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Toward Conceptual Competence in Psychiatric Diagnosis: An Ecological Model for Critiques of the DSM

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Critical Psychiatry

Abstract

Dissatisfaction with the Diagnostic and Statistical Manual of Mental Disorders (DSM), once an exception within mainstream clinical literature, has become a new kind of norm in recent decades. Critiques of the DSM, now in its fifth edition, have been put forward by psychiatrists, psychologists, and other scholars from across the sciences and humanities, as well as by service users, families, and diverse stakeholder groups. In order to understand the multiple levels on which the DSM-5 has been critiqued, we apply an ecological systems model and attempt to synthesize a range of perspectives. A researcher or clinician should be equipped to consider potential effects of the diagnosis on a client or patient, technical issues in the testing of the diagnostic construct, major institutional players that have stakes in the definition of the disorder and its codification in the manual, broader social and political concerns about the use of particular diagnoses to disadvantage certain groups, and contemporary debates concerning the relationship between the brain and an individual’s experiences, thoughts, and behaviors. The ecological approach presented here offers a framework for teaching and developing such “conceptual competence” in psychiatric diagnosis. We also consider the ways in which an ecological model might be applied to future diagnostic paradigms.

… without measuring reality against the wholly invented world of the unconditioned and self-identical, without a constant falsification of the world through numbers, people could not live.

Friedrich Nietzsche, Beyond good and evil, p. 7

The order that our mind imagines is like a net, or like a ladder, built to attain something. But afterward you must throw the ladder away, because you discover that, even if it was useful, it was meaningless.

Umberto Eco, The name of the rose, p. 492

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  1. Department of Counseling and School Psychology, University of Massachusetts Boston, Boston, MA, USA

    Justin M. Karter

  2. Wesleyan University, Middletown, CT, USA

    Sarah R. Kamens

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    Sandra Steingard

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Karter, J.M., Kamens, S.R. (2019). Toward Conceptual Competence in Psychiatric Diagnosis: An Ecological Model for Critiques of the DSM. In: Steingard, S. (eds) Critical Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-030-02732-2_2

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