#nosology

[eligalilei]

Diagnosis vs Symptomatology as Guide to Treatment

OP:

It's a view within psychiatry that diagnoses are not that helpful and we should look at symptoms or symptom clusters and treat those. I don't share that view, but it is a view.

If you don't want medication then you likely don't want a long term therapeutic relationship with a prescriber.

You may need to see someone different to get the clear diagnosis that you want. Me:

In what way is this an insufficient perspective? There are for sure some clear clinical entities, but regardless of whether you call them 'symptom clusters' or 'diseases,' the world contains plenty of limit cases and statistical 'long tails.' This seems to be a way to deal with feeling like you're locked in to a particular set of solutions based on a term that might or might not fit the totality of the clinical presentation.

Regardless, someone is going to have to put something down for insurance at some point, so at the end of the day this all may be moot. OP: I feel that the major issue is that medications are tested against diagnoses. So eg throwing antidepressants against all low mood when they have only been tested against (episodic mood associated with fatiguability and anhedonia) mdd is not ideal. For instance for the chronic low mood associated with borderline, they either haven't been tested or possibly worse, they've been small scale tested and failed. Me:

As I said, there are relatively concrete disease entities; they can be seen to consist of possible sets of transformations of states which are defined in contrast. You're right, you can't just treat symptoms, but you can recognize continua and patterns from one state set in other presentations, and thus, even, treat aspects of a patient that don't fit with the clinical picture as a whole, but don't neatly fit into another diagnosis either.

Borderline is a particularly good example, since one can have borderline features in many senses, especially in crisis, and even view yourself through the lense of these criteria while in a crisis state, without necessarily meeting the five requisites. This could reason to give us pause in using, hypothetically, more activating meds in people who present with affective switching, or use an antimanic in someone who tends toward activation and psychotic intrusions, but doesn't meet duration criteria for BP. Possible cyclothymia with some borderline features would present as another point of connection between BP and BPD, for instance, and might merit consideration of a stabilizer on either side. Is this tested? No. But it's no more an unreasonable of a leap as that of assuming that another clinician took a good patient history that wasn't biased by the confounds of the particular moment and context of presentation. Btw, is the suggestion that BPD's instability is aggrivable by ADs? I could buy that. And, like, while we might be able to conceive of BPD as a distinct category... we have at least some biomarkers for TRD that suggest there's utilable subtypes in depression, some of which interlap with BPD (inflammatory cytokines, cortisol abnormalities) so even if BPD is distinct as a system of behaviours and states, options within the MDD formulary with antiinflammatory properties might be worth keeping on the table due to lack of options .

There's also, then, the issue of the repeatability of diagnosis, which, while not null, is sometimes questionable. By using the data from studies, you implicitly trust that some random guy (never the people doing the studies, not uncommonly a rushed ward doc with hundreds of patients) was able to render a sufficient picture of the patient so as to be actually rule out all other possible codings. Patholognomes don't always perform on command, some are probably even shy characteristically; yet others may prefer the stage of the ward, and be otherwise reclusive.

I doubt the brain has some quantitative gauge such that a system of affects becomes some totally new thing after a requisite time has passed symptomatic. And who is to say that one couldn't have MDD and BPD, if they are indeed semi-discrete entities. Or does the BPD eat the MDD?

Basically, I'm just saying you should look at the clinical picture as focused on relations between states and their possible factors, since that's more logical than a list of symptoms. The numbers on AD efficacy are already not so great. If you'll take a chance on giving someone a drug at all, you might as well take a chance on getting a treatment for them specifically, the nature of which is literally nothing you'll be able to discern from a study, though occasionally a case. I kind of think both sides of the aisle strawman each other, but at least the symptoms side has the advantage of appearing to acknowledge complexity and individuality, though it refuses the patient the sacrament of symbolic suture which is specification.

