Finding Jesus in the Storm. John Swinton

Finding Jesus in the Storm - John Swinton


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who then redescribes them in terms of signs and symptoms of some kind of underlying pathological process.

       Categorizing Mental Health Experiences

      The process for determining diagnostic categories begins when groups of psychiatrists meet in various hotels across America to discuss which mental health experiences should fit within the various diagnostic categories. After a lot of discussing, arguing, categorizing, and recategorizing, the psychiatrists judge which classifications, names, and criteria are appropriate descriptions to guide clinical practice. Thus is born the DSM.

      Any given diagnostic category—schizophrenia, bipolar disorder, obsessive-compulsive disorder—comes into existence as it is constituted by the DSM criteria. The DSM has the power to establish, or at least to give formal, organized existence to, mental health experiences. As such, it is not only descriptive but also formative. Diagnoses are shorthand descriptions of complex human behavior. In descriptive mode, DSM-5 provides clinicians with concepts and forms of language that can be used to make sense of clusters of unusual human experiences. However, such descriptions also form the ways psychiatrists (and others) see and describe the person before them. Once you accept the DSM as the basis for your diagnostic practices, that becomes the way you see people. Diagnoses will help you to see some things very clearly, but they will inevitably occlude other things. The DSM thus propagates a certain type of clinical gaze that is bounded by the parameters of the knowledge and expectations of the clinician. The expectations of the clinician are not free-floating. Clinicians are deeply aware of the expectations of the system and the limitations of time. Shorthand descriptions are very helpful within a system that is bounded and limited by the pressures of time.

       Making Up “Mentally Ill” People

      The philosopher Ian Hacking opens his paper “Making Up People” with a quite startling assertion:

      The description of someone as a “pervert” wasn’t available before the late nineteenth century. It was only when law and medicine created a category and described those who fit that category as “perverts” that being a pervert became possible. Similarly, prior to formal categorization, again in the late nineteenth century, it was not possible to be either a homosexual or a heterosexual. There has been same-sex activity in all eras, but it was not until the legislative categories became available that one could be named “homosexual” or “heterosexual.” Once these categories (kinds of people) came into existence, a variety of responses became possible: a position for or against homosexuality, heterosexuality, gay rights, homophobia, and so forth. Once these categories were created, it was possible to be these kinds of people.


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