“The Madhouse” by Francisco Goya [Public domain], via Wikimedia Commons
So brilliant: an implicitly ironic but outwardly straight-faced reading of the DSM-5 as a dystopian horror novel, complete with a quasi-Ligottian assessment of the book’s narrative voice and view of humanity.
Great dystopia isn’t so much fantasy as a kind of estrangement or dislocation from the present; the ability to stand outside time and see the situation in its full hideousness. The dystopian novel doesn’t necessarily have to be a novel. . . . Something has gone terribly wrong in the world; we are living the wrong life, a life without any real fulfillment. The newly published DSM-5 is a classic dystopian novel in this mold.
Here, we have an entire book, something that purports to be a kind of encyclopedia of madness, a Library of Babel for the mind, containing everything that can possibly be wrong with a human being. . . . DSM-5 arranges its various strains of madness solely in terms of the behaviors exhibited. This is a recurring theme in the novel, while any consideration of the mind itself is entirely absent. . . . The idea emerges that every person’s illness is somehow their own fault, that it comes from nowhere but themselves: their genes, their addictions, and their inherent human insufficiency. We enter a strange shadow-world where for someone to engage in prostitution isn’t the result of intersecting environmental factors (gender relations, economic class, family and social relationships) but a symptom of “conduct disorder,” along with “lying, truancy, [and] running away.” A mad person is like a faulty machine. The pseudo-objective gaze only sees what they do, rather than what they think or how they feel. A person who shits on the kitchen floor because it gives them erotic pleasure and a person who shits on the kitchen floor to ward off the demons living in the cupboard are both shunted into the diagnostic category of encopresis. It’s not just that their thought-processes don’t matter, it’s as if they don’t exist. The human being is a web of flesh spun over a void.
. . . The word “disorder” occurs so many times that it almost detaches itself from any real signification, so that the implied existence of an ordered state against which a disorder can be measured nearly vanishes is almost forgotten. Throughout the novel, this ordered normality never appears except as an inference; it is the object of a subdued, hopeless yearning. With normality as a negatively defined and nebulously perfect ideal, anything and everything can then be condemned as a deviation from it. . . . If there is a normality here, it’s a state of near-catatonia. DSM-5 seems to have no definition of happiness other than the absence of suffering. The normal individual in this book is tranquilized and bovine-eyed, mutely accepting everything in a sometimes painful world without ever feeling much in the way of anything about it. The vast absurd excesses of passion that form the raw matter of art, literature, love, and humanity are too distressing; it’s easier to stop being human altogether, to simply plod on as a heaped collection of diagnoses with a body vaguely attached.
. . . For all the subtlety of its characterization, the book doesn’t just provide a chilling psychological portrait, it conjures up an entire world. The clue is in the name: On some level we’re to imagine that the American Psychiatric Association is a body with real powers, that the “Diagnostic and Statistical Manual” is something that might actually be used, and that its caricature of our inner lives could have serious consequences. Sections like those on the personality disorders offer a terrifying glimpse of a futuristic system of repression, one in which deviance isn’t furiously stamped out like it is in Orwell’s unsubtle Oceania, but pathologized instead. Here there’s no need for any rats, and the diagnostician can honestly believe she’s doing the right thing; it’s all in the name of restoring the sick to health. DSM-5 describes a nightmare society in which human beings are individuated, sick, and alone. For much of the novel, what the narrator of this story is describing is its own solitude, its own inability to appreciate other people, and its own overpowering desire for death — but the real horror lies in the world that could produce such a voice.
MORE: “Book of Lamentations“
For more on the DSM-V and the controversy it has elicited, see this.
Have you or anybody you care about ever suffered from depression? How about bipolar disorder? Autism? Schizophrenia? Attention-deficit disorder? Obviously, given the prevalence of these mental and neurological illnesses, the answer is almost certainly affirmative.
Or then again, maybe not. Here’s the dirty little trick that’s been pulled on all of us: each of those illnesses is a wholesale semantic/cultural invention, concocted out of thin air, that deserves to be put in scare quotes. And this, of course, imparts a whole new tone to them. Think about it: there’s an entirely different feeling when you say somebody suffers from “depression” or “ADD.” For full effect, imagine translating the scare quotes into the now-trendy “air quotes.” In fact, why not try it out. Say the words out loud and make the quotation marks with your fingers: “depression,” “autism,” “bipolar disorder,” “attention-deficit disorder,” “schizophrenia.” Feel the irony now coating these familiar psychiatric terms. Note how they no longer seem so familiar and meaningful, how they no longer seem to signify something literally real.
If you’ve successfully achieved this disorienting act of linguistic dislocation and decontextualizing, then you’ve begun to deprogram yourself and wake up from the spell of cultural hypnosis that’s been cast on us all by the American Psychiatric Association and Big Pharma. And that’s not just me talking; it’s actual members of the APA, including, most significantly, the lead editor of the DSM-IV, the fourth edition of the APA’s Diagnostic and Statistical Manual (see the linked and excerpted articles below).