The DSM in Practice: Research, Clinical and Institutional Perspectives

• In Event: 067 - Section on Science, Knowledge and Technology Roundtables (one-hour)
  In Refereed Roundtable: Table 03. Classification Work

Abstract

How mental illnesses are defined and diagnosed has significant ramifications given the substantial social and individual repercussions of these conditions. Accordingly, this paper analyzes how mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM) in their everyday work. Drawing on ethnographic observations of a neuropsychological laboratory and professional meetings, as well as in-depth interviews with a sample of 25 mental health professionals (psychiatrists, neurologists and psychologists), this paper investigates how the DSM is used in research, clinical practice and institutionally. Analysis suggests that, despite professionals’ reflexivity and critiques of the text, the DSM is a ubiquitous feature and has a pervasive influence on their professional work. In research, the DSM provided operational definitions and inclusion/exclusion criteria that informed research design and sample selection. In the clinic, the DSM was a heuristic for psychopathology, which influenced how disorders were conceptualized and treated, even when the text was not explicitly used. Institutionally, the DSM operated as an obligatory passage point, steering and constraining professional practices, while also linking professional action to insurance providers and pharmaceutical companies. Based on these findings, this paper argues that the DSM facilitates a limits and selections problem, wherein all possible actions must orient to DSM criteria. The paper closes with a discussion of the NIMH Research and Domain Criteria (RDoC) Initiative while also articulating connections between the literature on how the DSM is used in practice to critiques on the proliferation of mental disorders and the medicalization of behaviors.

Author

• Michael Allan Halpin, University of Wisconsin-Madison