The Epic Human Journey: Part 4, Autumn

Lost in the forest

The labyrinthine madness of the DSM-V.
JUSTIN PAGET/FUSE/GETTY

Bouts of mania, and eventual clinical insanity, are more often than not predicated by the need to establish order amidst an unraveling present. In early psychotic states, patients become obsessed with random linkages and relationships where none exist, leading to the self-manifestation of more concrete connections as they indulge increasingly strong impulses. This succession is slow at first, and then increases in frequency and scope as time passes. As detachment from reality grows, greater categorization, greater schematics, greater lists, become essential to manage internal panic. Eventually, individual tallies become tallies of tallies . . . and lists become lists of lists.

The progression of the Diagnostics and Statistics Manual (DSM) from 1952 to the present day DSM-V, follows an identical pattern. In fact, fitting all the mental afflictions of the West into a neat and tidy 947 pages is exactly the type of mania you would expect in a modern hyper-rational neurotic patient.

The latest version of the DSM was nearly two decades in the making. Thousands of practitioners, associations, foundations, students and universities and millions of hours of grunt work—not to mention the institutional backing of the 36,000-member American Psychiatric Association—went into its birth. The result is a highly profitable, and significantly profound, symptom of the insanity epidemic sweeping the globe. Part McLuhan, part Freud, inside the DSM-V is a deep and unintended revelation. Medium. Message. Subconscious. Drive. The revelation is not Big Pharma's influence on psychiatry or the relentless drive of capitalism to profit from mental illness—though these remain obvious concerns—but that the DSM-V project itself represents collective madness.

It wasn’t until Darwin located the mechanism of human evolution in genealogy rather than taxonomies that scientists truly began to understand, instead of react to, nature, says Canadian philosopher Ian Hacking in his review of the DSM-V in the London Review of Books. That same transition has yet to happen in mental health. Instead, the majority of Western approaches to insanity continue to operate within the taxonomy model, focused on symptom over causation, appearance over mechanism. And herein lies the heart of the argument that DSM-V is the ultimate symptom of the suffering modern mind. Unable to break from obsession over meaning and control, the entire symptomatic range of the abnormal has been designed for easy reading and easy diagnosis.

“Trying to get it right, in revision after revision, perpetuates the longstanding idea that, in our present state of knowledge, the recognized varieties of mental illness should neatly sort themselves into tidy blocks, in the way that plants and animals do,” Hacking says.

As it stands, the DSM-V is the ultimate symbol of the very plague it is trying to manage. And if the next DSM, which will come two decades from now, is to have any value, it must begin with uprooting the insanity at its core.

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