NEUROCENTRISM Feld, Meca, & Sauvigné, in Press)

NEUROCENTRISM feld, Meca, & Sauvigné, in press). In its Neurocentrism: Implications for Psychotherapy most extreme form, neurocentrism regards Practice and Research the CNS as essentially the only adequate level of analysis for conceptualizing and treating psychological phenomena. Scott O. Lilienfeld, Emory University The early 21st century is also awash in talk of psychological conditions as “brain Seth J. Schwartz and Alan Meca, University of Miami disorders.” For example, in a 2013 TEDx talk, Thomas Insel, director of the National Katheryn C. Sauvigné, Georgia State University Institute of Mental Health (NIMH), argued Sally Satel, American Enterprise Institute that “what we need conceptually to make progress here is to rethink these disorders [mental disorders] as brain disorders” (Insel, 2013; see also Insel & Cuthbert, 1989, SAMUEL GUZE, then one of the damental level of analysis—the brain. IN 2015). doyens of American psychiatry, laid down Hence, it is only at this level, Guze main- But is neurocentrism helpful in clarify- the gauntlet to his academic colleagues in a tained, that research will ultimately bear ing our thinking about the causes and provocative article, entitled “Biological fruit in understanding, treating, and pre- treatment of mental disorders? What are its Psychiatry: Is There Any Other Kind?”, venting mental afflictions. implications for psychotherapy practice published in a prestigious medical journal. Over a quarter of a century later, we find and research? On the opening page, Guze answered his ourselves confronting the same question own question with a resounding “no”: raised by Guze, but with respect to psy- The Long Swing of the Pendulum “There can be no such thing as a psychiatry chology. We also find ourselves in an era of which is too biological” (Guze, 1989, p. creeping neurocentrism. By neurocen- While an undergraduate at Cornell 316). For Guze, the study of mental illness trism, we mean the propensity of scholars University during the late 1970s, the first must focus squarely on the brain as the to embrace the brain and remainder of the author enrolled in a course on psy- principle, if not the exclusive, level of expla- central nervous system (CNS) as inherently chopathology. The professor, a clinical psy- nation. Because all psychiatric conditions the most appropriate level of analysis for chologist by training, confidently informed are ultimately instantiated in neural tissue, conceptualizing and treating psychological the class that infantile autism (today he insisted, they are all physiological disor- phenomena, including mental disorders known as autism spectrum disorder; ders once one drills down to the most fun- (Satel & Lilienfeld, 2013; Schwartz, Lilien- American Psychiatric Association, 2013)

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October • 2015 173 LILIENFELD ET AL. was a disorder of purely environmental eti- analysis, such as the traditionally persono- and the National Institute on Drug Abuse ology. Autism, he assured us, is a conse- logical, social, and cultural levels. (NIDA) that appear to signal a marked quence of inadequate or neglectful parent- Psychiatrist Kenneth Kendler (2014) shift toward neurocentrism. For example, ing. To buttress his point, he assigned similarly warned of “fervent monism” or the draft of the NIMH’s (2014) new Strate- Bruno Bettelheim’s (1967) The Empty the undue reliance on only one explanatory gic Plan informs readers that this agency’s Fortress, an impassioned tome that identi- level, whether neural or psychological, for major objectives comprise “defining the fied “refrigerator mothers” as responsible understanding human nature (see also biological basis of complex behaviors” (p. for autism (this theory, originated by child Craddock, 2014, for a discussion of the 15), “describing the molecules, cells, and psychiatrist Leo Kanner, 1943, has since need to accommodate both neuroscientific neural circuits associated with complex been debunked). and social levels of analysis in psychiatry). behaviors” (p. 17), and “mapping the con- This kind of thinking was hardly Concerns regarding fervent monism were nectomes for mental illness” (p. 18). As of unusual at the time. As a number of com- also expressed by a recent past president of this writing, the “Director’s Page” for mentators have observed, much of clinical the Association for Psychological Science, NIDA, which highlights the work of direc- psychology and psychiatry in that era could Nancy Eisenberg (2014), who lamented the tor Dr. Nora Volkow, states that “Dr. best be described as largely “brainless” “increasing tendency to assume that study- Volkow’s work has been instrumental in (Eisenberg, 1986). Many mainstream ing