The failure of diagnostic psychiatry and some prospects of scientific progress offered by critical realism.
Abstract
A brief overview is provided of sociological and historical critiques of Western psychiatry before focusing on pre-empirical, non-empirical and empirical aspects of psychiatric diagnosis. These are then discussed using the analytical devices of the ontic fallacy, the epistemic fallacy and generative mechanisms. It is concluded that mental disorders do not really exist but particular presenting problems of unintelligibility, interpersonal dysfunction and common human misery, in particular social contexts, recur in modern life and thus constitute real problems for those intimately implicated and for social order. These require new ways of understanding, beyond the option of deconstruction, which could displace categorical reasoning and be sensitive to causes, meanings and their situated social contexts. The paper concludes with an outline of an alternative future for research into mental health problems, which could be informed by critical realism.
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Diagnoses in the field of mental health are claimed to be uncertain and fundamentally problematic, underscoring that they do not identify patients with common symptoms and etiologies who respond to specific treatments.
“Diagnoses in the field of mental health are by different accounts claimed to be uncertain and fundamentally problematic (Bentall, 2006; Horn et al., 2007; Pilgrim, 2013), underscoring that they do not identify patients with common symptoms and etiologies who respond to specific treatments.”
From Moving toward connectedness – a qualitative study of recovery processes for people with borderline personality disorder (2019) · cites this paper as Pilgrim, 2013
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- Authors
- Pilgrim, D.
- Affiliations
- University of Liverpool (GB)
- Corresponding author
- Pilgrim, David
- ORCID
- Pilgrim, David
- Venue
- Journal of Critical Realism
- Publisher
- Informa UK Limited
- Published
- 2013-07
- Volume
- 12
- Issue
- 3
- Pages
- 336-358
- ISSN
- 1476-7430 (ISSN-L)
- 1572-5138
- OpenAlex
- W2035619837
- Cited by
- 32
- References
- 51
- Citations by year
- 2026: 2 · 2025: 5 · 2023: 3 · 2022: 3 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 1
- FWCI
- 21.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Critical Realism (publishedVersion)
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Sociology and Political Science › Critical Realism in Sociology
- Social Sciences › Arts and Humanities › History and Philosophy of Science › Philosophy and History of Science
- Keywords
- critical realism, sociology of psychiatry, history of psychiatry, psychiatric diagnosis, epistemic fallacy, generative mechanisms, mental illness, social context of mental health, deconstruction, categorical reasoning
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