ON THE FUTILITY OF PSYCHIATRIC DIAGNOSTIC MANUALS (DSMS) AND THE RETURN OF PERSONAL AGENCY

This article critiques the most recent version of the American Psychia tric Association's (1994) Diagnostic and Statistical Manual (DSM-IV). After pointing to the procedures employed in constructing the Manual, I note that unreliability of diagnosis is still a major problem and, m ore important, little attention has been paid to validity. Based on th e mechanistic Kraepelinian model, the Manual contributes to the increa sing medicalization of distress and directs clinicians to search for c auses of unwanted behavior in biochemical anomalies. The person as age nt is not part of the DSM diagnostic program. As an alternative to the DSM-IV, I propose a contextualist approach to understanding unwanted conduct. The person is treated as an agent who employs strategic actio ns to maintain a self-narrative. Strategic actions that fail to influe nce relevant others to supply warrants of social validation become the targets of clinical interventions.