“… Years of research and clinical observation have yielded catalogues of presumed mental dysfunction, culminating in the Diagnostic and Statistical Manual of Mental Disorders, or DSM. First produced by the American Psychiatric Association seven decades ago, and currently in its fifth edition, the DSM organizes conditions into families … More than any other document, the DSM guides how Americans, and, to a lesser extent, people worldwide, understand and deal with mental illness. …

The DSM as we know it appeared in 1980, with the publication of the DSM-III. Whereas the first two editions featured broad classifications and a psychoanalytic perspective, the DSM-III favored more precise diagnostic criteria and a more scientific approach. Proponents hoped that research in genetics and neuroscience would corroborate the DSM’s groupings. Almost half a century later, however, the emerging picture is of overlapping conditions, of categories that blur rather than stand apart. No disorder has been tied to a specific gene or set of genes. Nearly all genetic vulnerabilities implicated in mental illness have been associated with many conditions. A review of more than five hundred fMRI studies of people engaged in specific tasks found that, although brain imaging can detect indicators of mental illness, it fails to distinguish between schizophrenia, bipolar disorder, major depression, and other conditions. The DSM’s approach to categorization increasingly looks arbitrary and anachronistic. …

But there’s a larger difficulty: revamping the DSM requires destroying kinds of people. As the philosopher Ian Hacking observed, labelling people is very different from labelling quarks or microbes. Quarks and microbes are indifferent to their labels; by contrast, human classifications change how ‘individuals experience themselves—and may even lead people to evolve their feelings and behavior in part because they are so classified.’ …

By promising to tell people who they really are, diagnosis produces personal stakes in the diagnostic system, fortifying it against upheaval. …

To be named is to be acknowledged, to be situated in a natural order. …

Online communities such as the subreddit r/BPD crystallize psychiatric tags into identities to be socially accommodated and invite people to diagnose themselves. Such communities, Kriss fears, can ‘pervert’ B.P.D. [borderline personality disorder] into a self-serving justification for misconduct. …

Yet there’s a broader issue here. People’s symptoms frequently evolve according to the labels they’ve been given. …

Any new psychiatric taxonomy develops in the shadow of the old. It must contend with the echoes of the previous scheme, with people whose selves have been cast in the shape of their former classification. By failing to take these into account, models such as hitop risk re-creating the categories of their predecessors. Psychiatric diagnosis, wrapped in scientific authority and tinged with essentialist undertones, offers a potent script. As Layle wondered after she was told about her autism, ‘How did I know what was truly me, and what I had convinced myself I was?’

Manvir Singh: Why We’re Turning Psychiatric Labels Into Identities, The New Yorker online, 06.05.2024, im Internet.

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