Skip to main content

Iterative Generation of Diagnostic Categories Through Production and Practice: The Case of Postpartum Depression

Culture, Medicine, and Psychiatry volume 35, pages 484–500 (2011)Cite this article

Abstract

Examining the process undertaken to name and codify psychiatric illnesses provides important insights into how everyday healthcare practices are shaped by knowledge production processes. However, studies of illness classification often rely on an overly simplified distinction between the production of diagnostic categories and the application of those categories in practice. Drawing insight from science and technology studies, I argue that psychiatric diagnostic categories are iteratively generated through production and practice, even during the development of those categories. Through a discursive analysis of interviews, archival documents, and psychiatric literature, I identify the practical politics that enabled the creation of the postpartum depression (PPD) modifier in the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV). In addition, I demonstrate how the overarching discourses of evidence-based decision-making and biomedicine shaped the development of the postpartum modifier, and draw together comments made by interview participants regarding the administrative value of a PPD-related category in the DSM. These remarks suggest that, in their practice, researchers and clinicians also take into consideration their own knowledge about DSM production processes, providing further support for the argument that diagnostic categories are iteratively generated.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Notes

  1. Methodology section adapted from Godderis (2010).

  2. I first heard Veronique Ambrosini’s (2003) term “ambiguous resources” applied to an STS context in Kelly Joyce’s presentation, “Creating Chagas Disease in the United States” at the annual meeting for the Society for Social Studies of Science, October 2007.

  3. Interview with Michael O’Hara, 27 November 2007, notes in possession of author; Interview with Scott Stuart, 6 December 2007, notes in possession of author.

  4. I am borrowing the notion of workaround from Whooley’s (2010) article where his concept of “diagnostic workarounds” is fully developed.

References

  • Ambrosini, Veronique (2003) Tacit and Ambiguous Resources as Sources of Competitive Advantage. New York: Palgrave MacMillan.

    Book  Google Scholar 

  • American Psychiatric Association (1968) Diagnostic and Statistical Manual of Mental Disorders (2nd edition). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edition). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edition.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association (1996) DSM-IV Sourcebook (Volume 2). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Bayer, Ronald (1981) Homosexuality and American Psychiatry: The Politics of Diagnosis. New York: Basic Books.

    Google Scholar 

  • Bowker, Geoffery and Susan Leigh Star (1999) Sorting Things Out: Classification and Its Consequences. Cambridge, MA: MIT Press.

    Google Scholar 

  • Carabine, Jean (2001) Unmarried motherhood 1830-1990: A genealogical analysis. In: Wetherell M, Taylor S and Yates SJ (eds), Discourse as Data: A Guide for Analysis (267-310). London: Sage.

    Google Scholar 

  • Cutrona, Catherine (1982) Nonpsychotic postpartum depression: A review of recent research. Clinical Psychological Review 2(4) 487-503.

    Article  Google Scholar 

  • Davidson, Arnold (1996) Styles of reasoning, conceptual history, and the emergence of psychiatry. In: Biagioli M (ed) The Science Studies Reader (124-136). New York: Routledge.

    Google Scholar 

  • Figert, Anne (1996) Women and the Ownership of PMS: The Structuring of a Psychiatric Disorder. Hawthrone, NY: Aldine de Gruyter.

    Google Scholar 

  • Godderis, Rebecca (2010) Precarious beginnings: Gendered risk discourses in psychiatric research literature about postpartum depression. Health, 14(5) 451-466.

    Google Scholar 

  • Hopkins Joyce, Marsha Marcus, and Susan B. Campbell (1984) Postpartum depression: A critical review. Psychological Bulletin, 95(3) 498-515.

    Article  Google Scholar 

  • Horwitz, Alan (2002) Creating Mental Illness. Chicago: University of Chicago Press.

    Google Scholar 

  • Kendell, Robert (1985) Emotional and Physical Factors in the Genesis of Puerperal Mental Disorders. Journal of Psychosomatic Research 29(1) 3-11.

    Article  Google Scholar 

  • Kirk, Stuart and Herb Kutchins (1992) The Selling of the DSM: The Rhetoric of Science in Psychiatry. New York: Aldine de Gruyter.

