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Psychiatry increasingly accepts that diagnoses are not objective diseases or disorders discovered in nature.

Psychiatry's claim to privileged authority over human suffering is hard to justify.

The burden now falls on psychiatry to justify its authority, not on critics to justify their opposition.

For decades, critics such as Lucy Johnstone, James Davies, Joanna Moncrieff, and others have argued that psychiatric diagnoses are not scientific facts and that psychiatry lacks a coherent scientific foundation for its claims. Rather than identifying naturally occurring disorders, psychiatric classifications are shaped by social values, professional negotiations, institutional interests, and cultural assumptions. The response from psychiatry was often very dismissive, and such critics were labelled “antipsychiatry" and accused of denying the reality of mental suffering, undermining treatment, or simply misunderstanding the science. Times have changed. Increasingly, some of psychiatry's more thoughtful defenders are conceding many of the criticisms that were once treated as sacrilege within psychiatry.

In a recent essay, "The Ground Beneath the Clinic," influential psychiatrist and philosopher Awais Aftab acknowledges that the attempt to ground psychiatric authority in scientifically discoverable disorder concepts is no longer justified. Aftab says, "I take it for granted that the project of defining the authority of medicine and clinical disciplines in terms of disorder concepts on the basis of objective, value-free facts has failed." This is no minor concession. It amounts to an admission that one of psychiatry's central legitimating narratives has failed, and it is a concession to arguments critics have been making for decades.

Social Usefulness Rather Than Scientific Discovery

The crucial question, however, is what follows from this admission. Does it mean that psychiatry itself fails? Aftab does not think so. He does not regard the failure of objective disorder concepts as fatal for psychiatry. Instead, he attempts to reconstruct psychiatric legitimacy on different grounds. Human beings suffer, and societies create institutions to respond to that suffering. Psychiatry, on this view, is one such institution, and its authority need not depend on discovering natural disease entities but, instead, on its practical role in helping individuals and communities make sense of and respond to psychological distress. Its legitimacy derives from social usefulness, he........

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