Mind the gap between natural phenomena and human constructs in psychiatric diagnostic frameworks

Abstract

Debates over psychiatric diagnosis pivot on a tension between realism, which treats mental disorders as biologically grounded entities, and nominalism, which views them as human-defined categories. The Diagnostic and Statistical Manual of Mental Disorders (DSM) moved from early psychoanalytic typologies to structured, symptom-based criteria, yet robust biological markers remain elusive. The DSM-5 still relies on categorical diagnoses and therefore contends with high heterogeneity, frequent comorbidity, and blurred boundaries. Several complementary perspectives offer ways forward. Phenomenological psychopathology centers patients’ lived experiences. Network analysis models disorders as interacting symptom systems rather than discrete diseases. A pragmatic approach prioritizes clinical usefulness by integrating clinician expertise, patient narratives, and iterative refinement of assessment and treatment. Combining these perspectives can yield a more adaptable, patient-centered model that narrows the gap between natural phenomena and human-constructed categories.