The DSM-5: A Dystopian Novel

Reading the DSM-5 as a dystopian novel, it becomes an obsessive catalogue of haunting afflictions and nameless characters striving for an impossibly anodyne normality.


| March/April 2014



Losing mind sternocleidomastoid

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.

Art by Alvaro Tapia Hidalgo

The best dystopian literature, or at least the most effective, manages to show us a hideous and contorted future while resisting the temptation to point fingers and invent villains. This is one of the major flaws in George Orwell’s 1984: When O’Brien laughingly expounds on his vision of “a boot stamping on a human face—forever” he starts to acquire the ludicrousness of a Bond villain; he may as well be a cartoon—one of the Krusty Kamp counselors in The Simpsons, raising a glass “to Evil.” Orwell’s satire of Stalinism, or Margaret Atwood’s on the religious right in The Handmaid’s Tale tend to let our present world off the hook a little by comparison. More subtle works, like Huxley’s Brave New World, are far more effective. His Controller, when interrogated, doesn’t burst out in maniacal laughter and start twiddling his moustache. He explains, in quite reasonable terms, why the dystopia he lives in is the best way to ensure the happiness of all—and he means it. Everything’s broken, but it’s not anyone’s fault; it’s terrifying because it’s so familiar.

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. Maybe the greatest piece of dystopian literature ever written is Theodor Adorno’s Minima Moralia, a collection of observations and aphorisms penned by the philosopher while in exile in America during and after the Second World War. Even if, like I do, you disagree enthusiastically with his blanket condemnation of all “degenerated” popular culture, it’s hard not to be convinced that what we are living is “damaged life.” It’s not an argument so much as revelation. In Adorno’s bitterly lucid critique everything we take for granted is suddenly revealed in all its hideousness. The world Adorno lives in isn’t quite the same as ours; he’s coming at his subjects from a reflex angle—they’re a bunch of average Joes and Janes, he’s a misanthropic German cultural theorist with a preternaturally spherical head—but his insights are all the more relevant because of this. 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.

It’s also not exactly a conventional novel. Its full title is an unwieldy mouthful: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The author (or authors) writes under the ungainly nom de plume of The American Psychiatric Association—although a list of enjoyably silly pseudonyms is provided inside (including Maritza Rubio-Stipec, Dan Blazer, and the superbly alliterative Susan Swedo). The thing itself is on the cumbersome side. Over two inches thick and with a thousand pages, it’s unlikely to find its way to many beaches. Not that this should deter anyone; within is a brilliantly realized satire, at turns luridly absurd, chillingly perceptive, and profoundly disturbing.

If the novel has an overbearing literary influence, it’s undoubtedly Jorge Luis Borges. The American Psychiatric Association takes his technique of lifting quotes from or writing faux-serious reviews for entirely imagined books and pushes it to the limit: 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. Perhaps as an attempt to ward off the uncommitted reader, the novel begins with a lengthy account of the system of classifications used—one with an obvious debt to the Borgesian Celestial Emporium of Benevolent Knowledge, in which animals are exhaustively classified according to such sets as “those belonging to the Emperor,” “those that, at a distance, resemble flies,” and “those that are included in this classification.”

Just as Borges’ system groups animals by seemingly aleatory characteristics entirely divorced from their actual biological attributes, 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. In its place we’re given diagnoses such as “frotteurism,” “oppositional defiant disorder,” and “caffeine intoxication disorder.” That said, these classifications aren’t arranged at random; rather, they follow a stately progression comparable to that of Dante’s Divine Comedy, rising from the infernal pit of the body and its weaknesses (intellectual disabilities, motor tics) through our purgatorial interactions with the outside world (tobacco use, erectile dysfunction, kleptomania) and finally arriving in the limpid-blue heavens of our libidinal selves (delirium, personality disorders, sexual fetishism). It’s unusual, and at times frustrating in its postmodern knowingness, but what is being told is first and foremost a story.

This is a story without any of the elements that are traditionally held to constitute a setting or a plot. A few characters make an appearance, but they are nameless, spectral shapes, ones that wander in and out of view as the story progresses, briefly embodying their various illnesses before vanishing as quickly as they came—figures comparable to the cacophony of voices in The Waste Land or the anonymously universal figures of Jose Saramago’s Blindness. A sufferer of major depression and of hyperchondriasis might eventually be revealed to be the same person, but for the most part the boundaries between diagnoses keep the characters apart from one another, and there are only flashes. On one page we meet a hoarder, on the next a trichotillomaniac; he builds enormous “stacks of worthless objects,” she idly pulls out her pubic hairs while watching television. But the two are never allowed to meet and see if they can work through their problems together.

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