The End of Neo-Kraepelinism

In 1980, the American Psychiatric Association asserted that its subject matter was straight-forwardly medical and created a diagnostic manual— Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III)—consisting of supposedly discrete and independent mental disorders based on what were meant to be low-inference, easily observed sets of symptoms. It was taken for granted that such mental disorders existed and that biological research over time would unearth their specific somatic causes. The idea was to purge psychiatric diagnosis of jargon and unverified and unverifiable psychosocial theories of etiology and thereby place psychiatry on the road to discoveries regarding somatic pathology and causation that has proven so fruitful in the rest of medicine. When DSM-5 is published in 2013, however, biological information about the individual being diagnosed will play the same role as it did in DSM-III—namely, nothing. This article summarizes why adopting medicine as a model for conceptualizing personal distress and social difficulties was and is naïve and misguided. It is time for the mental health industry to stop pretending that psychological difficulties can be reduced to morbid physiology.