Vincent van Gogh Corridor in the Asylum (1889)
This review is from TNI Vol. 22: Self-Help, out in November.
A new dystopian novel in the classic mode takes the form of a dictionary of madness
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 Orwells’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 counsellors 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
“The
libidinal achievements demanded of an individual behaving as healthy in
body and mind are such as can be performed only at the cost of the
profoundest mutilation … the regular guy, the popular girl, have to
repress not only their desires and insights, but even the symptoms that
in bourgeois times resulted from repression.” – Minima Moraliagranted
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 dsytopian novel in this mold.
American Psychiatric Association DSM-5 American Psychiatric Publishing (991 pages)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’s 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.
This is not to say that there is no setting, no plot, and no
characterization. These elements are woven into the encyclopedia-form
with extraordinary subtlety. The setting of the novel isn’t a physical
landscape but a conceptual one. Unusually for what purports to be a
dictionary of madness, the story proper begins with a discussion of
neurological impairments: autism, Rett’s disorder, “intellectual
disability”. 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. We’re dealing with a truly unreliable
narrator here, not one that misleads us about the course of events (the
narrator
is compulsive, they
do have poor insight),
but one whose entire conceptual framework is radically off-kilter. As
such, the entire story is a portrait of the narrator’s own particular
madness. With this realization,
DSM-5 starts to enter the realm of the properly dystopian.
This madness does lead to some startling moments of humor. One
vignette describes in deadpan tones a scene at once touchingly
pathos-laden and more than a little creepy: “He rubs his genitals
against the victim’s thighs and buttocks. While doing this he fantasizes
an exclusive, caring relationship with the victim.” The entry on
caffeine intoxication disorder informs us, with every appearance of
seriousness, that the diagnostic criteria include “recent consumption of
caffeine” along with “1) restlessness 2) nervousness 3) excitement.”
There are, occasionally, what seem to be surreal parodies of religious
dietary regulations: “Infants and younger children […] eat paint,
plaster, string, hair, or cloth. Older children may eat animal
droppings, sand, insects, leaves, or pebbles.” What the levity of these
moments masks, though, is the sense of loneliness that saturates the
work.
The narrative voice of the book affects a tone of clinical
detachment, one in which drinking coffee and paranoid-type schizophrenia
can be discussed with the same flat tone. 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. 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-process don’t matter, it’s as if they
don’t exist. The human being is a web of flesh spun over a void.
With this radical misreading, the American Psychiatric Association is
following something of a precedent in the actual psychological
professions. Sigmund Freud himself performs a similar feat of
ostranenie in his
Three Essays on the Theory of Sexuality,
in which he appears to take the position of an alien observer of
everyday affairs, noting that “the kiss […] is held in high sexual
esteem among many nations in spite of the fact that the parts of the
body involved do not form part of the sexual apparatus but constitute
the entrance to the digestive tract.” If you’re going to make a properly
objective study of human behavior, to some extent you have to disavow
your own humanity. You have to ask,
why kissing? Why
do people press their mouths up against each other? In
DSM-5
we can see a perverse mirror image of this kind of estrangement. Freud
retreats to a position of inhuman detachment to ask questions. Here, the
narrator does it to issue instructions.
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. Even an outburst of happiness can be
We’re
told this consists of a prolonged period during which the sufferer’s
mood “may be described as euphoric, unusually good, cheerful, or high”
and in which “the person may spontaneously start extensive conversations
with strangers in public places,” or – more distressingly, admittedly –
“a salesperson may telephone strangers at home in the early morning
hours to initiate sales”diagnosed as a manic episode. And then
there are the “not otherwise specified” personality disorder categories.
Here all pretensions to objectivity fall apart and the novel’s
carefully warped imitation of scientific categories fades into an
examination of petty viciousness. A personality disorder not otherwise
specified is the diagnosis for anyone whose behaviors “do not meet the
full criteria for any one Personality Disorder, but that together cause
clinically significant distress […] eg. social or occupational.” It’s
hard not to be reminded of a few people who’ve historically caused
social or occupational distress. If you don’t believe that people really
exist, any radical call for their emancipation is just sickness at its
most annoying.
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.
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