Research Domain Criteria: Cutting Edge Neuroscience or Galen's Humors Revisited?

The Research Domain Criteria (RDoC) scheme has guided the research agenda of the National Institute of Mental Health for the past decade. The essence of RDoC is its dimensional conception of mental illness, with the assumption that psychopathology is a manifestation of extremes along axes of neuropsychological variation. Research, it follows, should emphasize normal neuropsychological function and its associated neurocircuitry. We argue that RDoC, dressed in terms of modern neurobiology, is in fact a return to the humoral theory of Galen, a dimensional approach in which physical and mental health requires a balance of the four basic bodily humors (blood, black bile, yellow bile, and phlegm). The RDoC/Galenic approach may be useful in understanding those conditions best understood as extremes along a continuum, such as personality disorders. However, we contend that for the most severe psychiatric disorders - categorically defined diseases such as schizophrenia, bipolar disorder, and autism - RDoC's Galenic dimensionalism is a retreat from the biomedical approach that seeks to find rational therapeutic targets by identifying etiologic factors and pathogenic pathways. Abandoning this medical model now, in the context of remarkable advances in genetics, neuroimaging, and neuroscience, is a major setback for the advancement of scientific psychiatry.