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will accept. The patient then self-describes, using that label to get consistent help from the next practitioner seen. The next practitioner accepts this as part of the patient's history of illness. As many of the examples in this book will show, this convergence may then be converted into data and at the aggregate level, seemingly disappear to leave the record as a collection of natural facts (Star, Bowker, and Neumann, in press). |
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Any classification system embodies a dynamic compromise. Harriet Ritvo writes of zoological classification in the nineteenth century: |
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But if the experts resisted granting recognition to competing claimants of the zoological territory they had staked out, they tacitly acknowledged the objections of various laymen in many ways. They even quietly incorporated vernacular categories into their classificatory schemes, especially with regard to mammals, the creatures most important to people and most like them. This consistently inconsistent practice illuminates both the nature of scientific enterprise during the period and the relation of science to the larger culture. (1997, xii) |
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As Ritvo shows us, these tracks do not disappear completely. Traces of bureaucratic struggles, differences in world-view, and systematic erasures do remain in the written classification system, however indirectly. The trick is to read the classification itself, restoring the narratives of conflict and compromise as we do so. This reading requires that we juggle the formal and informal aspects of classification while reading. Our reading teases out the cognitive, bureaucratic, and formal aspects of the work of designing and using classification systems. We are not here treating the generation or the detailed implementation of these categoriesboth topics well worthy of attention. (Young's (1995) description of posttraumatic stress disorder is a model here). For the purposes of this chapter, our emphasis is on reading the system, our argument being that one can read a surprising amount of social, political, and philosophical context from a set of categoriesand that in many cases the classification system in practice is all that we have to go on. |
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Sitting down and reading a document like the ICD is a curiously perverse activity. The three volumes of ICD-10, more than 2,000 pages long, have very little in the way of overt narrative. There is a short history of the enterprise of producing international classifications of disease at the beginning of volume two, which contains explanatory or prescriptive notes. It provides most notably a set of rules for using the classifications of the ICD with directions on what to do in ambiguous |
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