On the fragility (and consequences!) of our categories

Anne Dalke's picture


A NYTimes article today about Revising Book on Disorders of the Mind seemed to me curiously akin to -- and extending of -- some of our in-class conversations about category-making: an in-the-real world testimony to the constructedness of categories, and to the consequences of the constructions we choose. The article discusses the ongoing debate about updating the Diagnostic and Statistical Manual of Mental Disorders (DSM-MD) for the first time in a decade: "it has huge implications for stigma .... the more disorders you put in, the more people get labels." Critics say many diagnoses in the manual -- including a new one called "temper dysregulation disorder"--will "lack a rigorous scientific basis": "the scientific status of the main diseases in previous editions of the D.S.M. — the keystones of the vault of psychiatry — is fragile.”
 

Comments

aybala50's picture

Normal/Abnormal

I know that in class I've made my opinion about labeling clear. Though I am a psychology major, I am not very comfortable with what the DSM has become. There are way too many disorders and even more disturbing way too many categories that these disorders are split up into. Also, every single category has a subcategory that says 'not otherwise specified.' So, technically one can be diagnosed with a disorder even without fitting the category. 

I think that labeling something is very dangerous. By labeling a person, a book, or anything really a person can change the meaning and characteristics of what is labeled. For example: a person that is incorrectly labeled with depression can develop the symptoms very easily and this goes for most disorders. This is why I don't agree with labeling. It is, in my opinion, a dangerous business.

 

Anne Dalke's picture

"difference" rather than "illness"?

How about "difference" rather than "illness"?
See Depression, illness, culture and cultural change.

Anonymous's picture

The Self, Mental Illness, and Category-Making

If only "difference" were truly the preferred way of speaking about individuals rather than "illness." If we are to talk about category-making in terms of so called mental illness, in terms of its dangers and benefits, I can attest to the difficulties associated with being placed in those categories. As a Bryn Mawr student, who has at various times been labeled as depressed, bipolar, borderline personality, etc. I know how fragile and often overlapping many of these classifications are. Each of these categories carries negative connotations, and thus I am not inclined to be open with others about being placed inside of them. The problem is that I am "ill" in the sense that the traits that I possess cause me to behave and perceive in ways often deviant from the majority of the people around me. I have a double self, in a sense, in that I present myself as fitting a category that I believe will suit me better in my endeavors--as an intellectual, who is calm and measured in her self-presentation. I try to conceal those traits--extreme mood swings, grandiose, irrational thinking, constantly changing gender identity--that place me as inconsistent and somehow "less than" others. We are conceptual beings, and thus I know that we will attach concepts to one another, so I selectively choose what to show others, so that they will place me in a "better" category according to this hierarchy that we have so arbitrarily imposed on ourselves. I try to stifle those qualities that will make me seem "Other." Do we not all do this to a greater or lesser extent? Is this not proof how constructed the self is in every way? The construction of self, I think, leads ultimately to every other construction, every other category. We live in a world carved out according to what suits the needs of the dominant human discourse of the time. I choose to post this anonymously, because ultimately "identifying" myself would lead to further categories and judgments being imposed upon me. And also, I am so aware of how fragile, how interconnected the self is with everything else, that stating my identity is in a sense meaningless, and a pretension of an ego that is a category created due to the limits of our perceptions in the first place...

Paul Grobstein's picture

More on the self and category making

Thanks for this.  It provides important grist in support of an argument for Cultures of Ability, and I've linked to it from there ... At the same time, there is something to be said for having a "double self," for "dual consciousness" as an attribute that puts one in a position to contribute to changing cultures.   Cf culture and individual indentities and gender identity as an ongoing brain construction.  For more along these general lines, see Deconstructing and reconstructing cultures and individuals.  Yes, we all negotiate between individual and cultural identities "to a greater or lesser extent."  Maybe we could find a way to think about that that doesn't require "stifling"?   

Anne Dalke's picture

From labeling to framing?

One way to do this might be to shift from "labeling" to "framing"?
And to consider the (im)possibility of "unframed" states?

Paul Grobstein's picture

"unframed states" and "irreducible subjectivity"

From a discussion in neural and behavioral sciences senior seminar on brain imaging:

"Perhaps ... what we'll learn though is that there always remains an uncalibrateable and non-generalizable individual distinctiveness, and that this is part of the essence of brain function?

The problem ... [is] that people might assert that we are things different from and simpler than what we actually are.  That's a problem that long predates imaging.  Maybe its a problem that good brain research, including imaging, might actually help to solve?"

