The DSM validation method and its decision points: value judgments, metaphysical presuppositions, and validators

This paper offers an analysis of the DSM validation method, focusing on the role that non-empirical factors play in resolving forms of indeterminacy that cannot be settled by validator evidence alone. It begins by reconstructing the historical development and institutionalization of the DSM validation method, showing that although it emerged as an attempt to ground the classification of mental disorders in empirical evidence rather than in a priori preconceptions or contextual influences, it nonetheless came to rely on extra-empirical considerations at several crucial stages and was, in its very design, shaped by them.The paper addresses this tension by drawing on the concept of a decision point developed in the literature on science and values. By identifying a series of decision points that arise both in the application of the validation method to particular diagnostic categories and in the process of designing and developing the method itself, it argues that the incorporation of value judgments and metaphysical presuppositions constitutes a necessary and epistemically pertinent element that enabled the validation method to take shape and, when applied to specific categories, allows the validation process to move beyond its initial stages and reach a determinate conclusion.