Diagnosis and its discontents: Critical perspectives on psychiatric nosology and the DSM

Recent writings that critically analyze psychiatric diagnostic categories and the practices that are intertwined with them have descriptive, contextualizing and moral dimensions. Descriptive projects depict major trends in psychiatric classification. They focus on three such trends: medicalization, an increase in both the number of diagnostic categories and the number of persons to whom they are ascribed, and a move towards framing both pathological and normative behaviors and experiences in neurobiological terms. Contextualizing projects explore how micro- and macrosocial, cultural and political economic elements influence both how diagnostic categories take form and how people who live under the description of those categories interact with them. Many descriptive and contextualizing projects also have a moral dimension: they are motivated by questions about what constitutes help for mentally distressed or impaired persons as well as by concerns that some diagnostic labels and practices may cause harm. Such critical consciousness seems to have grown in tandem with increased medicalization and biological reductionism in psychiatry, and should be further promoted in the future.