Discourse and Hegemony: An analysis of DSM discourse over time (original) (raw)
Related papers
DSM over time: From legitimisation of authority to hegemony
BioSocieties (advance online publication), 2015
The proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), has reignited a protracted debate in psychiatry and clinical psychology regarding the criteria used to diagnose and classify mental disorders. Drawing on the concepts of legitimisation and hegemony, the aim of this study is to deconstruct how the authoritativeness of the DSM was discursively constructed, legitimised and consolidated over time. To fulfil this purpose, we combine a critical psychology perspective with critical discourse analysis and adopt a multi-level model of analysis that embraces the notions of genre and repertoire in scientific discourse. The materials were approached considering the following interrelated dimensions: (a) semantic macro-areas; (b) discursive strategies; and (c) linguistic means. The data set is constituted by the Forewords and Introductions of different editions of the DSM, from the DSM-I through to the DSM-5. The analysis highlights the discursive strategies that play an important role in self-legitimisation and the construction of a dominant hegemonic discourse.
2015
The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (known as the DSM) is a system for the classification of mental disorders that provides diagnostic criteria used by psychiatrists and experts in related fields. Although classification systems and standards are ubiquitous in social life, they are rarely conspicuous and almost never become an object of public debate. Yet the DSM has attained the status of a ‘cultural icon’ and has been an object of commentary and controversy internationally. This article offers an introduction to the DSM and to the conditions of possibility for its global influence, based on a critical synthesis of historico-sociological approaches to the manual. In the second part of the article, three keywords – polyvalence, ambivalence and participation – are offered to convey, respectively, the reasons for the manual’s continuing prominence and resistance to change since the publication of its third edition in 1980; some reasons why, while acknowledging the importance of the DSM, we should neither overestimate it nor take it at face value; and the question of participatory politics as part of a sociological research agenda in relation to the DSM.
Constructing normality: a discourse analysis of the DSM-IV
Journal of Psychiatric and Mental Health Nursing, 2000
The purpose of this research was to explore how the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) 1994, (American Psychiatric Association, 1994) defines mental disorder and the theoretical assumptions upon which this is based. The analysis examines how the current definition has been constructed and what the criteria for specific mental disorders suggest about what is regarded as normal. The method employed for the research was a critical discourse analysis. This critical approach to research is primarily concerned with analysis of the use of language and the reproduction of dominant belief systems in discourse. It involves systematic and repeated readings of the DSM-IV (1994) to examine what evidence was employed by the text to substantiate its definition of mental disorder and how in the process some assumptions are made about what constitutes normality. This study challenges a central assumption in the DSM-IV’s (1994) definition: that it is a pattern or syndrome ‘that occurs in an individual’. The proposal that it occurs in an individual implies that it is a consequence of faulty individual functioning. This effectively excludes the social and cultural context in which experiences occur and ignores the role of discourse in shaping subjectivity and social relations. This study proposes that the definition and criteria for mental disorder are based on assumptions about normal behaviour that relate to productivity, unity, moderation and rationality. The influence of this authoritative image of normality pervades many areas of social life and pathologises experiences that could be regarded as responses to life events.
Psychiatry and the DSM: Cracks in an epistemic empire
In this article it is argued that the ontological integrity of psychiatry as a medical science remains deeply problematic. Psychiatric practice and attendant descriptive methodology in the form of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have come under mounting scrutiny and criticism. Some of the most strident criticisms of psychiatric practice and theory have come from within its esteemed quarters (see Szasz, 1970) and have been reinvigorated through a recent publication by Allen Frances, the head of the DSM-IV Taskforce. The arguments put forward by Frances are not new but carry added significance in that they stem from one of the professions most revered voices. Frances heretical attack on psychiatry’s ‘bible’, the DSM, offers the reader a glimpse into the operations taking place within the ‘inner sanctum’ of psychiatry, the DSM Taskforce. It is argued that psychiatry’s co-option by Big Pharma is reflective of a form hegemonic alignment that is consistent with the historical and political functioning of the ‘psy-complex’ in modern bureaucratic society. This article provides a breviloquent review of this history. The paper closes with an ironic resolve by offering a new discursive architecture for the profession of psychiatry.
While a majority of cognitive behavioural researchers and clinicians adhere to the classification system provided in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), strong objections have been voiced among behaviourists who find the dichotomous allocation of patients into psychiatric diagnoses incompatible with the philosophy of behaviourism and practice of functional analysis. The aim of this paper is to give an overview of the current debate and to analyse the tension between the DSM-IV and functional analysis along the following contrasts: inductive versus deductive, idiographic versus nomothetic, contextualism versus mechanism, social constructions versus real entities, and dimensions versus categories. Finally, some suggested alternatives are discussed. It is concluded that there is a need for alternative systems to the DSM with treatment utility.
A Role for Philosophers, Sociologists and Bioethicists in Revising the DSM
Philosophy, Psychiatry and Psychology, 2017
The recent publication of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was accompanied by heated debate. I argue that part of the reason for these recent controversies is that the process of DSM revision involves making certain value judgments, yet requires a better means for explicitly and expertly addressing these issues. It is important to do so because a) there are certain value-laden questions that science cannot answer but which nevertheless need to be addressed in psychiatric classification, and b) the effects of psychiatric classification stretch far and wide. I suggest a means by which the value judgments involved in psychiatric classification can be more systematically and comprehensively examined – by including an independent ethics review panel in the revision process. An ethics review panel could include bioethicists, sociologists and philosophers of psychiatry who would be in a better position to address these issues.
Our cultural complicity in the DSM and the reduction of mental distress
Mad In America, 2019
The reductive, materialist approach to 'mental disorder' is running on fumes. The idea that disorders are simple, empirical things, comprised of smaller empirical things (thoughts, beliefs, desires etc.) that can be differentiated and isolated, reduced and explained by physical causes is a tale that is losing credibility by the day. The core philosophy that our mental experience just is physical experience really and is, as such, entirely conducive to the scientific method is therefore, I argue, lost. For far too long we have been seduced and overwhelmed by these ideas, and the time is increasingly upon us to reject them and think again about what 'mental disorder' is. Although there are several studies or avenues to make the case I want to make in this regard, I will focus on a very recent paper by Allsopp et al (2019).1 This paper comes to the arguably alarming conclusion that the DSM is not only conceptually problematic but "scientifically meaningless." The very fact that there is considerable overlap between disorders and that two people can (so the DSM says) have the same disorder but share none of the same symptoms, it is argued, contradicts the very purpose and relevance of a system that was based on discerning 'discrete disorders.' And it must be noted that Allsopp et al's paper is not a theoretical paper in a psychotherapy journal, but a study in a psychiatry journal. Being that the DSM essentially represents the culmination of decades of empirical research on the Psyche, and being that it also represents the very philosophy of minds, brains, and experience described above as applied in the real world, then this is clearly no small deal.