The Diagnostic System

Why the Classification of Psychiatric Disorders Is Necessary, Difficult, and Never Settled

Jason Schnittker

Columbia University Press

The Diagnostic System

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Pub Date: August 2017

ISBN: 9780231178068

368 Pages

Format: Hardcover

List Price: $35.00£27.95

Pub Date: August 2017

ISBN: 9780231544597

368 Pages

Format: E-book

List Price: $34.99£27.95

The Diagnostic System

Why the Classification of Psychiatric Disorders Is Necessary, Difficult, and Never Settled

Jason Schnittker

Columbia University Press

Mental illness is many things at once: It is a natural phenomenon that is also shaped by society and culture. It is biological but also behavioral and social. Mental illness is a problem of both the brain and the mind, and this ambiguity presents a challenge for those who seek to accurately classify psychiatric disorders. The leading resource we have for doing so is the American Psychiatric Association’s Diagnostic and Statistical Manual, but no edition of the manual has provided a decisive solution, and all have created controversy. In The Diagnostic System, the sociologist Jason Schnittker looks at the multiple actors involved in crafting the DSM and the many interests that the manual hopes to serve. Is the DSM the best tool for defining mental illness? Can we insure against a misleading approach?

Schnittker shows that the classification of psychiatric disorders is best understood within the context of a system that involves diverse parties with differing interests. The public wants a better understanding of personal suffering. Mental-health professionals seek reliable and treatable diagnostic categories. Scientists want definitions that correspond as closely as possible to nature. And all parties seek definitive insight into what they regard as the right target. Yet even the best classification system cannot satisfy all of these interests simultaneously. Progress toward an ideal is difficult, and revisions to diagnostic criteria often serve the interests of one group at the expense of another. Schnittker urges us to become comfortable with the socially constructed nature of categorization and accept that a perfect taxonomy of mental-health disorders will remain elusive. Decision making based on evolving though fluid understandings is not a weakness but an adaptive strength of the mental-health profession, even if it is not a solid foundation for scientific discovery or a reassuring framework for patients.
The particular strength of this very well-written critique of psychiatric diagnosis is to examine how the DSM has a variety of constituencies—clinicians, researchers, patients, and the general public—that each has its own way of approaching the manual. Allan Horwitz, Board of Governors Professor of Sociology, Rutgers University
In an area too often marked by advocacy and polemic, The Diagnostic System provides a well-informed, judicious, and, in fact, invaluable guide to a complex body of scholarship and controversy. Perhaps most important, it addresses those complex interrelationships between individual experience and the social, cultural, and institutional circumstances that in part constitute that experience. It is an important book on a foundational if elusive set of questions. Charles E. Rosenberg, professor of the history of science and medicine and the Ernest E. Monrad Professor in the Social Sciences, Harvard University
Acknowledgments
1. The Contested Ontology of Psychiatric Disorders
2. What Diagnoses Are: DSM-III and the Form of Contemporary Psychiatric Diagnoses
3. DSM-III and the Descriptive Science of Psychiatric Disorders
4. Rethinking the DSM
5. How Professionals Use Diagnoses
6. How the Public Uses Diagnoses
7. How Scientists Use the DSM
8. How Cultures Use Diagnoses
9. The Contemporary Science of Psychiatric Nosology
10. The Endless Search for Validity
11. The Endurance of the Diagnostic System
Notes
Index

About the Author

Jason Schnittker is a professor in the Department of Sociology at the University of Pennsylvania. His work has appeared in the American Sociological Review, the American Journal of Sociology, Social Forces, and Contexts, among others.