The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder

By Allan Young | Go to book overview

Four
The Architecture of Traumatic Time

POST-TRAUMATIC STRESS DISORDER is part of a monothetic system of classification. Within this system, each classification (disorder) is identified with a list of criterial features that are individually necessary and collectively sufficient for including or excluding a case from the classification. A case that overlaps the boundaries between classifications is handled in two ways. Either the patient is given concurrent diagnoses—the case is diagnosed as belonging to both categories X and Y—or the patient is said to have a “mixed disorder,” which includes features of two different disorders, such as schizo-affective disorder.


Polythetic Classifications

DSM-III included one entry, schizotypal personality disorder, that did not conform to the monothetic rule. To qualify as a schizotypal personality, a patient needed to exhibit any four features from a list of eight. This is a polythetic classification, meaning that it is possible for two correctly diagnosed cases to have no features in common. In DSM-III-R, the number of polythetic classifications expanded, and it now includes the personality disorders, behavior disorders, and chemical substance use disorders. While DSM-III did not call attention to its departure from the monothetic rule, DSM-III-R does (Amer. Psychia. Assoc. 1987:xxiv; Livesley 1985:355).

When, in its introduction, DSM-III-R discusses polythetic classifications, it is referring to an explicitly polythetic system (Widiger and Frances 1988:615). In order for a case to qualify as a member of a polythetic diagnostic category, it needs only to cross an indicated threshold value. Membership in the classification is based on overlapping features (family resemblances), as in the following example, where cases get the same diagnosis (“X”) if they possess three out of six attributes (A to F):

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The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder
Table of contents

Table of contents

  • Title Page *
  • Contents *
  • Acknowledgments ix
  • The Harmony of Illusions *
  • Introduction 3
  • Part I - The Origins of Traumatic Memory 11
  • One - Making Traumatic Memory 13
  • Two - World War I 43
  • Part II - The Transformation of Traumatic Memory 87
  • Three - The Dsm-Iii Revolution 89
  • Four - The Architecture of Traumatic Time 118
  • Part III - Post-Traumatic Stress Disorder in Practice 143
  • Five - The Technology of Diagnosis 145
  • Six - Everyday Life in a Psychiatric Unit 176
  • Seven - Talking About Ptsd 224
  • Eight - The Biology of Traumatic Memory 264
  • Conclusion 287
  • Notes 291
  • Works Cited 299
  • Index 321
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