Deconstructing the DSM-IV-TR: a critical perspective

This paper examines and offers a critique of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), underlying principles and assumptions, and the nature and consequences of its nosological framework. The reason for this critique is to look at the rationale for some of the diagnostic categories and also why some categories are retained, including some of the long-standing diagnostic groups, such as schizophrenia. It is not the intention here to rehearse the problems of biological psychiatric thinking, nor argue the strengths and weaknesses of the DSM-IV-TR in its definitions and descriptions of particular syndromes and illnesses. The ideas presented here derive from a range of previous research that argued that the DSM-IV-TR colludes in a system of psychiatric care in which all people, by virtue of characteristically human foibles and idiosyncrasies, are potentially classifiable into a variety of diagnostic mental health categories. In the present study, it was argued that because of resource constraints, professional dispute, and public concern, the major criterion for attracting a formal diagnosis is not classifiability according to the DSM-IV-TR, but rather, that of 'social risk', defined in terms of risk to oneself and/or others and embodying obvious social control functions. Here, we expand and develop some of these ideas, and relate them more specifically to insights offered by critical or deconstructive psychology and the development of the forthcoming the DSM-V.