Recent methodological, financial, and rhetorical shifts by the National Institute of Mental Health (NIMH) reveal the Institute’s growing interest in funding basic science research over clinical research. The most dramatic adjustment has been the abandonment of the Diagnostic and Statistical Manual of Mental Disorders in favor of an alternative classification protocol for psychiatric research, the Research Domain Criteria (RDoC) framework. I begin by giving a history of this shift, noting that RDoC is only a part a larger embrace by biomedical psychiatry of what has been called the “precision medicine model,” a new paradigm for medical research that uses biomarkers to stratify patients into new categories for treatment purposes. This shift in nosological practice is being accompanied—for contingent rather than necessary reasons, I show—by a heightened interest in neuroscientific explanations. I argue that these two new epistemic virtues—precision and neurocentrism—give rise to new epistemic puzzles about psychiatric progress, especially about the sort of explanations and interventions that biomedical researchers are likely to find. I conclude by showing that answering these epistemic puzzles will be a necessary part of tackling what I see as an important ethical concern about precision psychiatry: that it favors future patients over present ones.