Categorical taxonomies (DSM) Flashcards
1
Q
Why do we look at history of DSM-5?
A
The kind of conversations we will be having with our clients are not independent and they come from the way our society has been talking about mental health issues in the past, present but also future
- By understaning how DSM developed we can understand its influences, pros and cons
2
Q
How does a symptom become a symptom?
A
- It has to be observable (e.g. symptoms are visible because of the setting we live in)
- They have to become observable as deviations form cultural norms, the mean, explicit or implicit norms, expectations
- The deviation has to become a problem
- It’s only a symptom if we have a theory about these problems (otherwise we would only have a list of problems)
↪ Doesn’t need to be a scientific theory or a medical theory, it’s just important that there is some kind of theory which places the problems in a framework of a mental health problem - picture 1
3
Q
What are discourses and what role do they play in defining what a symptom is?
A
Discourses = broad social, medical, scientific, institutional, political, and economic narratives or frameworks that shape how people understand and interpret reality
- They influence expectations, norms, observations, and theories, which in turn affect the identification and classification of symptoms
- act as overarching systems of knowledge and power that determine what is considered normal, problematic, or deviant
- E.g. medical discourses define what is seen as illness, while political discourses shape policies on public health
4
Q
Who was Emil Kraepelin and what did he do?
A
- Important name in psychiatry in the 19th century
- End of 18th century, psychiatric instituitions were introduced where people who were mentally ill were placed - made their symptoms observable
- Kraepelin was a psychiatrist at one such institution and he was observing the phenomena that he found there (observable) - he talked with the people, observed what happened with their symptoms and then published these observations in books with book chapters
- The idea was that there we have psychiatric syndromes with a certain etiology, course, prognosis
- At first, these were only descriptive but later they became clear that these are kind of medical diseases that caused the symptoms that people had
- So Kraepelin made a distinction between psychiatric disorders
↪ The question became: Which mental disorder causes the symptoms? - Now, it’s known that it’s a bit more grey area than the specific, bordered distinctions that Kraepelin introduced
5
Q
How did Freud see symptoms?
A
- He had a very different view to Kraepelin of what symptoms are
- Symptoms in a psychoanalytic framework are something that appear from unconscious conflicts, fantasy, defense mechanisms
- The main question: Of which unconcious fantasies, drives and conflicts are these symptoms an expression and compromise?
- Completely different frame of reference to Kraepelin or even to Skinner
6
Q
How did Skinner view symptoms?
A
- Symptoms are behaviours learned through conditioning of stimuli
- Main questions: How have these symptoms been shaped through conditioning? (no clear cut disorders, rather learning histories)
7
Q
How did psychiatry change over the years
A
19th century: about the big psychiatric institutions with small groups of people having certain symptoms
After WWI and WWII these three - Kraepelinian, psychoanalysis, behaviourism became dominant frames of reference
- Psychiatry became more important in general population
8
Q
How did DSM-I and DSM-II look like?
A
- 1952: DSM-I; 1968: DSM-II
- Psychoanalysts created them
- Very different descriptions to what DSM includes now
- E.g. in picture 2
- The psychoanalyst who makes this diagnoses has to make lot of inference
↪ The client is dependent on how the psychoanalyst analyses the particular problems of the client
↪ Psychoanalytic theory is a dangerous model in terms of authority relations because it gives lot of power to the analyst and they may abuse it - DSM-I and DSM-II – administrative tools, not as important in clinical practice, not a major thing in research either
9
Q
What critiques were there on psychiatry and DSM-II in 60s and 70s?
A
- reliability of diagnosis (little inter-rater reliability between countries and clinics; little agreement between professionals on the diagnoses)
- the authority of psychiatrists
- quality of research when there was no criteria on which kind of patients are included in this kind of research
10
Q
To what did this critique lead to?
