Intersession 2018 AS.300.294 January 8 26, Tuesdays and Fridays 11:00 AM 2:00 PM Homewood Campus, Gilman 186 The Humanities Center Johns Hopkins University Avraham Rot avreimir@yahoo.com Gilman 213 A CRITICAL GENEALOGY OF ANXIETY DISORDERS Description Anxiety disorders constitute one of the most well-known and highly prevalent classes of mental disorders. But although they may seem to have always been with us, it was only in the nineteenth century that they began to be identified as such, that is, diagnosed as anxiety disorders. How have anxiety disorders acquired the status of an independent diagnostic category? How have they come to designate such a prevalent psychiatric condition as the one with which we are familiar today? In order to address these and related questions, this course will introduce the method of critical genealogy as developed by the philosophers Friedrich Nietzsche, Gilles Deleuze, and Michel Foucault. Unlike genealogies that have traditionally been used to justify political power, norms, and conventions, the method of critical genealogy consists in using similar tools, but in order to highlight their contingency, that is, the fact that things could have been, and therefore can still be, otherwise. Furthermore, unlike other forms of critique, which are directed towards others, critical genealogy is a form of selfcritique, involving self-observation at both the individual and the social levels. Using the method of critical genealogy, we will examine key junctures in the history of anxiety disorders as well as the contemporary debates concerning their nature and classification. Special attention will be given to the American Psychiatric Association s Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely influential manual that has had enormous bearing on the current conceptions of mental illness not only among mental health professionals but also among lay people both in the United States and around the globe. We will consider the evolution of anxiety disorders through the various editions of this manual, from the first edition (1952) to the fifth and latest one (2013). We will see how, through this evolution, anxiety disorders have been reified, that is, how they have come to be regarded as things. Considering what kind of things mental disorders are, we will engage with the more general question that has occupied philosophers of science as to what constitutes a natural kind. Taking the current state of affairs as both our end point and our point of departure as required by the genealogical method we will explore the historical sources of the DSM, how it has been shaped by advancements in the behavioral sciences, psychopharmacology, genetics, and the neurosciences, but also how it has been shaped 1
by such extra-scientific factors as public opinion, market demands, policy requirements, and changing demographics. Further tracing the origins of the DSM, we will examine the paradigm shift represented by DSM III (1980), prior to which this manual had primarily been influenced by psychoanalytic theory. It is the psychoanalytic tradition, as we shall see, that bequeathed to us the diagnostic class of anxiety disorders. But within this tradition, it used to be called anxiety neurosis, first introduced by Sigmund Freud in 1895. Why did anxiety neuroses transform into anxiety disorders? Whence did Freud come up with the notion that the concept of anxiety could be used as an independent diagnostic category? And why, when, and how did this idea gain popularity in psychopathological discourse? Inevitably, our explorations will lead us to the more basic question: What is anxiety? We will grapple with this question throughout the course, but towards the course s end we will focus on it. To this end we will read excerpts from the first major work dedicated to this theme, namely Søren Kierkegaard s The Concept of Anxiety, which was published in 1844. Although Freud was probably not even aware of the existence of this book, which only became famous more than two decades after he had introduced the diagnosis anxiety neurosis, and although this is a maddeningly difficult text, it offers compelling ways in which to think about the origins of the concept of anxiety and why this concept is so central in psychological deliberation by pointing to the special role that anxiety plays in the Christian tradition. Requirements 1. Attendance and active participation 2. Reading of the assigned materials 3. One presentation on one item from the list of recommended readings (approximately 15 minutes) 4. One short paper (approximately 3 5 pages) Schedule 1. Tuesday, January 9: Introduction 2. Friday, January 12: Genealogy and Critique Friedrich Nietzsche, On the Genealogy of Morals: A Polemic (Vintage, 1989), 16 28. Gilles Deleuze, Nietzsche and Philosophy (Columbia University Press, 2006), 1 8. Michel Foucault, Nietzsche, Genealogy, and History (1971), in The Essential Works of Foucault, Vol. II (Penguin Books, 2000), 369 393. 