The nature of psychiatric classification: Issues beyond ICD-10 and DSM-IV

Abstract

Objective: The aim of this paper is to provide an overview of the methodological underpinnings of current classification systems in psychiatry, their impact on clinical and social practices, and likely scenarios for future development, as an introduction to a series of related articles in this issue. Method: The method involved a selective literature review. Results: The role and significance of psychiatric classifications is placed in a broader social and cultural context; the 'goodness of fit' between ICD-10 and DSM-IV on one hand, and clinical reality on the other hand, is examined; the nature of psychiatric classification, compared to biological classifications, is discussed; and questions related to the impact of advances in neuroscience and genetics on psychiatric classification are raised for further discussion. Conclusions: The introduction of explicit diagnostic criteria and rule-based classification, a major step for psychiatry, took place concurrently with the ascent to dominance of a biomedical paradigm and the synergistic effects of social and economic forces. This creates certain risks of conceptual closure of clinical psychiatry if phenomenology, intersubjectivity and the inherent historicism of key concepts about mental illness are ignored in practice, education and research.