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.