[faitsansorganes]

I like how when I first submitted my essay proposal my teacher was like "I wonder how much you're going to polemicize with modern psychiatry, it's a bold move so use literature if you do" and I thought mmmmm polemicizing with modern psychiatry, that sounds interesting and now it's a significant section of the essay (with literature ofc)

[transmutationisms]

i think when people talk about dsm diagnoses being 'destigmatised' it's usually the case that what they mean is the public perception of the diagnosis name (depression, anxiety, etc) has become associated with minor, temporary, or resolvable forms of distress. the experience of being so depressed you cannot get out of bed, or brush your teeth, or work -- that experience and those behaviours have never been 'destigmatised,' only associated with other diagnostic labels in certain discourses seeking to present 'depression' as treatable or minor. it's basically a semantic nosological shift, rather than any actual 'destigmatisation' of the behaviours psychiatry exists to pathologise -- widening (minimising) the diagnosis, then just moving any leftover 'scary' symptoms to a different diagnostic bucket. it's a rhetorical shell game that does not challenge, but exists symbiotically with, the ableism that causes behaviours like "not being able to get out of bed" to be stigmatised in the first place.

[trans-axolotl]

"Just as 'most prisoners walk into prison because they know they will be dragged or beaten into prison if they do not walk,' we can say that most of the psychiatrically committed walk into hospitals because they know they will be restrained or dragged in if they don't walk. Often, this power has not required the psychiatrist to know the exact source of the ailment they treat nor exactly how their methods act upon the mind; what matters is that the machine is running. A whole system, a tightly interwoven mesh of relays and discourses is in place to transform the psychiatrist's judgment into effective action: a working theory and classificatory system to organize the clientele and separate them from other objects of care or punishment (taxonomy or nosology); institutional spaces (the asylum is historically the most pervasive, but also clinics, group homes, psychiatric wards, etc.); judicial codes defining the status of the mad (generally analogized to animals or children); prescribed roles for legal actors (police, judges, forensic experts); a chain of bureaucrats to sort out matters of insurance, finance, and property in cases of institutionalization or guardianship; and approved mechanisms or surveillance and reporting to translate individual complaints into the state's administrative codes. There are as many points of contact as there are spaces of encounter and discourses of legitimation in the social world. One or more of these elements can be revolutionized without fundamentally changing the connection between the parts. For example, at various points throughout its existence, as we've already seen, a theory of 'social causation' prevailed over a biological one without changing the matrix that defines modern psychiatry, and the same can be said for some of the legal alterations to the patient's status throughout the twentieth century.

There is no psychiatrist-patient encounter set apart from a broader circuit of relations: patient-apartment-work-family-cop-partner-school-neighbor-psychologist-state-guardian-probate-judge-psychiatrist-hospital. And to be clear: our biology itself is shared and leaks throughout this chain at every step. Our bodies are permeable, open, they leak, bleed, consume, excrete; our bodies flow out into a common world, and are open to outside influence, as the COVID-19 pandemic has made so excruciatingly clear. A patient of the Utica Asylum put it beautifully in The Opal in 1852: 'Like fermentation in the chemical world, [humanity's] atomic adhesions are in constant enlargement and in silent operation, seeking out relations, and forming relations of unsurpassed beauty and comfort, because in conformity with nature and adapted to its condition, means and end.' Attempts to neutralize this network by relegating every actor and space in the chain external to the domain of the psychiatrist onto the order of natural history ('we're just responding to the demands of the family...' or 'that's a matter for the police...I just deal with the patient once they arrive here') expose this posture as a naively religious one. In denial of the profane world and its complications extrinsic to the holy circuitry of neural or endocrine highways of the One in isolation, they declare a monastic fealty to an object of study over and above the matrix that makes its study possible or their conclusions efficacious in any real encounter...

...If psychiatry still takes refuge in the desert of scientism--speaking in tongues of prolix jargon--it's because a paradise of healing did materialize, but not as a Promethean forge of liberated humans, nor even as solemn resting place of broken souls, but sank so low as to appear as nothing more than a mundane prison. Burdened by the unbearable weight of their failure, the next generation abandoned their project and ran away to the labs, relinquishing responsibility for the armies of the living dead. At least they hung a sign at the door of the asylum on their way out. It read: 'abandon every hope, who enter here.'"

