What Makes Us Human? The Role of Psychiatry and the Future DSM

COMMENTARY

As a profession, we have focused—often wisely—on measurable symptoms, syndromes, and mechanisms. But that question is no longer merely philosophical. It is becoming increasingly clinical. We stand at a remarkable threshold. Artificial intelligence (AI) can compose music, write code, simulate empathy, pass professional examinations, and offer psychological advice. Gene editing challenges assumptions about identity and human enhancement. Human-derived brain organoids are being used for creating chimeras in mouse brains for growing xenocortical implants. Psychedelic-assisted therapies can alter boundaries of selfhood and meaning. Meanwhile, our diagnostic bible, the DSM,remains organized primarily around consensus-based descriptive symptom clusters, duration thresholds, and functional impairment. If psychiatry does not seriously engage with the question of human nature, others, including AI and transhumanistic technocrats, may answer it for us and our patients.

The field is already changing. The 2026 American Psychiatric Association Annual Meeting left us hopeful—not simply because speakers such as chief medical correspondent for CNN, Sanjay Gupta, and former US Surgeon General, Vivek Murthy emphasized psychiatry's importance, but because the field appeared increasingly willing to debate its future.

And change is necessary. The era of “one neurotransmitter, one gene, one drug, one disorder” has passed. Psychiatric trajectories emerge from interactions among genes, brain circuits, development, lifestyle, trauma, social determinants, loneliness, climate change, technology, aging, brain health, and resilience. Our diagnostic system must begin to reflect that complexity. Many scientific and government organizations are starting to recognize the importance of the whole person health. For example, the National Academies of Sciences, Engineering, and Medicine defined “whole health” as physical, behavioral, spiritual, and socioeconomic well-being as defined by the individuals themselves. Brain health is another emerging all-encompassing concept that unites the fields of psychiatry, neurology neurosurgery, neuroscience, psychology, climate sciences, education, and many others.

The Pros and Cons of the DSM

Psychiatry occupies a unique position in medicine. We cannot confine ourselves to an organ or laboratory value. Psychiatry inevitably enters the territories of meaning, identity, suffering, relationships, morality, freedom, and consciousness.

The DSM historically prioritized reliability over philosophy for good reasons. DSM-III and subsequent editions introduced operational criteria, improved diagnostic agreement, enabled large-scale research, facilitated clinical trials, and created a common language for clinicians, researchers, policymakers, insurers, and patients. These were enormous achievements. But something was also lost.

Diagnosis increasingly became a taxonomy of observable symptoms separated from the lived context of the person experiencing them. Patients can meet diagnostic criteria yet feel fundamentally unseen. Clinicians can complete required checklists while missing the narrative architecture of a human life.

AI makes this limitation especially consequential. If diagnosis becomes primarily pattern recognition from a checklist, increasingly sophisticated algorithms may perform parts of that task extraordinarily well. The more important question is therefore: What can a human psychiatrist offer that an algorithm cannot?

Human Beings Are More Than Symptom Clusters

Human beings are meaning-making creatures embedded in relationships, cultures, histories, bodies, aspirations, and moral worlds. Suffering emerges not only from disturbed biology but also from fractured belonging, loss of purpose, humiliation, loneliness, trauma, and existential despair.

At the same time, people possess strengths—compassion, resilience, creativity, wisdom, attachment, hope—that remain poorly represented in diagnostic systems. Human species is labeled “Homo sapiens” or a wise person. Symptom reduction has too often displaced human flourishing as our ultimate goal.

Consider 2 people meeting criteria for major depressive disorder. One may be grieving the collapse of a decades-long marriage; another may experience profound melancholia relatively independent of circumstance. They may cross the same diagnostic threshold while inhabiting radically different human realities and requiring different therapeutic approaches. Lived experience is the needed context for the clinical decision making, not just “noise” in patient’s history.

Nor should psychiatry perpetuate a false division between biology and meaning. Brains generate minds, but experience also reshapes brains and gene expression. Trauma alters neurobiology. Relationships affect physiology. Social isolation influences health. Meaning and purpose influence behavior and well-being, and ultimately longevity and mortality. Human experience is biological precisely because humans are biological organisms continually interacting with their environments.

The future DSM should therefore resist both reductionisms: mental illness is neither only brain disease nor merely social construction. A more sophisticated formulation would integrate symptom phenomenology with neurobiology, development and neurodiversity, trauma, functional impairment, culture, relationships, social and environmental context, resilience, strengths, brain health, aging, and existential meaning.

Equally important, psychiatry must distinguish psychopathology from normal suffering, existential crisis, socially produced distress, and adaptive emotional responses. A broader psychiatry should not become an excuse to medicalize the human condition.

AI and the Human Spirit

AI makes the question “What makes us human?” newly urgent. AI increasingly simulates language, reasoning, empathy, and psychotherapy-like interactions. Yet human beings are embodied, vulnerable, mortal, relational, and subjective. We do not simply process information. We experience existence. We suffer, love, hope, grieve, create, and seek meaning and transcendence.

