Measuring Mental Distress: Lessons from DSM-5's Failed Commensuration

• In Event: 147 - Regular Session. Current Issues in Mental Health

Abstract

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides the classifications of mental disorders that underpin most widely-used mental health measures. Given the prevalent use of the DSM-based measures in sociological research, it is important that sociologists understand the complex dynamics that inhere in the revisions to the DSM. Conducted through expert consensus, these revisions have cascading effects not only how sociologists measure mental distress but more fundamentally how we think about it. Drawing on in-depth interviews with participants (n=30) in the revision of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), this article examines the attempt to create severity scales of mental distress for inclusion in DSM-5 as a case study in commensuration –the process by which different entities are compared using a common metric. Framed as a part of a nosological “paradigm shift”, the scales produced during the revisions represented ad hoc, heterogeneous accommodations to conceptual and design questions on one hand and political demands on the other. They were ultimately rejected by rank-and-file psychiatrists. The failure of the DSM-5 Task Force to produce viable scales highlights the political stakes involved in the production of measures and metrics; it illustrates how extra-intellectual political dynamics can impinge upon, and even undermine, seemingly technical commensuration projects. Consequently, it behooves sociologists to recognize how these politics get written into the very measures that become tools of sociological research.

Author

• Owen Whooley, University of New Mexico