Redefining the Role of Rhetoric in the DSM for the Individual Experience

Transcription

1 Ho 1 Jenny Ho Professor Judy Segal ENGL March 2016 Redefining the Role of Rhetoric in the DSM for the Individual Experience Since its inception in 1952, the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders (DSM) has been a constant site of contention for scholars, practitioners, and the general public. Now in its fifth edition, the DSM remains a hot topic within academia, especially in the classroom context. Based on personal observations and experience as a Psychology and English Literature double major, I noticed how many of my classmates reacted quite negatively to the rhetorical strategies utilized by the American Psychiatric Association in the newer editions of the DSM. Although the DSM is not perfect, the American Psychiatric Association uses its methodologies of choice in order to convince medical professionals, scientists, policymakers, and the general population of the legitimacy of individuals experience mental health issues and psychiatric disorders. Generally speaking, a number of mental health issues and psychiatric disorders have limited physical manifestations that can be confounded with symptoms of other illnesses. Subsequently, there is a real challenge in having the masses recognize the existence of these issues. Like the famous saying out of sight, out of mind, if people cannot visualize the issue at hand, then it ceases to exist. To compensate, the APA s motive, as defined by Burke as the purposeful nature of language used to induce change in attitude or action in the listener/reader (qtd. in Lingard et al. 604), is to convince society at large of the legitimate medical perplexities

2 Ho 2 that a portion of the population experience within their lifetime. In return, the population living with these ailments finds solace with these classifications for reasons to be examined in this paper. In support, McCarthy and Gerring s 1994 article on the DSM-IV will be of primary focus with excerpts from other scholars, including sinologist/anthropologist Emily Martin. From the earlier editions of the DSM to its more recent publication, the length, depth, and diagnoses contained in the manual have continued to evolve over time. Although the standardization of diagnoses in DSM-I and DSM-II has contributed widely to the field of psychiatry, diagnostic reliability for mental disorders was extremely poor (McCarthy & Gerring 155). According to psychologist Robert Carson, it is common knowledge that diagnoses presented in the DSM-I and DSM-II had become something of an embarrassment by the advent of DSM-III because of the routine inability of clinicians to agree on what diagnosis ought to be assigned to a given patient (qtd. in McCarthy & Gerring 156). In hopes of bolstering diagnostic reliability, a dramatically different (McCarthy & Gerring 156) DSM-III was published in Due to the increased reliability observed in clinical diagnoses, the DSM-III has been hailed as a landmark achievement in American psychiatric health (McCarthy & Gerring 157). As a matter of fact, even its critics agree that DSM-III has achieved its primary goal of increasing diagnostic reliability (McCarthy & Gerring 157). Since the publication of the DSM-III, every subsequent edition contains an explicit statement of the manual s purpose to provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, and treat various mental disorders (Emmons 22).

3 Ho 3 However, it is the shift towards the biomedical model and the influence of German psychiatrist Emil Kraepelin that had a monumental impact on the acknowledgement and legitimization of people s lived experiences with mental health issues and psychiatric disorders. In Kraepelin s handbook titled Clinical Psychiatry: A Textbook for Students and Physicians, he outlined four guiding principles that American psychiatrist Gerald Klerman referred to as neo-kraepelinians (qtd. in McCarthy & Gerring 158). According to Klerman, Kraepelin attempted to establish psychiatry as a branch of medicine and should base its practice on scientific knowledge (McCarthy & Gerring 158). Furthermore, Klerman notes how mental illnesses were viewed similarly to physical ailments as discrete entities with a biological component (McCarthy & Gerring 158). Additionally, there is a boundary between the normal and the sick (McCarthy & Gerring 158). Lastly, neo-kraepelinians reaffirm how psychiatry is a legitimate area of study and how it should be valued and taught (McCarthy & Gerring 158). Having said that, it should not come as a surprise that Kraepelin s perspectives continue to generate controversy. For example, countless mental and psychiatric diagnoses are dependent on the patient s self-report of their experiences and maladies. Some critics argue how self-reports are low in reliability and validity, biased, selfserving, and often times dangerous. In a great deal of research conducted in the social sciences that rely measures of self-report, the audience is trained to be skeptical of the results. Speaking from personal experience, my studies in research methodologies in psychology has taught me to always take self-report measures with a grain of salt. As stated by McCarthy and Gerring, diagnoses in psychiatry are supposedly less precise than in medicine because it must be done without such supportive instruments as lab tests

4 Ho 4 and x-rays (159). Much like the people who claim to suffer from Morgellons, certain assessment tools may not be valid or appropriate for a given population. Hence, Keranen suggests rhetoric plays a crucial role in public healthcare exchanges involving emerging illnesses that sit at the intersection of biology and culture (37). When scientific authority is contested, the issue involves more than examining who is qualified to speak on a topic. Rather, it involves the active construction of believable or discreditable identities, and alignments that might shift in the course of one interaction (Myers 273). Nonetheless, the dramatic shift towards the biomedical model in the DSM-III and its subsequent editions was riddled with controversy. As stated by McCarthy and Gerring, this resistance to change amongst select groups was part of an ongoing struggle for dominance among competing models of mental disorder within psychiatry (158). In particular, this competition coincides with the competition between the natural and social sciences. Interestingly, the division between the natural sciences, social sciences, and other areas of knowledge are a recent phenomenon (Meyers 268). During the 18 th and 19 th centuries, science was open for comprehensive analysis and deliberation for those who were not bound by gender or class (Myers 268). Over time, disciplines were institutionalized and amateurs [were] excluded (Myers 268) from engaging in the discourse. For example, psychology as a discipline grew increasingly institutionalized towards the end of the 19 th century (Myers 268). Having said that, professionalization and specialization of the sciences played a monumental role in the explosive growth of scientific research, and have had many beneficial effects (Myers 268). Notwithstanding the debates surrounding the increasing exclusivity of science, the outcome of these events and developments in the biomedical model not only assumed a dominant position within

