Deliberating the science of madness: DSM-5 and the polytechtonic rhetorical economy of psychiatric nosological controversy

2016-07-24This study examines the rhetorical features of psychiatric nosological controversy. The locus of inquiry is the recent controversial revision of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders, now in its fifth edition (DSM-5). The dissertation seeks to answer the following research question: When the field of psychiatry assembles to revise itself, how do previous rhetorical arrangements organize into new vectors, evolve, and cluster together into what becomes a new network consensus (or quasi‐consensus)? ❧ This dissertation contributes to debates in the social study of science and the rhetoric of inquiry about the development and evolution of scientific fields. It contends that as psychiatric knowledge advances, discursive forms embodying old institutional logics and theoretical paradigms leave residues that retain their suasive character. These sedimented rhetorical residues play a significant role in many of the developments and impasses in the controversies surrounding DSM‐5. Our contemporary concepts of psychosis are the result of the projection of tensions between discrete and continuous terminologies, ontological and functional interpretations of health and sickness, and psychodynamic and neurobiological descriptions of the mind into the temporal dimension. This study argues that the inability of psychiatry to resolve a set of internal dilemmas combined with its temporizing can be understood in contemporary terms as a politics of the supplement. ❧ Several major DSM‐5 debates are analyzed, with special focus on the controversy over psychosis risk. Chapter 1 introduces the direct and indirect contexts of DSM‐5. Chapter 2 works out a theoretical toolkit and a model of polytechtonic rhetoric capable of appreciating the historical dynamics of interfield and public controversy. Chapter 3 examines the rhetorical history of 'psychosis,' which requires a larger rhetorical history of psychiatric nosology. This includes an account of the humoral model of pathology, which remains present in contemporary medical rhetoric. Chapter 4 examines the rhetorical history of risk and the evolution of research on early interventions for psychosis to contextualize the contemporary controversy over psychosis risk syndrome. Chapter 5 concludes the study by discussing the implications of these different lines of inquiry for an understanding of the rhetoric of psychiatry in our contemporary late modern epoch. It argues for a reading of DSM‐5 in terms of the 'politics of the supplement,' a field of contestation concerning the risks and benefits of the new technologies of the self with which we (re)define our human nature