genetic/neural/physiological processes demonstrating that drug addiction is a dis- authors conceptualized human nature as is more important than research on behav- ease of the human brain” (http://www. something akin to a “blank slate,” often ior and psychological processes per se drugabuse.gov/about-nida/directors- according scant consideration to the because biological findings will eventually page/biography-dr-nora-volkow). Con- genetic or neurobiological context of explain most of human psychological func- spicuously, this web page provides visitors behavior (see Lykken, 1991, Pinker, 2003, tioning” (p. 1). She noted that this trend is with no mention or even hint of research- for discussions). A provocative book enti- evident in “the funding priorities at some based or conceptual criticisms of this view, tled Not in Our Genes (Lewontin, Rose, & of the National Institutes of Health … it which demonstrate that drug addiction, Kamin, 1984), which argued forcefully can also be seen in the hiring patterns of although genetically influenced in many against genetic and other biological influ- many psychology departments that place a cases, is often highly responsive to external ences on intelligence, schizophrenia, and priority on hiring people who study biolog- incentives, classically conditioned cues, behavioral phenotypes more generally, was ical processes or aspects of cognition that and other nonbiological environmental widely read and taken seriously by scores of can be tied to neuroscience” (p. 1). influences (Lewis, 2015; Satel & Lilienfeld, academic psychologists of a radical envi- 2013). ronmentalist bent. How times have Evidence for the Ascendance of To fully appreciate the logical assump- changed. Neurocentrism tions underpinning neurocentrism and its implications for psychotherapy practice As the pendulum has—thankfully— In a recent article, we (Schwartz et al., in swung away from the often “brainless” psy- and research, however, we first need to press; see also Kagan, 2013; Miller, 2010, examine the oft-misunderstood concept of chology and psychiatry that were wide- for similar arguments) laid out several lines spread only a few decades ago, a growing reductionism. It is to this thorny concept of evidence suggesting that mainstream that we now turn. cadre of scholars, ourselves included, have psychology is increasingly adopting a neu- expressed concerns that these disciplines rocentric approach to human nature. Reductionism and Its Two Flavors now risk becoming “mindless” (Eisenberg, Among other things, we pointed to a dra- 2000; Lipowski, 1989; Satel & Lilienfeld, matic recent upturn in the proportion of Many psychologists routinely decry 2013). Because mental phenomena carry academic positions calling for expertise in “reductionism” as a scientific approach. negative connotations in some domains of neuroscience, many of which even man- But such criticism overlooks a key point: psychology, such as radical behaviorism date functional brain imaging skills; to the Reductionism is not one thing (Robinson, (e.g., McDowell, 1991), we should be growing number of elite psychology 1995). In particular, we must be careful to explicit about what we do and do not mean departments (e.g., Indiana University, Uni- distinguish constitutive from eliminative in this regard. First, by “mind,” we do not versity of Colorado at Boulder) that have reductionism (Ilardi & Feldman, 2001; imply a spooky, metaphysical essence that modified their names to emphasize neuro- Lilienfeld, 2007). Constitutive reduction- is either immaterial of or materially inde- science (e.g., “Department of Psychology ism, which we wholeheartedly endorse, pendent from the brain. Instead, as we later and Brain Science”; see also Lilienfeld, posits that the mind is what the CNS does, delineate in more detail, we refer to a psy- 2012); to findings that, compared with and that all psychological phenomena are chological level of analysis that differs journals in other medical areas, psychiatry ultimately traceable to neuronal activity. from, but complements, the neural level. journals are publishing a much higher per- Constitutive reductionists reject “sub- Second, by “mindless,” we do not mean centage of articles devoted largely or stance dualism,” the dubious notion foolish or vacuous. Rather, we mean an entirely to biological correlates (Stone, endorsed by Descartes (see Damasio, 2001) undue neglect of what William James Whitham, & Ghaemi, 2012); and to survey that mind and brain are composed of dif- (1890, p. 1) regarded as the essence of psy- data we collected indicating that 27% of ferent material “stuff.” At the same time, chology, namely, the “science of mental research psychologists reported “often,” some constitutive reductionists, ourselves life” (see also Cacioppo & Tassinary, 1990). “always,” or “almost always” feeling pres- included, remain open to “property dual- A mindless psychology, in our view, sured to incorporate neuroscientific mea- ism,” the proposition that mind and brain, focuses so substantially on the neural level sures into their grant proposals. although materially identical, differ in their of analysis that it excludes or at least mini- We also addressed recent public state- level of analysis—much as Beethoven’s 9th mizes a host of other important levels of ments by leading administrators at NIMH symphony can be conceptualized as a

