A Critical Approach to Abnormality 239Statistical Manual of Mental Disorders—DSM, which is published by the
American Psychiatric Association and used throughout the United States
and Canada, as well as part of the UK, and the International Classification
of Diseases—ICD, which is used across the rest of the world and provided
by the World Health Organization. These two manuals provide common
frameworks for psychiatrists and other mental health practitioners to make
sense of symptoms that individuals present regarding their specific
circumstances. After what is typically a lengthy assessment process—
which could include questionnaires, interviews, or overnight observation—
diagnoses are made based upon the individual being questioned meeting
specific criteria delineated in the diagnostic manual of reference.
Applying a critical lens to this process, we see this approach to
psychological suffering as being enmeshed with cultural institutions and
forms of power unique to Western norms and economic markets. For
example, the need by managed care and insurance companies to be notified
of a formal diagnosis by the practitioner in order for services to be
reimbursed speaks to the influence that such companies have regarding
what counts as abnormal and how it is treated. In these ways, the medical
insurance industry and, more broadly, the kind of neoliberal economic
system under which such markets operate, reinforce specific modes of
treatment, labeling, and the very definition of what is considered socially
maladaptive or abnormal.
This has led to the DSM, in particular, being popularly regarded as
“Psychiatry’s Bible” (see Jabr, 2012), insofar as it is the primary source of
criteria by which mental health diagnoses can be made. We might reflect
further on the metaphorical importance of characterizing the DSM in this
way given the colonial history of Christianity, in terms of what that implies
for dissenting opinions or frameworks. In such ways, language and culture
are fundamental to how we think about what constitutes normal vs.
abnormal, or health vs. illness. For patterns of thoughts and emotions to be
understood by professionals as ‘symptoms,’ they have to be interpreted
according to criteria listed in the DSM. And yet, this produces a certain
cultural spillover, one might say, inasmuch as the demand for diagnosis
extends into the realms of relationality, sociality, and culture without