A
The Neo-Kraepelin revolution
- 1972: Some psychiatrists realised that they need inter-rater reliability for diagnosis (for science but also for status of the profession) - so they developed ‘The Feighner criteria’ for syndromes
- Criteria they can use in research
- E.g. developed criteria for depression which are very comparable to what depression is considered now
- They were aware they’re making syndromes, covariance of problems, and not illnesses
↪ syndromes which according to them was some kind of agreement between experts what depression is for example
11
Q
What did the Neo-Kraepelian revolution lead to?
A
- 1972-1974: The Feighner criteria developed into the Research Diagnostic Criteria (RDC) which became the basis for DSM-III
- 1980: DSM-III = result of the Neo-Kraepelian revolution
12
Q
Debate on homosexuality in 1968
A
There was a big discussion about homosexuality – observed as a deviations that became a problem because it deviated from expectations and norms = became a mental disorder but at the beginning of 70s, it was removed from dsm
13
Q
How was the intorduction of DSM-III in 1980 a big change?
A
- The look changed
- The dsm became way more important than they thought (dsm-I and II not as important)
→ Researchers became very invested in it - very useful when you set up a study and say this study is for population who are diagnosed with depression = easier to get funding and get published
→ Insurance companies – they know what they are paying for, ‘’I’m treating patients on the basis of this diagnostic tools’’
→ The Netherlands also very quickly became dsm-based
→ Pharmaceutic companies also benefited – developed drugs that they could back up that they will help this population with these kinds of symptoms
→ At the level of society huge change in how we talk about symptoms – very likely that when someone was telling about their problems, they were describing symptoms from dsm - Prevalence rates changed
→ E.g. ADHD and depresson in 1980 were very rare
→ Initially, limited number of people from the general popualtion fit the diagnosis but as soon as it was established that you need only for example 5 out of 9 symptoms to get diagnosed = huge amounts of population actually applied to the diagnosis
→ Same with autism - very different criteria in 1943 which was for very extreme cases but later it became a spectrum and way more people fit into the diagnosis
→ Very rapid, strong differences in a few decades – double, triple diagnoses – not a story of epidemia but rather how we as a society think about deviations as problems
14
Q
How did ICD evolve and to what extent does it match with DSM?
A
- In 1948, ICD 6 included psychiatric disorders
- Over the time, allignment between DSM and ICD increased = in 1994 convergence of DSM-IV and ICD-10 and now they are very very similar but ICD-11 has stepped into dimensional model for personality disorders for example, whereas DSM-5 remains categorical
15
Q
When and for what may DSM (still) be a useful tool in clinical practice?
A
- Provide a common international language for mental health problems
- Make treatment possible within many social practices
- Generate hypotheses on etiology, course, prognosis and vulnerabilities
- Generates hypotheses on treatment options
16
Q
Pro 1
Provides a common international language for mental health problems
A
- It has some inter-rater relaliability (rather lot of problems with validity – what is the theory behind it?)
- If someone meets criteria for a DSM-5 or ICD-11 syndrome anywhere in the world, we have at least some common understanding of presenting symptoms
- If DSM-5 is used in a research project people have some common understanding of of symptoms people in that study were experiencing
- In communication between mental health professions and the rest of society we have some common ground for telling what kinds of problems we are treating in our practices (important to give society why psychologists are important, what they do and how they do it)
17
Q
Pro 2
Make treatment possible within many social practices
A
- Diagnosis-Treatment combination for insurance
↪ Insurance company – need dsm diagnoses for reimbursement - Socio-political status as a medical profession → it’s powerful in terms of social status, money, funding…
- Clear and easy message to a patient: ‘’you have X, we know that people with X often profit from Y, so we will start with Y’’
↪ Not always true but it’s a good starting point - Clear and easy message to society (e.g. ministry of health for funding): ‘’We have evidence that providing X to people with Y has positive consequences.’’
