BioSocieties

, Volume 13, Issue 1, pp 103–122 | Cite as

Contesting normal: The DSM-5 and psychiatric subjectivation

Original Article

Abstract

In this paper, we analyze the debates surrounding the fifth edition of the Diagnostic and Statistical Manual (DSM-5), psychiatry’s manual of mental disorders. One critical component of the recent DSM-5 debates focuses on how expanding definitions of illness reconfigure the underlying category of ‘normality.’ The literature on biomedicalization and neoliberalism suggests that we have moved past the discrete categories of abnormal/normal into an era in which we all must strive for scales of normality, only achievable via scientific optimization – a shift from normalization to normation. However, the DSM-5 debates suggest that this argument may be too totalizing. Many commentators on the DSM-5 revisions pine for an idealized era when the normal and abnormal were ontologically differentiated in dichotomous terms. We show how this desire to salvage normality from the ambiguity of the norm and the expansion of psychiatry’s domain over human conduct constitutes a critique of the neoliberalization of mental health and the biomedicalization of everyday life, which nonetheless essentializes ‘human nature.’ We excavate these figurations of the normal to highlight the ways in which psychiatry both relies upon and troubles the binary between normal and abnormality, and between optimization and essentialization.

Keywords

psychiatry knowledge biopolitics normalization diagnosis 

References

  1. American Psychiatric Association (2013) DSM 5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.CrossRefGoogle Scholar
  2. Barker, K. and Galardi, T. (2015) Diagnostic domain defense: Autism spectrum disorder and the DSM-5. Social Problems 62: 120–140.CrossRefGoogle Scholar
  3. Brekhus, W. (2000) A mundane manifesto. Journal of Mundane Behavior 1. http://www.mundanebehavior.org/issues/v1n1/brekhus.htm.
  4. Bumiller, K. (2008) Quirky citizens: Autism, gender and reimagining disability. Signs: Journal of Women in Culture and Society 33(4): 967–991.CrossRefGoogle Scholar
  5. Callard, F. (2014) Psychiatric diagnosis: The indispensability of ambivalence. Journal of Medical Ethics 40(8): 526–530.CrossRefGoogle Scholar
  6. Campbell, F.K. (2005) Legislating disability: Negative ontologies and the government of legal identities. In: S. Tremain (ed.) Foucault and the Government of Disability. Ann Arbor: University of Michigan Press, pp. 108–130.Google Scholar
  7. Carey, A.C. (2009) On the Margins of Citizenship: Intellectual Disability and Civil Rights in Twentieth-Century America. Philadelphia, PA: Temple University Press.Google Scholar
  8. Clarke, A.E., Shim, J.K., Mamo, L., Fosket, J.R. and Fishman, J.R. (2003) Biomedicalization: Technoscientific transformations of health, illness, and U.S. biomedicine. American Sociological Review 68: 161–194.CrossRefGoogle Scholar
  9. Clarke, A.E., Shim, J.K., Mamo, L., Fosket, J.R. and Fishman, J.R. (2010) Biomedicalization: Technoscientific Transformations of Health, Illness, and US Biomedicine. Durham, NC: Duke University Press.Google Scholar
  10. Conrad, P. (2007) The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore: Johns Hopkins University Press.Google Scholar
  11. Davidow, S. (2013) Sunday dialogue: Defining mental illness. New York Times, 23 March. http://www.nytimes.com/2013/03/24/opinion/sunday/sunday-dialogue-defining-mental-illness.html?_r=0.
  12. Deleuze, G. (1997) Negotiations 19721990. New York: Columbia University Press.Google Scholar
