Book of Lamentations
October 19, 2013 11:25 AM   Subscribe

A new dystopian novel in the classic mode takes the form of a dictionary of madness. Sam Kriss reviews a recent book.

[I]t is founded on a wrong appreciation of the nature of things. Bonus review from Ian Hacking.
posted by RogerB (26 comments total) 23 users marked this as a favorite
...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.
posted by justsomebodythatyouusedtoknow at 11:52 AM on October 19, 2013 [2 favorites]

The newly published DSM-5 is a classic dsytopian novel in this mold.

posted by chavenet at 11:58 AM on October 19, 2013 [1 favorite]

This is just another denial of mental illness, with what salient points it does have to make about the social drivers of mental illness buried in cynical too-clever-by-half literary wanking.
posted by Benjy at 12:08 PM on October 19, 2013 [4 favorites]

which is the wank? the novel or the review or both?
posted by philip-random at 12:24 PM on October 19, 2013

Harlan Ellison's "From A to Z, in the Chocolate Alphabet," an actual dictionary of madness, includes this entry:


He was a very nice person. History has no record of him. There is a moral in that, somewhere.

posted by infinitewindow at 12:27 PM on October 19, 2013 [7 favorites]

The DSM-V has a bad habit of medicalizing ordinary human experience, for example in its overbroad definition of depression. This is what the articleis digging at. We can say that while still acknowledging that depression is very,very real, and that it calls for medical treatment.
posted by justsomebodythatyouusedtoknow at 12:27 PM on October 19, 2013 [2 favorites]

cynical too-clever-by-half literary wanking

I certainly agree that DSM-5 seems in desperate need of an editor's red pen — it's probably impossible to read the whole thing cover-to-cover — but I think the overwhelming verbal excess is part of the point, you know, a desperate attempt to do the impossible, as if the task of totalizing about human experience could be accomplished by exhaustively listing minutiae. It's possible to appreciate that as an interesting formal strategy without denying that it's also the work of a "wanking" narrator.
posted by RogerB at 12:30 PM on October 19, 2013 [1 favorite]

I thank God that I'm not in a profession where even the driest technical publications are picked apart by pretentious know-nothings hoping to get linked to in Arts and Letters Daily.
posted by aw_yiss at 12:38 PM on October 19, 2013 [10 favorites]

This is quite a good and clever critique of psychiatry as both a tool of authoritarian coercion and a flawed diagnostic model. Not a denial of mental illness, but an acknowledgement that the institution that controls treatment of mental illness is by no means trustworthy or objective, and offers no model for right living or human potential except status quo and dysfunction. An acknowledgement of the absence of acknowledgement within psychiatry of the social responsibility of psychiatry, the role of social factors in influencing mental health and the essential value of each individual's experience.
posted by byanyothername at 12:40 PM on October 19, 2013 [19 favorites]

Ha! It's a good punchline.

But the arguments themselves are insipid. There's much too much hyperbole and rhetorical outrage surrounding the bashing of the DSM. We're in state of profound ignorance about the causes and the nature of mental disorders... in the face of such ignorance, what should we do? Critics laugh at the DSM's attempt at an answer without bothering to try to answer the hard questions themselves. If our diagnostic categories are going to miss the mark, should we make them broad and risk overpathologizing, or narrow and risk underpathologizing, thereby refusing to treat people who could be helped? What do we want from a concept of mental disorder? What functions does it serve? Should we have multiple establishment-sanctioned diagnostic manuals for multiple purposes (e.g. directing psychiatric intervention, settling insurance claims, judging criminal responsibility, directing research, etc.), or would a world with multiple manuals cause even further harms? Should a diagnostic manual consider etiology, or attempt not to make contentious claims about causes when we basically know nothing about most of them? What do we do with culturally-specific expressions of disorder? Tough questions. I think that given the colossal disagreement in the field, for any possible nosology, if it were the prevailing nosology it would be ridiculed as much as the DSM is ridiculed.

