Introductory Chapter: New Directions in the Study of Psychopathology

1. Introduction

This volume appears at an especially propitious time for psychiatry, clinical psychology, social work, and all the systematic attempts to ameliorate the morbidity and the mortality that is associated with abnormal function of the mind. One can say with conviction that many of the assumptions held by mental health professions for the last half century have come to be challenged and may prove to be false. What do I mean by this?

1. The presumptively atheoretical DSMs, III through V, have not proved to be tools that facilitated scientific progress in the theoretical conceptualization of psychopathology [1]. Nor have they provided clinicians with the kinds of precise diagnostic instruments that would guide treatment. The atheoretical descriptive precision of the DSMs introduces the problem of comorbidity wherein it is rarely the case that single patient will be adequately described by a single diagnosis. This fact greatly compromises the precision of research designs and has led us into a world of polypharmacy that makes the design of pharmacological or psychosocial interventions not only overly complex, but often reduces it to an inductive process of trial and error. Drugs, that in theory should improve depression, sometimes turn out to be more effective with anxiety. Supplementation with atypical anti-psychotics is widely practiced, though with limited empirical evidence.

2. The National Institute of Mental Health already has begun to move away from the approach of the DSMs, which is to define mental disorders based on clusters of symptoms that tend to covary [2]. The approach that may substitute for the DSMs is the putatively more scientific RDoC, or research domain criteria. RDoC is an attempt to return to theory that is structured by basic psychological dimensions: negative valence, positive valence, cognitive processes, social processes, and arousal/regulatory processes.

3. In the U.S. and Europe, the process for approving psychotropic drugs has fostered corruption and poor science. The overstated claims for the efficacy of psychotropic drugs has cast a pall of a field that was in the early 1990s considered on the brink of breakthrough success [3].

At this watershed moment in the mental health sciences, it is a particularly apt time to present an illustrious array of international experts and the scholarship that they bring to central and foundational issues in the field. The topics our author addresses range from substance abuse to anxiety, to prenatal factors, to the pathogenic effects of combat. These chapters are grounded in clinical observation and the best research practices. They represent a fascinating array of different perspective appropriate to the beginning of a new era in the mental health sciences.