174 the Behavior Therapist LILIENFELD ET AL. jumble of thousands of notes at one level One pointed challenge to eliminative of the story—most notably, the psycholog- and as a majestic subjective experience at reductionism derives from theorizing on ical meaning of prejudice to both its expe- another. emergent properties: complex, higher- riencer and its target. Eliminative reductionists, in contrast, order phenomena that are not fully go well beyond constitutive reductionists. reducible to lower-order levels. Cognitive Neurocentrism: Implications for According to them, scientists will eventu- scientist Douglas Hofstadter (2007) offered Psychological Treatment ally be able to dispense entirely with the a “traffic jam” as an example of an emer- psychological level of analysis, including gent property. The meaning of a traffic jam, Neurocentrism may offer us a one- such ostensibly “prescientific” concepts as he observed, cannot be extracted solely dimensional view of human nature, but is it “personality,” “thoughts,” “motives,” and from its basic elements, such as cars, buses, potentially harmful? We are inclined to “emotions” (Kihlstrom, 2010). Once the cabs, and trucks. “You won’t locate a traffic think so. For one thing, controlled data relation between brain and behavior is fully jam,” Hofstadter observes, “if you restrict suggest that although the framing of mapped out, eliminative reductionists pre- your search to the insides of a single taxi” mental illnesses, such as schizophrenia and dict that these and other psychological con- (p. 787). To “find” a traffic jam, one must major depression, as brain diseases typi- cepts will become superfluous, and that instead look to the higher-order interaction cally diminishes blame toward individuals psychology will be reduced and relegated to of its constituents, such as the number of with these illnesses, it heightens pessimism a branch of biology. Philosopher Daniel cars on the road, the timing of traffic lights, regarding prognosis and (probably) per- Dennett (1993) termed this perspective the spacing between cars, the decision of ceptions of dangerousness (Kvaale, “greedy reductionism” because it implies drivers to change lanes at the last moment, Haslam, & Gottdiener, 2013). Although that the more basic levels of analyses (e.g., slow driver reaction times, and so on. The well-intentioned, the movement to recon- the neuronal), which are lower in Comte’s whole is more than—and substantially dif- ceptualize mental disorders as brain dis- (1842) familiar pyramid of the sciences, ferent from—the sum of its parts (see also eases has at best mixed success in reducing will eventually “gobble up” the higher Marr, 1982). Although the existence of stigma (Deacon, 2013). We further worry levels (e.g., the psychological). emergent properties is still actively debated that neurocentrism has led some scholars, Eliminative reductionism remains alive among philosophers of mind, for the fore- practitioners, and laypersons to assume and well in many circles, even including seeable future valuable information about that the brain is not merely the optimal some psychology departments. About a behavior will almost always be lost when level of analysis for understanding mental decade ago, a psychology department chair descending from higher to lower levels of illness, but for treating and preventing it as (who was a systems neuroscientist by spe- analysis. Psychologist Jerome Kagan (2006) well. In this way, neurocentricism may cialization) was defending to one of us the made the same point with regard to works narrow the foci of potential intervention hiring of a researcher whom many of his of art. He noted that to appreciate an targets to the constituents of the CNS, such colleagues perceived as insufficiently inter- impressionistic painting, one must per- as neurotransmitters, neuromodulators, ested in behavior. The chair gestured ceive more than just the sum of its parts. and receptors, often to the neglect of higher proudly to a book on his shelf by eminent “As a viewer slowly approaches Claude levels of analysis, such as psychological neuroscientist Michael Gazzaniga (1998), Monet’s