Beckett, Borges, and the American Psychiatric Association

A different angle on the DSM-V


We've written a fair amount here at Reason about the new edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. But Sam Kriss at The New Inquiry has found an angle we missed: to review it as though it's an experimental dystopian novel. An excerpt:

Brave New Edition

The scene this prologue sets is one of a profoundly bleak view of human beings; one in which we hobble across an empty field, crippled by blind and mechanical forces whose workings are entirely beyond any understanding. This vision of humanity's predicament has echoes of Samuel Beckett at some of his more nihilistic moments—except that Beckett allows his tramps to speak for themselves, and when they do they're often quite cheerful. The sufferers of DSM-5, meanwhile, have no voice; they're only interrogated by a pitiless system of categorizations with no ability to speak back. As you read, you slowly grow aware that the book's real object of fascination isn't the various sicknesses described in its pages, but the sickness inherent in their arrangement.

Who, after all, would want to compile an exhaustive list of mental illnesses? The opening passages of DSM-5 give us a long history of the purported previous editions of the book and the endless revisions and fine-tunings that have gone into the work. This mad project is clearly something that its authors are fixated on to a somewhat unreasonable extent. In a retrospectively predictable ironic twist, this precise tendency is outlined in the book itself. The entry for obsessive-compulsive disorder with poor insight describes this taxonomical obsession in deadpan tones: "repetitive behavior, the goal of which is[…]to prevent some dreaded event or situation." Our narrator seems to believe that by compiling an exhaustive list of everything that might go askew in the human mind, this wrong state might somehow be overcome or averted. References to compulsive behavior throughout the book repeatedly refer to the "fear of dirt in someone with an obsession about contamination." The tragic clincher comes when we're told, "the individual does not recognize that the obsessions or compulsions are excessive or unreasonable." This mad project is so overwhelming that its originator can't even tell that they've subsumed themselves within its matrix…[T]he entire story is a portrait of the narrator's own particular madness.

Read the whole thing here.

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  1. Is Lou Reed still dead?

    1. Here’s hoping.

  2. That was actually a brilliant “fuck you” to Lacan.

  3. “repetitive behavior, the goal of which is[…]to prevent some dreaded event or situation.”

    “The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by an endless series of hobgoblins, most of them imaginary.”

  4. It’s hard for the government to know what to do to people unless they’re put into categories.

  5. I am constantly amazed by how much emphasis the lay community places on DSM. This is a billing manual to use to obtain the diagnosis you will file with the insurance company. The DSM has very little to do with actual treatment.

    I know many psychiatrists and none of them say, “DSM says you have this, therefore here is our treatment.” In fact, DSM has no information whatsoever about treatments!

    Docs treat the individual, not the book. Please just get over the DSM, it is really pretty meaningless for the average mental health professional’s practice.

    1. You’re constantly amazed?

      That sounds kind of obsessive. And if it brings you a lot of anxiety, then I think the DSM-IV code for that was DSM-IV-TR #300.3…

      If you want to see which treatments that diagnosis will be covered for reimbursement, I suppose you’ll need to consult DSM-V.

      And if you don’t think which treatments are covered determines what kind of diagnoses people get, then you might be delusional–which is a whole ‘nother set of codes.

    2. Hilarious, good find by Mr. Walker.

      Anacreon, speaking on behalf of insane people, we resent you and your DSM in part for the same reasons we resent accountants who tell us our book-keeping sucks and doctors who say we need to lay off our poison of choice. It’s not so much that you are wrong as that we don’t want to hear it.

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