Psychopathological fringes. Historical and social science perspectives on category work in psychiatry
Venue: Berlin, Institute for the History of Medicine, Dahlem
Organization: Nicolas Henckes, Volker Hess, Emmanuel Delille, Marie Reinholdt, Stefan Reinsch, Lara Rzesnitzek,
Funded by the Agence Nationale de la Recherche & the Deutsche Forschungsgemeinschaft in the framework of the project “Psychiatric Fringes. A historical and sociological investigation of early psychosis in post-war French and German societies”
Over the last few years, the revision process of both the DSM and the chapter V on mental disorders of the ICD has stimulated within psychiatry a series of attempts at challenging established diagnostic categories. These challenges reflect both dissatisfaction with categories as they are defined in existing diagnostic classifications, and a will to adjust them to the demands of clinical and research activities. They are expressed in ways that sometimes strongly resembles the discourse of critical social science. For instance, the conveners of the conference “Deconstructing psychosis” – organized by the American Psychiatric Association along with the WHO and the US National Institutes of Health in 2005 – developed a stringent critique of the proliferation of diagnostic categories in the field of psychosis: “Although these categories are meant to refer to broadly defined psychopathological syndromes rather than biologically defined diseases that exist in nature, inevitably they undergo a process of reification and come to be perceived by many as natural disease entities, the diagnosis of which has absolute meaning in terms of causes, treatment, and outcome as well as required sampling frame for scientific research.”
Controversies over diagnostic categorization in fact have a long history in psychiatry. Rejection of diagnosis has long been prominent among certain segments of psychiatry, from Adolf Meyer’s synthesis in interwar US psychiatry through parts of phenomenological psychiatry in Germany to antipsychiatry and Lacanian psychoanalysis in 1970s France. However, the deconstruction of diagnosis has also been a core feature of what might be termed category work in psychiatry, at least since the fall of the unitary psychosis concept in the last quarter of the 19th century. By the notion of category work we understand the multifaceted practices developed by clinicians, epidemiologists, biologists, administrators and patients to negotiate and objectify the boundaries of diagnostic categories. While such practices have mostly been devoted to securing the internal coherence of major categories, the requirements of both research and clinical work have prompted the development of liminal categories meant to target conditions situated between illness and health, or between broader established diagnostic classes. Examples of such categories include prodromal schizophrenia, latent depression as well as “borderline” disorder and a range of personality disorders. Closely related to these constructs are notions of comorbidity and dimensional concepts of diagnostic spectra or continua. In many of these cases, the challenge for psychiatrists has been to devise entities that include in their very definition the possibility of their transitory status. These diagnostic constructs thus convey a paradox: while they question categorical thinking, they are usually framed within the language of categories.
The aim of this workshop is to offer a historical and social science perspective on the history and current status of category work at the fringes of psychopathology. Unlike constructionist perspectives on psychiatric diagnosis that have aimed to demonstrate the less than solid nature of core categories such as depression, schizophrenia and neurosis, we are interested in the already internally contested and marginal categories devised to target conditions situated at the borders of psychopathology. Thus, rather than elaborating on the longstanding debates between “lumpers” and “splitters”, we would like to examine the ways in which psychiatry has developed knowledge and practices to target these conditions.
Participants: Annika Berg, Céline Borelle, Ivan Crozier, Steeves Demazeux, Stefan Ecks, Bolette Frydendahl Larsen, Nicolas Henckes, Volker Hess, Lara Keuck, Ken MacLeish, Julie Mazaleigue, Jörg Niewöhner, Richard Noll, Vincent Pidoux, Egidio Priani, Marie Reinholdt, Lara Rzesnitzek, Edward Shorter, Benjamin Zajicek
Full Program is available at this address: http://www.cermes3.cnrs.fr/images/pdf/psychopathological-fringes-programm.pdf