The DSM and its lure of legitimacy

Abstract

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.

A Feminist Phenomenological Description of Depression in Low-income South African Women

“…The diathesis-stress and biopsychosocial models move towards combining these two dominant perspectives by postulating that a person who is vulnerable to depression (via their biology, cognitive style or personality) may become depressed in response to stressful or unfavourable environmental or social conditions (Accortt, Freeman, & Allen, 2008). However, although these "combined" models were created with the intention of giving equal consideration to the different aspects of experience, in practice, they often prise biological over social or psychological aspects (Lafrance & McKenzie-Mohr, 2013). …”

“…These authors attribute some of the DSM's dominance to the powerful pharmaceutical industry, noting that medical and psychological research into depression is often funded by pharmaceutical companies who stand to benefit from the popularisation of the idea that depression is a biological condition which can be treated with medicine. Unsurprisingly then, the vast majority of South African and international psychological studies on depression are informed by the tenets of the medical model (and thus subscribe to the DSM), which has, in turn, caused both professional and public opinion on depression to focus largely on biological explanations (Johansson, Bengs, Danielsson, Lehti, & Hammarstrom, 2009;Lafrance & McKenzie-Mohr, 2013). International authors, McMullen and Stoppard (2006) similarly attribute this world-wide phenomenon to clinical psychology's reliance on individualist conceptions and the recent demands for evidence-based health care.…”

“…Feminist psychologists and researchers have cited numerous reasons for eschewing traditional psychological assessment and diagnostic procedures (Lafrance & McKenzie-Mohr, 2013;Marecek & Gavey, 2013;Swartz, 2013), the most fundamental of which will briefly be summarised here.…”

“…10! LaFrance, 2009;LaFrance & Stoppard, 2006;Lafrance & McKenzie-Mohr, 2013;Liebert, 2010;Stoppard, 2000;Ussher, 2010).…”

“…Today, the primary relational and discursive feminist critique remains that the medical focus in women's mental health research serves to divert attention away from the actual lived experience of depression and the different social contexts within which women become depressed (Lafrance & McKenzie-Mohr, 2013). These authors therefore choose to explore women's lived experiences of depression and highlight the shortcomings of reductionistic, biological explanations (Jack, 1991;Lafrance & Stoppard, 2006;MacKay & Rutherford, 2012;Stoppard, 2000;Stoppard & McMullen, 2003).…”