Where do classifications come from? The DSM-III, the transformation of American psychiatry, and the problem of origins in the sociology of knowledge

Abstract

When something serves a function, it is easy to overlook its origins. The tendency is to proceed directly to function and retroactively construct a story about origin based on the function it fills. In this article, I address this problem of origins as it appears in the sociology of knowledge, using a case study of the publication of the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The manual revolutionized American psychiatry and the treatment of mental illness, because it served the function of classification that had become critical to the field of mental health by this time. But this function must be bracketed in order to reveal the "extra-functional" origins of the DSM-III. Using field theory, I argue that the manual was necessary for reasons other than the function it filled as a classification. Specifically, its origin lies in a series of conflicts among psychiatrists, psychoanalysts, and clinical psychologists within the field of mental health, which followed in the wake of the collapse of psychoanalysis as the dominant treatment type for mental illness. I reveal the generative formula behind the production of the DSM-III, capturing a variety of social processes that influenced the format of the manual and made it a useful classification, but which are not reducible to function. In this way, I reproduce its raison d'etre in a manner similar to how the DSM-III appeared for the people who produced it. This focus on generative formulas offers the sociology of knowledge a way to capture the epistemic importance of a range of different social processes. Most importantly, it avoids the functional fallacy of reducing origin to function, and ignoring the idea that innovations might appear necessary even without clear recognition of their functional consequences.

Preserving the unpreservable: docile and unruly objects at MoMA

“…It is through classification that institutions effectively standardize and synchronize actions and meanings across different domains, organize coherent systems of categories, distribute forms of value, and produce univocal and legible objects of knowledge (Bowker and Star 1999;Strand 2011). These processes are particularly critical in museums, as institutions that have within their purview the creation, management, and reproduction of complex cultural taxonomies.…”

Diagnosis and the DSM

“…One reason why the first versions of the DSM were elaborated so poorly is that initially American psychiatrists didn't believe in the relevance of elaborating mere classificatory diagnostic systems (Strand, 2011). On the one hand, they had a holistic mental health concept, and assumed that mental illnesses "were precipitated by a combination of psychological and environmental etiological factors that were mediated by the constitution or predisposition of the individual" (Grob, 1991, p. 422).…”

“…However, existing classification schemas, like the Statistical Manual for the Use of Institutions for the Insane (which was strongly oriented toward residential psychiatry), were of little use in this context: "Only 10% of the total cases seen [by military psychiatrists] fell into any of the categories ordinarily seen in public mental hospitals" (DSM-I, p. vi). Since neurotic problems and trauma-related psychopathology were not represented in the manual, the US Army and Navy took to developing their own classifications to get hold of the magnitude of mental disorders among soldiers and veterans (Strand, 2011). Inspired by both this new classification system and the Statistical Manual for the Use of Institutions for the Insane, the American DOI: 10.1057/9781137404688.0005 Psychiatric Association made it their business to develop its own statistical manual: the DSM-I was published in 1952.…”

“…As the DSM-I was adopted in the 1950s, diagnostic classification remained a marginal concern to the then dominant group of DOI: 10.1057/9781137404688.0005 psychodynamic psychiatrists in the US (Strand, 2011). This changed only slightly when the American Psychiatric Association was asked to attune the manual to the standards outlined by the International Classification of Diseases (ICD).…”

Pathological normalcy: A construct for comprehending and overcoming psychological aspects of alienation.

“…299 pathophysiologies has been disconfirmed by the DSM-5, and therefore by the American Psychiatric Association, as it has by the National Institutes of Mental Health (see Strand, 2011 for insights into certain social bases of the DSM).…”