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Contesting normal: The DSM-5 and psychiatric subjectivation

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.

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Notes

  1. The shift from Roman to Arabic numerals was supposed to “make room for scientific advances that hadn’t happened yet” (Greenberg, 2013, p. 152). The new manual is meant to be a living document that can be easily changed as new research emerged, thereby leading to DSM-5.1, DSM-5.2, etc.

  2. Access to interventions for people with autism is a fraught political issue. For some neurodiversity activists, autism requires no interventions. Rather, autism is a ‘natural’ expression of neurodiversity which should not be the target of normalization efforts (Bumiller, 2008; Silverman, 2008; Orsini, 2009). Other people with autism (or their parents) access only mainstream behavioral methods, and still others access more ‘biomedical’ or alternative therapies. In fact, it is well documented that parents of children with autism are quite hybrid in their approach to interventions, combining a social and medical model of disability (Silverman, 2012; Hart, 2014). We use ‘optimization’ simply to signal the fact that it is quite common for people with autism (or their parents) to access some form of intervention, in order to improve behavior and thus better the chances of inclusion. And in fact, this was a major feature of the debates we tracked. Parents of children with Asperger’s were concerned that losing the label would delimit their opportunities to access resources for their children.

  3. These comments are not part of our analysis.

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Correspondence to Paige L. Sweet.

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Sweet, P.L., Decoteau, C.L. Contesting normal: The DSM-5 and psychiatric subjectivation. BioSocieties 13, 103–122 (2018). https://doi.org/10.1057/s41292-017-0056-1

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  • DOI: https://doi.org/10.1057/s41292-017-0056-1

Keywords

  • psychiatry
  • knowledge
  • biopolitics
  • normalization
  • diagnosis