Diagnosis and disputation: “archiving” DSM–5

Book display at the DSM5 conference, Institute of Psychiatry, 4 June 2013

Book display at the DSM5 conference, Institute of Psychiatry, 4 June 2013

Diagnosis and disputation: “archiving” DSM–5

I have spent the last few months gorging on DSM–5 media discussions. (All too often I have felt as though I have been ingesting too many empty, sugar-spiked calories.) I had promised myself, then, that I would start a DSM–5 free diet on June 6, 2013, the day after my participation in the two-day international conference on DSM–5 at the Institute of Psychiatry, King’s College London and the associated Maudsley Debate on psychiatric diagnosis. So far, I have kept to one half of the bargain: no ingestion of newly minted, DSM–5-tinged materials. But there remains the question of how to finish digesting – and putting on record – what has already happened.

I work on the history and geography of twentieth-century Anglo-American psychiatry. I cannot but imagine that other social scientists and historians might be interested – in the future if not now – in reflecting on how those discussions about DSM­­–5 took place. Many of those scholars may feel – as I guess I was beginning to, as I thought out loud as a member of the closing roundtable of the DSM–5 conference – that DSM–5 might be remembered more for the extraordinary and vigorous series of discussions that surrounded it, than for its scientific innovations. (The contrast here would be, of course, DSM–III and the bold epistemological and ontological transformations in psychiatry that its architects effected.) If so, then I, as a contributor to both those Institute of Psychiatry events, should try to capture some of that discursive complexity for the benefit of fellow researchers.

And so this blog post documents links to resources that are closely tied to the Institute of Psychiatry DSM–5 conference, and to the associated Maudsley debate:

  • My ‘Storify’ of live tweets from the DSM–5 conference
  • My ‘Storify’ of tweets, photos and commentary relating to the Maudsley debate on psychiatric diagnosis
  • Prof Sir Simon Wessely’s fascinating blog post on the conference and debate. Simon was one of the organizers of the DSM–5 conference, a speaker at it, and chair of the debate.
  • The discussion page that we at the Centre for Medical Humanities blog have initiated on what those who live under, through and beyond psychiatric diagnosis think about the DSM–5 ‘debates’ and what has been left out of them.
  • A link to the podcast of the Maudsley debate on psychiatric diagnosis (I shall update this page when the podcast has been uploaded).
  • A link to the “Head to head” article (“Has psychiatric diagnosis labelled rather than enabled patients?”) in the British Medical Journal that reprises some of the arguments from the Maudsley debate on psychiatric diagnosis (and which is co-authored by Felicity Callard/Pat Bracken and Anthony David/Norman Sartorius).

Let me add a few thoughts on what it might mean to “archive” discussions that have taken place via Twitter and/or blogs.

Both the British Library and the Library of Congress are devoting extensive resources to archiving Twitter posts and webpages. Every public tweet (plus material on 1bn webpages) might eventually end up in the archive being initiated by the British Library (in alliance with the Bodleian Library, Cambridge University library, the National Library of Scotland, the National Library of Wales and Trinity College library, Dublin). The Library of Congress reported in January 2013, meanwhile, on its progress towards archiving every public tweet from Twitter’s inception through to April 2010 (when its agreement with Twitter was made), as well as noting that the agreement allows the Library to collect all public tweets on an ongoing basis. By January 2013, the Library had gathered approximately 170 billion tweets.

Some might well throw up their hands and despair at the sheer bigness of these big data. How on earth could any researcher navigate archives such as these? Graeme McMillan has argued in relation to the Library of Congress project, that it is far from clear whether we currently have the technological expertise “to actually make it an archive that serves any real purpose, as opposed to a permanent record that is – for all intents and purposes – unavailable to anyone outside of the Library itself”.

The web-application “Storify” – which is described by Wikipedia as a “Social Network Service” – is a means to cut a path through some of those data. It offers authors the chance to “curate” (what has happened to that verb? I lament how flaccid it has become) tweets alongside other material (including photographs, videos and webpages). It pulls certain tweets into alignment and lets others fall by the wayside.

I would love to know if media and/or archival studies scholars have yet written about Storify – about how its technological, juxtapositional and narratological specificities help to materialize particular modes of recording, discoursing and remembering. (If one wants to think harder about the historical capture of “data” and the logics of different kinds of archives, one could do no better than follow the work being done within Professor Lorraine Daston’s “The Sciences of the Archive” project (2010–2015) at the Max Planck Institute for the History of Science.)

As I produced my first two Storifies (is that the plural?) on the Institute of Psychiatry DSM–5 events, many unresolved questions passed through my mind. (One of them was: “Is there any point in doing this at all?”). In the Storify of the DSM–5 conference, I wanted to gather a complete record of all the live tweets that had been sent from delegates at the conference. (The process of searching under relevant hashtags resulted, additionally, in the capture of some – though not all – responses by others to those live tweets.)

