Recently, an article I wrote advocating the removal of the DSM was published in Nature—one of the most influential scientific journals in the world.

That alone signals something important: what was once unthinkable is now part of mainstream scientific debate.

For years, criticism of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was seen as fringe. Today, it reflects a growing and legitimate doubt about the foundations of the DSM model.

Publishing this argument in Nature matters. Not because of prestige, but because it shows that the question—is the DSM still relevant?—can no longer be ignored.

DSM Criticism in Mental Health: What is wrong with the DSM?

At the core of current DSM criticism in mental health lies a fundamental issue: its underlying logic.

The DSM assumes that psychological suffering can be divided into distinct disorders—like depression, anxiety, or psychosis—similar to physical diseases such as tuberculosis. But this comparison fails.

Categories overlap
Diagnoses are unstable
They say little about prognosis or care needs

Yet, these categories are presented as objective realities.

This creates epistemic injustice. People receive labels that may not reflect their lived experience but still shape their identity, treatment, and future. Over time, individuals may internalize these labels, lowering expectations and adapting their behavior accordingly.

This is not neutral classification—it profoundly affects lives.

From diagnosis to care needs

Receiving a diagnosis can sometimes feel like relief. Recognition matters. But recognition is not the same as medicalisation.

When people enter a cycle of increasing diagnoses with little improvement, relief often turns into disappointment.

People don’t need labels.
They need a better life.

That’s why we must shift from classification to care needs:

Not: What disorder do you have?
But: What has happened to you, and what helps you move forward?

From 400 diagnoses to 4 essential questions

In my book De DSM voorbij, I propose replacing hundreds of diagnostic labels with four guiding questions:

What happened to you?
What are your vulnerabilities and strengths?
Where do you want to go?
What support do you need?

These questions form the basis of a new approach currently being developed in the Netherlands: a GEM ecosystem of care.

Instead of fragmented systems based on diagnoses, this model creates an open network where people can move freely between forms of support.

Understanding transdiagnostic dynamics

Another key element in modern DSM criticism in mental health is the idea of transdiagnostic dynamics.

Psychological suffering does not behave like neatly separated disorders. Instead, it acts more like an underlying force:

It can drain hope
Cause isolation
Lead to overwhelming internal experiences

In extreme cases, these dynamics may manifest as hallucinations or dreams. These patterns appear across multiple DSM categories, suggesting shared underlying processes rather than distinct diseases.

A transdiagnostic approach allows us to understand these dynamics without prematurely labeling individuals.

Diagnosis as a tool—not a truth

This does not mean abandoning diagnosis entirely.

If needed, symptoms can still be described in a functional way, such as:

Sensitivity to psychosis
Sensitivity to anxiety
Sensitivity to mood fluctuations

This keeps diagnosis descriptive rather than definitive—useful, but not absolute.

Diagnosis should support care, not define identity.

Don’t just look at problems—see possibilities

The second guiding question—about vulnerabilities and strengths—introduces the concept of neurodiversity.

Mental healthcare should not only identify deficits but also recognize:

Talents
Resilience
Potential

Together with Lars Veldmeijer, I’ve explored diagnostic alternatives based on co-design: collaborative tools that support dialogue and decision-making.

In this perspective, the DSM becomes:

👉 A conversation starter—not a final verdict.

A necessary shift in science

The argument is not that diagnoses should disappear entirely.

It is that they should be a means, not an end.

Science must not cling to tradition when its foundational logic no longer holds. If a system does not work, it should not be refined—it should be reconsidered.

That is why it matters that Nature published this perspective.

Conclusion: Thinking beyond the DSM

The time has come to move beyond rigid classification systems.

A future-focused mental healthcare system should:

Prioritize care needs over labels
Embrace complexity over simplification
Support identity rather than constrain it

It is time to think beyond the DSM—and toward a better future for patients.