The DSM: A Critical Reading Guide
The Diagnostic and Statistical Manual of Mental Disorders (DSM) plays a powerful role in how we understand psychological distress. It shapes clinical training, influences how therapists conceptualize their clients' experiences, informs insurance and healthcare systems, and provides much of the language through which mental health is discussed.
But what does the DSM actually tell us about human suffering—and what does it leave out?
This essay series examines the DSM as more than a clinical reference manual. It explores the history, assumptions, institutional functions, and limitations of psychiatric diagnosis, asking what happens when a classification system becomes a framework for understanding people themselves.
The goal isn't to dismiss the practical uses of diagnosis or the meaningful ways diagnostic language can help people make sense of their experiences. It's to look more critically at the system: what it can offer, what it cannot explain, and what becomes possible when we make room for more contextual, relational, and historically informed ways of understanding distress.
Read the series
Part 1: The DSM — Why Every Therapist's Practice Is Shaped by a System They Were Never Truly Taught to Question
An introduction to the DSM's influence on clinical practice and the questions that emerge when therapists are taught to use a diagnostic system without necessarily being taught to critically examine it.
Part 2: The DSM
Continue the series' examination of psychiatric diagnosis, its assumptions, and the systems that shape how mental health is understood.
Part 3: What the DSM Actually Does—and What Might Come Next
What is the DSM designed to do, and what are we asking it to do beyond that purpose? This installment examines diagnostic reliability and validity, the administrative role of diagnosis, the limits of diagnostic categories, and alternative frameworks for understanding distress.
Part 4: When the Diagnosis Becomes the Story
What happens when a diagnosis stops being one way to describe an experience and becomes the explanation for who someone is? This installment continues the series' exploration of how diagnostic language can shape identity and narrow the stories available to us.
Part 5: What I Wish I Had Been Taught
A reflection on what clinical education could offer if learning to use the DSM were accompanied by a deeper critical understanding of diagnosis, its limitations, and the broader contexts in which distress develops.
Beyond diagnosis
Diagnosis can offer language, recognition, access to care, and a way to communicate across clinical settings. It can also obscure context when categories are treated as explanations rather than tools.
Understanding distress requires more than identifying symptoms. It calls for attention to relationships, histories, culture, disability, material conditions, and the systems of power that shape people's lives.
The question isn't simply whether the DSM is useful or flawed. It's how we can use diagnostic frameworks without allowing them to become the only stories available to us.
Between Stories explores the assumptions embedded in the systems we inherit—and what becomes possible when we begin to question them.