From DSM-I to III-R; voices of self, mastery and the other: A cultural constructivist reading of U.S. psychiatric classification

The continual process of mental disease classification in U.S. psychiatry is assumed to reflect advancing professional knowledge of these disorders. To date, the American Psychiatric Association has developed four standard classifications, or nosologies, called Diagnostic and Statistical Manuals ('DSMs'). DSM-I, the earliest, appeared in 1952 while the most recent, DSM-III-R, appeared in 1987. This paper employs a cultural constructivist perspective to deconstruct these nosologies and the classificatory process itself. Constructivism's premises, which emphasize culture, history, meaning and the constructed nature of medical phenomena, serve as the framework for the analysis. The paper shows that professional psychiatric classification expresses an underlying cultural psychology which encompasses four phenomenological domains and one of three Western person conceptions. Classifications are found to be explorations of culturally meaningful etiologies that explain the absence of 'self control', a central ethnopsychological aspect of the idealized self. Consideration of the vantage point of the voice of classification indicates that the ideal self is gender- (male), ethnic- (German Protestant) and age-specific (adult). The ethnic self's essence, and that of the Other, is believed to be biological, itself assumed to be natural and beyond culture or bias. Consequently, the ethnopsychology constructs as biologically caused the real and imagined differences in the gender, age or culturally Other. This invidious ethnobiological essentialism acts to create and maintain self-worth through a radical differentiation of self from those represented as Other.