Classifying Madness: A Philosophical Examination of the Diagnostic and Statistical Manual of Mental Disorder

Extract

Rachel Cooper, Classifying Madness: A Philosophical Examination of the Diagnostic and Statistical Manual of Mental Disorder , Berlin: Springer, 2005. Pp. vii + 172. €79.00. ISBN 1–4020–3344–3.

Whether or not mental disorders can be classified in the same way as physical diseases has been debated since the nineteenth century when the second ontological model of mental disorder (the so-called ‘anatomo-clinical’) was first proposed. After reviewing physiological, pathological and symptomatological methods of classification, Tuke concluded that ‘the wit of man has rarely been more exercised than in the attempt to classify the morbid mental phenomena covered by the term insanity. The results have been disappointing’. ¹ His words ring as true today as they did in 1892, as the reason for this difficulty is not empirical but conceptual and has to do with the very definition of mental disorder. Views on this issue remain polarised, and those like Ellenberger have deemed the entire classificatory enterprise an illusion. Others, however, who reject such a position adopt different approaches. The American Diagnostic and Statistical Manual of Mental Disorders (DSM) system proposes a classification driven by phenomenological description while others, like the late Robert Kendell, advocate one based on pattern recognition techniques. The naïve realism underlying current official classifications of mental disorder started to creep into psychiatric thinking during the 1960s. This is well illustrated by the famous 1965 Washington conference on psychiatric classification, when the psychoanalytical propensities of American psychiatry were roundly challenged by epidemiologists, statisticians and hard-nosed clinical classificators. In that meeting, Max Hamilton incisively observed that even if the prediction was to come true that the future of psychiatry was in the hands of biochemists and geneticists, they would be ‘blind and helpless without the clear guidance of precise observation and description’. ²