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This article seeks to re-examine the links between an epistemological model, constructivism, a care model, community care, and a movement specific to psychiatry, namely anti-psychiatry. The article recalls the origins of the constructivist movement and shows how sociologists and philosophers seized on this movement to question certain mental health diagnoses, in turn fueling the anti-psychiatric current of the sixties and seventies. A naturalistic conception of mental illness involves a deterministic causality that leaves no room for patient contingency or freedom. This is the main reason why the constructivist and anti-psychiatry lobby accuse mental illness in general and schizophrenia in particular of being simply a product of psychiatry. A glance back into history serves to remind us that the psychiatric hospital is not synonymous with the exclusion of madness or with a naturalistic conception of madness, however. It is important to differentiate between an epistemological question (how to define and classify madness) and a social question (where and how to manage it). It is inaccurate to think that a naturalistic conception of mental illness is the preserve of classical hospital psychiatry, and that community care is innocent of it, just as it is incorrect to convince people that the construction of psychiatric diagnoses is the cause of the exclusion of individuals with socially inappropriate discourses or unsuitable social behavior.