-Storming Bedlam: Madness, Utopia, and Revolt by Sasha Warren, pg 32-34

[sysmedsaresexist]

(A Shitty But Important) News Flash ⚡️

📣🚨📣🚨📣🚨

Record scratch

Stop now

Please read

Before we forge on, this is unfinished. I just couldn't get through it. This article upset me. Posting just for the link and my unfinished thoughts.

Put down your pitchforks and pick up your reading glasses, we've got a mutual enemy.

Explanatory hypotheses of the ecology of new clinical presentations of Dissociative Identity Disorders in youth

This was published in 2022 and... please tell me no one else knew this paper existed? How have I never seen it before? I feel cheated. I feel like I just found out there's mean girls talking about our communities behind our backs.

I'm kind of speechless. I've highlighted the important bits, read those.

Abstract

Dissociative Identity Disorders (DIDs) are controversial psychiatric conditions encountered in clinical practice and nosology. DID, as described in the international classifications, has little similarity with the clinical picture of “DID” met in current youth psychiatry. From this perspective, we hypothesize that this current clinical presentation does not satisfy the categorical criteria of the international classifications. Based on the two terminological challenges related to the definition of DID (i.e., the notion of dissociative disorders and the different meanings of the term identity), we propose to differentiate two distinct entities from each other. The first is medical and listed in diagnostic criteria of international classifications; the second comes from popular culture and refers to the vast majority of clinical presentations received in daily clinical practice—presented under the term Dissociative Identity Conditions (DIC).

Pause, because I need that to sink in.

We've been downgraded.

I say "we," as if I'm including myself in this "youth" group. This article will tell you that it cannot be applied to adults.

But despite the fact that I'm (very) old, and despite that it explicity says it can't be applied to me, it does.

I feel personally attacked, despite my journey ending long before this applied to me. This tells me there's a flaw somewhere.

Since the status of DIC is a hot topic in current clinical psychiatry, we aim to identify eight possible explanations that can be provided to support its occurrence: (1) impact of iatrogenicity;

I need to stop right there and just... bask for a moment.

This article is about to tell you that your knowledge of DID is so good that you EDUCATED yourself into having a fake form of it.

There's no going back. We forge on.

(2) factors of suggestibility and desire for social acceptability; (3) psychoanalytic explanations; (4) neuropsychological explanations; (5) socio-cognitive explanations; (6) emotional labeling; (7) narrative explanations; (8) and transient illnesses explanations.

Let's pause again.

Let's think very hard for a second.

In conclusion, we sustain that DIC results from a narrative interpretation of medical discourse by popular culture, developing in patients presenting undeniable distress. Such a transient disease fits in an ecological niche, which echoes the values of society, persisting under the action of a need for narrative continuity of the self.

[ghelgheli]

something that reading histories of the transgender child really solidified for me is how deep the pathological narrative of transness as an acute condition runs. doctrines of the body as developmentally plastic, with this plasticity fading over time, with puberty as the main punctuation of this decrease—and nosology of transness as something that demands treatment and correction, normalization, modification up to an end goal—these work together to 1) render the "late" (post-pubescent) transitioner a primitive relic of times we did not know or could not do better, something to be dreaded and avoided through the "right" "treatments" we have now, and 2) the trans child as a site of repair-through-plasticity, so that they grow up into an unmarked form that the ideologies of binary gendersex can be at ease with, so that their transness is transient as far as the public is concerned and, adding 1 to 2, so that adult transness disappears outside the clinic

[atthecenterofeverything]

could you tell us more about your personal journey with anti psych? did you used to adhere to psych nosology in your understanding of the world? what brought you to the conclusions you have now?

first, sure! for your second question, yes, I did adhere to it.

for your third question, the short answer is tumblr and other platforms of discussion with fellow psychiatrized people.

