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The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) incorporates a number of novel diagnoses, whereas some diagnoses appearing in earlier editions were abandoned. This article comments on and clarifies some of the controversies associated with the ebb and flow of diagnosable mental disorders over time. The purpose of this article is to investigate the ontological status of a psychiatric diagnoses (in particular 'neurasthenia'); to what degree and in which way do psychiatric diagnoses represent reality? The article is based on a review of the literature and reports a conceptual analysis and case study of neurasthenia. An attempt was made to investigate the ontological status of psychiatric diagnoses (in particular 'neurasthenia') by examining whether we must understand them as natural, artificial, practical, interactive, or indifferent kinds. A critical analysis of the literature supports the conclusion that the way in which we view the 'kind-ness' of mental disorders is determined by our entrenched 'subject–object thinking.' The dichotomy between natural (object) and artificial (subject) should be abandoned, allowing the ontological status of psychiatric diagnoses to be viewed in a relational framework.