Psychiatric diagnosis as a political device

Diagnosis in psychiatry is portrayed as the same type of activity as diagnosis in other areas of medicine. However, the notion that psychiatric conditions are equivalent to physical diseases has been contested for several decades. In this paper, I use the work of Jeff Coulter and David Ingelby to explore the role of diagnosis in routine psychiatric practice. Coulter examined the process of identification of mental disturbance and suggested that it was quite different from the process of identifying a physical disease, as it was dependent on social norms and circumstances. Ingelby pointed out that it was the apparent medical nature of the process that enabled it to act as a justification for the actions that followed. I describe the stories of two patients, which illustrate the themes Ingelby and Coulter identified. In particular they demonstrate that, in contrast to the idea that diagnosis should determine treatment, diagnoses in psychiatry are applied to justify predetermined social responses, designed to control and contain disturbed behaviour and provide care for dependents. Hence psychiatric diagnosis functions as a political device employed to legitimate activities that might otherwise be contested. Social Theory & Health (2010) 8, 370–382. doi:10.1057/sth.2009.11