Our lives and careers (hopefully) are full of bridges, some recognised, but not taken, others passed-by on our way (and unseen). Before I completed my training as a student mental health nurse beginning in 1977, I saw a critical bridge between the knowledge and skills on mental health nursing and general nursing. Crossing this bridge was essential (for me) to being a registered 'nurse'.
Chapter 6 on Psychodiagnostic Categories is a gift therefore. It's a gift because another bridge emerged in 1980-1981 with the Sinclair microcomputers and advent of 'home computing'. With a ZX81 there was going to be a need to navigate this space between the what is human and what is machine. Two categories that remain key concerns today.
The DSM (Diagnostic and Statistical Manual of Mental Disorders - published by the American Psychiatric Association [APA] ) is on the chapter's first page, plus the patient, researchers, psychiatrists and the conditions learned during their medical education, contrasted with individual psychiatrist's clinical encounters with patients.
Very quickly (the next page p.86) Murphy identifies the 'circumstantial factors' that cause mental illness. This is very positive as acknowledging the determinants across health is key, however framed, e.g. social determinants, economic, educational we must take into account all of them. Otherwise our assessment must be considered as incomplete, or at least lacking?
The utility of Prof. Murphy's short book is in how prior to the case studies we see the problem of definitions. And how what is determined is often a matter of convenience. This is a non-trivial matter - especially in health, economics, sciences, politics, future and peace studies: you get the idea...
Of immediate relevance in the USA is the need for categories for insurance purposes. It is an industry. Yes, indeed: 'The truth is that psychiatric patients vary in every possible way', p.86. Computers of course are well-equipped to help us in the creation, revision and publication - access to categories; with classification, taxonomy, nomenclature ... also in the mix. I was reminded of
WHO's history of classification (see below) which I point students and colleagues to.
The way DSM is applied is explained and the politics duly noted (especially in Chap. 7). Resort to 'miscellaneous' is described as a sign that 'the categories are not necessarily picking out 'natural kinds'. I remember in the 90s, our PICK database on a community mental health project had Murphy's 'X' not otherwise specified. I don't think I read the word 'caseness', but there is a lot 'inside'!? References are ongoing. I wondered if there could be more recent examples, but perhaps this is in turn symptomatic of categorisation tending to be the rear car? Fuzziness is discussed. Plus, the observation that 'a few psychiatric categories may be true natural kinds, like gold or rainbow trout.' p.89.
'Change' is a mantra for all disciplines in the NHS and global healthcare. So pragmatic to see how revision and change in the DSM can be used by - dare I mention - anti-psychiatry advocates and clinicians as to what change represents to these respective interest groups? At a time when research is experiencing funding changes, Murphy contrasts how DSM was developed for the use of clinicians to identify people with similar profiles, but they were not developed to identify (research - Nat. Inst. for Mental Health) underlying causes. Raising the determinants once again, p.91.
It is obvious but as personnel and Brits may look at private medicine with coding purposed for insurance purposes; there is within the NHS (public-funded healthcare) and psychiatry (a single domain too) within and the need by patients for diagnosis, and the welfare system. Here in the UK the rise of mental health in young adults, autism and waiting lists for assessment for
ADHD are a moot point.
Through Hodges' model we some possibly fascinating bridges, that are much less-travelled these days? In many cultures, even if we do not need permission to be sick, it needs to be recognised socially - and so politically. Society needs to deal with individuals who are ill, infirm, disabled. It's interesting then to reflect on this issue and phenomena through the lens of anthropology and medical sociology. Murphy warns to of the dangers 'of thinking of something as being the category'. In medicine a new approach is needed, as Murphy also notes. A nice bridge to chapter 7 Categories and Power.
'The case studies discussed in the previous chapters remind us that categories can be political and social tools. An old department chair of mine had the saying, "She who sets the agenda controls the meeting." We might coin a new one, "Those who make the categories control the outcomes." If your psychodiagnostic categories are made by working therapists and physicians, they might facilitate treatment- -and also benefit those practitioners. If they are made by researchers, they might not be very useful for treatment at all. And if they are made by insurance companies, all bets are off.' p.95.
Trying to take my attempts to find theoretical underpinning (category 'trying to clever') I've a diagram scribbled here. Nearby, p.100, I picked up on 'the cost of losing information or distorting reality to some degree.' Murphy picks up on the ICD Int. Classification of Diseases here. Twitter is still twitter here - thumbs up for that! There is a useful example of the impact of categories in age, pregnancy and medical attention provided.
From Chapter 8, I picked out: Naming Nature: The Clash Between Instinct and Science, by Carol Kaesuk Yoon. W. W. Norton: 2009. 352 pp. £19.99/$27.95 9780393061970 | ISBN: 978-0-3930-6197-0; and checking, I remember the book's cover. Murphy's book overall highlights the convenience of our categories, the ongoing challenges and everyday conundrums they present though the remaining chapters on Species (8); Peanut Butter, Potato Chips, Almond Milk... (9); Racial Categories (10). These all contribute, still building a coherent picture, chapter 10 vital among them with a url provided (which may have changed):
https://anthropology-tutorials-nggs7.kinsta.page/adapt/adapt_4.htm
The one-drop rule (David, 1991) on p.126, is deeply troubling. Especially so given some examples of human reasoning even today. Medicine, by way of blood tests, features again. I smiled wryly reading how people from different countries have different rates of disease, e.g. 'heart disease in Scotland'. Instantly, and crackling - a
deep-fried Mars bar popped into my mind.
The things people do. You - really could read this book!
Murphy, Gregory L.
Categories we live by: how we classify everyone and everything. Cambridge, MA: The MIT Press, 2024.
Many thanks again to
MIT Press for the review copy and Prof Murphy for a great read.
orcid.org/0000-0002-0192-8965
