Abstract:
Within a biomedical worldview, the processes and practices of psychiatric diagnosis aim to achieve objectivity, reliability, and neurobiological veracity in the codification of mental illness. Yet these same practices are cultural, socio-material achievements that have profound effects on the individuals being categorized, especially because diagnostic considerations frequently inform prognostication as well as direct a variety of biological and psychological interventions. The implications of these interrelations are of particular significance for the area of first episode psychosis (FEP), where diagnostic uncertainty is often the norm and prevention of disability the aim.
In this paper I draw on my own three-year ethnographic study (The Psychosis Narratives Project) to explore juxtapositions that exist between psychiatric service users, family members, and clinicians in relation to the processes of diagnostic categorization. I offer an analysis of the ways that diagnostic practices in FEP that dramatizes the relationship between biopolitics and the materialization of psychosis in the clinic setting. Situating my work within feminist epistemology and feminist philosophy of science, I go on to discuss the frictions that would arise, for instance linking tensions around the acceptance of antipsychotic medications to forms of epistemic injustice within the clinic.
Philosophy of psychiatry often frames issues of diagnosis as a question of natural kinds and scientific generalizations, despite limitations stemming from the narrowness of this approach (Tekin 2016). While this paper draws on and extends philosophical discussions of diagnosis, it does so by demonstrating how the richness of lived experience can index the stakes of categorization: diagnostic practices fundamentally relate to identity and subjectivity, carrying significant material implications for world and self-making.
Speaker Bio:
Suze Berkhout is an early career clinician-investigator at the University of Toronto, a practicing psychiatrist based out of Toronto General Hospital, and an affiliate of the Institute for the History and Philosophy of Science and Technology at U of T. She is a graduate of UBC’s MD/PhD program, where she carried out her doctoral research under the supervision of Scott Anderson. Her program of research is situated in feminist philosophy of science/STS, where she focuses on ways to innovate methodologies in order to understand the social and cultural dynamics that shape health systems access and the impact of technologies and biomedical intervention on lived experience. She uses ethnographic, narrative, and research-creation approaches to critically engage the contours and implications of what has been called medicine’s curative imaginary: the disciplinary matrix of norms, beliefs, practices, and metaphors that sees disability as tragedy and intervention as necessary and inevitable. She leads SSHRC, NFRF, and CDTRP-funded projects that cut across populations and issues, including first episode psychosis, treatment refractoriness in mental health, solid organ transplantation, and the field of placebo studies.
