Back in high school, I made the mistake of taking a sociology class.
I’m sure sociology is very interesting and ground-breaking at a graduate or PhD level, but it didn’t take me long to realize that everything below that level was just a not-so-fun game of “Let’s Learn Definitions!” Gesselschaft, Gemeinschaft, mores, quasi-group, ethos, role-set, anomie – word searches and fill in the blanks galore!
This pissed me off more than any class ever has since.
I sincerely felt like all of these terms were 100% made-up – somebody once sat down and said, “I’d like to write about the world has gone to crap and everyone pretty much deserves to die for their heatheness, but it doesn’t sound… scientific.. that way, so I’ll call it ‘anomie’.”
Even worse, asking you to memorize a definition without proof of why it exists is asking for implicit acceptance of a concept that doesn’t deserve it yet.
But the truth is, despite how unclear I am on what it brings to the liberal arts table*, sociology is a real thing. I just didn’t get any sense of appreciation for it.
This reminds me of how a lot of people in our class feel about psychiatry. Sure, there’s a few people who just flat-out have never believed in it, and an entire religion dedicated to bringing it down – but aside from that, most people would send their loved ones to a psychiatrist if they started hearing voices or crying 12 hours a day.
I guess the problem is that the “check off the boxes” approach to diagnosis is inherently… well, made-up. And I defend it instinctively because we don’t see any pertinent serologies or blood tests on the horizon, so we have to use something, right? It’s nice when 3 psychiatrists independently evaluating a guy can all agree on what he has. The certainty is comforting.
But the other day I was talking to a psychiatrist, and realized there’s a lot of internal dislike of the system, too. (here’s a fascinating article about how this is/isn’t shaping the DSM 5.)
See, our psych class is taught based on DSM classifications. But the psychiatrists I’ve met in real life don’t even have most of the DSM criteria memorized – exactly the opposite of the impression we get in class.
When I ask about DSM diagnoses, all of the psychiatrists I’ve met have said variants of “Once you’ve identified significant problems, it doesn’t matter if they fall into a category or not. You can use the closest diagnosis to guide treatment, and eventually, you need one for billing, but it’s not something to obsess about.” The reason they don’t memorize the DSM is because, when it comes down to it, it’s not going to do your job for you.
And speaking as someone who reads her psychiatry book for fun (nerd alert) – that’s so interesting to me. Although psychiatry is necessary and helpful, I guess the idea that the DSM categories aren’t always so? More generally acknowledged than I thought.
So what I wonder if whether we’re focusing only on the DSM categories and how to diagnose each one because a) you gotta walk before you run, or b) our teachers hope it makes us feel like the psychiatric method is scientific (compared to teaching “each patient is an individual, and you have to really find out what makes them tick instead of just sticking them in the first convenient category and calling it a day,” which sounds all liberal-arts-y.)
Because the people who dislike the lack of science in psychiatry? Are never going to go into psychiatry, no matter how much you try to avoid the liberal-arts-like uncertainty of it.
But the people who feel like the DSM categories are made-up and subjective might be relieved to know that not all psychiatrists treat them as the bible.
* Isn’t most of sociology covered by cultural and psychological anthropology? I never understood that.