Protest by Speak Out Against Psychiatry (SOAP) outside Institute of Psychiatry during DSM5 conference, 4 June 2013

I want to stress that this is not the same as gathering together all Twitter discourse encircling the conference.  For a start, I gathered tweets produced by delegates and not by those at the conference. While the category of delegate is pretty cut and dried, being ‘at’ a conference is less clear. In a certain sense, two groups of protesters (from Speak Out Against Psychiatry [SOAP] and  from the Citizens Commission on Human Rights [CCHR]) were ‘at’ the conference. Of course, protestors could not have live tweeted the DSM–5 presentations even if they had wanted to, since they were on the pavement and not in the lecture theatre. While the Storify includes (my) photos from the two groups of protesters, I could find no record of any tweeted exchanges between delegates/organizers and protestors. (The Dean of the Institute of Psychiatry, Prof Shitij Kapur did converse face-to-face with the protestors, though this was not captured, as far as I know, on media that can be pulled into Storify.) Perhaps, though, some of those delegates who tweeted from inside the conference identified themselves with the protestors outside? How would one know? How might future historians and sociologists come to interpret the skeins of relations and non-relations within these Storifies? And how might they begin to interpret what is not there, in those digital data?

Second, what of the tweets that are included in the Storify of the DSM–5 conference? Many are from me, since I had taken it upon myself to live tweet the conference. I had intended the tweets to be relatively flat summaries of each speaker’s talk. But how flat, exactly? How did my historical and social-scientific interests and investments inflect what I tweeted, what I photographed, and what I did not record? While I tried to capture a number of the questions from the floor (some of which posed robust challenges to members of the DSM–5 Task Force and the conference organisers), I certainly did not capture all questions and all responses.

The tweets from the other main live tweeter, Simon Wessely, tend more explicitly to comment on – rather than flatly to summarize – the presentations. It bears repeating that Simon was an organizer of the conference and is one of the most prominent researchers within the institution at which the conference was held. His tweets would undoubtedly have been somewhat different if he had been “simply” a delegate. There are, in short, numerous factors that – of course – affected how and what both of us tweeted. What will future historians think those factors are? Will they be the same as those I can list now?

All this is to say that I have started to think much harder about what it means to describe a digital “archive” as having gaps, infelicities and difficulties of navigation. I have been thinking about those rich bodies of work developed by historians and cultural theorists to theorize gaps and silences in non-digital archives. At the heart of that work are efforts to understand the constitutive absences that inhabit the creation of sources (who or what comes to be a historical source? Who or what doesn’t?); the creation of archives (what is judged worthy of archiving?); the structuring of archives (how do archival practices privilege certain voices and occlude others?); and the interpretation of archives (how do certain readings of certain archives come to be anointed as “official” history?).

All those questions are of course also at play in relation to the collecting of digital data. They are accompanied by additional questions about how those (big) data might be navigated – and of how different socio-technological practices carve out (create? uncover?) certain patterns amongst those data.

I have used the first few days of my DSM–5-free diet thinking, then, about how best to parse the different ways and means through which voices – in both digital and non-digital “archives” – can come to be heard, given weight, recorded, mimicked, not heard, lost, inflected, kept out, destroyed, misrepresented, transposed into another key, marginalized and foreclosed.

In the meantime, I hope that there is something to enjoy in what has been captured about the DSM–5 events at the Institute of Psychiatry. And do, of course, transform those “archives” by registering your voice below!

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4 Responses to Diagnosis and disputation: “archiving” DSM–5

  1. Hearing the Voice says:

    Reblogged this on and commented:
    Felicity Callard is a Senior Lecturer in Social Science for Medical Humanities in the Department of Geography and a key member of the Hearing the Voice research team.

  2. Nev says:

    One thought or question I have relates to the reception & interpretation of live Twitter feeds, Storify pieces, and even more fully fleshed bog posts by scholars and activists at a substantial geographical and cultural remove from events such as the IoP DSM conference: e.g. The UK seems to have acquired a mostly deserved (?) mystique or romantic status in the US as a kind of crucible of substantially more nuanced and intellectually rigorous explorations of key issues in the history, philosophy, and cultural theory of psychiatry. I wonder, however, how “realistic” a picture we (‘foreigners’/outsiders) acquire from social media, and what the implications of the myriad forms of projection and phantasy that the gaps in distance, context and access involved likely engender?

    By perhaps the same token, these gaps also seem to underscore a whole new level of textual autonomy. If there is “nothing but context” (Derrida’s later re-phrasing) what is the context here? How does ‘it’ diverge from more traditional markers, linkages, ties and geographical/physical/cultural manifestations of discursive ’embeddedness’?

    • Felicity Callard says:

      Hi Nev — yes, I have been fascinated at how Twitter feeds, in particular, help facilitate particular kinds of fantasy and projection. My own fall into Twitter came at roughly the same moment that I made a significant geographical move. The Twitter ‘feed’ became a strange projection screen as I sat, or lay, alone in a room that did not, yet, feel my own. I think a great deal about how both geographical and psychic distance and proximity work in relation to the strange rhythm of tweets that seem to fall down one’s screen. They cannot but remind me of my ferocious capture by Tetris many years ago. Though with Twitter, the instruction or command that those falling blocks give to me, the addressee, feels more opaque, if, at times, no less gripping.

  3. Felicity Callard says:

    I have updated my post to include links to the “Head to Head” in the British Medical Journal (Callard/Bracken v David/Sartorius, which reprises some of the arguments from the Maudsley Debate on psychiatric diagnosis), and to the podcast of the Maudsley Debate.

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