↪ Gives disclaimers to those around the patients - what people can expect and should adjust to so that clients can fit in with society
↪ It gives the alternative for possibly stigmatizing diagnosis (people thinking that this person is mad and crazy) by giving a more nuanced, better story
↪ That’s also a reason why he wouldn’t just throw dsm away
18
Q
Pro 3
Generate hypotheses on etiology, course, prognosis and vulnerabilities on the basis of scientific literature
A
- Reasearch on large groups provides claims as to how the disorder might develop (e.g. 50% of people with depression relapse within a year) which allows for e.g. preventive treatments for that specific individual
- We can only use that kind of research if we have an understanding of the DSM
19
Q
Pro 4
Generate hypotheses on treatment options
A
Randomized clinical trial -> specific individual
- Here is the big problem – we don’t know how it works, and why it works – and for many people the treatment works and for many it doesn’t
- But it’s still a hypothesis that the treatment might work for this specific individual based on all the research we have on large groups
- If a client doesn’t respond to treatment, we should never say the client is treatment-resistant – we could say that only if we have 100% knowledge that the treatment works for everyone – we don’t have that kind of treatment
20
Q
What is the conclusion? Should we or should we not use dsm?
A
We shouldn’t throw it away (because lot of our literature is based on dsm + the reasons above) but we shouldn’t cling to it too much either because then we have some scientific and social problems
21
Q
What is the point of the article by Ian Hacking and how should we understand it?
A
- We may not agree with everything Hacking says, rather it’s suppose to make us think and reflect on what it means to diagnose
- Understand the core ideas, what they mean and how Hacking uses them to help us understand the history of diagnoses, e.g. autism, multiple personality disorder
22
Q
What is the socio-cultural problem according to Ian Hacking?
A
- Before DSM-5 came out, people with BED were having binges but they didn’t have a mental disorder (BED was not in DSM-IV) but after DSM-5 came out, they did have a mental disorder → What does that mean? How does that affect those people? → Questions that Ian Hacking has been asking his whole life
- Ian Hacking: ‘’Sometimes, our sciences create kinds of people that in a certain sense did not exist before’’
→ As if we invent new people - The moment this diagnosis is made, we in a certain way make up people – he doesn’t want to say that but he is implying it
↪ In the 60s, Szasz wrote a book called The Myth of Mental Illness and he says that mental illness doesn’t exist
o Ian doesn’t say what Szasz did but he does recognise that we have to get a good account of what happens in our society when diagnosis is introduced
23
Q
What are the core ideas in Ian Hacking’s article Making up people?
A
- Making up people
- Moving targets
- Looping effects
- Transient mental illness
- Engines of discovery are also engines of making up people
24
Q
How does science make up people?
A
In the process of science, we not only make research and get info, but we also, by wanting or not, we create new kinds of people
- By introducing criteria (e.g. The Feighner criteria) – process of making up new groups of people
- Because people are moving targets
25
Why are people and diagnosis moving targets according to Hacking?
- He distingushes the difference in classifying human beings and classifying any other phenomena by those moving targets (e.g. classifying a chair as a chair introduces a new word but is not a moving target because even if I call if a table it's not gonna change into a table; chair will remain a chair and the name will not influence its characteristics, properties, behaviour etc)
- However, moving targets, so human beings, change over time (also what we call depression changes) – we cannot say that people in 1980 and now with a specific diagnosis are the same
* If I label a child with autism, the environment around them changes – and after some time, the child will change a little bit
* Not only this individual child but a whole group of people who get diagnose change – they will speak about their symptoms more – changing what autism is, also changes what science recognises as what autism is = looping effects
26
What is a looping effect?
Once a new way of being a person is recognized (like being "multiple"), it changes how people understand themselves and behave—a process of a looping effect
- People start identifying with the diagnosis, which in turn shapes their symptoms.
27
What do looping effects explain?
They can partly explain the rapid explosion in the number of people diagnosed – someone talking about their depression and someone is like yeah I feel like that as well so rather than someone who is sad you can become someone who has MDD
28
What are transient mental illnesses?
- Transient mental illness isn't a universal disorder but one that appeared at a specific time and place
- "Transient" not because individuals recover from it quickly, but because the disorder itself only exists in certain social and historical conditions - it requires an "ecological niche" (a specific cultural environment) to exist
- Later we'll see that Multiple Personality Disorder is an example of a transient mental illness
29
What does Hacking say about engines of discovery?