painting of the Seine at dawn there states—for example, attitudes, moods, entitled The Mind’s Past, and opened to the comes a moment when the scene dissolves motives, and thinking styles—that may be Preface, which proclaimed unequivocally into tiny patches of color.” When we adopt amenable to treatment. that “psychology itself is dead ... the odd eliminative reductionism and focus solely This misapplication of neurocentrism thing is that everyone but its practitioners on the lower-order elements of a painting, may stem in part from ex juvantibus rea- knows about the death of psychology” (p. though, “the coherent psychological com- soning, a mouthful of a logical fallacy 1). The department chair insisted that it ponent vanishes” (p. 213). meaning “reasoning backward from what only was a matter of time, and not much Kenneth Kendler (2005) has advanced works” (Ross & Pam, 1995). It is tempting, time at that, before psychologists would be similar arguments, arguing forcefully for but fallacious, to assume that if the causes regarded as expendable in departments of the importance of considering multiple of a mental disorder are in part biological, psychology. Some prominent neuroscien- levels of analysis in understanding psy- its proper treatment must also be biologi- tists are advocates of eliminative reduction- chopathology. Specifically, he contended cal, and vice-versa. But we should bear in ism, either explicitly or implicitly. In his that certain levels of analysis are more help- mind the medical truism that headaches book Neuronal Man, Jean-Pierre ful than others for approaching different are not caused by a deficiency of aspirin in Changeux (1997) wrote that “all forms of scientific questions (see also Cacioppo & the brain. Nor do schizophrenia and vom- behavior mobilize distinct sets of nerve Tassinary, 1990). For example, when devel- iting share the same etiology even though cells, and it is at their level that the final oping and testing medications intended to both can be alleviated by means of medica- explanation of behavior must be sought” target the amyloid plagues and neurofibril- tions, such as Compazine or Haldol, that (p. 97). Similarly, physicist and popular lary tangles of Alzheimer’s disease, the block the binding action of the neurotrans- writer Robert Park (2008) argued that brain-based level of analysis will be the mitter dopamine in the brain. Inferring eti- “Psychology is becoming a ‘hard science,’ most helpful. In contrast, when attempting ology from treatment, or treatment from one that is last transforming the subjective to understand the causes of racial prejudice etiology for that matter, is a tricky business. study of human behavior into objective and strategies to combat it, the psychologi- Just as important, the assumption that measurements of the physical entities that cal and cultural levels will be most relevant. biomedical interventions are necessarily define us ... we need to get inside the brain In principle, of course, we may one day the optimal line of attack for psychological to see what’s actually happening among the trace prejudice to the firing patterns of spe- disorders has not stood up under empirical billions of neurons, and simplify it to the cific neurons in the brain. But in doing so, scrutiny. Despite the growing preeminence most basic functions” (p. 198). we would inevitably leave out crucial parts of neurocentrism in the public eye, psycho-

176 the Behavior Therapist LILIENFELD ET AL. logical and psychiatric researchers are environment, the neuropsychotherapist ... would be hard pressed to glean from an busily working behind the scenes to [can obtain] a thorough grasp of the client’s inspection of their web sites and promo- develop effective psychological interven- situation” (http://www.neuropsychothera- tional materials. Second, these interventions for mental disorders, even those pist.com/about/). tions are bedeviled by a vexing conceptual marked by a hefty genetic component. • Brain-spotting (Grand, 2013) directs problem. Although it is plausible that basic Although one would be hard-pressed to clients’ eye movements to specific positions neuroscience knowledge may one day surmise it from the plethora of medication that are purportedly linked to emotional inform the development and implementa- ads flooding our web pages and magazines, trauma housed in specific brain regions, tion of psychological treatments, not nearly research increasingly demonstrates that such as the amygdala and hippocampus. enough is presently known about the link- cognitive-behavioral therapy (CBT), which According to its proponents, “the mainte- ages between such knowledge and psy- focuses on modifying maladaptive think- nance of that eye position/Brainspot within chopathology to