Psychological Disadvantage and a Welfarist Approach to Psychiatry: An Alternative to the DSM Paradigm

The American Psychiatric Association released the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 amid criticism from the British Psychological Society and other eminent voices. Among DSM-5’s problems are its over-emphasis on biological causes of mental distress and its classification of arguably normal states as disorders. We explain why these strategies are harmful and argue that the purpose of psychiatry—and of medicine generally—must be reconsidered if advances in medicine are to be effective in benefiting people. We advance an alternative framework in which medicine focuses not on disease but on psychological traits that, combined with other factors, reduce well-being. This ‘welfarist’ approach could avoid many problems encountered on the current model, bring order to those aspects of current medical practice that do not focus on curing disease, and target undesirable states regardless of whether they are symptomatic of disease. We call such states ‘psychological disadvantage’.