Emerging technologies expose gaps in our diagnostic vocabulary. People can form emotionally significant relationships with AI companions, raising questions about attachment, intimacy, and what constitutes genuine recognition by another person.

Psychedelic-assisted therapies present another challenge. Patients may describe their experiences not merely as symptom reduction but as transformations in selfhood, connectedness, and meaning. Neuroplasticity and neural-network models are important, but they do not fully describe the lived experience.

Digital life and interactions with AI raise similar questions. The curated, performative self-constructed through social media may contribute to self-estrangement or symptoms resembling psychosis that conventional symptom categories capture only partially. Patients may not simply feel bad; they may feel unreal. Psychiatry needs language capable of addressing these experiences without automatically declaring them disorders.

Toward a More Humanistic DSM

A more human-centered DSM need not abandon scientific rigor. Reliability remains essential. But reliability should be the foundation, not the endpoint. We compliment the new DSM Committee for the replacing term “Statistical” in its title “DSM” with “Scientific,” and for proposing to add social determinants of health and biomarkers to the manual. Our hope that the next iteration of the DSM will include not only symptoms and risk factors, but also protective resilience factors that will include patient’s strengths.

Future psychiatric diagnosis could become more dimensional and contextual rather than predominantly categorical. Psychological functioning exists along continua shaped by biology, development, environment, and experience. Narrative formulation should regain formal importance. Diagnostic criteria cannot substitute for understanding a patient's story.

Social, relational, and economic determinants should become central rather than peripheral. Economic insecurity, chronic isolation, discrimination, community fragmentation, environmental stressors, poor food, and harmful screen-based technologies are not simply background variables; they can influence mental and brain health.

The DSM should also incorporate positive dimensions of functioning. Resilience, psychological flexibility, meaning, creativity, attachment, wisdom, and capacity for recovery matter clinically. Psychiatry should ask not only, “What is wrong?” but also, “What remains strong, and what can be strengthened?”

A future DSM might also incorporate phenomenological dimensions: continuity of self, meaning-making, quality of relatedness, experience of time, and existential orientation. Such dimensions require rigorous measurement and validation, but they deserve serious investigation.

The individual should no longer be treated as an isolated unit of analysis. Humans are fundamentally relational. A relational perspective could deepen our understanding of depression, trauma, personality, loneliness, environment, and emerging human-AI attachments.

Finally, future DSM development should draw on broader intellectual traditions. Psychiatrists and neuroscientists should work alongside psychologists, philosophers, anthropologists, sociologists, ethicists, patients, and caregivers. Cultural perspectives—including non-Western conceptions of personhood and interconnectedness—should challenge rather than merely decorate our existing assumptions.

Psychiatry's Responsibility

Psychiatry truly occupies an extraordinary position among the human sciences and has the ability to influence the evolution of human species. We are medical and biological, but also psychological, social, relational, and interpretive. We listen to stories and attempt to make sense of suffering within the context of a life. If psychiatry defines human beings narrowly—as brains, behaviors, diagnoses, or datasets—we risk reinforcing a culture already drifting toward depersonalization. But if psychiatry can integrate neuroscience with meaning, biology with narrative, technology with wisdom, and diagnosis with dignity, it can preserve something essential.

Viktor Frankl argued that the search for meaning is among humanity's most powerful motivations and that its frustration can produce profound suffering. Modern neuroscience does not make that insight obsolete. It gives us another level at which to understand it. The future DSM should therefore aspire to more than reliability; it should aspire to wisdom.

The ultimate question is not simply how accurately we classify mental disorders. It is whether our classifications leave room for the whole human being. The question of what makes us human will not be answered by neuroscience, evolution, technology, or philosophy alone. It is answered every day in the consulting room—in taking seriously what it means to suffer, love, lose, recover, create meaning, and live with mortality.

Psychiatry's role in that conversation may never have been more important. It would be a historic missed opportunity if our next diagnostic system were not equal to the moment.

Dr Lavretsky is a professor in residence in the Department of Psychiatry at the University of California, Los Angeles, Semel Scholar in Integrative Mental Health, and director of Brain Health Innovation. She is a past president of the American Association for Geriatric Psychiatry, a distinguished fellow of the American Psychiatric Association and the American Association for Geriatric Psychiatry, and a fellow of the American College of Neuropsychopharmacology. She is also on the Editorial Board of Psychiatric Times.

Dr Jeste is director of the Global Research Network on Social Determinants of Mental Health and Exposomics, president elect of the World Federation for Psychotherapy, and editor-in-chief of the International Psychogeriatrics journal, and a former professor of psychiatry and distinguished researcher at the University of California in San Diego, and former president of the American Psychiatric Association.

Dr Eyre is the lead of Neuro-Policy and Harry Z. Yan and Weiman Gao Senior Fellow at Rice University’s Baker Institute for Public Policy. He is also the Executive Director of the Global Brain Economy Initiative and an adjunct associate professor at the UCSF Department of Psychiatry.