- Engines of disovery - correlation, finding biological correlates, doing genetic analysis, twin research
- Engines of disovery are **also** engines of making up people
- !Hacking doesn't want to delegitimize these methods he is trying to say that science does shape how we look at people and how people behave!
30
What 10 engines of discovery does Hacking identify?
1. Count!
2. Quantify!
3. Create Norms!
4. Correlate!
5. Medicalise!
6. Biologise!
7. Geneticise!
8. Normalise!
9. Bureaucratise!
10. Reclaim our identity!
First seven are engines are designed for discovery (ordered roughly according to the times at which they became eective), the eighth is an engine of practice, the ninth of administration, and the tenth is resistance to the knowers
- He explains the 10 engines with examples of autism and obesity to show that engines work in different ways on different kinds of people
31
Counting
- By counting instances of a category, researchers create a basis for studying it further
- Numbers don’t just reflect reality, they can expand categories
- In the case of autism, the more we count, the more cases we seem to find
↪ This doesn’t necessarily mean autism itself is increasing; rather, it suggests that as counting becomes more precise, the category grows and includes more people
32
Quantify
- Numbers don't just count; they define
- Autism is difficult to quantify, but various diagnostic checklists and scores attempt to measure it
- Obesity, on the other hand, has clear numerical cutoffs (BMI over 30)
- These numbers influence how people see themselves
- E.g. someone who might have considered themselves just "a little heavy" might start thinking of themselves as medically obese once they see their BMI
33
Create norms
- Norms define what is typical and what is deviant
- The moment we say "children normally start speaking by age two," those who don't meet that norm might be seen as abnormal
- This process turns natural human variation into structured classifications
- In autism, children who don't follow typical developmental milestones get classified as autistic. In obesity, the idea of an "ideal weight" turns some bodies into medical problems
34
Correlating
- By correlating autism with things like parental age, diet, or brain structure, we reinforce the idea that it is a distinct, measurable phenomenon with identifiable causes
- Correlations make conditions seem more real by giving them scientific legitimacy
- In obesity, correlations with health risks like diabetes or heart disease shape how we understand what it means to be overweight
35
Medicalize
- Medicalization means shifting something from being seen as a personal trait to being seen as a medical problem
- Autism used to be seen as just an odd personality type; now, it is a medical diagnosis
- Obesity was once just a body shape; now, it is classified as a disease
- This affects how society treats people and how individuals see themselves
- A medical label changes identity → it provides explanations but can also impose stigma
- Some may embrace the diagnosis as a way to access treatment, while others may resist it as unnecessary pathologization
36
Biologize
- By linking autism to neurobiology and obesity to metabolism, these conditions become framed as biological realities rather than personal choices
- This can remove blame (e.g., "autistic people are not just being difficult; their brains work differently") but can also make the category feel more fixed and unchangeable
- If your traits are seen as biological, you might accept them as an inherent part of yourself, as having less personal control/responsibility over their condition
37
Geneticise
- The search for genetic markers for autism or obesity reinforces the idea that these are deeply ingrained, almost essential characteristics
- This can be empowering (it’s not just bad parenting or lack of willpower) but also limiting (people might think their traits are predetermined)
- If something is seen as genetic, it affects how people approach it
- Some might seek genetic testing, while others might feel helpless or trapped by their biology
38
Normalize
- Efforts to "normalize" people—through behavioral therapies for autism or weight-loss treatments for obesity—imply that certain traits need correction
- This shapes how people see their own conditions: is autism a problem to be treated or just a different way of being? Is obesity a disease or just a body type?
39
Bureaucratize
- Government policies, insurance systems, and school accommodations all require official definitions of conditions
- This leads to a feedback loop: Bureaucracies define categories, which in turn shape how people see themselves - it becomes real
40
Reclaim our identity
- Not everyone accepts the labels given to them
- Some autistic people reject the medical model and advocate for neurodiversity
- Some obese people reject the idea that they are unhealthy just because of their weight
- Resistance changes the meaning of these categories
- Resistance redefines identity
- When people fight back against medical or scientific classifications, they shift social perceptions and create new ways of understanding their experiences
41
What is a summary of the engines of dicovery that Hacking emphasizes?
