Diagnostic line-drawing, professional boundaries, and the rhetoric of scientific justification: A critical appraisal of the american psychiatric association's dsm project

This article briefly reviews the role of social, professional, and bureaucratic issues in shaping the development and dissemination of DSM-III, and its successive revisions — DSM-III-R and DSM-IV. A series of illustrations are presented which highlight the sensitivity of the DSM process to sociocultural qualification and its striking insensitivity to empirical literature and research data-sets. It is argued that the value-neutral language of justification routinely employed by proponents of the DSM project is inappropriate and misleading. The DSM serves to define and demarcate the professional areas for which psychiatry claims specialist expertise and overriding authority, and thus functions as a scientific, ideological, and rhetorical instrument. The politico-professional concerns that seem to have impacted most transparently on the inception of the DSM project are described and then analysed from a historicist-contextualist perspective. It is concluded that the American Psychiatric Association's continuing attempts to develop an encompassing nosology for psychological disturbance are far from disinterested, and should be treated with considerable caution by psychologists and other mental health professionals.