    Google Scholar 

  • Lakoff, Andrew (2005) Pharmaceutical reason: Knowledge and value in global psychiatry. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Luhrmann, Tanya M (2001) Of Two Minds: The Growing Disorder in American Psychiatry. New York: Alfred A. Knopf.

    Google Scholar 

  • Lunbeck, Elizabeth (1994) The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Miller, Peter and Nikolas Rose (2008) Governing the Present. Cambridge, UK: Polity Press.

    Google Scholar 

  • Mol, Annemarie (2002) The Body Multiple: Ontology in Medical Practice. London: Duke University Press.

    Google Scholar 

  • Parkinson McCarthy, Lucille and Joan Page Gerring (1994) Revising Psychiatry’s Charter Document, DSM-IV. Written Communication 11(2) 147-192.

    Article  Google Scholar 

  • Paulson James F. and Sharnail Bazemore (2010) Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA 303(19) 1961-1969.

    Article  Google Scholar 

  • Pincus H, Allen Frances, Wendy Davis, Michael First M and Thomas Widiger (1992) DSM-IV and new diagnostic categories: Holding the line proliferation. American Journal of Psychiatry 149(1) 112-117.

    Google Scholar 

  • Purdy, Daniel and Ellen Frank (1993) Should Postpartum Mood Disorders be Given a More Prominent or Distinct Place in DSM-IV? In Sourcebook Review (Vol. 1). American Psychiatric Association, ed. Washington, DC: American Psychiatric Association.

  • Ramchandani, Paul and Lamprini Psychogiou (2009) Paternal Psychiatric Disorders and Children’s Psychosocial Development. The Lancet 374(9690) 646-653.

    Article  Google Scholar 

  • Restivo, Sal and Jennifer Croissant (2008) Social Constructionism in Science and Technology Studies. In The Handbook of Constructionist Research. James A. Holstein and Jaber F. Gubrium, eds., 213–229. New York: Guildford Press.

  • Scott, Wilbur J. (1990) PTSD in DSM-III: A case in the politics of diagnosis and disease. Social Problems 37(3): 294-310.

    Article  Google Scholar 

  • Shorter, Edward (1997) A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley and Sons, Inc.

    Google Scholar 

  • Silverman, David (2000) Doing Qualitative Research: A Practical Handbook. London: Sage Publications Ltd.

    Google Scholar 

  • Taylor, Verta (1996) Rock-a-by Baby: Feminism, Self-help, and Postpartum Depression. New York: Routledge.

    Google Scholar 

  • Wetherell, Margaret, Stephanie Taylor, and Simeon J. Yates, eds. (2001) Discourse as data: A guide for analysis. London: Sage.

    Google Scholar 

  • Whooley, Owen (2010) Diagnostic ambivalence: Psychiatric workarounds and the Diagnostic and Statistical Manual of Mental Disorders. Sociology of Health and Illness 32(3) 452-469.

    Article  Google Scholar 

  • Wilson, Mitchell (1993) DSM-III and the transformation of the American psychiatry: A history. American Journal of Psychiatry 150(3) 399-410.

    Google Scholar 

  • Wisner, Katherine, Christine Chambers, and Dorothy Sit (2006) Postpartum depression: A major public health problem. JAMA 296(21) 2616-2618.

    Article  Google Scholar 

Download references

Interviews

Frank, Ellen. Interview by author. Telephone digital recording, 7 January 2008.

O’Hara, Michael. Interview by author. Telephone digital recording, 27 November 2007.

Parry, Barbara. Interview by author. Telephone digital recording, 7 February 2008.

Stuart, Scott. Interview by author. Telephone digital recording, 6 December 2007.

Author information

Authors and Affiliations

  1. Health Studies, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T 2Y3, Canada

    Rebecca Godderis

Authors
  1. Rebecca Godderis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca Godderis.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Godderis, R. Iterative Generation of Diagnostic Categories Through Production and Practice: The Case of Postpartum Depression. Cult Med Psychiatry 35, 484–500 (2011). https://doi.org/10.1007/s11013-011-9232-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11013-011-9232-0

Keywords

  • Psychiatric diagnosis
  • Diagnostic categories
  • DSM-IV
  • Postpartum depression
  • Science and technology studies