- Counting and quantifying help bring categories into existence
- Norms, correlations, and medicalization define what is considered a problem
- Biology and genetics make these categories seem more real and fixed
- Normalization, bureaucracy, and resistance influence how people relate to their classification
42
What is the five-part framework Hacking introduces?
Picture 3
- There are five ''actors'' (people, experts, classification, knowledge, institutions) that interact in creating, developing and increasing the likelihood of diagnoses being given and the meaning that those diagnoses have
- Complex dynamics of people and experts who get together and the expert finds out the specific classification of this group of people (e.g. autism)
- Institutions are build around this group of people and the knowledge is used in those intitutions by the experts to help the people who were diagnosed = all of these are becoming entangled with the classification
- So we cannot simply change a word (because it's stigmatizing) because all of our knowledge becomes organized around a certain classification
43
What is the historical dynamic in terms of concepts, observations and experiences?
- Concepts change over time
- Because of the introduction of concepts, we as a society will look at/observe the problems differently (example with dsm-III - became popular and lead to the big change we talked about earlier)
↪ people look at the deviations differently now and how they look at them in the 70s
- Not only observations change but also our experiences change = looping effects and moving target
44
What do we get from the historical dynamic of observations, concepts and experiences?
We can a complex, ambivalent, nuanced history:
- The (hi)story us different for each classification - not a good idea to have the general picture that diagnoses are just labels, psychiatry is just like that and that
- That (hi)story is told in different ways by different people – experts in 80s, 90s and the neurodivergent movement were telling different stories
↪ Even at the same moment in time, there is no one specific way to talk about the story, rather it's a discussion (there might be a dominant view but it's important that it remains discussed about)
- Implications and consequences for individuals in mental healthcare greatly vary – some feel stigmatized and some feel relieved
↪ When talking about a certain diagnosis with a client, try to understand what it means for that client to get a diagnoses, don’t assume you know how they will react
45
What two examples are used in the article that demonstrate the core ideas?
1. Multiple personality disorder (MPD)
2. Autism
46
What is the timeline of MPD?
- Nowadays, majority of people don't use that term anymore (even if some still do) but it was a dominant topic in the 80s
- Around 1970, a few psychiatrists began to diagnose multiple personality
- First, a person had two or three personalities. They started talking about it in conferences and part of treatment was to look for the other personalities - within a decade the mean number of personalities was 17 - this fed back into the diagnoses and became part of the standard set of symptoms
- This became **a way to be a person** in the 80s onwards (it's about the identity - in 60s you could have dissociative experiences but you could not be a person with MPD because this kind of identity didn't exist back then but in 80s it became an identity - there were even 'split bars')
- 1980: DSM-III criteria for MPD
- 1994: in DSM-IV: multiple personality was renamed DID, symptoms evolve, but the expectations changed - patients are no longer expected to come with a roster of altogether distinct personalities – it's about the dissociation but not that you look for the different personalities
- The typical picture of multiple personalities is transient - it was something very big in 80s but not anymore nowadays
47
Why is MPD considered a transient mental illness?
- By the time MPD was renamed DID, its symptoms had changed
- Patients were no longer expected to display multiple fully developed personalities, and as a result, they stopped presenting that way
- This suggests that mental illnesses can evolve based on societal expectations
48
How can MPD be understood with the five-part framework?