effectively bridge the mul- ing patterns and behaviors and imparting the attentional focus on the body’s ‘felt tiple levels of analysis that intervene helpful skills to combat them, is at least as sense’ of that issue or trauma stimulates a between neurons and abnormal behavior effective for treating major depression in deep integrating and healing process (Schwartz et al., in press). As a conse- the short run as is antidepressant medica- within the brain. This processing . . . quence, it is not at all evident that basic tion. Furthermore, in several large-scale appears to take place at a reflexive or cellu- brain science can tell us much about the studies, CBT has emerged as more effective lar level within the nervous system” design of psychotherapies that we do not than medication for preventing recur- (https://brainspotting.pro/page/what- already know. For example, although neu- rences of major depression (Butler, Chap- brainspotting). ropsychoanalysis advocates are surely correct that emotional processing shapes our man, Foreman, & Beck, 2006; but see • Brain Gym, an educational technique in psychological make-up in powerful ways, Johnsen & Friborg, in press, for suggestions use in more than 80 countries, consists of functional brain imaging findings are not that the efficacy of CBT for depression is 26 prescribed activities (most involving needed to achieve this age-old insight declining), probably because it provides movement) that supposedly influence the (Ramus, 2013). individuals with enduring skills for ward- activity of brain areas involved in learning Similar cautions regarding the overea- ing off relapse. Similarly, the devastating and memory. For example, Brain Gym ger application of neuroscience are not signs and symptoms of schizophrenia, until ostensibly claims to augment blood flow to new, and were sounded by B. F. Skinner recently believed to be resistant to psy- the brain by massaging specific bodily (1955) decades ago. As described by chosocial interventions, are now proving to regions (“brain buttons”), thereby boosting O’Donohue (2013), “Skinner judged that be at least somewhat amenable to family the acquisition of new information (Den- [there] was too much of what he came to and individual therapies designed to help nison & Dennison, 1989). patients manage everyday stressors (Jauhar call ‘premature physiologizing’—that the • Neuropsychoanalysis, although more of et al., 2014). zeitgeist of psychology of his time thought a research program than a school of ther- Neurocentrism has also born witness to, it was imperative that any discussion of apy per se, aims to integrate Freudian ther- and almost certainly fueled the popularity perception and learning must be cased out apeutic principles with cutting-edge devel- of, legions of novel—and dubious—brain- in terms of the physiology of the nervous opments in neuroscience (Panskepp & based psychotherapies of various stripes system” (p. 112). Solms, 2012; C. Schwartz, 2015), perhaps (see Cozzolino, 2002). Although these The central problem with assertions consistent with Freud’s (1895) view that treatments differ in their specifics, all pur- regarding brain-based psychotherapies is psychoanalysis would ultimately be port to draw on findings in basic neuro- not that they are necessarily incorrect. reduced to neuroscience. For example, science to inform psychological interven- Instead, it is that these assertions are pre- some advocates of neuropsychoanalysis tion. A selective sampling of some items mature and almost always promise far maintain that functional brain imaging more than they can currently deliver. As a from the growing menu of brain-based data demonstrating the potency of limbic treatments includes the following: consequence, mental health practitioners regions (e.g., amygdala, insula) in psycho- and consumers alike must be vigilant of logical processing helps to vindicate “brain scams" (Beyerstein, 1990): glitzy but • Brain-based trauma therapy (see Arden Freudian claims regarding the overriding & Linford, 2008) is a broad approach that unsupported techniques that capitalize on influence of unconscious sexual and the cachet of neuroscience to persuade the “synthesizes neuroscience, evidence-based aggressive urges on behavior. treatment, psychotherapy research, and unwary that they are grounded in high- quality science. attachment theory into a hybrid therapeu- In all fairness, it is conceivable that some or tic model” and accords “special attention to all of these techniques may eventually the neurodynamics of PTSD and the cru- Implications of Neurocentrism prove to be efficacious, at least for certain for Treatment Research cial role of memory” (http://www.aasw. clinical problems. Nevertheless, to our asn.au/events/event/brain-based-trauma- eyes, there