Psychiatry's little other: DSM-5 and debates over psychiatric science

Abstract

In 2013, the National Institute of Mental Health (NIMH) broke rank with the American Psychiatric Association (APA) over the release of DSM-5, psychiatry's 'bible' of mental disorders. Announcing that it would use its own biological categorization system in place of DSM-5, NIMH ignited a debate about the nature of psychiatric epistemology. We analyze these DSM-5 debates as a critical moment in psychiatry's history of epistemological 'revolutions.' Psychiatric pioneers, throughout the field's history, have presumed that biological dysfunction anchored mental disorders, and yet locating biological cause has proved elusive. Each time its failure to secure biological cause is unveiled, psychiatric experts reinvent the field in the image of greater scienticity. Using psychoanalytic theory, we argue that biology operates as Lacan's objet petit a. The field of psychiatry is propelled forward by a mismatch between its imaginary identification as an objective science and its fragmented actuality as a symbolic system. Despite their attempts to repress the field's fragmentation, leaders in psychiatry continuously bump into their failure to elucidate the biological foundation of mental disorders, compelling them to reiterate psychiatry's fantasy identifications, now through imagery of the 'mysterious' brain.