The Ian Hacking LRB review linked in the More Inside is a much more interesting read, because he tries to suggest alternatives. His claim -- that Linnean subtype/supertype classifications are only appropriate when describing clades that are the product of natural selection -- is interesting, but I am skeptical. (Physical diagnostic manuals include subtypes of injuries: types of contusions, types of cancers, types of respiratory disfunctions, etc... why think that mental disorders should be treated differently?)
posted by painquale at 1:04 PM on October 19, 2013 [6 favorites]

This thing is full of typos. "Public hair"? Also no that's not what trichotillomania is. Also hardly original to write a winky winky piece about how psychiatry wants to make everyone into docile cows.
posted by sweetkid at 1:27 PM on October 19, 2013

There are very, very legitimate criticisms to make about the APA/DSM V, but I rarely see those criticisms n articles discussing it. They instead always seems to boil down to "they're making feelings into a sickness, maaaan" - for example:
"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."
Feeling pain is an inherent part of the human experience, no getting around that. You know what goes beyond that? Becoming so angry you smash your fist into a concrete wall, shattering multiple bones in your hand. Having a panic attack so severe that your face turns blue from inability to breath. Soiling yourself because you feel like your rapist is less likely to return if you're dirty. I challenge any of the oh-so-artistic writers who romanticize mental illness as "feeling" to spend a few hours trying to convince a man who is homeless because of his schizophrenia, or a teenager who stays up all night cutting herself to distract her from the fact that her abuser lives under the same roof, or the foster kid who fails every course on purpose in order to avoid disappointing another set of parents, that the real problem in society is this book that attempts to group sets of symptoms and behaviors together.
You want to criticize the DSM V, that's fine, but the most dystopian part of it is that pathologizing problems of a more social or existential nature is necessary in our society. Thanks to our shitty social safety net and poor healthcare system, the only way many people will ever get help addressing the social factors that lead to or exacerbate mental and emotional illness is if someone, somewhere, can bill for it and scrape their dollar off the top. The very need to address social justice and the personal dignity of all people through a medical text points to much bigger problems than the people who try to put it together, and while the end result may be a reference that is over encompassing in scope and sets off alarm bells for those whose chief interaction with human misery is through literary conventions, you're blaming the doctor for the nausea caused by the chemo and ignoring the tobacco exec who got rich giving you lung cancer.
posted by Benjy at 1:44 PM on October 19, 2013 [12 favorites]

Also hardly original to write a winky winky piece about how psychiatry wants to make everyone into docile cows.

The problem is the conceit of the dystopian novel. It's too easy. Yes, of course a long list of mental disorders makes it sound like the entire world is made of psychosis, but this is because while the author may be familiar with Adorno, he is almost certainly not familiar with the ICD-10, which features something like 69,000 separate diagnostic codes. And in that comparison he would have found the real metaphor, that the DSM is a romance novel, a love letter to the insurance industry, a peacock showing its many detailed feathers in desperate hope of approval. It is a letter of which we are not the intended audience, and so its strangeness is like that of the lover's language, the in-joke and the shared past, the private philosophy that can only be whispered tete-a-tete, because for outsiders to hear it would only sully its delicate truths, its secret understandings, and the only real obstacle to a perfect consummation, is that the subject of this conversation is us.
posted by mittens at 1:54 PM on October 19, 2013 [19 favorites]

Words can hardly describe how disappointed I was to find out that this is not actually about a dystopian novel written in the form of a dictionary of madness. Because I would absolutely love to read one.
posted by daniel_charms at 2:51 PM on October 19, 2013 [10 favorites]

I dunno, I'm about as pro-psychiatry as it gets, but I enjoyed this. The idea of taking the DSM as a Borgesian literary stunt is just too awesome to get in a snit over.
posted by Now there are two. There are two _______. at 3:23 PM on October 19, 2013 [6 favorites]

Very much BTW: The Future Dictionary of America is a good book.
posted by kozad at 3:40 PM on October 19, 2013

The idea of taking the DSM as a Borgesian literary stunt is just too awesome to get in a snit over.

I know what you mean. I really enjoyed it as a gustatory piece of writing without forming any judgement on the subject matter.
posted by walrus at 3:50 PM on October 19, 2013

For a second there I was like, "This book being reviewed sounds really cool. (I'm trying to get into new writers after a long phase of only reading dead people's writing.) It kinda sounds like a modern version of Robert Burton's Anatomy of Melancholy." So, what's the name of it? When I read DSM-V, I immediately knew this was going to be a bit too clever and insider joke-ish for me. Anyone who stumbles on this review and doesn't know what the DSM-V is having their leg pulled by a bit of a smartass.
posted by ChuckRamone at 5:54 PM on October 19, 2013 [1 favorite]

That book is crazy. I mean SERIOUSLY wacked out.
posted by Samizdata at 6:34 PM on October 19, 2013

Words can hardly describe how disappointed I was to find out that this is not actually about a dystopian novel written in the form of a dictionary of madness. Because I would absolutely love to read one.

