Читать книгу Finding Jesus in the Storm - John Swinton - Страница 23

The process for determining diagnostic categories begins when groups of psychiatrists meet in various hotels across America to discuss which mental health experiences should fit within the various diagnostic categories. After a lot of discussing, arguing, categorizing, and recategorizing, the psychiatrists judge which classifications, names, and criteria are appropriate descriptions to guide clinical practice. Thus is born the DSM.

Any given diagnostic category—schizophrenia, bipolar disorder, obsessive-compulsive disorder—comes into existence as it is constituted by the DSM criteria. The DSM has the power to establish, or at least to give formal, organized existence to, mental health experiences. As such, it is not only descriptive but also formative. Diagnoses are shorthand descriptions of complex human behavior. In descriptive mode, DSM-5 provides clinicians with concepts and forms of language that can be used to make sense of clusters of unusual human experiences. However, such descriptions also form the ways psychiatrists (and others) see and describe the person before them. Once you accept the DSM as the basis for your diagnostic practices, that becomes the way you see people. Diagnoses will help you to see some things very clearly, but they will inevitably occlude other things. The DSM thus propagates a certain type of clinical gaze that is bounded by the parameters of the knowledge and expectations of the clinician. The expectations of the clinician are not free-floating. Clinicians are deeply aware of the expectations of the system and the limitations of time. Shorthand descriptions are very helpful within a system that is bounded and limited by the pressures of time.

There is thus a complicated dialectic between the consensus-based formation of diagnoses by clinicians and the pressures of the system clinicians have to use. A system like the DSM fits well into a pragmatic and instrumental system where therapeutic explanation and “getting things done” may be perceived as primary goals. There is little room here for thick descriptions that require more than fifteen minutes with a patient. This is why many people don’t recognize themselves in the descriptions that emerge from the DSM. As Esmé Weijun Wang puts it: “To read the DSM-5 definition of my felt experience is to be cast far from the horror of psychosis and an unbridled mood; it shrink-wraps the bloody circumstance with objectivity until the words are colorless.”24 This is clearly a problem. However, there are other, perhaps greater problems with the thin descriptions that we encounter in the DSM. It is descriptive and formative, but it is also a mode of creation: it brings mental health conditions into existence and takes some out of existence.