Consideration is given to the extent to which the DSM and ICD approach to psychiatric case definition and treatment supports clinical activity. Their validity as a way of defining ‘mental illness’ is found wanting and they do not, in themselves, usefully guide treatment. These conclusions are set in a critical realist approach to ‘mental illness’, which draws attention to the legitimacy of several differing perspectives, each reflecting their own sets of interests and allegiances. DSM‐V and ICD‐11 are due to be published in 2012 and 2014 respectively, and their architects are called upon to be clear about which of these constituencies they are representing.
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