the long answer is that i kept believing that doctors had to be at least a little right and i had to be at least a little wrong about the whole thing for far longer than i should have. the last time i was in voluntary therapy was like 3 years ago, for some shitty things that were happening in my life at the time, and I only stopped going because it became increasingly clear that the only path forward she saw for me was institutionalization. I didn't actually stop believing in any redemptive possibility for psychiatry, the dsm, and the mental illness paradigm until a little after that. however i've also been heavily lying to doctors and psychiatrists to achieve my ends in any way that was available to me at the time literally since I was a child so it's not like I had any kind of unwavering faith in medical knowledge before that. I just somehow thought that every horrible thing that had happened to me and many people around me within psychiatry had been, if wrong and abusive, then at least even remotely based on some kind of correct assessment. more precisely, what brought me to the conclusions i have now was reading about it but I'll say that for me this only came after I had more or less made up my mind (again, mostly thanks to blogs on tumblr and then sitting with my own experiences and my own life) because I simply don't think that anything would have reached me without that paradigm shift occurring in me.

[ontologicalevil]

will elaborate later perhaps but: well yes. but also, crucially, this isn't pop psychology's doing per se. it is also very much scientific psychology's (or psychiatry's) doing most evidently felt in the nosology of DSM-5. like according to DSM-5, you can in fact qualify for delusional disorder if you do believe someone is into you while they are not.

[dansnotavampire]

reblog for sample size and also a cookie

[eligalilei]

ex tempore remarks on (self-)diagnosis and its critics

I wrote most of this up as a comment, but thought it might be worth reposting, since it seemed like a pertinent thing to add to the discussion. I imagine this will get hate, if the enthusiasm of the opposing 'argument' is any indication, but I felt it bore repeating.

Before you jump down my throat about using the word 'enjoyment’ (sive/cum *jouissance*, plastic, &c. + their concepts) in certain contexts… I'll say that all things that serve a psychological function are accompanied by some manner of satisfaction. No, no one has a diagnosis purely recreationally, but they serve a certain role in the constitution of identity psychologically: the constitution of both 'reasons' and ‘causes’ for experiences:, they 'explain' why one is different, and are the foci of communities which offer various sorts of support and camaraderie (nothing said of their more or less positively certain antinomes). So, in that(,) they take on a(/,) not unmelancholic,(/) set of positive emotional valences. Even anger serves to give a kind of enjoyment, if not in the same way as more positive emotions.

I think that these attacks on people who are independently exploring, or merely at the beginning of an undertaking of exploration of, diagnosis are an indicator of some things that are deeply problematic about the psychology and 'politics' of identity in communities built around mental health diagnoses.

What I think is interesting, is that,: while the presence, or perhaps even the mere existence, of 'fakers' and the 'self-diagnosed' (or even just the not-yet-diagnosed) is often decried, few provide any kind of actual reasoning for their being troubled by it, much less one that seems to justify the vitriol, and the need for it to be restated every few days.

Who cares if someone says something on the internet? Who cares if someone 'diagnoses themself? They aren't writing themselves scripts for antipsychotics, ffs (and, let’s all be frank: before c. aripiprazole… who the hell would?) And while there probably have been literal 'fakers' at times, the people doing that clearly have some kind of psychological or social issue (which may, in isolated instances, even be theirs!) and thus deserve our pity, care, and carefully differentiated compassion, not hate. How crazy do you have to be to want to be crazy, exactly? Is such a desire plausible,.. even and especially if its subject(ivities) are capable of bringing them voice?

…

If you can't explain why something bothers you, or the depth of your botherment, I think there's a good chance that the reasoned or plummable cause is might be something with which your conscious mind might not be comfortable, and thus might not be entirely reasonable. Ok, sure, you don't get behind the idea of self-diagnosis, or just the idea of internet diagnosis, but why treat it as something that's a threat to the community? And to treat it as that to the patient themselves, or, much less, that as pathology or nome itself… how hard is it just not to click on a post? (Or, hell… just not to freaking post… lookin’ at you, Jorpers..) … Problem easily avoided.

I feel like the issue has something to do with the way we see psychiatry as being a tiny bit like a church .. (to what extent? And, thatmentioned, some not at all, with their bloody inheritances… ) with True Knowledge being only available through the priest-doctor, as well as maybe envy of those who are able to question diagnosis, which is a kind of substitute satisfaction, or supplement to identity that allows one to excuse one's failings (which we must see as being 'truly real' and 'scientific' in order to be valid, science being the arbiter of truth in this day and age).

