Health Studies, Wilfrid Laurier University, 73 George Street, Brantford, ON N3T 2Y3, Canada.
Cult Med Psychiatry. 2011 Dec;35(4):484-500. doi: 10.1007/s11013-011-9232-0.
Examining the process undertaken to name and codify psychiatric illnesses provides important insights into how everyday healthcare practices are shaped by knowledge production processes. However, studies of illness classification often rely on an overly simplified distinction between the production of diagnostic categories and the application of those categories in practice. Drawing insight from science and technology studies, I argue that psychiatric diagnostic categories are iteratively generated through production and practice, even during the development of those categories. Through a discursive analysis of interviews, archival documents, and psychiatric literature, I identify the practical politics that enabled the creation of the postpartum depression (PPD) modifier in the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV). In addition, I demonstrate how the overarching discourses of evidence-based decision-making and biomedicine shaped the development of the postpartum modifier, and draw together comments made by interview participants regarding the administrative value of a PPD-related category in the DSM. These remarks suggest that, in their practice, researchers and clinicians also take into consideration their own knowledge about DSM production processes, providing further support for the argument that diagnostic categories are iteratively generated.
探讨命名和编纂精神疾病的过程，为了解日常医疗保健实践如何受到知识生产过程的影响提供了重要的见解。然而，疾病分类的研究往往过于简单地将诊断类别的确立与这些类别的实际应用区分开来。本文从科学技术研究中汲取灵感，认为精神科诊断类别是通过生产和实践不断产生的，即使在这些类别的发展过程中也是如此。通过对访谈、档案文件和精神科文献的话语分析，我确定了在《精神障碍诊断与统计手册》第四版（DSM-IV）中创建产后抑郁症（PPD）修饰符的实际政治因素。此外，我展示了循证决策和生物医学的总体话语如何影响产后修饰符的发展，并综合了访谈参与者对 DSM 中与 PPD 相关类别的管理价值的评论。这些言论表明，在实践中，研究人员和临床医生也考虑到了他们自己对 DSM 生产过程的了解，进一步支持了诊断类别是不断产生的论点。
