Problems of diagnostic psychiatry—and the search for a way forward

The recent history of psychiatry is one of diagnostic expansion. Since the etiological model of mental illness was superseded by the symptom model around 1980, new diagnoses have continuously been added to the reigning manuals of psychopathology, most recently with DSM-5 and ICD-11. This article unfolds some of the criticism that has recently been directed at diagnostic psychiatry with a focus on two quite different lines of critical thought: One represented by a neuroscientific approach known as RDoC, which argues that psychiatry must move beyond symptoms and find the causes of mental illness in the brain (Insel et al., 2010), and another represented by a contextual approach known as PTMF, which argues that mental distress is by and large understandable in light of what happens to people (Boyle & Johnstone, 2020). These oppositional perspectives stand out as prototypical, and each contain valuable insights but also limitations. The article ends by arguing that the limitations can be overcome if the perspectives are united by a hybrid theory stating that mental illness is always a property of a relation between a person and an environment. Two such theories are introduced and discussed (Gannik, 2002; Wakefield, 1992).