Pre-dsm-thinking in a post-dsm-era
background Over the past few years the DSM-system was the subject of discussion in several leading journals. Recently, a review of Jongedijk summarised this by putting side by side the different advantages and disadvantages that were discussed in these journals. The main thesis of this essay is that we can achieve a better understanding of these advantages and disadvantages once the epistemological background of the classification of psychopathology is elucidated.
aim To discuss the epistemological background of the DSM-system in comparison with the epistemology of other classification systems in order to achieve a better understanding of the difficulties of the classification of psychopathology.
method Two problems that are typical of the classification of psychopathology are discussed from three different points of view: the field of tension between subjective symptoms and the objective criteria on the one hand, and that between the static aspect of a classification system and the dynamic aspect of the psychopathology on the other hand. The three points of view are: the DSMsystem as an example of a system of classification with realism as epistemological background; the psychodynamical classification thinking as an example of instrumentalism; and the Lacanian school as an example of relativism.
results and conclusion This discussion from an epistemological view shows the limitations of the different classification systems. A preliminary delineation of the goals and the applicability is essential. This will result in a more realistic vision on the possibilities and impossibilities of a psychiatric classification, the DSM system in particular.