You May Ask Yourself 5e by Dalton Conley

Author:Dalton Conley
Language: eng
Format: epub
Publisher: W. W. Norton & Company

Rise of Diagnostic Psychiatry

In 1952, the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM ), which described about 60 disorders. The social meanings of mental illness have always been contested, and the DSM is interesting because it represents the social construction of mental illness. In the nineteenth century, for example, women were frequently diagnosed as hysterical, and today the increasing diagnosis of borderline personality disorder, whose symptoms are analogous to those of hysteria, is a similar diagnosis under a different name. What the DSM did was standardize the canon of mental disorders and their definitions, such that a woman diagnosed with mania by one psychiatrist in Maine would (in theory) receive the same diagnosis from another psychiatrist in Texas (although it’s never been that cut-and-dried, despite the APA’s attempts at standardization). The second edition of the DSM did not make sharp distinctions between normal and abnormal behavior; rather, behaviors were considered to exist on a continuum in reaction to various life circumstances. For example, if one of your parents was killed in an automobile accident, you might be depressed, but this was still considered a normal reaction. (The second edition also included homosexuality as a psychiatric disorder, although this entry was removed in 1973.)

A major change occurred in 1980 with the publication of DSM III. This version was largely atheoretical, meaning that diseases were not attributed to certain causes (such as life events). In this way, it was primarily diagnostic and largely adopted a medical model (as opposed to a psychological one). You receive a diagnosis of “depressed” if you exhibit the associated symptoms for a period of two weeks or longer, much in the same way you might be diagnosed with chicken pox if you have a fever and red, itchy bumps. Unlike earlier editions, however, DSM III removed the social context in favor of the biomedical model. If you are depressed, it is presumed that you have a chemical imbalance. In the diagnosis criteria, no consideration is given to what life events, if any, may have triggered your feelings, although according to the manual, doctors were expected to take life factors into account.

Today the DSM is in its fifth edition and contains information on almost 400 distinct mental illnesses. Its use has increased, largely because of the bureaucratic requirements of the insurance industry: In order to get paid, mental health professionals must find a diagnosis category that “fits.” Hence, the proliferation of new entries such as attention-deficit/hyperactivity disorder (ADHD), generalized anxiety disorder, and premenstrual dysphoric disorder—all of which previously belonged to less medical, lay categories.

The major changes in the DSM that took place between its second and third editions reflect both changes in the field of psychiatry and our social understanding of mental illness. Dynamic psychiatry, which focused on identifying the internal conflicts that produced a mental illness, was usurped by diagnostic psychiatry, which seeks to identify the symptoms of specific underlying diseases. As noted above, this change

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