Abstract

The new edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) by the American Psychiatric Association (Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington, DC, 2013) has sparked considerable debate. Allen Frances (Saving normal: an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma, and the medicalization of ordinary life, 1st edn. William Morrow, New York, 2013) and others (Heinz A, Friedel E, Der Nervenarzt 85:571–577, 2014) have argued that this revision may increase the risk to inadequately pathologize socially unwanted behavior and to defocus psychiatric treatment. An undesirable result can be that more severely ill patients will not be adequately provided with services, while an abundance of problems of everyday life in modern societies receives a medical label. This may cause the ambivalent consequence that psychotherapeutic aid can be provided but that social problems are individualized and isolated from their context instead of being open to social rather than medical or psychotherapeutic interventions. These concerns will be discussed with respect to three topics: firstly, it will be described how the general definition of mental disorders underwent a slight change with nevertheless considerable consequences; secondly, it will be exemplified how a loss of psychopathological traditions and a new definition of core symptoms in schizophrenia together with a lack of consideration of neurological disorders have widened the schizophrenia category to a degree that it may do more harm than good to patients; and thirdly, it will be discussed by way of example how the merging of the previously distinct categories of harmful substance use and substance dependence combines a diagnostically unreliable (harmful substance use) and a diagnostically reliable (substance dependence) clinical category resulting in a socially potentially abusive and poorly defined new category of “substance use disorders.” It is argued that the underlying changes would have deserved a more profound discussion of their philosophical and social implications.