ABSTRACT
Living with a mental disorder can be frightening, debilitating, and discouraging. Although the history of psychiatry has been that of containment within insane asylums-not only of the mentally ill, but also of the mentally retarded, wayward girls, and those who fail to conform to norms of society-the current face is one of helping and treating people (Shorter 1998). This chapter analyzes a particular way of thinking about the institution of psychiatry that can get in the way of accurate diagnosis. As a philosopher of psychiatry, my perspective is informed by the importance of examining assumptions in nosology and diagnosis. This chapter focuses on epistemological issues in diagnosis that are embedded in psychiatric interpretations of patient defiance. I argue that defiance can be misinterpreted and thus can lead to misdiagnosis. My primary example comes from literature on behavior interpreted as defiant in African American boys and that can lead eventually to a diagnosis of oppositional defiant disorder (ODD).
