Special Issue: Feminism & Psychology, “DSM-5 and Beyond: A Critical Feminist Engagement with Psychodiagnosis”

The current issue of Feminism & Psychology is an open source special issue focusing on the long-promised, upcoming revision to the Diagnostic and Statistical Manual of Mental Disorders. Entitled “DSM-5 and Beyond: A Critical Feminist Engagement with Psychodiagnosis,” the issue is guest edited by Jeanne Marecek and Nicola Gavey. As they write in their introduction:

The articles in this special issue take the practices associated with the DSM as objects of scrutiny. In doing so, they throw the DSM’s limitations into sharp relief. Its knowledge base does not hold up well to scientific scrutiny. In many instances, it does not promote good care. Its evidentiary base is shoddy. For researchers, teachers, or clinical practitioners, critical distance from the DSM is intellectually responsible and ethically necessary. Following David Harper’s urging, we can inculcate a critical consciousness in our students and trainees regarding this and other tools of the ‘psy’ trade. When we teach about psychodiagnosis, we can also teach about the historicity of categories of psychological disorder and of psychological knowledge more generally. We can also discuss with clinical trainees how the workaday language practices of mental health professionals (such as those Goicoechea describes) tacitly reaffirm the subordination of patients and uphold institutional power (Rossiter, et al., 1998). (7)

Included in the issue are two full length essays, several shorter “Points of View” essays, and three research articles. The abstracts (or links to the full document) have been posted below.

Essays

Diagnosis and its discontents: Critical perspectives on psychiatric nosology and the DSM

Suzanne R Kirschner

Recent writings that critically analyze psychiatric diagnostic categories and the practices that are intertwined with them have descriptive, contextualizing and moral dimensions. Descriptive projects depict major trends in psychiatric classification. They focus on three such trends: medicalization, an increase in both the number of diagnostic categories and the number of persons to whom they are ascribed, and a move towards framing both pathological and normative behaviors and experiences in neurobiological terms. Contextualizing projects explore how micro- and macrosocial, cultural and political economic elements influence both how diagnostic categories take form and how people who live under the description of those categories interact with them. Many descriptive and contextualizing projects also have a moral dimension: they are motivated by questions about what constitutes help for mentally distressed or impaired persons as well as by concerns that some diagnostic labels and practices may cause harm. Such critical consciousness seems to have grown in tandem with increased medicalization and biological reductionism in psychiatry, and should be further promoted in the future.

Whose account matters? A challenge to feminist psychologists

Gail A Hornstein

Most critiques and commentaries concerning the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) focus on the expanding scope of the system, on particular categories of disorder, or on unwarranted claims about the biological bases of symptoms embedded in DSM descriptions. In contrast, this essay focuses on phenomenology, the subjective experiences of those supposedly being categorized by this whole framework. In addition to allowing us to see extreme states and unusual perceptions, thoughts, actions, and feelings with fresh eyes – from the perspective of the distressed person’s own categories and explanations – a phenomenological approach forces us to confront important ethical and political issues often ignored in discussions of diagnosis and treatment. Feminist psychologists in particular need to think more deeply about these issues, to avoid taking untenable moral positions and violating core assumptions about the right to define one’s own experience.

Points of View essays

Feminism and psychiatric diagnosis: Reflections of a feminist practitioner – Sally Swartz

Sexual dysfunction and paraphilias in the DSM-5: Pathology, heterogeneity, and gender – Robbie Duschinsky and Netta Chachamu

Social constructionist contributions to critiques of psychiatric diagnosis and classification – Eugenie Georgaca

Diagnosing difficult women and pathologising femininity: Gender bias in psychiatric nosology – Jane M Ussher

Lessons from the borderline: Anthropology, psychiatry, and the risks of being human – Rebecca J Lester

On the persistence of psychiatric diagnosis: Moving beyond a zombie classification system – David J Harper

Client subversions of DSM knowledge – Michael Guilfoyle

Articles

Industry’s colonization of psychiatry: Ethical and practical implications of financial conflicts of interest in the DSM-5

Lisa Cosgrove and Emily E Wheeler

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), scheduled for publication in May 2013 by the American Psychiatric Association (APA), has created a firestorm of controversy because of questions about undue industry influence. Specifically, concerns have been raised about financial conflicts of interest between DSM-5 panel members and the pharmaceutical industry. The authors argue that current approaches to the management of these relationships, particularly transparency of them, are insufficient solutions to the problem of industry’s capture of organized psychiatry. The conceptual framework of institutional corruption is used to understand psychiatry’s dependence on the pharmaceutical industry and to identify the epistemic assumptions that ground the DSM’s biopsychiatric discourse. APA’s rationale for including premenstrual dysphoric disorder in the DSM-5 as a Mood Disorder is reviewed and discussed.

Invoking and inscribing mental illness: A discursive analysis of diagnostic terminology in inpatient treatment planning meetings

Jessie Goicoechea

Critical feminist analyses document the power of psychiatric labeling, but less attention has been given to the social processes involved in giving and acquiring labels. Utilizing a discursive method based on conversation analysis, this study examined conversations among staff and with patients in treatment team meetings on an adult, involuntary inpatient unit of a state psychiatric hospital in the US, with a focus on how problem formulation and role negotiations are achieved and how diagnostic terminology figures into that work. In this brief report, extracts from treatment planning meetings with two female patients are presented to illustrate how diagnostic terminology steers conversations away from addressing the context of these women’s lives.

The DSM and its lure of legitimacy

Michelle N Lafrance and Suzanne McKenzie-Mohr

The Diagnostic and Statistical Manual of Mental Disorders (DSM) offers a biomedical framing of people’s experiences of distress and impairment, and despite decades of criticism, it remains the dominant approach. This dominance is maintained not only by powerful corporate interests such as the pharmaceutical industry, but also through the everyday talk of people as they attempt to make meaning of themselves and their experiences. This paper explores how and why the DSM holds such cultural currency for individual speakers, and unpacks what is being accomplished in their taking up the language of psychiatric diagnosis. In particular, we argue that a biomedical construction of distress offers the lure, or promise, of validating persons’ pain and legitimizing their identities. However, we also argue that the very assumptions of biomedicine ensure that this promise can never entirely be fulfilled and, despite its lure, a biomedical construction of ‘mental illness’ all too frequently fails to protect individuals from delegitimation and stigma.