On Psychopathology: A defense

Jasper’s General Psychopathology is revered as a seminal work in the history of psychiatry. Yet there is a growing school of thought that sees biological psychiatry as the only scientific psychiatry and the only psychiatry worthy of being a branch of medicine. This school, as represented by the authors of the Research Domain Criteria project, rejects the notion of psychopathology, arguing pathology must occur at the biological level. For the RDoC pathology is to be sought at the level of neural circuit dysfunction. Insel, former head of the NIMH, talked of psychiatry as a branch of clinical neuroscience.
This view runs well in advance of the science, however. It is a reductionist view, even when it argues that it is not. It depends on the view psychology can be reduced, for the explanations that matter, to neurobiology. But why should we assume there cannot be pathology that arises at the level of the psyche that is best explained at that level, rather than at the level of neurobiology? This is not to say there is a mind that is separate from and distinct from the brain. There are good reasons, however, for thinking that mental functions of the brain may be different than other functions of the brain in a way that is most amenable to understanding by studying them at the level of the mental.
There is recent work, for example, on molecular changes associated with the development of PTSD in victims of trauma. Do these represent a better way of understanding PTSD than does a narrative that takes account of the actual trauma? For what purpose? If we could produce these brain changes by pharmacologic manipulation in the absence of trauma, would we still speak of PTSD? Do we think the symptoms, if any, would have the same meaning to the individual suffering them – and to us treating them –as would symptoms produced by trauma? Is PTSD the only disorder for which we might have these questions? Or should we maintain a space for a genuine psychopathology?