  13. Dumit, J. (2012) Drugs for Life: How Pharmaceutical Companies Define our Health. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  14. Elkins, D. (2011) Open letter to the DSM-5 task force. Coalition for DSM-5 Reform, 2 February. http://dsm5-reform.com/the-open-letter-to-dsm-5-task-force/.
  15. Ericson, J. (2014) A pill for every ill. Newsweek, 6 February. http://www.newsweek.com/2014/02/07/pill-every-ill-245476.html.
  16. Fitzgibbon, R. (2013) A big worry in happy valley. Rebecca Fitzgibbon Tumblr, 11 March. http://rebeccafitzgibbon.tumblr.com/post/45105684309/big-worry-in-happy-valley.
  17. Foucault, M. (1963, 2012) The Birth of the Clinic. London: Routledge.Google Scholar
  18. Foucault, M. (1999, 2003) Abnormal: Lectures at the Collège de France, 1974–1975. New York: Picador.Google Scholar
  19. Frances, A. (2013) Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. New York: HarperCollins.Google Scholar
  20. Freud, S. and Strachey, J. (1962, 2000) Three Essays On the Theory of Sexuality. London: Basic Books.Google Scholar
  21. Grandin, T. and Panek, R. (2013) Temple Grandin on DSM-5. Salon, 18 May. http://www.salon.com/2013/05/18/temple_grandin_on_dsm_5_sounds_like_diagnosis_by_committee/.
  22. Greenberg, G. (2013) The Book of Woe: The DSM and the Unmaking of Psychiatry. New York: Penguin.Google Scholar
  23. Hacking, I. (1995) The looping effects of human kinds, In: D. Sperber, D. Premack and A.J. Premack (eds.) Causal Cognition: A Multi-Disciplinary Debate. Oxford: Clarendon Press, pp. 351–383.Google Scholar
  24. Hacking, I. (2006) Kinds of people: Moving targets. British Academy Lecture, 11 April 2006. http://nurs7009philosophyofinquiry.weebly.com/uploads/6/0/4/0/6040397/hacking_20071.pdf, accessed 8 May 16.
  25. Hart, B. (2014) Autism parents & neurodiversity: Radical translation, joint embodiment and the prosthetic environment. BioSocieties 9(3): 284–303.CrossRefGoogle Scholar
  26. Hazen, E.P., McDougle, C.J. and Volkmar, F.R. (2013) Changes in the diagnostic criteria for autism in DSM-5: Controversies and concerns. Journal of Clinical Psychiatry 74(7): 739–740.CrossRefGoogle Scholar
  27. Horwitz, AV (2002) Creating Mental Illness. University of Chicago Press.Google Scholar
  28. Horwitz, A.V. and Wakefield, J.C. (2007) The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder. Oxford: Oxford University Press.Google Scholar
  29. Illouz, E. (2008) Saving the Modern Soul: Therapy, Emotions, and the Culture of Self-Help. Berkeley: University of California Press.Google Scholar
  30. Kafer, A. (2013) Feminist, Queer, Crip. Bloomington: Indiana University Press.Google Scholar
  31. Kelland, K. (2010) Mental health experts ask: Will anyone be normal? Reuters, 28 July. http://www.reuters.com/article/us-mental-idUSTRE66Q4BJ20100728.
  32. Kriss, S. (2013) Book of Lamentations. The New Inquiry, 18 October. http://thenewinquiry.com/essays/book-of-lamentations/.
  33. Kutchins, H. and Kirk, S.A. (1997) Making Us Crazy. London: Constable.Google Scholar
  34. Leader, D. (2010) Being mad is one thing, going mad quite another. The Guardian, July 29. http://www.theguardian.com/commentisfree/2010/jul/29/mental-health-psychiatry-dsm, accessed 14 March 2014.
  35. Livingston, G. (2010) Is it normal grief or depression. The opinion pages. New York Times, 18 October. http://www.nytimes.com/2010/08/20/opinion/l20grief.html.
  36. McRuer, R. (2010) Compulsory able-bodiedness and queer/disabled existence. In: L.J. Davis (ed.) The Disability Studies Reader, Vol. 3. New York: Routledge, pp. 383–392.Google Scholar
