Deconstruction in Psychiatry: Are We Missing the Forest for the Trees?

Background Although the field of psychiatry has recently seen significant advancement in neurobiological knowledge, we have not seen corresponding improvements in clinical practice. In response to this stagnation, some researchers have turned to concepts such as deconstruction by incorporating programs like the Research Domain Criteria (RDoC) into psychiatric research. Methods This review examines the role of deconstruction in psychiatry and analyzes efforts to apply a dimensional approach to psychopathology. Results In this article, we argue that deconstruction rejects current medical knowledge in favor of an ill-fitting dimensional approach, placing symptoms in a broader spectrum rather than treating symptoms as individual characteristics of categorical diagnoses. We contend that psychiatry is not unique among medical fields and that a categorical approach continues to be most effective for achieving clinical success. While heterogeneity in clinical presentations complicates efforts to better understand psychiatric disorders, it is not an inherent impediment to progress and does not warrant redefining psychiatric illness. Conclusions Deconstruction in psychiatry is unlikely to yield any improvement in clinical practice. Ultimately, further study is needed to better understand the heterogeneity found in psychiatric disease.