How mental distress is understood and defined has significant social and political implications. For this reason, psychiatric nosology – the classification of mental disorders – has come to occupy a central role in debates over mental health policy, patient identity politics, and the professional authority of psychiatry. This chapter explores the sociological research on psychiatric nosology. The first section examines the history of classification of mental disorders in the United States, focusing on the professional dynamics that have shaped the Diagnostic and Statistical Manual of Mental Disorders (DSM). The second section describes three key areas of sociological research on psychiatric nosology – medicalization, diagnostic practice, and patient identity – that highlight the manner in which social and political factors influence the classification of mental disorders and the concomitant effects of psychiatric nosology. How does medicalization impact our understanding and classification of mental health disorders? How do social and political factors affect the categorization of mental disorders? Specifically, how has the production, use, and reception of the DSM shaped political (professional or otherwise) considerations?
Introduction
In the early 1970s, fresh off the dramatic events of the Stonewall Riots, gay activists converged on the typically staid meetings of the American Psychiatric Association (APA) to challenge the classification of homosexuality as a mental disorder. The second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) defined homosexuality as a sexual deviation on par with pedophilia and, in turn, subject to psychiatric treatment that included aversion therapy, electroconvulsive therapy (ECT), and even lobotomy. Although an improvement on the traditionally held view of homosexuality as an abomination, activists derided psychiatry's diagnosis of homosexuality as a disease, arguing that it unjustly pathologized sexual orientation. They descended upon the APA's annual meetings to pressure psychiatrists to remove homosexuality from the DSM-II. Supportive psychiatrists, some of them homosexuals themselves, joined the protest. At the 1972 meeting, psychiatrist John E. Fryer – using the pseudonym of “Dr. Anonymous” – spoke eloquently of his struggles as a gay psychiatrist, while donning a mask to maintain his anonymity so as to avoid any professional repercussions that might stem from his testimonial. Eventually the disruptive tactics worked.
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