Dissertation Research: (Un) Bounding DSM 300.3: Exploring the Negotiation of Obsessive Compulsive Disorder in Three Communities of Practice

这项科学与社会科学、工程和技术项目的社会研究论文改进基金将为一名博士生提供研究资金，帮助她完成关于精神病学诊断类别的本地谈判的论文，特别是在与强迫症谈判中使用的话语、技术和实践，以及该类别所产生的新的主体性和社会形态。在过去的二十年里，《精神疾病诊断与统计手册》（DSM）——一个为精神疾病的诊断提供标准化标准的工具——在规模和范围上都有了相当大的增长，这是一个显著的发展，因为它对精神疾病的定义已经越来越多地成为精神病学概念化/精神痛苦管理的一部分。虽然这一趋势刺激了心理健康社会学领域的大量研究，但人们对强迫症（OCD）相关问题的关注有限，尽管强迫症在美国人群中被认为是第四大常见精神障碍（Krochmalik & Menzies 2003: 18）。此外，强迫症被认为是一种慢性的、鲜为人知的疾病，这意味着，对许多人来说，处理诊断意味着与这一类别固有的模糊性进行永久的谈判。除了填补这一实质性空白之外，本论文提案还试图将医学实践的技术科学研究扩展到精神病学实践领域，弥补[精神病学]诊断使用实证研究的不足（Manning 2001: 78）。检查当地与精神病诊断的接触有可能阐明这些类别的效用，想象和管理精神痛苦的替代模式（在那些接受过精神病临床诊断的人的情况下，通常通过与官方概念化的互动而出现），以及生活经验。这个论文项目提出了以下的研究问题：强迫症是如何在它所穿越的三个空间内和空间之间进行协商的：学术研究实验室、诊所和被诊断为强迫症的人的生活？通过考察多个社区内部和社区之间的协商，可以研究官方本体论被复制或替代本体论被想象的辩证过程。该提案的资金支持与采访这些社区成员有关的研究费用，以及在会议和治疗或诊断为强迫症的人参加的小组治疗会议上进行参与者观察所需的差旅费和费用。本论文对心理健康社会学的理论贡献在于为精神病学诊断类别协商中所使用的实践和材料/话语工具的研究开辟了一个空间；此外，本研究还试图推动对慢性精神障碍的定性实证研究的回归，在过去的几十年里，这种研究被精神病学的话语研究和精神疾病的流行病学研究所掩盖（Mulvaney 2001）。此外，如上所述，这项研究试图将医疗实践的技术科学研究扩展到精神病学实践领域，从而扩大这一科学和技术研究分支的范围。就其更广泛的影响而言，对精神病学类别进行批判性的、但不容忽视的定性实证研究，可能会为类似类型的研究开辟一个空间，从而(a)从那些讨论这些类别的人的角度增加对精神病学类别的现有知识，(b)最终为定性社会学家和心理健康专业人员之间更大的合作铺平道路。从而有可能将经验定性研究的结果纳入临床和/或社区管理实践的设计中。

This Science and Society Social Studies of Science, Engineering, and Technology Program Dissertation Improvement Grant will provide research funding for a Ph.D student to help her complete her dissertation on the local negotiation of psychiatric diagnostic categories, in particular the discourses, technologies, and practices used in negotiations with obsessive compulsive disorder, and in turn, the novel subjectivities and social formations to which the category gives rise. Over the last twenty years the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- a tool which provides standardized criteria for the diagnosis of psychiatric conditions -- has grown considerably in size and scope, a notable development since its definitions of mental disorders have become increasingly integral to the psychiatric conceptualization/management of mental suffering. While this trend has stimulated much research within the sociology of mental health, limited attention has been given to issues related to the category of obsessive compulsive disorder (OCD), even though OCD holds the reputation of being the fourth most common mental disorder found in the US population (Krochmalik & Menzies 2003: 18). OCD moreover is regarded as a chronic, poorly understood condition, meaning that, for many, dealing with a diagnosis signifies perpetual negotiation with the ambiguities inherent to this category. In addition to filling this substantive gap, this dissertation proposal seeks to extend technoscience studies of medical practices to the realm ofpsychiatric practices, redressing the shortage of empirical research on the use of [psychiatric] diagnoses (Manning 2001: 78). Examining local engagements with psychiatric diagnoses holds the potential to illuminate the utility of such categories, alternative modes of imagining and managing mental suffering (which, in the case of those who have received a psychiatric clinical diagnosis, often emerge through interactions with the official conceptualization), as well as lived experiences. This dissertation project proposes the following research question: How is obsessive compulsive disorder negotiated within and between three spaces through which it travels: the academic research laboratory, the clinic, and the lives of those who have been diagnosed as such? By examining negotiations within and between multiple communities, the dialectical processes through which the official ontology is reproduced, or alternative ontologies are imagined, can be studied. Funding for this proposal supports research expenses related to interviewing members of these communities, as well as travel expenses and fees required for participant-observation at the conferences and group therapy sessions attended by those who treat, and those diagnosed with, obsessive compulsive disorder. This dissertation makes a theoretical contribution to the sociology of mental health by opening a space for the study of the practices and material/discursive tools employed in the negotiation of psychiatric diagnostic categories; this study additionally seeks to prompt a return to qualitative empirical study of chronic mental disorders, which in the last few decades has been overshadowed by discursive studies of psychiatry and epidemiological studies of mental illness (Mulvaney 2001). Furthermore and as noted above, this study seeks to extend technoscience studies of medical practice to the field of psychiatric practice, thereby broadening the purview of this subdivision of science and technology studies. As for its broader impact, a critical, yet nondismissive, qualitative empirical study of a psychiatric category potentially will open a space for similar types of research, thereby (a) increasing the existing knowledge of psychiatric categories from the perspectives of those negotiating them, and (b) ultimately paving the way toward a greater collaboration between qualitative sociologists and mental health professionals, and thus potentially incorporating the results of empirical qualitative research into the design of clinical and/or community-based management practices.