It's one thing to talk about the mechanisms of reproduction and habitus
as many of us do-- not only on this list but on a few others I am on; and
quite another to take on City Hall. What Ravotas and I are doing-- has
been to find those venues where we can present the data from two studies we
conducted to people who have the ability to affect APA policy (American
_Psychiatric_ Association, in this case), and to practitioners themselves.
Toward this end, we've given a day long workshop on to psychologists,
social workers, and counsellors, on "therapist's paperwork dilemmas" at
the annual Narrative Therapy Conference in Vancouver, Canada (1996). And
in December, 1997, we gave a 45 minute presentation to psychiatrists,
philosophers of psychiatry, clinical psychologists, and psychiatric social
workers (on the material you read) at a conference called "Values in
Psychiatric Nosology: A conference for Mental Health Professionals" at
Southwestern Medical Center in Dallas. Present were Robert Spitzer, Alan
Pincus, and Tom Widiger, three of the major architects of DSM III, IIIR,
and IV. Mike Cole just signed permission to reprint "Genre as Tools" in the
Dallas Conference Proceedings volume with a response by the editor of the
_Journal of Abnormal Psychology_, Anna Lee Clark. Clark's position-- the
genre in which she's writing is an antogonistic one-- is that Ravotas and I
are arguing naively to throw out the baby with the bath and get rid of the
DSM. In her essay she makes use of a powerful warrant among psychiatrists
and psychologists, namly that they need a classificatory system in order to
ensure interrater reliability in diagnosis , and she alsouses such
rhetorical appeals as "If you don't like the diagnosis, don't wear it"-- as
an admonition to Ravotas and other clinicians as an option, I guess, to
meekly filling out Initial Assessments.
The whole issue of black boxing and the mechanisms of billable knowledge
and how it is produced is backgrounded.
These small moves that Doris and I have made may seem quiet compared to
Herb Kutchin's and Stuart Kirk's recent book (1997)_ Making us Crazy-- DSM:
the Psyhiatric bible, and the Creation of Mental Disorders_ published by
a trade press, the Free Press. But what we learned at the Dallas Conference
is that the the loudest voices in the medical model branch of psychiatric
community, a group of very powerful power brokers with networks extending
to NSF and NIMH-- have found ways to neutralize or naturalize work of
outsiders ( as well as others) under the rubric of "anti-psychiatrist
movement."
So there is considerable controversy going on over the issues we attempted
to describe in the_ MCA_ essay. Other researchers in sociology of science
and technology-- Leigh Star, Geof Bowker, Marc Berg, are working in closely
related areas-- Leigh and Geof have been for quite a long time and have
recently finished/ are finishing a book-- _How Classification Works_ (MIT
Press) and have written several papers, and Marc published an essay last
fall in _Science, Technology, and Human Values_,"Of Forms, Containers and
the Electronic Medical Record: Some Tools for a Sociology of the Formal"
that looks at the medicalized body of the patient through electronic
paperless technology.
Lots of "outsiders" including Ravotas and I are interested in the
practices of classification-- the trick is to engage the insiders, many of
whom are stakeholders in improving the DSM through its future iterations,
but not threatening its sovereignty.
Carol Berkenkotter
On Friday, Feb. 9, 1998, Francoise Hermann wrote:
> How do you espcape the bind of
>>intertextuality, the web of institutional pressures to
>>"pathologize"? It is great to see it, to analyze it, to unveil
>>the "dirty" secrets. but what are the alternatives? How do you
>>escape being locked into a status quo of "pathology" and its
>>reproduction? The therapist as researcher is a lousy one that only
>>uses "etic" means of approaching the culture of his or her client.
>>Where and how did you begin to change that?
>>
>>Francoise Francoise Herrmann fherrmann who-is-at igc.apc.org
>>http://www.wenet.net/~herrmann