3. Tuesday, January 16: Current Debates Allan Horwitz and Jerome Wakefield, All We Have to Fear: Psychiatry s Transformation of Natural Anxieties into Mental Disorders (Oxford University Press, 2012), 221 241. 2
Dan J. Stein and Randolph M. Nesse, Normal and Abnormal Anxiety in the Age of DSM-5 and ICD-11, Emotion Review, Vol. 7, No. 3 (2015): 223 229. 4. Friday, January 19: Paradigm Shift Rick Mayes and Allan Horwitz, DSM-III and the Revolution in the Classification of Mental Illness, Journal of the History of the Behavioral Sciences, Vol. 41, No. 3 (2005): 249 267. 5. Tuesday, January 23: Freud s Concept of Anxiety Sigmund Freud, Anxiety, in Introductory Lectures on Psycho-Analysis: Part Three. General Theory of the Neuroses, The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 16 (Hogarth, 1963 [1917]), 392 411. Sigmund Freud, On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description Anxiety Neurosis, in The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 3 (Hogarth, 1962 [1895]), 87 115. 6. Friday, January 26: Kierkegaard s Concept of Anxiety and Conclusion Søren Kierkegaard, The Concept of Anxiety, trans. Reidar Thomte (Princeton University Press, 1980), 14 24, 41 46. Genesis 2:15 3:24 Recommended Readings / Items for Presentations 1. David Barlow, Anxiety and Its Disorders (Guilford, 2002), 1-36 (chapter 1) or 37 63 (chapter 2). Gerrit Glas, A Conceptual History of Anxiety and Depression, in Handbook of Depression and Anxiety, eds. S. Kasper et al. (Marcel Dekker, 1986), 1 47. Arne Öhman, Fear and Anxiety: Overlaps and Dissociations, in Handbook of Emotions, eds. Michael Lewis et al. (Guilford, 2008), 709 729. Michael Stone, History of Anxiety Disorders, in Textbook of Anxiety Disorders, eds. Dan Stein and Eric Hollander (American Psychiatric Publication), 3 12. Edward Shorter, How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (Oxford University Press, 2013), 51 79 (chapter 5: Anxiety ). 2. Paul di Georgio, Contingency and Necessity in the Genealogy of Morality, Telos, Vol. 162: 97 111. 3
Edward Shorter, A History of Psychiatry (John Wiley, 1997), 1 32. 3. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Publishing, 2013), xli xliv, 5 18, 189 233. Massimiliano Aragona, The Role of Comorbidity in the Crisis of the Current Psychiatric Classification System, Philosophy, Psychiatry, & Psychology, Vol. 16, No. 1 (2009): 1 11. Raymond Bergner and Nora Bunford, Mental Disorder Is a Disability Concept, Not a Behavioral One, in Philosophy, Psychiatry, and Psychology, Vol. 24, No. 1 (2017), 25 40. Lane Christopher, Shyness: How Normal Behavior Became a Sickness (Yale University Press, 2008), excerpts. Rachel Cooper, What is Wrong with the DSM? History of Psychiatry, Vol. 15, No. 7 (2004): 5 25. Michael Davis, Are Different Parts of the Extended Amygdala Involved in Fear Versus Anxiety? Biological Psychiatry, Vol. 44 (1998): 1239 1247. Ian Dowbiggin, High Anxieties: The Social Construction of Anxiety Disorders, The Canadian Journal of Psychiatry Vol. 54, No. 7 (2009): 429 436. Allen Frances and Thomas Widiger, Psychiatric diagnosis: lessons from the DSM-IV past and cautions for the DSM-5 future, Annual review of clinical psychology, Vol. 8 (2012): 109 130. Matthew Friedman et al., Classification of Trauma and Stressor-Related Disorders in DSM-5, Depression and Anxiety 28 (2011): 737 749. Steven Hyman, The diagnosis of mental disorders: the problem of reification, Annual Review of Clinical Psychology, Vol. 6 (2010): 155 179. Allan Horwitz, Creating Mental Illness (University of Chicago Press, 2002), excerpts. Charles Rosenberg, Our Present Complaint: American Medicine. Then and Now (Johns Hopkins University Press, 2002), 13 59 (chapter 2) or 38 58 (chapter 3). Jerome Wakefield, DSM-5: An overview of changes and controversies, Clinical Social Work Journal, Vol. 41, No. 2 (2013): 139 154. Jerome Wakefield, DSM-5 and clinical social work: Mental disorder and psychological justice as goals of clinical intervention, Clinical Social Work Journal, Vol. 41 No. 2 (2013): 131 138. Thomas Widiger, Classification and Diagnosis: Historical Development and Contemporary Issues, in Psychopathology: Foundations for a Contemporary Understanding, eds. James Maddux and Barbara Winstead (Routledge, 2016), 97 110. 4