  37. Mechanic, M. (2013) Psychiatry’s new diagnostic manual: ‘Don’t buy it. Don’t use it. Don’t teach it.’ Mother Jones, 14 May. http://www.motherjones.com/politics/2013/05/psychiatry-allen-frances-saving-normal-dsm-5-controversy.
  38. Murphy, M. (2012) Seizing the means of reproduction: Entanglements of feminism, health, and technoscience. Durham, NC: Duke University Press.Google Scholar
  39. Orsini, M. (2009) Contesting the autistic subject: Biological citizenship and the autism/autistic movement. In: S. Murray and D. Holmes (eds.) Critical Interventions in the Ethics of Health Care. London: Ashgate Publishing, pp. 115–130.Google Scholar
  40. Pickersgill, M.D. (2013) Debating DSM-5: Diagnosis and the sociology of critique. Journal of Medical Ethics. doi:  10.1136/medethics-2013-101762.Google Scholar
  41. Rogan, M. (2012) The Asperger attraction. National Post, 28 February. http://www.nationalpost.com/index.html.
  42. Rose, N. (1999) Powers of Freedom: Reframing Political Thought. Cambridge: Cambridge University Press.Google Scholar
  43. Rose, N. (2007) The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press.Google Scholar
  44. Rubinstein, M. (2013) New psychiatric disorders and their social side-effects. Huffington Post, 7 June. http://www.huffingtonpost.com/mark-rubinstein/dsm-5_b_3328188.html.
  45. Silverman, C. (2008) Fieldwork on another planet: Social science perspectives on the autism spectrum. BioSocieties 3(3): 325–341.CrossRefGoogle Scholar
  46. Silverman, C. (2012) Understanding Autism: Parents, Doctors and the History of a Disorder. Princeton: Princeton University Press.Google Scholar
  47. Smullens, S. (2013) A conflicted, fractured mental health system: What to do? Huffington Post, 25 July. http://www.huffingtonpost.com/sarakay-smullens/mental-health-system_b_3640937.html.
  48. Steinberg, D.L. (2015) The bad patient: Estranged subjects of the cancer culture. Body & Society 21(3): 115–143.CrossRefGoogle Scholar
  49. Stevenson, T. (2013) Mind field. The Financial Times, 24 May. http://www.ft.com/cms/s/2/25391482-c2f5-11e2-bbbd-00144feab7de.html#axzz3EvCaqcDH.
  50. Torres, J.M.C. (2014) Medicalizing to demedicalize: Lactation consultants and the (de) medicalization of breastfeeding. Social Science & Medicine 100: 159–166.CrossRefGoogle Scholar
  51. Townsend, T. (2013) Changes to psychiatric manual ignite debate over grief, mental illness and faith. St. Louis Post Dispatch, 20 May. http://www.stltoday.com/news/local/metro/changes-to-psychiatric-manual-ignite-debate-over-grief-mental-illness/article_5b72d2f7-6759-52d9-b3f7-0a1f306ee1ae.html.
  52. Voosen, P. (2013) A revolution in mental health. The Chronicle of Higher Education, 9 September. http://chronicle.com/article/A-Revolution-in-Mental-Health/141379.
  53. Waldschmidt, A. (2005) Who is normal? Who is deviant? ‘Normality’ and ‘risk’ in genetic diagnostics and counseling. In: S. Tremain (ed.) Foucault and the Government of Disability. Ann Arbor: University of Michigan Press, pp. 191–207.Google Scholar
  54. Whooley, O. (2014) Nosological reflections the failure of DSM-5, the emergence of RDoC, and the decontextualization of mental distress. Society and Mental Health 4(2): 92–110.CrossRefGoogle Scholar
  55. Wicks, K. (2012) Suffer the children under new rules. Sydney Morning Herald, 20 February. http://www.smh.com.au.

Copyright information

© Macmillan Publishers Ltd 2017

Authors and Affiliations

  1. 1.University of Illinois, ChicagoChicagoUSA

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