Context and Diagnosis in the DSM: The Issue of Validity

Abstract

In this chapter Stijn Vanheule discusses how the DSM-5 takes context into account and clarifies the “kind of entity” the manual considers mental disorders to be. In the DSM-5 the context of the individual (i.e., the personal life history, social circumstances, cultural background) is thought to play a minor moderating role in relation to symptom formation and expression. Moreover, as the manual follows a sign-based logic, it coheres with the assumption that biological irregularities lie at the basis of mental distress. The author argues that, by doing this, the DSM cultivates a naive essentialistic view of mental disorders, which is not supported by relevant evidence. Starting from phenomenological psychiatry and Lacanian psychoanalysis, Vanheule makes a plea for a “reflexive” account of psychopathology. Such an account does not neglect problem-specific or disorder-specific regularities, but assumes that typical configurations never (unequivocally) apply to single cases, thus demanding a casuistic approach to diagnosis