Nosological Reflections

Abstract

Since the establishment of the symptoms-based categories in the Diagnostic and Statistical Manual of Mental Disorders ( DSM), Third Edition, sociologists have raised concerns about the DSM’s failure to appreciate social, contextual factors when defining mental disorders. The author describes recent developments in psychiatric nosology—the DSM-5 revision process and the emergence of the Research Domain Criteria (RDoC)—and then considers their implications for decontextualization. Drawing on in-depth interviews with psychiatrists involved in the DSM-5 controversy and a content analysis of key documents, the author first recounts the ambitious DSM-5 revisions, illuminating the DSM-5 Task Force’s embrace of dimensionalization as a solution to the problem of validity and the ultimate rejection of this “paradigm shift” by psychiatrists. The Task Force’s failures prompted the National Institute of Mental Health to promote RDoC as an alternative nosological framework that eschews DSM categories altogether. Next, the author explores the ramifications of these events for decontextualization, which neither DSM-5 nor RDoC explicitly addresses, demonstrating how RDoC is poised to escalate decontextualization through its brain-centric conceptualization of mental disorders. To counteract these developments, sociologists should continue to promote ways of defining mental distress that underscore its social embeddedness.