ABSTRACT

This chapter outlines the key features of critical realism (CR) and compares them with other traditions in social science from positivism and idealism. It contrasts the philosophy with positivism, on one side, and strong social constructivism, on the other. The chapter offers case studies about psychiatric diagnosis and child sexual abuse to illustrate these differences. It also introduces some major elements of CR. Those elemental aspects of CR are, ontological realism, epistemological relativism, and judgemental rationality. CR as its name implies, is about reality, but it is also about scepticism and critique. Three versions of the latter are important and have relevance to the investigation of mental health: immanent critique, omissive critique and explanatory critique. An immanent critique of psychiatric diagnosis reveals the following shortcomings, which undermine its credibility as a form of medical science in practice: measurement/empirical validity, construct validity, prognosis/predictive validity, inter-rater reliability, aetiology and pathogenesis, treatment specificity, and acceptability.