Suze G. Berkhout, MD, PhD, FRCPC , Clinician-Investigator, University Health Network Centre for Mental Health and Assistant Professor, Department of Psychiatry, University of Toronto
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 (Kupfer and Regier 2011). Yet these same practices are cultural, socio-material achievements that have profound effects on the individuals so-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 discuss findings from a three year-long ethnographic study examining meanings and experiences of psychosis within an early intervention program in Toronto, Canada. Through participant observation and longitudinal narrative interviews with service users, family members, and clinic staff, I explore the juxtapositions that exist between psychiatric service users, family members, and clinicians in relation to the process and outcomes of diagnostic categorization. Highlighting the ways in which diagnostic practices could bring relief from suffering through the naming of confusing and frightening experiences while simultaneously enmeshing service users in regimes of truth and medical authority, I offer an analysis of diagnostic practices in FEP that dramatizes the relationship between biopolitics and the materialization of psychosis in the clinic setting. Drawing on feminist philosophy of science, I go on to relate this analysis to frictions that would frequently arise, for instance linking tensions around the acceptance of antipsychotic medications to forms of epistemic injustice and knowledge politics that would occur within the clinic.
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