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

这项科学和社会社会科学科学、工程和技术项目论文改进补助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，以及反过来，该类别产生的新的主观性和社会形态。在过去二十年中，《精神疾病诊断和统计手册》--一种为诊断精神疾病提供标准化标准的工具--在规模和范围上有了相当大的增长，这是一个显著的发展，因为它对精神疾病的定义已日益成为精神疾病概念化/精神痛苦管理的组成部分。虽然这一趋势刺激了心理健康社会学的大量研究，但与强迫症(OCD)类别相关的问题受到的关注很少，尽管OCD拥有在美国人口中发现的第四种最常见的精神障碍的声誉(Krochmalik&Amp；Menzies 2003：18)。此外，强迫症被认为是一种慢性的、知之甚少的疾病，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棱两可的问题进行永久的谈判。除了填补这一实质性的空白之外，这篇论文还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，弥补关于[精神病学]诊断使用的经验研究的不足(Manning 2001：78)。审查当地与精神病学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(对于那些接受精神病学临床诊断的人来说，这些模式往往是通过与官方概念化的互动而出现的)以及生活经验。本论文项目提出了以下研究问题：强迫症是如何在其传播的三个空间内和之间进行谈判的：学术研究实验室、临床和被诊断为强迫症的人的生活？通过考察多个社区内部和之间的谈判，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。这项提案的资金支持与采访这些社区成员有关的研究费用，以及在治疗强迫症的人和被诊断患有强迫症的人参加的会议和集体治疗会议上观察参与者所需的旅费和费用。本论文对心理健康社会学做出了理论贡献，为研究精神病学诊断类别谈判中使用的实践和材料/话语工具开辟了空间；这项研究还试图促进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，这一研究被精神病学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，对某一精神病学类别进行批判性但不可轻视的定性实证研究可能会为类似类型的研究开辟空间，从而(A)从谈判者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精神卫生专业人员之间更大程度的合作铺平道路，从而可能将经验性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.