Updates to the ‘bible’ for mental-health conditions will miss the mark — is it time to ditch the DSM?
Summary
Jim van Os argues that planned updates to the Diagnostic and Statistical Manual of Mental Disorders (DSM) — which aim to add biological, environmental and cultural data and include lived experience — are merely incremental fixes to a fundamentally flawed system. He contends that diagnostic labels based on symptom checklists fail to capture the social drivers and personal contexts of mental distress, and so do little to improve care. Instead of refining diagnoses, psychiatry should pivot to mapping individual care needs: the supports, relationships and interventions that restore agency, coherence and a future sense of purpose.
Key Points
- The DSM remains the dominant diagnostic manual but has long faced serious critique.
- Planned DSM changes (adding biological, environmental, cultural info and lived experience) are useful but insufficient, according to the author.
- Diagnostic labels often obscure the social drivers of distress (inequality, educational pressure, stressors) and can misdirect responses towards medical solutions alone.
- Mental distress cuts across diagnostic categories — similar subjective experiences (entrapment, hopelessness) appear in anxiety, addiction and psychosis.
- A care-needs model would assess an individual’s context, developmental vulnerabilities and strengths, and map tailored supports (social, relational, educational, peer) rather than just naming a disorder.
- Example: someone with paranoia, voices, withdrawal and cannabis use might receive substance-regulation support, relationship-rebuilding help and peer support instead of defaulting to a schizophrenia label and medication-first pathway.
Content summary
The DSM, updated most recently in 2022, is widely used for diagnosing mental-health conditions. The American Psychiatric Association’s proposed roadmap to address criticisms includes richer data and engagement with people who have lived experience. Van Os welcomes attention to causes and context but argues these tweaks leave the core logic unchanged: symptom-based labels that insufficiently inform care.
He highlights that diagnoses do not reveal why people feel as they do, nor which interventions will actually help. Population data (for example, about the Netherlands) show high diagnosis rates, but these numbers do not translate into understanding individual needs. The author calls for abandoning the DSM’s dominant role and adopting approaches that prioritise the mapping of care needs — social supports, relationship repair, learning processes and peer networks — tailored to each person’s circumstances.
Context and relevance
This piece matters for clinicians, policy-makers and anyone interested in mental-health services: it reframes the problem from labelling to delivering effective care. The argument aligns with broader trends emphasising social determinants of health, personalised care and lived-experience input. If adopted, a needs-based model would shift funding, training and service design away from diagnosis-centred pathways and towards integrated, contextual interventions.
Why should I read this?
Short answer: because it punts on niceties and tells you plainly that tweaking labels won’t fix people’s lives. If you work in health, policy or frontline support — or just care about better mental-health systems — this is a brisk, provocative read that saves you the trouble of wading through technical DSM discussions and gets to the practical point: focus on what people actually need, not what box they fit into.