Katia Romelli

Sempre più spesso ci imbattiamo in giovani che manifestano nuove forme di disagio. Le classificazioni diagnostiche non mancano, anzi si aggiornano rapidamente e si moltiplicano in modo esponenziale sotto la categoria del “Disturbo di o della…”, che implicitamente rinvia alla necessità di trovare modi e mezzi per tacitarlo se non, addirittura, estirparlo. Genitori e Servizi sono spesso impotenti di fronte alle nuove forme del disagio contemporaneo, dove gli ideali che un tempo riuscivano in qualche modo a offrire delle soluzioni collettive o a temperarne l’angoscia hanno perso valore. Così il disagio si manifesta sempre più nella sua urgenza e l’unica soluzione possibile è la richiesta di interventi volti a “normalizzare” il comportamento del minore, interventi che spesso finiscono per acuire il disagio stesso e le modalità in cui ciascuno lo esprime. L’esperienza delle istituzioni che si rifanno alla psicoanalisi di Jacques Lacan rovesciano, invece, la prospettiva comune. Il disagio prima di tutto è una forma di appello, non un disturbo, e il comportamento che lo rivela è la parola, sebbene ridotta al torsolo, spesso mal formulata o espressa tramite agiti. Occorre ascoltarla nella sua declinazione singolare per farsi partner di ciascuno in modo unico, ritessendo relazioni di fiducia e sostenendo le invenzioni singolari che ognuno riesce a mettere in campo per trasformare il disagio in qualcosa d’altro. Quanto testimoniato in questo volume parte dalle esperienze di accoglienza di minori in diverse istituzioni, per introdurre una riflessione sul soggetto contemporaneo e abbozzare un discorso politico critico sulla spinta all’omologazione sempre più presente e offerta come l’unica possibile in una società che continua, invece, a dichiararsi democratica e globalizzata

Vegetative state is a medical condition with a strong impact on psychological wellness of family involved in caring. This research investigates relationships, conflicts and family functioning during patient’s vegetative state, care process at home and in clinic, economic impact of the event on family, wellness caregiver. The sample was made up of 120 caregiver of patients in vegetative state cured in Lombardia (North Italy). The study centred a semi-structured interview analysed using the software ‘T-Lab’ and 2 tests: the Symbolic Drawing of the Family Life Space and SF-36 Questionnaire on State of Health. Results show as family functioning and caregiver’s wellness depends on caregiver’s role and gender, time elapsed by the event and patient’s place of care. Research noticed an extreme poverty and closure of family relations, difficulties during patient’s transfer, a strong isolation of some members of family from social activity and weak relations with extended family, strong impact on work activity on at least one of family members.

The proposed revision of the DSM, published by the American Psychiatric Association (APA), and in particular the proposed exclusion of Narcissistic Personality Disorder from the fifth edition, has recently reopened a long lasting debate in psychiatry and in clinical psychology on the criteria adopted in the diagnosis and classification of mental disorders. Taking a critical psychological perspective, we integrate argumentation theory and critical discourse analysis in order to investigate the decision-making process through which the divide normality/pathology is established in DSM-5. For this purpose, we analyse 29 papers published between 2010 and 2013 which explicitly referred to a controversy about the propose of deletion of NPD in DSM-5, plus 3 Guidelines for making changes in DSM-5 published by the APA. The materials were approached considering how (a) diagnostic criteria are accounted for and legitimated; (b) evidence for these criteria is supported; (c) discursive and rhetorical devices are used to make the status of the knowledge about NPD “visible” in discourse, and doing so constructing the evidence upon which to found the criteria adopted to divide pathology and normality. The study highlights the role that evidentiality and epistemic positioning play in the construction and legitimisation of diagnostic criteria for NPD, focusing in particular on the so called evidence-based data.

The proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by American Psychiatric Association (APA), has reopened the debate in the psy-complex on the criteria adopted in defining pathology. Taking a critical psychological framework, we integrate the Gramsci’s concept of cultural hegemony with discourse analysis theory in order to study how the APA creates and legitimises its position as instruments to locate DSM as the hegemonic discourse within the mental-health domain. We focus on the argumentative and rhetorical devices used in DSM to establish evidences for diagnostic criteria and setup this knowledge as an objective order for shaping normal and abnormal in society. The analysis highlights two phases. First, the APA legitimises its position in the psychiatric domain via: a top-down strategy, which works to construct the APA as invested by other relevant public institutions with the authority to establish general nomenclature; a bottom-up strategy, which serves to characterize the APA as an organism that recognizes mental-health professionals’ needs and it is able to offer solutions. Second, the APA consolidates the DSM hegemony through the proposal of an atheoretical approach, grounded on evidence based and epidemiological surveys, and a cross-cultural validation.