On some level, people might feel that if anyone can receive such an identity from oneself, that it undermines the feeling of Truth it gives them. One needs to be seen by one with Knowledge to Actually Have the identity; it's an excuse for failings that must be doled out by one with authority... (which is never yet still quite theirs). if anyone can get it, then it no longer feels as good or 'real' of an excuse, and it fails to be as good of a suture for the severance from the social order which is the illness itself.

Also, all in(/-)groups come with a kind of unconscious enjoyment one can derive from inscribing its borders, and their inscription: only done by exclusion and inclusion. The gaze of the doctor is the means by which this is accomplished, which gives it scienceyness, allows it not be our own acts of inclusion or disclusion, and therefore we're not mean, just being 'Scientific'.

I think that sometimes, the very fact that an explanation is bothersome, might even be a clue that it's in fact true, since the uncomfortable is what is disavowed/repressed into the unconscious, or, rather, never fully constructed in the conscious mind to begin with, and perhaps even learned by imitation.

Honestly, I think the very fact that there are all these weird gatekeeping posts could be an indication that something like what I'm saying is the case; people enjoy communally making borders, and kicking people out, and by placing the onus on psychiatry, this enjoyment can be disavowed. Furthermore, there is else sadly deserving of comment: the idea of allowing people to consider (cf.: etym., *’desire*, ‘divine’ [perhaps astrally…], or even scry,] their own diagnosis as undermining or deprivileging the role of the psychiatrist, thus undermining the psychological 'satisfaction' (or, perhaps more easily understood, the 'role') of diagnosis and/of identity… for themelves, others, or, most comically… médicos themselves.

[librarycards]

i keep seeing that bpd is a response to complex trauma, but i developed bpd symptoms before experiencing any trauma at all. i would say it was probably "diagnosable" in high school, even tho nothing traumatic had ever happened to me. isn't it possible that there are mental illnesses that just exist? just an unhappy mix of genetics and brain chemistry? bc antipsychiatry seems founded on the predicate that mental illness is a response to life lived, but that hasn't been my experience

this is a good question! i think there are a couple of things to note here.

i should have been more clear about what i meant by trauma, and probably not used the clinicizing add-on. i disagree with the psychiatric monopoly on what does and does not constitute trauma, especially 'capital T'.

given the above, i think that it is more reasonable to say that personality traits - both those that are understood as normative and those seen as pathological - develop as a result of our lived experiences, traumas (quotidian and significant), relationships, and - i mean, maybe genetics, but i'm agnostic on the role of 'biology'.

i think that there is also space for the ineffable here. things that develop out of nowhere, for no discernable reason. part of the project of medicine/psychiatry is to name and "confirm" not only what it defines as problems but also their respective etiologies, hence the fixation with biology, life experiences, etc. as "creating" certain diagnoses.

so...

with all of this in mind, i think you have a few options. you don't have to identify with the diagnosis of bpd at all. you can use it as a way to contextualize the way you experience the world, with or without recourse to particular life experiences or perceived genetic antecedents. you can use it strategically to find support and abandon it otherwise. you can mix these up or imagine something else entirely.

i think what's important to remember here is that bpd, like any dx (especially PD dx's) are shorthands used to describe a collection of traits that a group of people seem to share. you are you before you are someone who has been marked as having bpd, and your personality is your personality regardless of what it's called, or if it's identified as somehow deviant. antipsychiatry doesn't mean that you need to find "organic" experiences that correlate 1:1 with pathologized traits, but instead to free yourself from the nosological impulse to find a concrete reason, definition, and reaction to everything you do/are.

tl;dr: you're you. you have traits associated with the contemporary diagnosis of bpd. what matters isn't so much "why," but what you do next.

[whencyclopedia]

Germ Theory

The Germ Theory, which emerged in the late 19th century, demonstrated that microscopic germs caused most human infectious diseases. The germs involved included bacteria, viruses, fungi, protozoa, and prions. Louis Pasteur (1822-1895), a French chemist and microbiologist, and Robert Koch (1843-1910), a German physician and microbiologist, are credited with the discovery of the germ theory in the 1860s-1880s.