- To tell the story of MPD we need the five actors
- The **classification**, multiple personality, which was associated with what was at the time called a disorder
- **People** who recognise themselves in the diagnosis
- There were **experts** who became experts of MPD - their career is dependent on the disorder existing
- These experts have **knowledge** about it and part of that knowledge is to look for more personalities and to look for a early sexual trauma that caused this (people 'miracelously' started to remember those) → this feeds back into what it is (=multiple personalities) and by looping effects it becomes a certain set of preconceptions = knowledge of what it actually is
- this knowledge is refined within the **institutions** which include clinic but even talkshows that made a big thing out of MPD
- This feeds very strongly into the people with MPD → susceptible to being influenced by the diagnosis, the experts and their knowledge (suggesting them that they have multiple personalities, that they may have trauma that brought these about = **suggestibility**)
- Looping effects make it such that the people diagnosed will experience themselves and their symptoms differently
Hacking: 'There are (e) the experts or professionals who generate (d) the knowledge, judge its validity, and use it in their practice. They work within (c) institutions that guarantee their legitimacy, authenticity and status as experts. They study, try to help, or advise on the control of (b) the people who are (a) classied as of a given kind.'
49
What are two sentences that we can say to describe MPD as a transient mental illness?
A: There were no multiple personalities in 1955; there were many in 1985; there are none in 2023.
B: In 1955 this was not a way to be a person, people did not experience themselves in this way, they did not interact with their friends, their families, their employers, their counsellors, in this way; but in 1985 this was a way to be a person, to experience oneself, to live in society. In 2023 it is quite rare for people to identify themselves as MPS.
50
What does Hacking think about those two sentences?
According to Hacking, both sentences are true but he thinks that A leads to unhelpful debates about whether MPD was 'real' in the past, instead B highlights his main point: MPD became a culturally available way to experience mental distress by the 1980s
51
How do the two different sentences demonstrate the importance of describing MPD as *a way to be a person*?
We can distinguish between sentence A and sentence B
A-sentences are about the **realism** of the phenomena that we observe (Does it really exist?)
- Important question, but not what the essay of Hacking is about
- The danger of these kind of discussions is that we mix A and B - e.g. homosexuality was something invented in the 18th century; saying that ADHD doesn't exist because it was invented in the 20th century is wrong because then people feel like they are not understood for what they're going through, that's why it's better to say that before the 20th century ADHD was not a way to be a person for most of the people
- Hacking says that instead of arguing over A, everyone can agree on B: MPD was a socially and culturally shaped way of being a person that emerged at a particular time
B-sentences: **Dynamic nominalism** - things are changing because of the name we give them
- What happens after a classification (name, nomen) has first been proposed?
- How does this affect the people classified? How do these people in turn affect the classification?
- This is **not** a form of relativism or denial of the reality of mental illness ('it is just a myth, a label etc)
- Hacking thinks that it is through such sentences like B that the looping effect occurs
52
What is the timeline of autism?
- 1943: Leo Kannr – ‘infantile autism’ – non-verbal children
- Later: other people are recognised as autistic but they were able to speak – ‘high-functioning autism’ (this feeds back into the what autism is and what are its symptoms because some other people who never had language problems but had other symptoms similar to the nonverbal children , so they started to be recognised as autistic and the spectrum broadened)
- 1980: DSM-III autism criteria (no longer based on Kannr but on all the stories of the people described above so more people apply to that)
- 1981: Lorna Wing introduced even more people who have similar problems but don't fit into the dsm-III diagnoses because they don't have lot of the mental difficulties: Asperger’s syndrome
- 1994: Aspergers’ syndrome and autism in DSM-IV in the pervasive neurodevelopment disorders
↪ PDDNOSers (not otherwise specified) – in the Netherlands – didn’t meet criteria for either so fell into the non-specified category
- 2013: DSM-V autism spectrum syndrome (the number of people on this spectrum is 10000 more people than the original diagnosis in 1943)
- Emerging since the 90s: neurodiversity movement
53
What is the problem with the name Asperger's syndrome?
- Asperger was a scientist who was friends with Nazis
- he made the distinction between high and low functioning autists
- high functioning autists could be used for beauracratic work but low functioning autists were send to the camps, it was a death sentence
- Nowadays that term is not used anymore because of this
54
How can we apply the A and B sentences when talking about autism?
A: There were no high-functioning autists in 1950; there were many in 2000.
