TheDSMand Professional Practice

Abstract

How mental illnesses are defined has significant ramifications, given the substantial social and individual repercussions of these conditions. Using actor-network theory, I analyze how mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) in their work. Drawing on observations of a neuropsychological laboratory and interviews with 27 professionals (i.e., psychiatrists, psychologists), I investigate how the DSM is used in research, clinical, and institutional work. In research, the DSM influences study design and exclusion/inclusion criteria. In the clinic, the DSM influences how disorders are conceptualized and diagnosed. Institutionally, the DSM aligns the patient-professional encounter to insurance and pharmaceutical interests. I conclude that the DSM operates as multiple, context-specific taxonomies that pervasively influence professional practices, such that all possible actions must orient to DSM criteria, with professionals both a source and an object of institutionalized gaze.

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

“…Agreement between clinician and research diagnoses is often poor, with clinical settings showing more conservative diagnostic practice [14,15]. Additionally, diagnostic decisions in real clinical contexts may be influenced by patient preferences, clinician biases and pragmatic considerations [16][17][18], to which the structured assessment criteria in research studies are less sensitive. Understanding the diagnostic trajectories that occur in clinical settings is important for numerous reasons.…”

Vulnerability as practice in diagnosing multiple conditions

“…Questioning the validity of diagnostic categories has been particularly associated with, but by no means limited to, mental ill-health conditions, most recently in the wake of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition manual 54–57. Manuals and coding protocols may also be used variably across different settings as to whether diagnostic procedures, categories and treatments are followed strictly or used more as helpful guidance towards treatment 58 59. Analysts of diagnostic procedures within mental healthcare have called for greater allowance for ambivalence and permeability of categories,60 61 a call that may be instructive for diagnostic practice more widely.…”

DSM-5: Επτά Χρόνια Μετά -Εξελίξεις Και Προκλήσεις Στην Ταξινόμηση Ψυχικών Διαταραχών

“…Μια δεύτερη μελέτη, βασισμένη σε εθνογραφικές παρατηρήσεις σε ένα κέντρο νευρο-επιστημών, καθώς και σε συνεντεύξεις με ψυχιάτρους και ψυχολόγους που ασκούσαν κλινικό έργο, διερεύνησε τη χρήση του DSΜ-5 ως ερευνητικό εργαλείο στην καθημερινή κλινική πρακτική, καθώς και σε σχέση με διοικητικά και θεσμικά ζητήματα (Halpin, 2016). Σύμφωνα με τους συμμετέχοντες, ως ερευνητικό εργαλείο, το DSΜ-5 είναι χρήσιμο για ερευνητικούς σκοπούς, όπως για αποφάσεις κριτηρίων συμμετοχής και αποκλεισμού για την επιλογή δείγματος, καθώς και για αιτήσεις χρηματοδότησης και πρωτόκολλα δεοντολογίας.…”