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Både reformen av den amerikanske diagnosemanualen Diagnostic and Statistical Manual of Mental Disorders (DSM) i 1980 og utviklingen av diagnoseverktøy basert på denne reformen, som Structured Clinical Interview for DSM Axis I Disorders (SCID I), har blitt kalt en revolusjon innenfor psykiatrien. Det viktigste med denne revolusjonen var at den la til grunn observerbare tegn og symptomer for diagnostiseringen. Den skulle, som de viktigste pådriverne for endringen framhevet, "focus on observable behavior only", og ikke gjøre slik psykatrien hadde gjort tidligere, å fokusere på "unconscious processes." Med fokus på det observerbare skulle psykiatriens diagnoser og verktøy bli mer pålitelige. Revolusjonen var en epistemologisk transformasjon. Denne artikkelen viser at den også var en ontologisk transformasjon. Grunnlaget for å fokusere på "observable behavior only" var en tillit til statistiske analyser og at sykdommen ville vise seg gjennom et bestemt antall forekomster av tegn og symptomer. Fra et statistisk grunnlag som i høyden kunne brukes til å si noe om sannsynlighet for en sykdom, ble bestemte fordelinger av tegn brukt som grunnlag for å konkludere om bestemte sykdommers 156 Tidsskrift for Forskning i Sygdom og Samfund, nr. 25, 157-171 eksistens. Gyldigheten til sykdommer ble basert på statistiske beregninger av forekomster av observerbare tegn. Artikkelen problematiserer både det epistemologiske og ontologiske grunnlaget for denne revolusjonen gjennom en studie av de vitenskapelige arbeider og begrunnelser som ledet fram til transformasjonen, samt ved studie av diagnoseverktøyet SCID i bruk. SCID blir studert gjennom bruken av verktøyet på massemorderen Anders Behring Breivik. Dette caset er et unikt materiale siden SCID ble brukt to ganger av to forskjellige team av psykiatere, og med diametralt forskjellig utfall. Caset brukes dermed til å tydeliggjøre svakhetene med grunnlagstenkningen. Do reliable signs give valid diagnoses? The psychiatric revolution and the use of its diagnostic instrument on a mass murdererThe reform of the American diagnostic manual for mental illnesses, Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 and the development of psychometric instruments based on this reform, like the Structured Clinical Interview for DSM Axis I Disorders (SCID I), has been called a revolution in psychiatry. The most important element in this revolution was that the diagnostic criteria was based on a knowledge production that "focus on observable behavior only", and not, as psychiatry had done earlier, with "reference to unconscious processes." By focusing on the observable, the diagnostic criteria and instruments in psychiatry should become more reliable. The revolution represented an epistemological transformation. This article shows that it was also an ontological transformation. The grounding for focusing on "observable behavior only" was a trust in statistical analyses and a belief that a specific illness could be found from specific number of appearances of signs and symptoms. From a statistical grounding, which could be used for saying something about the probability of an illness, specific distributions of signs were used for claiming the existence of illness. The validity of illnesses was based on statistical distributions of observable signs. This article problematizes the epistemological and ontological grounding of this revolution through a study of the scientific publications leading to the revolution and also by studying the use of the diagnostic instrument SCID. The latter is studied through the case of the mass murderer Anders Behring Breivik. This case gives a unique material, as Breivik was tested twice by two different psychiatric expert teams, but with diametrically opposed outcomes. The case is used to make evident some of the inherent weaknesses of the grounding.

In this article, we introduce Part II of the special issue on qualitative content analysis (QCA). To begin with, we provide a short summary of the rationale underlying both parts of the special issue and present some core conclusions based on Part I. Whereas in Part I we combined contributions by authors taking an inside perspective on QCA, focusing on conceptualizations of the method as well as challenges in applying it, in Part II we put together articles by authors who take more of an outside view. Like Part I, Part II is divided into two sections. In the first section, papers are presented in which QCA is employed in different disciplines. It can be seen that methodological requirements vary between disciplines, and that this results in different ways of using and adapting QCA. In the second section are contributions in which the relationship between QCA and other methods / approaches is examined or illustrated. Comparisons are made between QCA and Grounded Theory Methodology only, whereas combinations can be found with a variety of methods / approaches. We end by summarizing our main conclusions concerning the goals we pursued with this special issue, and highlighting some open questions and suggestions for future methodological discussion and development of QCA.

In this contribution we introduce Part I of the special issue on qualitative content analysis (QCA). We start by describing the rationale on which this special issue is based and our considerations in dividing the topic into two separate parts. We then provide an overview of concerns in the current methodological discussion of QCA, identifying four core areas: 1. the conceptualization of QCA as a hybrid of quantitative and qualitative elements or as a genuinely qualitative method; 2. the relationship between the German and the international discourse on QCA; 3. the question of whether theoretical and / or epistemological foundations of QCA can be identified; and 4. the lack of transparency in documenting the application of QCA. Next, we outline the process of putting together this special issue and provide an overview of the structure and how the contributions relate to each other. In this current Part I, we focus on contributions in which authors deal with questions concerning the conceptualization of QCA, and on discussions of challenges that arise during the application of QCA and how these challenges were met. We conclude that there are multiple conceptualizations of QCA in the literature, and that this multiplicity is reflected in the variety of challenges and creative solutions described by the authors in this first part of the special issue.