In January of 2026, the American Psychiatric Association (APA) announced with great fanfare its roadmap for the future of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which would cease to be “Statistical” in order to become “Scientific.” This entails annual updates and a shift toward a biopsychosocial approach, which represents a significant change in this globally used guide for diagnosing mental disorders.
I raise this point because the new DSM will seek to integrate an intersectional perspective that accounts for the different dimensions of inequality shaping lived experience (gender, race, sexual orientation, and class), as well as socioeconomic, cultural, and environmental determinants. As María Oquendo, president of the Strategic Committee for the APA’s future DSM, points out, it will be a living document.
At first glance, this might seem like a step forward: abandoning the categorical framework of the recent DSMs and opening up to the context of individuals. However, from a more critical and profound perspective, this news does not constitute a real paradigm shift, but a deepening of the same biopsychiatric power apparatus that has colonized human experience for decades, only now incorporating additional dimensions.
This is to say, current hegemonic psychiatry – the biological approach with the DSM as its global bible – still operates from a naive realist epistemology: it believes in the existence of an objective pathological reality “out there,” external and independent of the observer, which can be captured through external variables. Adding measured contextual factors does not question that premise: it reinforces it.
Consequently, the same Cartesian framework as always – rationalist and objectivist – is perpetuated, subtly denying individuals’ subjective experience and emotions while imposing its brain-centered conception. The notions of “illness” or “mental disorder” are never seriously questioned, even if there is now an attempt to incorporate non-biological dimensions. In practice, the aim is still to validate pathologizing and reductionist diagnoses.
This is precisely what psychiatrist Vittorio Guidano, the creator of post-rational cognitive psychology, repeatedly reminded us: there are no mental disorders floating around as if they were natural entities. What exists is a person in a constant, recursive auto-organization that stems from their relational, emotional, and attachment history, which together constitute them.
Therefore, as Guidano pointed out, human psychic suffering does not arise from a “chemical imbalance” or a “dysfunctional circuit” that an expert can objectify from the outside –as hegemonic psychiatry still assumes–. It emerges when the internal coherence of the self is threatened, when the meaningful world the person has constructed collapses or becomes unviable.
From this viewpoint, the therapist does not classify or apply protocols to a “pathological object” extracted from a DSM symptom list or a pharmacological treatment. Instead, they help to reorganize narratives toward greater emotional and relational viability. No external diagnosis matters: there is dialogue, which involves a mutual recognition of the legitimacy and dignity of the person.
Guidano’s post-rationalist perspective – critical of psychiatry and the DSM – is inspired by the Escuela de Santiago (Humberto Maturana and Francisco Varela), who scientifically demonstrated that no knowledge – including clinical knowledge – is independent of the observer. While psychiatry continues to insist on a supposed external objectivity (even if now it tries to present it as “intersectionality”), it will remain a practice of social control, not of liberation.
That said, the APA can change the manual’s name as many times as it likes and add whatever dimensions it deems convenient, but as long as it does not make an epistemological turn in its foundations, it will continue to perpetuate the same psychiatry: reductionist, commercial, and colonizing of the human experience. Because, ultimately, we do not need a more “scientific” manual. We need to stop pretending that suffering is a biological error and dare to accompany human beings in their vulnerability.