 

aybala50's picture

creating a truth by labeling

 

 I think there is a lot of legitimacy in what Paul said in his post. I think talking about "difference" rather than an "illness" would be better in general. I also enjoyed his discussion of changing cultures. "And it seems to me demonstrably not true that cultures can't be changed.  Both the civil rights movement and the gay rights movement are relatively recent examples of cultural change generated by people able/willing to not only look critically at culture but to act on the critique." (Paul) So, there is evidence that culture can change. It is obvious to me with the generational gaps in behaviors alone shows that there is constant change in cultures. However, some cultures may change faster than others, or the changes may be more obvious. I feel like the cultural gap between parents in the United States and their children (maybe college age) is very obvious. 

Can we relate this back to the effect increasing labels have had in the United States? The diagnosis of 'illnesses' or 'differences' in the field of psychology have not only encompassed more categories, but also an increasing number of diagnosis. An example that I can think of is the diagnosis of depression. According to data that the American Psychiatric Association collected, between the years of 1999-2007 there has been a major increase in the diagnosis of depression. Is this because there is just more labeling? Or has the labeling of people with depression increased the level of depression in this culture? Or something else?

APA data source:http://pn.psychiatryonline.org/content/44/14/29.full 

 

rachelr's picture

Helping vs. Hindering

 I think that in some instances, labeling can be an advantage. When a commonly known label is used, that single word or phrase can embody a fully body of, say, symptoms of a sick patient. There needs to be a standard for being able to measure symptoms, performance, comprehension, and behavior. Many also have reported that having a name and an understanding of perhaps why they are the way they are has been beneficial, and that with a label they have been able to understand that there is a reason that they are the way they are. 

 

On the other hand, symptoms, for instance, can be experienced on different levels for different people, and professionals tend to jump to conclusions when diagnosing, or "labeling," patients. As in psychology, often the most understood or most frequently seen result, or illness, will be diagnosed simply because of its frequency; it is not always correct, however. Also the method for diagnosis (or labeling) was once decided by a group of doctors who were, as we all are, human. So it stands to reason that they were not always correct. Their studies also focused on only a portion of the population at the time; the dynamics of generations are constantly in fluctuation, and no two individuals are alike, further distancing an exact or correct "label" from people.

For certain diagnosis, I think that this labeling has definitely increased the number of people diagnosed. Depression and ADHD are two of these over diagnosed illnesses. And it seems like children are being diagnosed younger and younger. How can a five year old be diagnosed with ADHA? Some children have more energy than others, and reading and academics do not come as easily to some children as they do to others. 

In severe cases of illnesses or disorders, when medication could perhaps help a person lead a more healthy and happy life, I believe that diagnosis can be beneficial. However using diagnosis and "labels" to over analyze each and every aspect of a person only ends up giving them excuses and aids in creating a barrier between children, and even adults, who are "abnormal" and those who are "normal."

 

Paul Grobstein's picture

Learning from/about categories

Very interesting set of related issues here.  I'm inclined to agree that indeed " having a name and an understanding of perhaps why they are the way they are has been beneficial" to lots of people.  And, additionally, that it plays an important and necessary role in science, among other social activities.   At the same time, I'm also inclined to agree that labelling can be "a dangerous business." 

The history of "mental illness" diagnosis is a good case in point, and, as noted, a timely one (cf Revising book on disorders of the mind, NYTimes, 10 Feb 2010).  There's pretty good evidence that mental health problems and diagnoses are indeed both contagious  (cf The Americanization of mental illness, Ian Hacking's Mad Travelers, and Ann Harrington's A History of Mind-Body Medicine), and disabling.  At the same time, recognizing differences among people has been and continues to be valuable for many individuals.  

Maybe we could have our cake and eat it too?  Perhaps it isn't "category-making" in and of itself that is a problem but rather some deeper assumptions about the significance of categories.  We might, for example, keep categories, but challenge an assumption that they importantly distinguish between those who "are abnormal" and those who are "normal"."  Categories describe differences, rather than deficiencies relative to some norm?  We might also recognize categories as constructions, always in flux, rather than as definitive descriptions of essential characteristics.  The categories used at any given time are not only temporary but are to be valued to the extent they raise questions and open the possibility of seeing things in ways yet to be imagined?   Perhaps we can keep categories and their desirable features and get rid of their less desirable ones?    

aybala50's picture

what are categories?

 Ok, I like this having our cake and eating it too...but i'm a little confused. I agree with rachelr in that categorizing certain illnesses has been beneficial. This is how science or medicine began, isn't it? Early doctors wanted to find cures for illnesses in order to help people. This want to help turned into something completely different. 

I agree with Paul that the problem may not be "category-making" in and of itself, but I don't think that this is completely true. Paul suggested that maybe the problem is that categories describe differences, rather than deficiencies relative to some norm. If we fix this problem, some how, what do categories turn into? If everything in this world can be defined by certain characteristics, such as poetry having characteristics that make it a poem, can categories themselves be broken down? What are the characteristics that make a category what it is? 

