The representation of ADHD in psychiatric institutional discourse and the social construction of sufferers' identity: DSM-V as a case study.
Sarah Vilar Lluch (University of East Anglia)
This research analyses how psychiatric institutional discourse shapes Attention Deficit/Hyperactive Disorder (ADHD) in order to understand how this discourse (1) has an active role in modelling a canonical representation of the illness, and (2) contributes to the social formation of an identity for the diagnosed individuals. Attention is paid to any evidence of stigmatization in the data. The investigation is performed through a qualitative data-driven critical discourse analysis (CDA) of the ADHD chapter of the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) (APA:2013). The data analysed sums a total of 2622 words. DSM-V was selected as source of data for its international authority and application (Horwitz, 2011; Horwitz & Wakefield, 2006). Halliday and Matthiessen (2004) Systemic Functional Linguistics (SFL) is adopted as methodological framework, complemented by Jeffries (2010) text-based analytical toolkit, grounded in SFL. The analysis is mainly focused in the study of the analytical metafunction and is developed in three analytical axes or complementary studies, each one articulated around one of the major participants in the diagnostic process: (A) ADHD, (B) the patient, (C) the clinician. ADHD is taken into consideration as object of discourse, the study does not intend to question the ontology of ADHD nor to undervalue the psychiatric discourse. Discourse is understood in the Foucauldian terms, as the socially constructed representation of reality, legitimized and spread through the institutions, that defines what can be known and the different possible positions subjects can occupy (Foucault, 1969:73), adopted in CDA tradition by Fairclough (1989). The results show that the prototypical ADHD target is identified with a querulous elementary school-aged white boy. ADHD is defined by its symptoms and established as perilous in virtue of its associated consequences. Insufficient attention and excessive movement or talk are graded according to standards ultimately founded on social desirability. DSM-V not only provides the orthodox description of all categorized mental disorders, it also establishes the standards all individuals have to meet to be sane.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders 5th Edition Arlington, VA, American Psychiatric Association.
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Fairclough, N. (1989). Language and power. London: Longman.