O DSM, o sujeito e a clínica

Abstract

This thesis aims to show that, although the Diagnostic and Statistical Manual of Mental Disorders (DSM), since its third edition, states the atheoretical character of itsmethodology, there is a relevant contribution of the psychoanalytical theory about hysteria that underlies the Somatoform Disorders and Dissociative Disorders described in it. In order to do so, we have selected events that illustrate the controversial situations that exposed psychiatry to public questioning in terms of its scientific base and, then, organized a brief history of the development of psychiatric classifications, identifying the methodology used in its elaboration. We have verified that the application of the scientific method to the study of mental diseases, having been inspired by other fields such as botanic and physics, was associated with the objective of establishing a universal classification of mental diseases. The reference to the scientific method led psychiatry to a bipolarity between a base organicism and another psychogenic aspect, not having ever, in the range of scientific methodology, been able to solve the deadlock of the establishment of the etiology of mental diseases. The dissemination of psychoanalysis in the United States, following Freud conferences in 1909 at Clark University and also through Adolf Meyer's work, influenced the first two versions of the manual, and led to a movement of the North American psychiatry by suppressing these references from DSM-III. It was considered that the psychoanalytic etiology of the mental diseases did not suit science and threatened to disassociate psychiatry from medicine. On the other hand, studies in dependability that had taken place in Europe and North America, in mid-20th century, revealed problems in the validation of diagnosis, which led the American Psychiatry Association (APA) to deal with the lack of validity of the diagnosis by increasing its dependability, by applying a statistical index (Cohen's Kappa coefficiet), and to standardize the clinic interview. We show that these efforts constitute strategies for the exclusion of the subject not only from the manual, but also the clinic and professional training. Finally, we have specified the diagnosis of the Conversion Disorder, which has been historically connected to hysteria - an extinct category from tje manual - as an example of the psychoanalytic heritage of the DSM.