Regarded as the most important discovery in the history of medicine, the germ theory challenged the medical profession to reevaluate how disease was thought about, offered possibilities for both the prevention and treatment of disease, as well as the discovery and implementation of new technologies to combat disease.

Previously, doctors assumed that disease was an internal process of the human body especially Hippocrates' long-standing four humors theory notion that excesses or deficiencies of four bodily fluids (blood, phlegm, yellow and black biles) led to illness and disease. The germ theory contradicted that idea by separating the disease from the afflicted persons. Furthermore, the new theory ushered in a regimented way of classifying diseases (nosology) according to the type of microorganisms causing the disease.

Historical Theories of Disease

Prior to the discovery of the germ theory, various theories were advanced as possible explanations for illness and disease in humans. The earliest theory was the miasma theory attributed to Hippocrates (460-370 BCE), a Greek physician. Derived from the Greek word meaning pollution or "bad air", the miasma theory suggested that decomposing particles from organic materials, plants or animals, poisoned the air. Although easily detected by smell, people who inhaled the "bad air" would become ill. Additionally, planetary movements, disturbances to the Earth, poor hygiene, and polluted water often contributed to miasma. Attempts to remove waste along with cleanliness were thought necessary to improve the atmosphere to avoid infection and disease.

Aristotle (384-322 BCE), a Greek philosopher, offered the spontaneous generation of disease. It was possible, Aristotle thought, for living organisms to spring from non-living matter. Furthermore, this process, like maggots appearing from dead flesh, was a regular and natural phenomenon.

Galen (129-216 CE), a Roman physician, extended Hippocrates' earlier speculation about the imbalance of bodily fluids as the cause of disease. Galen attached each of the four humors to a particular season characterized by hot, cold, dry, and wet. For example, colds and flues occurred most often during cold and wet weather. Any change in the weather or season could upset the balance of the four humors so treatments were devised to restore said balance e.g., purges, bloodletting, enemas, and vomits. These ancient theories dominated Western medical thinking about illness until the 19th century.

Another theory of the origin of diseases referred to supernatural causes. A person's sins resulted in contracting a disease or illness as a punishment from the gods or God. Ghosts, demons, and evil spirits also possessed the ability to afflict a person with illness. Magic, divination, spells, exorcism, and various drugs were used to diagnose and treat illness. It fell to a variety of healers – shamans, priests, diviners, medicine men – to drive away the evil spirits. Illness as a punishment for sins, as well as a test of faith, was later offered by Christian theologians as an explanation for disease.

Additional theories on the origin of diseases continued to emerge. Girolamo Fracastoro (1476-1553), an Italian physician, is credited with first using the word "contagion" when describing the transmission of illness. His "seeds of disease" theory argued that disease could be spread by direct or indirect contact or over long distances through no contact at all. A German chemist, Justus von Liebig (1803-1873), one of the early founders of organic chemistry, suggested that as a result of a chemical process from decaying organic matter, disease simply emerged in the blood (the body's "chemical factory").

Continue reading...

[transmutationisms]

to be honest i think the notion that autism is accepted / destigmatised / not carcerally punished is a distortion falling out of the atypically successful last few decades of largely 'high-functioning' autistic self-advocacy & corresponding widening of the diagnostic category. none of this really holds if you're talking about people designated very 'low functioning' / high support needs / etc—autism is very much still an extremely incarcerated diagnosis, you can't generalise from a subset of people online who are disproportionately likely to have more access (physically, mentally, financially...) & to be treated more like voluntary psych patients. like okay people sometimes think of the historical split between schizophrenia and autism as done and gone, but this is absolutely still considered to be a 'spectrum' presentation in a lot of psychiatric practice, including more psychoanalytically informed practice — and those swept into 'lower-functioning' autistic categories are absolutely still being institutionalised and abused, often in ways explicitly continuous with the treatment of schizophrenia. they're just not separate things. you can't really do a politics of psychiatrisation based on billing labels, especially with a label like autism explicitly configured as a spectrum in the professional discourse. the incarceration & punishment directed at one end of that spectrum is basically categorically completely different to the kind of softcore liberal 'fuck you, i got mine' advocacy popular on the other end. you can make of that what you will nosologically but it's an important phenomenon to attend to politically.

