Making Up Patients: Diagnostic Classification, Administrative Kinds, and the Limits of Psychiatric Identity

Across a variety of clinical settings, electronic medical records coordinate care while structuring documentation, billing, eligibility, and institutional decision making. As a necessarily partial representation of the whole person, the record translates complexity into standardized forms that enable institutional action. Drawing on Hacking’s later work, this analysis introduces the concept of administrative identities to describe what happens when psychiatric classifications become embedded in digital records and begin standing in for the persons they represent. As medical records travel through institutional systems, they can become evidentiary baselines for subsequent decision making, extending, intensifying, and transforming looping effects. The epistemic injustice lies not merely in the record’s inevitable incompleteness, but in granting one partial interpretation the authority of reality while diminishing the person’s capacity to contest, contextualize, or revise it.