IN 1994, the American Psychiatric Association published a fourth edition of its official nosology. The new manual, DSM-IV, perpetuates the Kraepelinian framework established by DSM-III. Disorders are generally represented as monothetic categories, each one bounded by a distinctive list of criterial features. The manual's most obvious departure from the previous editions is rhetorical and concerns the definition of its eponymic subject, “mental disorders.” In DSM-III and DSM-III-R, the term is defined in a way that includes all of the factions and orientations that were then represented in the American Psychiatric Association:
[E]ach of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is typically associated with either a painful symptom (distress) or impairment…. In addition, there is an inference that there is a behavioral, psychological, or biological dysfunction. (Amer. Psychia. Assoc. 1980:6; my emphasis; see also Amer. Psychia. Assoc. 1987:xxii)
The definition can be read as a kind of contract whose purpose is to reconcile the claims of rival parties—psychoanalysts, behavioralists, biological reductionists, eclectics—to the field of mental disorders. DSM-IV scraps this contract and advances a unitary orientation, an essentially biologized conception of “mental disorder”:
Although this volume is titled the Diagnostic and Statistical Manual of Mental Disorders, the term mental disorder unfortunately implies a distinction between “mental” disorders and “physical” disorders that is a reductionistic anachronism of mind/body dualism. A compelling literature documents that there is much “physical” in “mental” disorders and much “mental” in “physical” disorders. (Amer. Psychia. Assoc. 1994:xxi)
This kind of talk, criticizing an outdated dualism, is not new. It has been in the air since the 1950s, and DSM-IV simply makes explicit what many readers already knew in the days of DSM-III, namely, that “mental” disorders are deployed across domains of nature and (therefore) across domains of science. Mind-body dualism, because it insulates mental life and psychological processes from their biological substratum, torpedos the hierarchy of nature and science on which psychiatric fallibilism has constructed its distinctive epistemology (see chapter 8). In the contest between dualism (whose standard bearer is psychodynamic psychiatry) and fallibilism, dualism has lost out.