Abstract
Psychiatric diagnosis has become pervasive in modern culture, exerting an increasing influence on notions of personhood, identity practices and forms of self‐governing. The broadening of diagnostic categories and increasing awareness regarding popular diagnostic categories has led to an increased demand for formal diagnosis within clinical encounters. However, there is continuing ‘epistemological uncertainty’ (Fox 2000) surrounding these entities, in part due to their lack of associated clinical biomarkers and their ‘fuzzy boundaries’. Meanwhile, this diagnostic expansion has encountered resistance from those concerned with the alleged ‘over‐pathologisation’ of emotional distress. Drawing upon the concepts of ‘diagnostic cultures’ (Brinkmann 2016) and the ‘looping effects of human kinds’ (Hacking 1995), this article considers some of the competing forces acting upon the contested boundaries of diagnostic categories as they play out within diagnostic interactions. The study involved ethnographic observations of diagnostic encounters within several UK‐based mental health clinics. By focusing on interactions where diagnosis is negotiated, findings illustrate the role played by different kinds of diagnostic uncertainty in shaping these negotiations. It is argued that diagnostic reification plays a key role in the moral categorisation of patients, particularly where there is uncertainty regarding individual diagnostic status.
Highlights
Psychiatric diagnosis has become pervasive in modern culture, exerting an increasing influence on notions of personhood, identity practices and forms of selfgoverning
By focusing on interactions where diagnosis is negotiated, this article contributes to the sociology of diagnosis by illustrating the opposing forces acting upon the boundaries of diagnostic categories within clinical interactions
It explores the role played by different types of uncertainty in shaping diagnostic interactions which have significant psychosocial consequences for patients; in particular it focuses upon the implications of individual diagnostic uncertainty when combined with a de-emphasis upon ontological uncertainty regarding the underlying nature of psychiatric diagnosis
Summary
Psychiatric diagnosis has become pervasive in modern culture, exerting an increasing influence on notions of personhood, identity practices and forms of selfgoverning. Psychiatric diagnosis has become a pervasive presence within modern culture (Brinkmann 2016), exerting an increasing influence on notions of personhood, identity practices and forms of self-governing Both modern classification systems such as the DSM–5 (American Psychiatric Association 2013), and the trend towards dimensional models of mental disorder have encouraged the broadening of many psychiatric and neurodevelopmental categories, with increasing numbers receiving diagnoses such as autistic spectrum disorders (Navon and Eyal 2016) and attention deficit hyperactivity disorder (ADHD) (Conrad and Potter 2000). Professionals retain the power to officially assign diagnosis, meaning that if formal diagnosis is required it must be successfully negotiated
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