Paul suggested that, "We might also recognize categories as constructions, always in flux, rather than as definitive descriptions of essential characteristics." This would be lovely, however once something is placed in a certain category, I feel that it is, in most cases, very difficult to change societies mind otherwise. Lets say, for example, that a man murders someone when he is young. Will he ever be able to escape the category of murderer? 

rachelr's picture

Should productivity or accuracy be favored?

  Well categories can always be broken into subcategories, but I think, with respect to literature, that it would be difficult to further break down the categories just due to sheer quantity. By creating subcategories maybe categories and genres would not restrict and box in literature as much (because more information about different elements of the literature would be available), but all books are so different that overlap between subcategories might not be productive. But is the point to be productive? Or is the point to give a better representation of literature (or, if we are discussing the classification of people into categories and "labeling" them, people) and not to worry about whether or not it is productive?

 

The word 'category' stems from katēgorein to accuse, affirm (Merriam-Webster). I think that this is really interesting, because to accuse usually has a negative connotation and affirm a positive. And yet they are both a definition of the same word. But this is fitting because it seems like Paul, aybala50 and I all agree that categorizing, or "labeling," can be both positive and negative. When I think about what characteristics make a category what it is, I think of division and something that has more than one property. So because it has more than one property, it falls into more than one grouping, and hence where organization comes into play. My question is: should we forgo organization in an effort to not label and induce biases, or to over categorize so that there can still be organization, but more parts of the whole are represented?

Aybala50 asks, "Lets say, for example, that a man murders someone when he is young. Will he ever be able to escape the category of murderer?" I think that aybala50 is right- murderer is a multilayer category, and one that I think is very difficult, if not impossible, to overcome. Once the category of murderer is mentioned people will question how long it has been since the act occurred, why the person did it, whether or not they are still violent... I think that categories can be in flux, but most are so fixed in our mindsets that our biases make it impossible to overlook certain categories. 

 

Anne Dalke's picture

escaping our categories

Tim Burke (who will visit our class next Tuesday) is also doing some interesting thinking along these lines -- that individual stories resist generalization/categorization -- @ One story is enough: Meaning-making is always a comparative act. Still, there’s a common impulse to very quickly fit a local or individual narrative neatly into some larger issue, and in so doing move beyond the unsettling contradictions that any closely-examined life will inevitably reveal. So it’s been with the story of Amy Bishop ... Amy Bishop seems to me for the moment to explain primarily herself .... In every story she is being made to carry or exemplify, she’s the completely idiosyncratic exception.

If you are really interested in the evolution of the category "murderer" --or perhaps, more pointedly, in the evolution of  individual murderers--then I'd recommend the film, "Concrete, Steel, & Paint," to be screened in Haverford Stokes Auditorium @  7 p.m. on Thursday, February 18, 2010.

Bryn Mawr’s Hepburn Center and Haverford’s Center for Peace and Global Citizenship are co-sponsoring a screening of this documentary film  about the healing power of the Mural Arts Prison Project. Following the screening, there will be a discussion about the criminal justice system, the concept and practice of restorative justice, and the contribution of public art to building and strengthening communities. The filmmakers Cindy Burstein and Tony Heriza, as well as Philadelphia Mural Arts Director Jane Golden (recipient of 2006 Honorary Degree from Haverford College and 2009 Hepburn Medal) will participate in the discussion. The discussion will be facilitated by Barb Toews (who has worked for the Prison Society, helped to facilitate the Healing Walls mural project, and leads the Inside-Out class for Haverford and Bryn Mawr students), and Cameron Holmes (Life Skills Educator/Job Coach at the Pennsylvania Prison Society). A reception following the screening and discussion will be held in the Multi-Cultural Center, Stokes 106 (around the corner and down the hall from the auditorium).

“Concrete, Steel & Paint” takes the audience behind the walls of Pennsylvania’s Graterford State Prison to reveal the tensions, challenges and rewards of a unique restorative justice program in which prisoners worked with victims of crime on a set of murals. The project was conceived as a way for victims of crime and their families to express the full impact of the crime upon their lives; a chance for the prisoners to ask for forgiveness; and as a symbol of hope and healing for the community. At times during the film, the divide between the prisoners and the victims seems too wide to bridge. But as the participants begin to work together, mistrust gives way to genuine moments of human contact and common purpose. Their struggle and the insights gained are reflected in the art they produce.

_________

I was trained, btw, this past summer, as a facilitator in the Inside/Out Prison Exchange Program, in which college students study together with incarcerated men and women as peers in a seminar behind prison walls. The experience certainly opened up and re-figured quite a few fixed categories I had going in--and I'd be happy to talk about it with anyone interested in listening....




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