Measurements and production of “hard facts” are at the core of the biomedical paradigm dominating in psychiatry and clinical psychology. The hegemony of this perspective, which aims at constructing a universal knowledge, has consequences in cultural, economic and political fields, as well as in the social practices. Taking a critical psychological framework, we integrate the Gramsci’s concept of cultural hegemony with discourse analysis theory in order to study the discourse of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA). For this reason, we use the lacanian discourse theory to analyse construction and legitimisation of the APA authority as an instrument to establish a specific epistemological perspective about normal and abnormal in society. In our view, this diagnostic classification system, grounded on evidence based model and epidemiological surveys, is the paradigmatic example of this approach to the psychological distress. Analysis highlights that the legitimisation of authority is accomplished via two discourses: the discourse of master and the discourse of university. The master’s discourse constructs order and control, creating apparent connections between particular signifiers, around which the knowledge can be stabilised and organised. Leaning on this discourse, in DSM-I and DSM-II, the APA aims to set up dominance in the psychiatric domain. In the meantime, it draws dichotomies between inclusion/exclusion and friend/enemy. The university’s discourse claims authority by virtue of expertise. This kind of power discourse can serve as a sophisticated way to legitimate the reigning master signifiers, through the elaboration of a “disinterested knowledge”. This discourse hides its performative dimension, presenting what effectively amounts to a political decision based on power as a simple insight into the factual state of things. Indeed, in DSM-III and DSM-IV, through the university’s discourse, the APA presents itself as “neutral” actor and the DSM’s knowledge as systematic and universal.

"The proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by American Psychiatric Association (APA), and, in particular, the eventual  exclusion of Narcissistic Personality Disorder (NPD) from the upcoming fifth edition, has recently reopened a long lasting debate in psychiatry and clinical psychology on the criteria adopted in defining pathology/normality. This study is intended to contribute to a well established scholarly trend that aims both to historicize psychiatry’s more essentialist claims and to challenge the pathologization of individual experience dominating both in clinical psychology and psychiatry.
Taking a critical psychological perspective, the main purpose of this study is to explore how mental disorders have been constructed and reconstructed throughout the course of different DSM’s editions, from DSM-I to DSM-V, and to uncover the underlying ideological assumptions on which these definitions are based.
In particular, we focus on the construction and legitimization of the authority position as instruments to convey knowledge and beliefs about the separation between abnormal and normal behaviour, and the way of shaping what is regarded as normal in society.
Critical discourse analysis is used as a methodological and analytical tool as it regards discourse as a form of social practice, constructed for particular purposes and serving the interests of particular groups, and permits to analyse structural relationships of dominance, power and control as they are manifested in language
In our case, it allows for the understanding of the argumentative and rhetorical strategies used in the DSM to construct and legitimate its authority in relation to the establishment of evidences for diagnostic criteria. We are particularly interested in the way in which the psychiatric discourse works to established an objective order that tends to naturalize its own arbitrariness.
Our analysis highlights that the legitimization of the authority is accomplished via two main strategies. The top-down strategy works to construct the APA as invested by other relevant public and political institutions with the authority to establish general nomenclature. The bottom-up strategy serves to characterize the APA as an organism that recognize mental-health professionals’ needs and is able to offer solutions.

The ways in which the psychiatric discourse has naturalized the effects of power and ideology is through the adoption of a particular form of what can be defined “technocratic discourse”, which implies “objectifying the subjective and, through this, to turn profound human issues into technical issues” (McKenna & Waddell, 2006: 213). The more and more sophisticated classificatory system adopted by the DSM over time can be regarded as a way to establish control over the subjective experience of psychological distress and to realize the purpose of turning the subjective experience into an objective collection of certainties.
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"The proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by American Psychiatric Association (APA) has recently reopened a long lasting debate in mental health field on the criteria adopted in defining pathology/normality. Taking a critical psychological perspective, the main purpose of this study is to explore how mental disorders have been constructed and reconstructed throughout the course of different DSM’s editions and to uncover the underlying historical and socio-cultural assumptions on which these definitions are based. In particular, we focus on the construction and legitimization of the authority position as instruments to locate the DSM as the hegemonic discourse within the mental health field, a standard reference for both supporters and detractors, which drives research, clinical practice and insurance decisions.
Our analysis highlights that the legitimization of the authority is accomplished via two main strategies. The top-down strategy works to construct the APA as invested by other relevant public institutions with the authority to establish general nomenclature. The bottom-up strategy serves to characterize the APA as an organism that recognizes mental-health professionals’ needs and is able to offer solutions.
The more and more sophisticated classificatory system adopted by the DSM over time can be regarded as a way to turn the subjective experience of psychological distress into an objective collection of certainties, and to realize a particular form of what has been defined “technocratic discourse” (McKenna & Waddel, 2006).
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