Our circuits, ourselves: What the autism spectrum can tell us about the Research Domain Criteria Project (RDoC) and the neurogenetic transformation of diagnosis
The Research Domain Criteria (RDoC) project is an ambitious new initiative by the National Institute of Mental Health that aims to comprehensively redefine mental illnesses as problems of neurogenetic ‘circuitry’. This essay explores potential implications of this nascent approach. Drawing on data from two studies that examine the diagnosis of autism spectrum disorder, itself recently reconceptualized along lines similar to this new diagnostic paradigm, I argue that such ‘circuit disorders’ differ from their predecessors in two significant ways. First, while psychiatric disease entities under the previous paradigm were understood as fundamentally separable from the affected person, circuit disorders are bound up in intimate neuropsychological processes such as memory, perception and desire; they are thus often experienced as constitutive of identity by those living under their description. Second, rather than being limited to matters of ‘clinically significant impairment’, circuit disorders are multivalent, encompassing valued as well as devalued traits. Given that one major aim of the RDoC is to allow for pre-emptive biomedical intervention upon pre-symptomatic states, these emergent qualities of circuit disorders raise complex ethical concerns. I conclude by illustrating the way these concerns become obscured in the transition to an ostensibly value-neutral biophysiological paradigm.
KeywordsRDoC psychiatry diagnosis autism aspergers mental health
The research leading to this publication was made possible by generous support from the NIMH (Ruth L. Kirschstein National Research Service Award for Individual Predoctoral Fellows, Award #F31MH082551-02), a National Science Foundation Dissertation Improvement Grant (Award #0823390) and a Dissertation Fieldwork Grant from the Wenner-Gren Foundation for Research in Anthropology (Award #7836). Its contents are the responsibility of the author and – perhaps manifestly – do not necessarily represent the official views of awarding organizations. The author would like to thank Christine El-Ouardani, Kathryn Goldfarb, Chloe Silverman and four anonymous reviewers for their support in developing the arguments in this article, and the students in her “Clinical, Critical and Cultural Approaches to Mental Health” seminar at the University of Chicago for thinking through many of the issues in this article with her.
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