DSM-5: The Delayed Demise of Descriptive Diagnosis

Abstract

In 1980, DSM-III adopted a descriptive approach to psychiatric diagnosis, creating checklists of unwanted behaviors to define and use as required criteria when posing each of several hundred diagnoses. The objective of this novel approach was to validate psychiatry as a scientifically legitimate branch of medicine, by enabling research into hopefully homogeneous groups of patients to pinpoint the implicit hypothesized physiological causes of the disorders the patients were presumably sharing. In each subsequent revision of the DSM including the DSM-5, however, no physiological criteria of any sort are included for any diagnosis, confirming the empirical failure of this attempt to substantiate the medical model of madness. The futile endeavor to validate countless human faults and suffering as medical diseases explains most of the “scientific” conundrums and controversies surrounding the release of DSM-5, including whether to include or exclude diagnoses, where to draw boundaries for each, and why clinicians still fail to agree on which diagnosis they should apply in a given case. Despite DSM-5’s insolvency, the essentially moral project of descriptive psychiatric diagnosis has today vast socio-economic ramifications that help to preserve it.