are at least two serious difficul- Neurocentrism also carries noteworthy therapy-integrating-neuroscience-and- ties with the marketing and dissemination implications for research on mental illness psychotherapy_brisbane). of brain-based approaches. First, the claims and its treatment. For example, neurocen- • Neuropsychotherapy (Grawe, 2007) associated with these methods go well trism can lead policymakers to funnel grant advocates contend that “armed . . . with beyond the available research evidence. funding primarily or exclusively to projects microscopic insight into the activity of a Notably, none of the interventions that target the brain as the principal level of particular neural network involved with a described in the preceding bulleted list has analysis for approaching the diagnosis, eti- client’s fear, as well as a macroscopic view been subjected to even a single published ology, treatment, and prevention of psy- of their interpersonal relationships and controlled trial, a salient caveat that one chological disorders. Indeed, over the past

178 the Behavior Therapist NEUROCENTRISM decade, obtaining federal funding to exam- arousal systems) that may go awry in these for us” (Gever, 2013; see also Pine & ine the psychosocial correlates and causes conditions (Insel et al., 2010; Sanislow et Liebenluft, 2015). In addition, a recent past of psychological maladjustment has al., 2010). president of the American Psychiatric become increasingly challenging (Schwartz RDoC has much to recommend it, espe- Association characterized RDoC as a blue- et al., in press). In the case of substance cially its loosening of the hegemony of the print for “the creation of a new diagnostic addictions, the lion’s share of grant fund- reigning DSM-ICD “paradigm” over psy- system based upon genetics, neurobiology, ing has been channeled into the largely chopathology research. In this respect, it brain circuits, and biomarkers” (Lieber- quixotic search for medications (e.g., vac- may offer a fresh transdiagnostic perspec- man & Ogas, 2015, p. 284). As RDoC cines, endogenous opiate antagonists) as tive on psychiatric classification that could moves forward in the coming years, NIMH opposed to psychosocial interventions, eventually yield enhanced treatment utility. must therefore ensure that the biological despite the more promising track record of At the same time, several scholars have level of analysis is not privileged at the efficacy of the latter (Lewis, 2015). voiced concerns that RDoC may push psy- expense of other levels in our attempts to Another reason for caution concerning chological and psychiatric research, includ- understand and treat mental problems. neurocentrism derives from the Research ing work on treatment and prevention, in The search for biomarkers of psy- Domain and Criteria (RDoC) initiative an even more biological direction (Beren- chopathology is valuable and should be recently launched by NIMH. RDoC aspires baum, 2014; Lilienfeld, 2014). To be clear, encouraged, but it should not preclude to develop a psychiatric classification RDoC is open to the inclusion of measures research at alternative levels of analysis. system that can provide a viable alternative at multiple levels of analysis, including self- to those of both the Diagnostic and Statisti- report, interview, and behavioral observa- Parting Thoughts cal Manual (DSM) and the closely related tions, and does not limit its scope to bio- International Classification of Diseases logical indices per se (Cuthbert, 2014). Given that the history of clinical psy- (ICD), which many scholars believe are Nevertheless, it is worrisome that a number chology and allied disciplines has long been rapidly approaching an asymptote in terms of prominent figures in psychiatry appear characterized by radical pendulum swings of scientific progress (Insel, 2009). Specifi- to view RDoC more narrowly than its orig- between dogmatic sociotropy and dog- cally, RDoC regards mental disorders as inal formulators. For example, in a com- matic biotropy (see Meehl, 1990, for a dis- the products of dysfunctions in brain cir- ment in support of RDoC, John Scully, the cussion), some readers may justifiably cuitry, and it delineates several promising American Psychiatric Association's chief wonder whether we are sounding an unjus- psychobiological domains (e.g., positive officer, stated that “We want him [Thomas tified alarm call. After all, they might con- valence systems, negative valence systems, Insel, director of NIMH] to get biomarkers tend, it is probably only a matter of time