4. Thomas Widiger and Whitney Gore, Mental Disorders as Discrete Clinical Conditions: Dimensional Versus Categorical Classification, in Adult Psychopathology and Diagnosis, eds. M. Hersen et al. (John Wiley & Sons, 2012), 3 32. Peter Zachar, Psychiatric Disorders Are Not Natural Kinds, Philosophy, Psychiatry, and Psychology, Vol, 7, No. 3 (2000), 167 182. Lori Zoellner et al., PTSD Not an Anxiety Disorder? DSM Committee Proposal Turns Back the Hands of Time, Depression and Anxiety 28 (2011), 853 856. Mark Altschule, Invalidity of the Diagnosis Anxiety Neurosis : Notes on Curiosity and Boredom as Motivating Forces, New York State Journal of Medicine, Vol. 59 (1959): 3812 3822. Robert Bayer and Robert Spitzer. Neurosis, Psychodynamics, and DSM-III: A History of the Controversy, Archives of General Psychiatry, Vol. 42 (1985): 187 196. Hannah Decker, The Making of DSM-III: A Diagnostic Manual s Conquest of American Psychiatry (Oxford University Press, 2013). William McReynolds, Anxiety and Fear: A Behavioral Approach to One Emotion, in Emotions and Anxiety: New Concepts, Methods, and Applications, eds. Marvin Zuckerman and Charles Spielberger, (Psychology Press, 1976), 281 316. Ruth Leys, Trauma: A Genealogy (University of Chicago Press, 2000), 1 17. Charles Spielberger (ed.), Anxiety and Behavior (Academic Press, 1966): o Charles Spielberger, Theory and Research on Anxiety, 3 22. o Carroll Izard and Silvan Tomkins, Affect and Behavior: Anxiety as a Negative Affect, 81 128. o Robert Malmo, Studies of Anxiety: Some Clinical Origins of the Activation Concept, 157 176. o Joseph Wolpe, The Conditioning and Deconditioning of Neurotic Anxiety, 179 192. o Richard Lazarus and Edward Opton, The Study of Psychological Stress: A Summary of Theoretical Formulations and Experimental Findings, 225 261. Robert Spitzer and Janet Williams, Proposed Revisions in the DSM-III Classification of Anxiety Disorders Based on Clinical Experience, in Anxiety Disorders, ed. B. F. Shaw et al (Plenum Press, 1986), 1 19. A History of the Controversy, Archives of General Psychiatry, Vol. 42 (1985): 187 196. Robert Spitzer, Introduction, in Diagnostic and statistical manual of mental disorders, 3rd edition, ed. American Psychiatric Association (American Psychiatric Association, 1980), 1 14. 5
5. 6. Edward Shorter, A History of Psychiatry (John Wiley, 1997), 288 327 (chapter 8: From Freud to Prozac ). Mitchell Wilson, DSM-III and the Transformation of American Psychiatry: A History, American Journal of Psychiatry Vol. 150, No. 3 (1993): 399 410. William Battie, A treatise on Madness (Whiston and White, 1758), 27 40. George Beard, American Nervousness: Its Causes and Consequences (Putnam s Sons, 1881), v-xviii, 1 17. Alan Compton, A study of the Psychoanalytic Theory of anxiety I: The Development of Freud s Theory of Anxiety, Journal of the American Psychoanalytic Association, Vol. 20, No. 1 (1972): 3-44. Sigmund Freud, Analysis of a Phobia in a Five-year-old Boy [ Little Hans ], The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 10 (Hogarth, 1955 [1909]), 5 36. Sigmund Freud, Inhibitions, Symptoms, and Anxiety, The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 20 (Hogarth, 1959 [1926]), 87 96, 124 143. Adolf Grünbaum, Psychoanalysis and theism, The Monist, Vol. 70, No. 2 (1987): 152-192. Augustine, Eighty-three Different Questions (Catholic University of America Press, 1982), 62 67. Gordon Marino, Anxiety in The Concept of Anxiety, in Cambridge Companion to Kierkegaard, eds. Alastair Hannay and Gordon Marino (Cambridge University Press, 1998), 308 328. Samuel Moyn, Anxiety and Secularization: Søren Kierkegaard and the Twentieth-Century Invention of Existentialism, Situating Existentialism: Key Texts in Context, eds. Jonathan Judaken and Robert Bernasconi (Columbia University Press, 2012), 279 304 6