Bowker and Star shine a light at the intense battles which are often fought before a classification system becomes standardized. They use the example of the International Classification of Diseases (ICD). A set of diseases should be fairly straightforward, one would think. But developing this classification took many years and there are still many disagreements over it. For instance, tropical countries believe that tropical diseases are grossly underrepresented compared to "rich-world" diseases like cancer and heart disease. In Japan, heart attacks are considered a low-status way of dying, so death certificates will often list a stroke as the cause of death, leading to a skewing of results when compared to other nations.
They go on to demonstrate the many ways in which classification systems can "torque" one's own self-identity. They start with two extreme cases: tuberculosis patients who are completely dependent on their doctors to diagnose their status, and blacks in South Africa under apartheid, where a government declaration of one's race forced one to change residences, jobs and families. But it's easy to extrapolate back to our everyday lives.
How often do we face multiple choice boxes where none of the choices are right? We spend some time hemming and hawing, choose one that's closest, and go on our way. However, in the official record, the only piece of information was the final choice; all of our indecision as to which category was most relevant has been lost. In many cases, our identity has now been set by which box we filled out.
Bowker and Star examine this problem closely. They take the example of the Nursing Intervention Classification (NIC), where nurses were asked to describe what they do, so that it could be classified, standardized, and integrated into a billing system. Some nurses cheered the fact that they would now be "in the system". Others were aghast that they would not be free to do what they thought was right, and be forced to use a system that might not be appropriate. The tension between the system, and between the local adaptations one has to make for the system to actually function, was made clearly evident in this example.
No classification system is perfect. There will always be elements which do not slot neatly into a category. But it is important to remember that this is not a reflection of the element - it is a reflection of the inadequacy of the system. For instance, the platypus is not some sort of monster because it does not fit into our conventional definitions of mammal and reptile. It just illustrates that our definitions are incomplete.
Classification systems tend to get black-boxed, in the sense of Bruno Latour. They tend to become invisible, and we forget how much effort went into creating them, and the political and ethical issues that were bound up in their creation. Bowker and Star remind us of the centrality of classification systems, and provide an educational tour through their construction, our relation to them, and issues associated with them.