- making an error because it’s like suggesting that no one in 1950 had this disorder
- Even Hacking says that this is a false statement
B: In 1950 this was not a way to be a person, people did not experience themselves in this way, they did not interact with their friends, their families, their employers, their counsellors, in this way; but in 2000 this was a way to be a person, to experience oneself, to live in society.
- very much true and important
55
What are critical issues raised against classification and DSM?
1. Stigma
2. Reification
3. Commodification
4. Essentialism
56
What is stigma? Who introduced it?
- Term introduced by the sociologist Erwin Goffman – ‘’an attribute that is deeply discrediting’’
- e.g. slaves - people started talking about them as if being a slave was the kind of a person they were that's why nowadays we talk about 'being made a slave'
- in 1851, Cartwright called **drapetomania**, a psychic disturbance that causes black slaves to escape (Szasz discusses this in his book The Myth of Mental Illness)
↪ Black people were naturalised (stigmatized) like that, i.e. slaves, and if they were deviating from how they should behave, this was observed as a problem and was diagnosed as drapetomania
57
How does Szasz relate stigmatization of black people as slaves and ADHD?
- Six-year-olds should sit in a classroom, pay attention, be still and quiet but they don't wanna do it, they wanna jump, play, don't wanna be concentrated and that we now call ADHD (exaggeration of course)
- Szasz argues that what we do with diagnosing a mental illness is giving a certain power to people who want certain institutions or certain ways of being remained and we shouldn't do it
58
What is reification?
- A created concept is often so named and discussed that we start to take it simply as a thing that exists in nature
- We don't take classifications in DSM as something that simply exists out there
- We tend to forget the human powers, forces that were involved in the construction of these concepts (e.g. concepts in dsm were created by a group of American psychiatrists in the 80s in order to make science possible)
- The question is: once we recognise this, what should we do? But if we don't see how these categories/concepts were made, we take it as that they are part of nature
- And this may easily block our options and imaginations of alternative perspectives
- Trudy Dehue argues this about ADHD: our expectations of what human beings should do and be are too high
59
ADHD
- Attention, impulsivity, activity and arousal – naturally occuring individual differences in these
- In order for these to become a symptom, we have to see them as problematic deviations that are part of a theory
- Certain deviances in these dimensional phenomena are being classified as ADHD, which is just a name, a way to describe a certain phenomena, but over time it becomes associated with a whole story of a disorder which is somehow related to the brain → ADHD becomes something that is in the brain; it becomes connected to nethylfenidate which is a way to treat it; the problem becomes attributed to an individual child
- Once we get into the idea that it's a disorder and a latent cause (natural disease that you just have it - I'm badly concentrated because of my ADHD - this is not true - you apply for the criteria for ADHD because of problems in attention - this is true, not the other way around)
- Reification happens all the time, we shouldn't blame each other but alternative attributions may get out of the picture
60
What are these alternative attributions?
- What may cause inattention and arousal?
- Context: school, home?
- For whom is this a problem?
- Is it a developmental phase?
- Being playful and energetic?
- Interesting differences in abilities and preferences?
- What environment suits this kid?
- Are the expectations correct? Should we expect the same from all children?
This is what's happening when the idea of the disorder related to the brain becomes very dominant
61
What is Commodification?
- Something is reconstructed in such a way that it can be traded on markets (e.g. pharmaceutical companies promoting antidepressants not just because they want to help people but because they want to sell them)
- This means that one should be able to clearly generalize and compare → in order to sell something we cannot have this one vague, existentialist perspective → Individuality has to be ‘translated’ in comparable measures
- So a transition from qualities to quantities is necessary in order to determine prices:
↪ How many pills can be sold for depression for which price?
↪ How much should an insurance pay for how severe problems?
↪ How many sessions of therapy can be sold for a given quantity of symptoms?
62
How does Kohne describe the problem with essentialism?
"The a priori suppositions that psychopathology behaves as categories seems to blind us. Although the idea is that the DSM is merely a descriptive text of what is perceived by experts, the categorical model seems to be informed by an essentialist causal hypothesis."
- critique of classification = essentialism
- We attribute symptoms to disorder
