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The article by Paolo Azzone, “Looking Through a Distorted Mirror: Toward a Psychodynamic Understanding of Descriptive Psychopathology of Depression,” is an excellent article arriving at a very timely moment. Indeed the DSM will soon receive its fifth revision and become DSM-V. Many criticisms and suggestions have been made toward the improvement of DSM-V. Still, a fundamental criticism of the approach to mental illness in the latest editions of DSM seems not to be considered in the current revision. DSM-V, just as its prior siblings (since DSM-III; Azzone, this issue), intends to be theoretically neutral. However, aiming at being theory neutral is a theory. Worse, in the case of a theory neutral approach to mental illness, one is reduced to a behavioral view of mental illness as consisting of a number of observable symptoms (deficits).
The epistemological approach of DSM is therefore contrary to the rest of medicine, in some ways. In dermatology, a rash is a symptom which the physician interprets as being caused by scratching, or by poison in the blood or by a microbe. Different treatments are chosen for the same external symptom dependent upon the hypothesized cause. Refusing all theory for interpreting mental illness symptoms thus necessarily deprives the mental health profession relying only on DSM information from flexibility which would be possible if observable symptoms were also interpreted.
The ultimate justification of the a-theoretical stand of DSM is the belief that ultimately there is a biological cause for mental illnesses. The current belief is further that science is not yet far enough advanced to