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October • 2015 179 LILIENFELD ET AL. before the pendulum swings away from physiological signals. American Psycholo- Hofstadter, D. R. (2007). I am a strange neurocentrism, ideally equilibrating into a gist, 45, 16-26. loop. New York: Basic books. position in which social and biological Changeux, J. P. (1997). Neuronal man: The Ilardi, S. S., & Feldman, D. (2001). The levels of analysis are both valued. biology of mind. Princeton, NJ: Princeton cognitive neuroscience paradigm: A uni- Perhaps such readers are correct; we University Press. fying metatheoretical framework for the certainly hope so. At the same time, there Comte, A. (1842). Cours de Philosophie science and practice of clinical psychol- positive (selections translated by Mar- ogy. Journal of Clinical Psychology, 57, are ample reasons for concern. Because fac- 1067-1088. ulty hiring, research, and grant funding are garet Clarke as The Essential Comte). New York: Barnes & Noble. Insel, T. R. (2009). Translating scientific increasingly being directed toward neuro- Cozzolino, L. J. (2002). The neuroscience of opportunity into public health impact: A scientific approaches to psychopathology psychotherapy. New York: Norton. strategic plan for research on mental ill- and away from competing approaches, ness. Archives of General Psychiatry, 66, Craddock, N. (2014). Social neuroscience: there is a danger that psychosocial research 128-133. Bringing an end to the destructive and on mental disorders and their treatment misguided “social” versus “biological” in Insel, T.R. (2013). Toward a new under- will not receive the attention that it psychiatry. World Psychiatry, 13, 140- standing of mental illness. [TED talk]. deserves. As a consequence, we may be left 141. http://www.ted.com/talks/thomas_insel_ toward_a_new_understanding_of_ment with an impoverished picture of the causes Cuthbert, B. N. (2014). Response to Lilien- al_illness/transcript?language=en and amelioration of psychopathology. feld. Behaviour Research and Therapy, Furthermore, it is crucial that future 62, 140-142. Insel, T. R., & Cuthbert, B. N. (2015). Brain disorders? Precisely. Science, 348, generations of graduate students in clinical Damasio, A. (2001). Descartes' error: Emo- 499-500. psychology and allied fields receive multi- tion, reason and the human brain. New Insel, T. R., Cuthbert, B. N., Garvey, M. A., disciplinary training that bridges diverse York: Random House. Heinssen, R. K., Pine, D. S., Quinn, K. J., Deacon, B. J. (2013). The biomedical levels of analysis, including the cellular, ... Wang, P. S. (2010). Research domain model of mental disorder:A critical physiological, psychological, social, and criteria (RDoC): Toward a new classifica- analysis of its validity, utility, and effects cultural (Shoham et al., 2014). 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Can Biomedical Models of Psychopathology focus on the individual, professional, and societal consequences of such conceptual- Interfere With Cognitive-Behavioral Treatment izations. Research has found that public adop- Processes? tion of the biomedical model has been on the increase (Pescosolido et al., 2010; Stephen A. Kichuk, Yale University School of Medicine Schnittker, 2006). Many might hope or believe this would lead to reduced stigmati- Matthew S. Lebowitz, Yale University zation of psychiatric disorders (Pesco- solido et al.), but evidence suggests the T. Grover Adams Jr., Yale University School of Medicine opposite has occurred (Kvaale, Gottdiener, & Haslam, 2013; Kvaale, Haslam, & Gott- THE DOMINANCE OF BIOMEDICAL models Institute of Mental Health (Deacon, 2013) diener, 2013; Read, 2007). Biomedical of psychiatric disorders is undoubtedly due or foundations such as the Brain and explanations of psychiatric disorders may to multiple factors. Modern research has, Behavior Foundation. Additionally, advo- cause laypeople to believe that those with without question, revealed a wealth of bio- cacy groups like the National Alliance on psychiatric disorders are fundamentally logical factors implicated in the pathophys- Mental Illness have emphasized to con- different (Corrigan & Watson, 2004) and iology and maintenance of psychiatric sumers and the general public alike that that these differences are nonmalleable problems. Grant funding has increasingly psychiatric conditions are akin to any other (Lebowitz & Ahn, 2014). These associa- been directed at investigations of biological medical condition or disease. The present tions may stem from “genetic essentialism” mechanisms and treatments, some from manuscript is not, however, concerned and “neuroessentialism,” which refer to pharmaceutical companies and some with the validity of biomedical models of views in which DNA or neurobiology, through agencies such as the National psychiatric disorders. We instead wish to respectively, are seen as the immutable

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