Classification, selfhood, and culture in the Diagnostic and Statistical Manual of Mental Disorders and the Psychodynamic Diagnostic Manual

Abstract

For decades, social scientists have critiqued the construction of knowledge in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). However, they have not conducted research with an alternate classification from psychoanalytic and psychodynamic practitioners known as the Psychodynamic Diagnostic Manual (PDM), which is beginning to disseminate globally. This article analyzes cultural assumptions underpinning the classification rationale, concept of the self, and relationship between culture and mental disorders through close readings of DSM-5-TR (2022) and PDM-2 (2017). It shows that DSM-5-TR's notion of scientific evidence is informed by an emphasis on biological research in psychiatry, which PDM-2 views as mostly irrelevant to clinical work. Instead, PDM-2 claims to speak authoritatively for the inner experiences of patients and clinicians in the therapeutic relationship. Both classifications share a concept of an ideal self that is individualistic, consistent across time, able to narrate rather than just feel emotions, and in control of cognition, emotion, and relationships. Whereas DSM-5-TR views the culture concept as a lens to interpret the patient–clinician encounter, PDM-2 uses the culture concept inconsistently. I situate these findings within extant anthropological research and propose new directions to examine how both classifications are used in local contexts.