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Fitting Categories to Circumstances |
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An academic friend on the East Coast tells an anecdote of negotiation with her long-term psychoanalyst about how to fill out her insurance forms. She was able to receive several free sessions of therapy a year under her health insurance plan. Each year, she and her therapist would discuss how best to categorize her. It was important to represent the illness as serious and long-term. At the same time, they were worried that the information about the diagnosis might not always remain confidential. What could they label her that would be both serious and nonstigmatizing? Finally, they settled on the diagnosis of obsessive-compulsive. No academic would ever be penalized for being obsessive-compulsive, our friend concluded with a wry laugh! (Kirk and Kutchins (1992) document similar negotiations between psychiatrists and patients.) |
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Theoretically, this rubric is anathema to them, systematically replacing the categories of psychoanalysis with the language of the pharmacopoeia and of the biochemistry of the brain. The DSM, however, is the lingua franca of the medical insurance companies. Thus, psychoanalysts use the categories not only to obtain reimbursement but as a shorthand to communicate with each other. There are local translation mechanisms that allow the DSM to continue to operate in this fashion and, at the same time, to become the sole legal, recognized representation of mental disorder. A "reverse engineering" of the DSM or the ICD reveals the multitude of local political and social struggles and compromises that go into the constitution of a "universal" classification. |
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Standards, categories, technologies, and phenomenology are increasingly converging in large-scale information infrastructure. As we have indicated in this chapter, this convergence poses both political and ethical questions. These questions are by no means obvious in ordinary moral discourse. For all the reasons given above, large-scale classification systems are often invisible, erased by their naturalization into the routines of life. Conflict and multiplicity are often buried beneath layers of obscure representation. |
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Methodologically, we do not stand outside these systems, nor pronounce on their mapping to some otherworldly "real" or "constructed" nature. Rather, we are concerned with what they do, pragmatically speaking, as scaffolding in the conduct of modern life. Part of that |
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