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,
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.” (( van Os, J. and C. Tamminga (2007). “Deconstructing psychosis.” Schizophrenia Bulletin 33(4) p. 861. ))
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.
This workshop has its origins in the German-French research program “Psychiatric Fringes. A historical and sociological investigation of early psychosis in post-war French and German societies” funded by the ANR and the DFG for the period 2012-2014, and it will be an opportunity to discuss results from this research project. We welcome papers on other aspects of the history, the sociology and the anthropology of psychiatry at the fringes of psychopathology that complement our research and might lead to a wider understanding of this work. Papers may explore for instance one or more of the following issues:
- The construction of knowledge at the fringes of psychopathology. What knowledge practices have been involved in the creation of categories targeting liminal conditions? What have been the respective roles of epidemiology, biological science, brain imaging, biometrics, and the clinic in the development and objectification of these categories? What have been the practical and ethical implications of such work?
- Diagnostic practices. Liminal categories have been developed to address specific clinical uncertainties, but they also have raised new ones. What are these, and how are they practically managed by clinicians and patients? What are the specific diagnostic instruments developed by clinicians, and how are these used? What has been the role of psychopathological scales, psychological tests or biological treatments in diagnostic processes?
- The specific role of patients´ experience in category work. To what extent have patients, as individuals or as organized groups, contributed to shaping categories at the borders of psychopathology?
- The trajectories of categories. Like the psychiatrists quoted above, we might be tempted to think that categories always end up in some ways reified. Is this always the case? What has been the use of liminal categories in different historical and social contexts? What has been the influence of these contexts on the very definition of such categories?
Interested prospective participants should send a title and a 350-word paper description to Ms. Stefanie Voth: firstname.lastname@example.org by September 15th. Travel expenses and accommodation in Berlin will be covered by the conference organizers.