Iterative generation of diagnostic categories through production and practice: the case of postpartum depression

Examining the process undertaken to name and codify psychiatric illnesses provides important insights into how everyday healthcare practices are shaped by knowledge production processes. However, studies of illness classification often rely on an overly simplified distinction between the production of diagnostic categories and the application of those categories in practice. Drawing insight from science and technology studies, I argue that psychiatric diagnostic categories are iteratively generated through production and practice, even during the development of those categories. Through a discursive analysis of interviews, archival documents, and psychiatric literature, I identify the practical politics that enabled the creation of the postpartum depression (PPD) modifier in the Diagnostic and Statistical Manual of Mental Disorders, version four (DSM-IV). In addition, I demonstrate how the overarching discourses of evidence-based decision-making and biomedicine shaped the development of the postpartum modifier, and draw together comments made by interview participants regarding the administrative value of a PPD-related category in the DSM. These remarks suggest that, in their practice, researchers and clinicians also take into consideration their own knowledge about DSM production processes, providing further support for the argument that diagnostic categories are iteratively generated.