In der aktuellen Ausgabe des New Yorker ist ein Artikel von Manvir Singh erschienen, seines Zeichens Assistant Professor am Department of Anthropology der Universität von Kalifornien, der sich mit der Tatsache befasst, dass Diagnosen (etwa des DSM) nicht nur Problembeschreibungen konstruieren, als seien sie Ausschnitte einer objektiv beschreibbaren Realität, sondern auch Menschen dazu bringen, sich diesen Beschreibungen entsprechend zu verhalten. Im Text heißt es:
„The DSM as we know it appeared in 1980, with the publication of the DSM-III. Whereas the first two editions featured broad classifications and a psychoanalytic perspective, the DSM-III favored more precise diagnostic criteria and a more scientific approach. Proponents hoped that research in genetics and neuroscience would corroborate the DSM’s groupings. Almost half a century later, however, the emerging picture is of overlapping conditions, of categories that blur rather than stand apart. No disorder has been tied to a specific gene or set of genes. Nearly all genetic vulnerabilities implicated in mental illness have been associated with many conditions. A review of more than five hundred fMRI studies of people engaged in specific tasks found that, although brain imaging can detect indicators of mental illness, it fails to distinguish between schizophrenia, bipolar disorder, major depression, and other conditions. The DSM’s approach to categorization increasingly looks arbitrary and anachronistic.
Steven Hyman, who directed the National Institute of Mental Health from 1996 to 2001, told the Times that he considered the manual an “absolute scientific nightmare.” In 2009, four leaders of the DSM-5 revision wrote about their hopes to “update our classification to recognize the most prominent syndromes that are actually present in nature.” The outcome didn’t live up to those aspirations. In April, 2013, weeks before the DSM-5’s slated release, Thomas Insel, then the director of the N.I.M.H., remarked, “The final product involves mostly modest alterations of the previous edition.” As a result, he announced, the institute “will be re-orienting its research away from DSM categories.”
In “DSM: A History of Psychiatry’s Bible” (2021), the medical sociologist Allan V. Horwitz presents reasons for the DSM-5’s botched revolution, including infighting among members of the working groups and the sidelining of clinicians during the revision process. But there’s a larger difficulty: revamping the DSM requires destroying kinds of people. As the philosopher Ian Hacking observed, labelling people is very different from labelling quarks or microbes. Quarks and microbes are indifferent to their labels; by contrast, human classifications change how “individuals experience themselves—and may even lead people to evolve their feelings and behavior in part because they are so classified.”
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