Abstract

This dissertation explores ontological and epistemological issues in developing a scientific psychiatric taxonomy, concentrating on the Diagnostic and Statistical Manual of Mental Disorders - IV. In particular, I address the ongoing debate on the question of whether psychiatric categories isolate "real" diseases or whether they are myths used to impose social control. Medical modelers maintain the former and argue that current weaknesses will be reduced as knowledge of the nature and causes of mental disorder increases. Anti-psychiatrists, in contrast, conclude that diagnosis is moral evaluation of individuals since there is no evidence of biological abnormality. While Foucault's thesis differs from anti-psychiatry, he argues that psychiatric concepts misconstrue their object because mental illness is a product of social, historical and linguistic practices, not an objective entity or process. Despite apparent contradiction between medical modelers and Foucault, I argue that there are no fundamental ontological or epistemological disagreements. Both sides concede that social factors are important to the identification, description, classification and explanation of mental disorder and both sides allow that biology and psychology are significant components. Further, while medical modelers contend that psychiatric taxonomy is scientific, and Foucault posits that categories are constitutive, I argue that diagnostic classification is pre-scientific, and perhaps quasi-scientific, because current taxonomy demarcates different disorders on the basis of "similarity" of behaviours without providing criteria for assessing similarity or theory hypothesizing the relationship between symptoms and disorder