The tearducts moistened a little, and I raced to the NIMH site to see if, just maybe, the revolution had finally started.

Yes, it did. It definitely, DEFINITELY, did!

'A couple of snippets.

Research Domain Criteria (RDoC)

Strategy 1.4 of the NIMH Strategic Plan calls for the development, for research purposes, of new ways of classifying psychopathology based on dimensions of observable behavior and neurobiological measures. The Research Domain Criteria project (RDoC) has been launched by NIMH to implement this strategy.  In brief, the effort is to define basic dimensions of functioning (such as fear circuitry or working memory) to be studied across multiple levels of analysis, from genes to neural circuits to behaviors, cutting across disorders as traditionally defined.

and

RDoC will follow three guiding principles, all diverging from current diagnostic approaches. First, RDoC is conceived as a dimensional system (reflecting, e.g., circuit-level measurements, behavioral activity, etc.) spanning the range from normal to abnormal. As with dimensions like hypertension or cholesterolemia in other areas of medicine, this approach incurs both the problem and advantage of defining cutpoints for the definition and extent of pathology – e.g., mild, moderate, and severe. (To the extent that DSM-V introduces dimensions in addition to classes, the crosswalks to RDoC dimensions may be enhanced.) Second, RDoC is agnostic about current disorder categories.  The intent is to generate classifications stemming from basic behavioral neuroscience. Rather than starting with an illness definition and seeking its neurobiological underpinnings, RDoC begins with current understandings of behavior-brain relationships and links them to clinical phenomena. Third, RDoC will use several different levels of analysis in defining constructs for study (e.g., imaging, physiological activity, behavior, and self-reports of symptoms). Indeed, RDoC, as a research framework, has been developed with the explicit goal of permitting investigators to choose an independent variable from one of several different units of analysis. 

I'll have more on this later but the time for peace, at the cost of one's freedom and dignity, is past.

The revolution has started.