Points if it's not directly influenced by the Cthulhu Mythos and Lovecraft's brand of motif of harmful sensation, which is way too overexposed in fiction these days.
posted by Apocryphon at 9:48 PM on October 19, 2013

Words can hardly describe how disappointed I was to find out that this is not actually about a dystopian novel written in the form of a dictionary of madness. Because I would absolutely love to read one.

Yeah, this. "Wow, that sounds like an awesome read!" is what I thought before I clicked the link.

Turns out it's just some candy-ass word-style hero slagging medicine he doesn't understand and not giving me a great new book to read
posted by Ray Walston, Luck Dragon at 2:21 AM on October 20, 2013 [1 favorite]

Under the pretense of dispassion this voice embodies a whole raft of terrifying preconceptions. Just like the neurological disorders that appear at the start of the book, mental illnesses appear like lightning bolts, with all their aura of divine randomness. Even when etiologies are mentioned they’re invariably held to be either genetic or refer to other illnesses such as substance abuse disorders. At no point is there any sense that madness might be socially informed, that the forms it takes might be a reflection of the influences and pressures of the world that surrounds us.

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.

This is hardly an unfair criticism. The notion that every mental illness has its supposed cause within the individual is a grave and harmful error in modern psychiatry.
posted by Wemmick at 7:59 AM on October 20, 2013 [2 favorites]


Please don't use homophobic slurs.
posted by This, of course, alludes to you at 8:31 AM on October 20, 2013 [2 favorites]

Other things that are totally part of the ordinary human experience: Ingrown hairs. Warts. Erectile dysfunction. Arthritis. Nobody complains that arthritis treatment is medicalizing the ordinary effects of aging, because having arthritis sucks and people are entitled to want something that will relieve pain, even if it's just annoying and not debilitating.

In the course of a life, you will qualify for dozens of different diagnoses, at least, of physical disorders and diseases. Colds. Cancer. Heart disease. We don't generally demand that any model for disease be one in which 99% of the public is completely healthy. Yet any model that finds mental disorders to be as common as physical disorders is instantly dismissed as impossible to be correct, because we have this idea that the vast majority of people are "normal" and completely free of any dysfunction?

I've met some small subset of humanity, and I didn't need a book to tell me that a lot of us are pretty darn dysfunctional. Now, excuse me, my eyes itch, I need to go find a Claritin...
posted by Sequence at 12:06 PM on October 20, 2013 [4 favorites]

This is hardly an unfair criticism. The notion that every mental illness has its supposed cause within the individual is a grave and harmful error in modern psychiatry.

It's also hardly a criticism of the DSM. The DSM doesn't make any such claims.
posted by painquale at 12:22 PM on October 20, 2013

Nobody complains that arthritis treatment is medicalizing the ordinary effects of aging

To make this analogous, though, you would have to push it further. There is a circle of patients with severe arthritis receiving appropriate treatment. But the analogy would require widening of that circle: People coming into the orthopedist's office for mild joint pain, which could be treated with a couple of ibuprofen, being instead put on regimens of steroids and Enbrel, wrecking metabolisms and racking up side effects. People going to see their GP, who is ill-informed about the effects of the drugs, prescribing them without giving patients sufficient education on them. An explosion of arthritis diagnoses, slicing them ever more finely, with great emphasis given to getting exactly the right diagnosis, coding it perfectly. Books and television shows about how arthritis is really a metaphor for our society, to the point you grow exhausted whenever someone compares the economy to your swollen and inflamed knuckles. Suspicion over trying glucosamine/chondroitin as self-medicating, and fear that if you ask the doctor for the one drug that ever worked for your joints, you'd get blamed for drug-seeking behavior. Your relatives all sending you articles on how you caused this yourself by cracking your knuckles so much as a kid.

I mean, I do see your point; but perhaps because psychiatry is both a science in its infancy, and given great cultural weight despite evidence of its limited effectiveness, it is problematic to see it so confidently touted as a working domain in the way that, say, ophthalmology is. (Compare and contrast to oncology, with its own abysmal success rate, but constantly racking up new discoveries and at least hints of effective treatments, with a growing understanding of the biology of its chosen disease, and very little cultural pushiness outside of us describing any unloved growing phenomenon as a cancer!)
posted by mittens at 5:55 AM on October 21, 2013

« Older Two words that should not go together: "Vagina...   |   Money Newer »

This thread has been archived and is closed to new comments