5 Ho 5 psychiatry, it also helped psychiatry achieve superiority among neighboring disciplines within the mental health field (McCarthy & Gerring 155). For people experiencing mental health illnesses and/or psychiatric disorders, the developments in the field of psychiatry and the evolution of the DSM has been tremendously helpful for understanding their inner workings. In Emily Martin s book Bipolar Expeditions: Mania and Depression in American Culture, she describes her experience of living with bipolar disorder and explores the function of depression and mania in American popular culture. In a chapter titled Inside the Diagnosis, Martin details the impact of living with the diagnosis of bipolar disorder. For starters, she explains how her diagnosis has a numerical designation (112), which is used to describe her condition, characteristics, and the severity of her most recent episode of mania or depression. She is quick to point out how the majority of diagnosed individuals do not use this level of specificity to describe their conditions when speaking to laypeople. Regardless, these DSM designations are frequently used when filling out bills and claim forms before insurance companies and state or federal programs will reimburse them or issue support payments (Martin 112). Consequently, many people have become generally familiar (Martin 112) with the language used in the DSM. Even when associated behaviours can be observed by medical professionals, something [as] objectively there as behaviour must be observed through one or another kind of terministic screen that directs the attention in keeping with its nature (Burke 120). Furthermore, Martin states how the DSM categories are abstract text-atoms (112). Coined by sociolinguists Michael Silverstein and Greg Urban, Martin describes text-atoms as the condensed, detailed contexts of daily life in which people experience

6 Ho 6 moods of all sorts (112). To echo Silverstein and Urban, to turn something into a text is to seem to give it a decontextualized structure and meaning, that is, a form and meaning that are imaginable apart from the spatiotemporal and other frames in which they can be said to occur (112). In other words, modifying DSM categories and diagnostic criteria is especially powerful for people living with psychiatric conditions. In Martin s field studies, she observed that people who attended support groups were deliberately taught a new vocabulary for what they were experiencing (112). Such rhetorical strategies were especially precious for these individuals as finding a language for experiences you could not name and that you did not know were shared can bring relief from feelings of isolation (Martin 112). Similarly, and contrary to popular belief, a rhetorical care of the self does not deny the potential effectiveness of such interventions (Emmons 17). This encourages open dialogue about mental health issues while reducing stigma at the same time. As well, Lingard et al. states how the tolerance for ambiguity is a necessary characteristic for quality care of ambiguous medical conditions, as no definition can fully capture the individual experience (604). More importantly, the presence of uncertainty in medicine does not necessarily mean the presence of paralyzing doubt (Lingard et al. 604). Above all, these techniques serve as terministic screens that direct the attention (Burke 115) towards the individual experience. As a matter of fact, one participant at a group support meeting embraced the new terminologies as a way of demarcating her special moods (Martin 112). Generally speaking, Martin concludes how the terminology found in the DSM can help people clarify the types of experiences they have. Although it remains easy for scientists, scholars, and members of the public to

7 Ho 7 criticize the rhetorical strategies used in varying editions of the Diagnostic and Statistical Manual, it is pivotal that the public recognizes the DSM can be extremely valuable to those experiencing psychological and psychiatric afflictions. Not only is it necessary to use forceful strategies to convince society of the legitimacy of psychiatry as a science, these modes of expression are intrinsically valuable for people who experience ailments that are not immediately perceptible to the naked eye. As suggested throughout this paper, there is a necessity of a rhetorical approach to mental health care (Emmons 25). To have a discourse available for experiences that are frequently stigmatized can provide a sense of relief to this population and help dissipate feelings of isolation. Ultimately, society as a whole should acknowledge what the DSM might mean for individuals who find it to be expressive.

8 Ho 8 Works Cited Burke, Kenneth. Terministic Screens. On Symbols and Society. Ed. Joseph R. Gusfield. Chicago: University of Chicago Press, Print. Emmons, Kimberly K. Depression, a Rhetorical Illness. Black Dogs and Blue Words: Depression and Gender in the Age of Self-Care. New Brunswick, NJ: Rutgers University Press, Web. Keranen, Lisa. This Weird, Incurable Disease : Competing Diagnoses in the Rhetoric of Morgellons. In Health Humanities Reader. Eds. Therese Jones, Delse Wear, and Lester D. Friedman. New Brunswick, NJ: Rutgers UP, Print. Lingard, Lorelei, et al. A Certain Art of Uncertainty: Case Presentation and the Development of Personal Identity. Social Science and Medicine 56 (2002): Web. Martin, Emily. Inside the Diagnosis. Bipolar Expeditions: Mania and Depression in American Culture. Princeton, NJ: Princeton University Press, ebook. McCarthy, Lucille Parkinson, and Joan Page Gerring. Revising Psychiatry s Charter Document DSM-IV. Written Communication 11 (1994): Print. Myers, Greg. Discourse Studies of Scientific Popularization: Questioning the Boundaries. Discourse Studies 5 (2003): Web.