DSM in Philosophyland: Curiouser and Curiouser
In this chapter I cover three topics areas of conceptual importance in the development of a psychiatric nosology. The first is the epistemological status of psychiatric diagnoses. Do the diagnostic constructs represent a realistic representation of the psychopathology they attempt to depict? Or are they simply social constructs developed by the nosologists that bare no relation to the real world? Or, finally, are they constructs that attempt to depict the world of psychopathology, and that do so in a flawed, uncertain way? I argue for the third alternative, and against the purely realist and the purely constructivist versions of our diagnostic constructs. In the second part of the paper I take up the question of definition of mental illness. None of the efforts at formulating a satisfactory definition, including that of my own DSM-IV, have succeeded in this effort, but we need the definition and should live with our best effort. Finally, I discuss the question of whether, in the construction of the DSM-5, we should take a conservative or aggressive approach toward making changes in the new manual. For DSM-5 I argue for the approach we assumed with DSM-IV. Since the science is still not in place to justify major changes in the new manual, we should be quite conservative in the matter of introducing change.