[oleandersbertamendez]

The Moon' paragraphy nosology deflects counsciouness, and advert the rest of its mind to a sense of passangers of aisles; in which its intended the solar system to manner a replica, just by moving ecuations and making present he breaktrought of time.

What is the purpose of light in ilumination?

[haggishlyhagging]

“Within the feminist analysis, the labelling process is seen to serve the function of maintaining women's position as outsiders within patriarchal society; of dismissing women's anger as illness - and so exonerating the male oppressors; and of dismissing women's misery as being a result of some internal flaw - and thus protecting the misogynistic social structures from any critical gaze. The earlier dissenters may have been correct in pointing out that psychiatric labels serve society: what they omitted from their analysis was that it is a patriarchal society.

In the historical analysis of women's madness, we have seen how nosological categories were ascribed to women who were actually archetypally feminine. The Victorian maiden wasting away in her darkened boudoir, the hysteric, the neurasthenic, the anorexic - all were aspiring to heights of femininity within the narrow confines which patriarchy dictates. The twentieth-century mad woman is no different. As madness itself is synonymous with femininity, those women who wholeheartedly embrace the gender role assigned to them, or those who reject it, are at high risk of being diagnosed as mad. As Chesler has commented:

Madness and asylums generally function as mirror images of the female experience, and as penalties for being 'female', as well as for desiring or daring not to be. (Chesler, 1972: 16)

The socialization of women can be seen to prepare women for the mask of madness, the 'desperate communication of the powerless' (Showalter, 1987: 5). Having no legitimate outlet for feelings of frustration, anger and misery evoked by the reality of living in a patriarchal society, women fall into the psychiatric trap. Madness in the wentieth century has become institutionalized as a discourse which legitimates the positioning of women as good/bad - attractive and seductive, dangerous and fearful. The discourse, associated with the fear of women and the confining power of madness in the nineteenth century, has merely taken on a tougher veneer of respectability, as well as extending its authority to greater numbers of women.

Thus the labels applied to women, labels which so cleverly place the problem within her as a person, distracting from the social reality of her life, serve to mystify the reality of her oppression, a process buttressed by the gender bias in psychiatric nosology, the labelling process itself.”

-Jane Ussher, Women’s Madness: Misogyny or Mental Illness?

[atthecenterofeverything]

In place of groundless "stereotypes" that posited continuities between homosexuality, vice, and deviance, a more scientific understanding could construct these associations not just as politically harmful but as objectively incorrect—as taxonomic errors. DSM reformers thus embarked on a larger epistemic project that sought to alleviate social stigma by reinvigorating sexuality as an object of science. Thus, reformers did not so much have to argue that psychiatrists alter their values, just that they better adhere to their own research standards.

In accordance with these efforts to produce more taxonomically precise sexual knowledges, "homosexuality per se" became an especially widely used turn of phrase amongst gay activists and allied professionals. This designation sought to circumscribe understandings of homosexuality, stripping it of wrongful associations with behavioral and personality types that were peripheral to same-sex object choice. By disarticulating homosexuality "per se" from gender nonconformity, for instance, activists could construe more damning images of homosexual gender variance as a simple confusion of diagnostic categories.

Similarly, responding to popular associations of homosexuality with transsexuality, Gold emphasized in a 1973 speech that being gay involved no uncertainty about one's gender or body and that he knew of "very few gay men who are... 'frightened' of their genitals." Gold even suggested that existing cases of gay effeminacy could be attributed to the emasculating effects of stigma and that gay men might be able to better achieve normative gender roles if they were afforded greater social acceptance.

In this view, correcting the nosology of homosexuality might actually help treat the symptoms of transvestism. By emphasizing that atypical gender expression had no intrinsic relation—or even correlation—to sexual object choice, the depathologization of homosexuality was secured through a repsychiatrization of gender nonconformity.

“We Are Certain of Our Own Insanity”: Antipsychiatry and the Gay Liberation Movement, 1968–1980, Abram J Lewis