Great article! The ongoing evolution of psychiatric classification raises fundamental questions about the nature of mental disorders and the criteria used to define them. The tension between the 'labeling theory' and the 'standard medical view' remains particularly relevant as new revisions continue to reshape the landscape of mental health.
How do we ensure that diagnostic categories remain clinically meaningful while avoiding the risk of pathologizing variations in human experience?
Thanks. One idea behind much of psychiatry, which is little spoken about, is that someone asks for help. This is not usually because they have read the science, it is usually because they (or someone close them) are reporting significant loss of functioning, or stress to self or others. The dsm then attempts to identify a way to classify what might be behind this to guide treatment. The science of deciding what is abnormal is then half of this process and measuring loss of functioning or stress (non research based) is the other. What becomes political is perhaps what society finds “stressful”. And in what places has a psychiatric concept developed to help society with its more prejudiced ‘stresses’.
Nice points. Thank you for the feedback. In cases of voluntary psychiatric treatment, it is clear that the person who is in need of help is asking for it. However, in cases of involuntary hospitalization, it is more complex and the person being treated is usually refusing help. I also think that the claim that a person needs help is often given for why they need psychiatric treatment, and sometimes the diagnosis is a means of getting the person help or services even if they do not have a psychopathology. Jerome Wakefield has a fascinating discussion of these issues in a paper titled "Psychological Justice: DSM-5, False Positive Diagnosis, and Fair Equality of Opportunity." I'll discuss it in a future post.
Everyone does grasp that the DSM is not a scientific document from a reputable research organization, but a commercial catalog engineered for pricing and billing purposes by a trade organization.
It resembles an old Sears catalog more than a dictionary. Open up a CRC.
Are you suggesting that we stop studying history and just focus on political activism? I totally agree that we need to stand up for the civil rights of people who are gay and trans. I don't understand how writing about this episode is history is erasing anyone?
Thanks for the response. John Z. Sadler has just published *Vice and Psychiatric Diagnosis* (OUP, 2024) where he takes a close look at the use of values in the definition and diagnosis of many disorders, and how the personality disorders (esp. conduct disorder and anti-social PD) and the impulse control disorders (e.g. intermittent explosive disorder and kleptomania) contain a lot of what he calls "vice-laden" language. The presence of vice-laden language in a diagnosis and classification does cast doubt on it being a genuine psychopathology. They do seem more a matter of enforcing social norms than treating an illness. Of course, what counts as a genuine psychopathology seems to be the core issue here.
Great article! The ongoing evolution of psychiatric classification raises fundamental questions about the nature of mental disorders and the criteria used to define them. The tension between the 'labeling theory' and the 'standard medical view' remains particularly relevant as new revisions continue to reshape the landscape of mental health.
How do we ensure that diagnostic categories remain clinically meaningful while avoiding the risk of pathologizing variations in human experience?
That question does get to the heart of the matter. I hope to explore it more in future posts.
Thanks. One idea behind much of psychiatry, which is little spoken about, is that someone asks for help. This is not usually because they have read the science, it is usually because they (or someone close them) are reporting significant loss of functioning, or stress to self or others. The dsm then attempts to identify a way to classify what might be behind this to guide treatment. The science of deciding what is abnormal is then half of this process and measuring loss of functioning or stress (non research based) is the other. What becomes political is perhaps what society finds “stressful”. And in what places has a psychiatric concept developed to help society with its more prejudiced ‘stresses’.
Nice points. Thank you for the feedback. In cases of voluntary psychiatric treatment, it is clear that the person who is in need of help is asking for it. However, in cases of involuntary hospitalization, it is more complex and the person being treated is usually refusing help. I also think that the claim that a person needs help is often given for why they need psychiatric treatment, and sometimes the diagnosis is a means of getting the person help or services even if they do not have a psychopathology. Jerome Wakefield has a fascinating discussion of these issues in a paper titled "Psychological Justice: DSM-5, False Positive Diagnosis, and Fair Equality of Opportunity." I'll discuss it in a future post.
Yes it can be and has been and will be again. At the same time, there are people asking for help.
Learned a lot in this article! Thanks for your efforts 🙏
Thanks for your feedback! I'm glad it's useful.
Everyone does grasp that the DSM is not a scientific document from a reputable research organization, but a commercial catalog engineered for pricing and billing purposes by a trade organization.
It resembles an old Sears catalog more than a dictionary. Open up a CRC.
Are you suggesting that we stop studying history and just focus on political activism? I totally agree that we need to stand up for the civil rights of people who are gay and trans. I don't understand how writing about this episode is history is erasing anyone?
Thanks for the response. John Z. Sadler has just published *Vice and Psychiatric Diagnosis* (OUP, 2024) where he takes a close look at the use of values in the definition and diagnosis of many disorders, and how the personality disorders (esp. conduct disorder and anti-social PD) and the impulse control disorders (e.g. intermittent explosive disorder and kleptomania) contain a lot of what he calls "vice-laden" language. The presence of vice-laden language in a diagnosis and classification does cast doubt on it being a genuine psychopathology. They do seem more a matter of enforcing social norms than treating an illness. Of course, what counts as a genuine psychopathology seems to be the core issue here.