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The Diagnostic System: Why the Classification of Psychiatric Disorders Is Necessary, Difficult, and Never Settled
Mental illness is many things at It is a natural phenomenon that is also shaped by society and culture. It is biological but also behavioral and social. Mental illness is a problem of both the brain and the mind, and this ambiguity presents a challenge for those who seek to accurately classify psychiatric disorders. The leading resource we have for doing so is the American Psychiatric Association’s Diagnostic and Statistical Manual , but no edition of the manual has provided a decisive solution, and all have created controversy. In The Diagnostic System , the sociologist Jason Schnittker looks at the multiple actors involved in crafting the DSM and the many interests that the manual hopes to serve. Is the DSM the best tool for defining mental illness? Can we insure against a misleading approach?
Schnittker shows that the classification of psychiatric disorders is best understood within the context of a system that involves diverse parties with differing interests. The public wants a better understanding of personal suffering. Mental-health professionals seek reliable and treatable diagnostic categories. Scientists want definitions that correspond as closely as possible to nature. And all parties seek definitive insight into what they regard as the right target. Yet even the best classification system cannot satisfy all of these interests simultaneously. Progress toward an ideal is difficult, and revisions to diagnostic criteria often serve the interests of one group at the expense of another. Schnittker urges us to become comfortable with the socially constructed nature of categorization and accept that a perfect taxonomy of mental-health disorders will remain elusive. Decision making based on evolving though fluid understandings is not a weakness but an adaptive strength of the mental-health profession, even if it is not a solid foundation for scientific discovery or a reassuring framework for patients.
Schnittker shows that the classification of psychiatric disorders is best understood within the context of a system that involves diverse parties with differing interests. The public wants a better understanding of personal suffering. Mental-health professionals seek reliable and treatable diagnostic categories. Scientists want definitions that correspond as closely as possible to nature. And all parties seek definitive insight into what they regard as the right target. Yet even the best classification system cannot satisfy all of these interests simultaneously. Progress toward an ideal is difficult, and revisions to diagnostic criteria often serve the interests of one group at the expense of another. Schnittker urges us to become comfortable with the socially constructed nature of categorization and accept that a perfect taxonomy of mental-health disorders will remain elusive. Decision making based on evolving though fluid understandings is not a weakness but an adaptive strength of the mental-health profession, even if it is not a solid foundation for scientific discovery or a reassuring framework for patients.
- GenresPhilosophy
368 pages, Hardcover
Published August 8, 2017
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Displaying 1 - 3 of 3 reviews
January 15, 2024
Giving a 5 star review to counteract the 2-star review from earlier. Picked this up from a free library/book giveaway at a Philly apartment (the author is a Penn prof).
The Diagnostic System is a pretty dense book on what its subtitle tells us - classifying psychiatric diseases is tough. Its history is storied, and I'm somewhat familiar as I took Nicholas Bartlett's class on [predominantly] East Asian mental health - really fascinating and loved my TA Tianyuan. Over its existence, the DSM, effectively the de facto mental health diagnosis manual, has undergone heavy changes as sociocultural & biological understandings of mental health have changed over the years. As such, these changes are often made with some level of tensions which reveal the core confrontations that clinicians and researchers have to make to qualify X disease with some reasonably defined criteria ,that over time develop more flexibility, open-endedness in the definitiveness of such criteria, and potentially sub-diagnoses that leave more room for granularity.
It's also worth noting this book is focused almost entirely on classification history and methods because it is the predicate to treating patients - does it make sense to treat a patient with PTSD if they have some combination of anxiety and depression instead, e.g.? Nevertheless, I think if you're willing to read something fairly dry, there is a ton to learn and appreciate here.
The Diagnostic System is a pretty dense book on what its subtitle tells us - classifying psychiatric diseases is tough. Its history is storied, and I'm somewhat familiar as I took Nicholas Bartlett's class on [predominantly] East Asian mental health - really fascinating and loved my TA Tianyuan. Over its existence, the DSM, effectively the de facto mental health diagnosis manual, has undergone heavy changes as sociocultural & biological understandings of mental health have changed over the years. As such, these changes are often made with some level of tensions which reveal the core confrontations that clinicians and researchers have to make to qualify X disease with some reasonably defined criteria ,that over time develop more flexibility, open-endedness in the definitiveness of such criteria, and potentially sub-diagnoses that leave more room for granularity.
It's also worth noting this book is focused almost entirely on classification history and methods because it is the predicate to treating patients - does it make sense to treat a patient with PTSD if they have some combination of anxiety and depression instead, e.g.? Nevertheless, I think if you're willing to read something fairly dry, there is a ton to learn and appreciate here.
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October 12, 2020"Modern science has illuminated the puzzle of psychiatric disorders in an unprecedented way. Perhaps one unfortunate side effect of this progress, however, is that the rise of a scientific approach has largely pushed normative discussions to the side. Yet normative considerations are no less relevant today than they were in the past. They continue to inform, for instance, what we regard as a significant disorder and continue to shape what we are prepared to admit as a major life event. They lie behind discussions of proportionate responses to stress, and they form the basis for what symptoms we regard as abnormal . . . The diagnostic system demands distinctions, but those distinctions will be a matter of discretion rather than fact."
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October 29, 2018616.89075 S361 2017
Displaying 1 - 3 of 3 reviews