Psychiatric classification, stigma, and mental health

Work on DSM-5 and ICD-11, and the simultaneous development of alternative approaches to psychiatric classification such as the Research Domain Criteria of the National Institute of Mental Health 1 , has led to renewed interest of colleagues, patients, decision-makers, and the lay media in psychiatric diagnosis.Psychiatrists find themselves reading rationales for these classification systems by those who have worked on them, as well as strong criticisms by those who have perceived key weaknesses.How should we respond?How best to formulate psychiatric diagnoses, and how best to respond to public debate about our field are complex conceptual issues that overlap with major questions in the philosophy of medicine and psychiatry, and perhaps even indeed with some of the biggest questions that we can ask about life.In this brief editorial I will outline some of these "big questions", and suggest a middle path through what I see as some of the conceptual thickets surrounding them.The aim of this editorial is to argue that the publication of DSM-5 and ICD-11 provides us a crucially important opportunity to decrease the stigma associated with psychiatric diagnosis and treatment, and to increase the mental health literacy of colleagues, patients, decisionmakers and the general public.This requires us to acknowledge both the enormous progress that has been made in psychiatry, as well as the tremendous gaps in knowledge that remain.