Deconstructing Psychiatry's Ever-Expanding Bible

Recent studies have called into question the fifth and latest version of psychiatry’s Diagnostic and Statistical Manual’s creation of new diagnostic entities and categories that are scientifically unsubstantiated and that over-pathologize vulnerable populations such as young children and the elderly. In an earlier blog post (http://www.psychologytoday.com/blog/feeling-relating existing/201202/pathologizing-grief), I criticized the DSM-5 for pathologizing grief by classifying grieving that extends beyond a very short period as a major depressive illness. In this post, I seek to expose and challenge the philosophical presuppositions that underwrite the entire DSM enterprise. These presuppositions descend directly from the metaphysical dualism of Rene Descartes.

Descartes’s metaphysics divided the finite world into two distinct basic substances: res cogitans and res extensa, thinking substances (minds) with no extension in space and extended substances (bodies and other material things) that do not think. This dualism concretized the idea of a complete separation between mind and world, between subject and object. Descartes’s vision can be characterized as a decontextualization of both mind and world. Mind is isolated from the world in which it dwells, just as the world is purged of all human meaning. In this vision, the mind is pictured as an objective entity that takes its place among other objects, a “thinking thing” that, precisely because it is a thing, is ontologically decontextualized, fundamentally separated from its world.

The DSM is a pseudo-scientific manual for diagnosing sick Cartesian isolated minds. As such, it completely overlooks the exquisite context sensitivity and radical context dependence of human emotional life and of all forms of emotional disturbance. Against Descartes and his legacy, the DSM, I am contending that all emotional disturbances are constituted in a context of human interrelatedness. One such traumatizing context is characterized by relentless invalidation of emotional experience, coupled with an objectification of the child as being intrinsically defective. No wonder receiving a DSM diagnosis can so often be retraumatizing!

Copyright Robert Stolorow