I recently had a conversation with a friend about the DSM, which I’m always surprised when reminded that it’s an actual book that you can purchase. At the current going-rate of $149 ($199 for the hardbound), the retail price of the DSM has increased at twice the rate of inflation since the 3rd edition went into print in 1980 (it’s currently in its 5th iteration). The book provides a list of disorders used to diagnose, categorize, identify patients. If I were to allow myself a Foucauldian or Deleuzian slip, I might even call it an ever-growing list. In the newest DSM, you won’t just find a listing for depression but also its myriad forms, including ones that are based in grieving the loss of a loved one for an “unusually long” time. Without interrogating too much the positivist or scientivist basis of a diagnostic instrument like the DSM, a few disparate observations about its effects and what I think might be related phenomena:
public gains, interpersonal risks
As an undergraduate at UC Santa Cruz, Jonah Peretti, who co-founded both The Huffington Post and BuzzFeed and currently serves as the CEO of the latter (he is also the brother of Chelsea Peretti) published an article in the now-defunct journal of “20th century social criticism,” Negations that cites an impressive variety of primary material ranging from Deleuze and Lacan to Butler, Haraway, and Jameson to argue that capitalism would need to create an ever-growing number of micro-identities for people to fit themselves into, so that those identities could be commodified and marketed to. Aside from coming into its own as a now-interesting piece of internet trivia, the paper presents an interesting reversal of the Frankfurt School tradition that posits a contracting of commodified identifies, that the culture industry would of course subsume and create a predetermined selection of discrete categories from which consumers make an undifferentiated selection. Peretti writes, “late capitalism not only accelerates the flow of capital, but also accelerates the rate at which subjects assume identities. Identity formation is inextricably linked to the urge to consume, and therefore the acceleration of capitalism necessitates an increase in the rate at which individuals assume and shed identities.” That Peretti wrote this, and then went on to form BuzzFeed—the company responsible for the entire genre of “Which ___ character are you most like” quizzes— that we’ve come to associated with algorithmic feed culture, is perhaps one of the more insidious internet origin stories. If paragons of the contemporary internet like Elon Musk or Mark Zuckerberg feel threatening, they at least feel mockable in their narrow-mindedness. Peretti, by contrast, feels like a creature of greater cunning. Where we can at least see personalized newsfeed and algorithmic ad serve as mechanisms of mind control and self-driving cars as at least being a little suspicious, we seem to have, by comparison, happily accepted, and even advocated for, the proliferation of micro-identities to be publicly displayed and enforced. It’s not only that the expanding and colonizing effect of identity proliferation makes us feel secure and logical (the warm hug of being recognized), but that we’ve immediately moved to defending our identifications as somehow inherently and morally right. It’s identity politics being affirmed and contested in the everyday. It no longer takes widely circulated news articles of prominent figures guilty of cultural appropriation. The internet is filled today with people defending their micro-identities. We yell at each other all day on Twitter about whether any given sexual, psychological, or gender-related identity is valid. It’s not only expected to have a plethora of micro-identities, having the micro-identities themselves entitles you to moral capital.
And unsurprisingly, as mental health has begun to gain its place in the public health discourse and we become more capable of talking about the struggles that are often less visibly obvious, our newfound vocabulary has itself become an object of moralization. Sometimes I feel as though although mental health struggles have gained wider cultural recognition, it comes most visibly in the form of “men will literally [do] ______ instead of going to therapy” memes and conversations that start and end with “I was doing therapy homework,” rather than talking to each other about the struggle to make meaning out of our battles. There is a sense in which mental health discourse at the moment are just short games of call-and-response. Defenders of progress might retort, “the first step is awareness,” and I certainly agree. What I am less optimistic about, however, is the way in which we, at the moment, reward awareness above all else. That our friends go to therapy makes them interesting; that we can name our battles makes us personable. And further, when we reveal ourselves to each other the act of vulnerability is sometimes converted into intimacy, that sometimes these identifications bring us closer to each other, at least momentarily. But to interrogate our mental health any further risks these interrelational victories. There is that alarming NY Times essay, immediately maligned on social media, which warns readers “to be mindful” of spending too much time with friends who struggle with weight, depression, or substance-abuse issues. Although I, like many in the Twitterverse, was injured by the suggestion that cutting out our depressed friends should be part of a normative ethics, I understood, as well, what the author was trying to express, even if it was executed callously. The often heartbreaking truth is that we are not always present as our most compassionate selves to our friends and loved ones in need, because feeling present in those circumstances very often touches on feelings of responsibility, obligation and emotional weight. It’s inherent in the way in which we talk about mental health as a precarity that when we sense that someone that we care about is in a precarious situation, the ways in which we are and are not able to show up risk falling short, and instead we sometimes decide that we either do not want, or are not capable of, learning, by many bouts of trial and error, to share the burden. I think anyone that has ever opened up about a personal struggle will reveal that it’s not the shame or embarrassment of diagnosis that comprises the vulnerability and gives hesitation, it’s the fear of how someone very important to you will react to the implications placed upon them, however unintended. And someone that’s been in this position will probably share as well that they’ve ran through the prospect of forever altering a relationship that they probably wish to remain as it was, even as they desperately cling onto the hope that this won’t be the case. So, no doubt, you can see where I’m going. There are inherent risks in living with mental health diagnoses that are only confronted long after identifying with them. Having a conversation about a diagnosis is very different from having the dozens of subsequent conversations about how you are managing and failing to manage to live with the affective realities of that diagnosis, the latter conversations posing disproportionately more interpersonal risk than the former. Using the DSM as a sort of Wu-Tang name generator for our personal identity may be increasingly recognizable—we seem to be making strides in deterritorializing the lexicon, but much of the discourse on the lived experience by its sufferers remain hostile grounds, which leaves us stuck in a place where self-identification is valorized without any incentive (and lots of real risk) to move the conversation to a place beyond. And so we celebrate being halted in our neat, approachable matrix of categories, labels, and identifications.
normalization, destigmatization, inequalities
There are two competing paradigms that I think would both consider themselves progressively-minded. There is, on the one hand, the belief that the suggestion that mental health disorders are inherent parts of the brain, is frankly, bullshit; there is, on the other hand, the work being done to map these disorders to their neurological sites.
In the first school, the argument goes:
“If we were to believe that the diagnoses of the DSM were inherent to the human brain, we’d also have to believe that Black people’s brains are inherently three to four times more psychotic than white people’s, that LGBTQ people’s brains are inherently more depressed and prone to suicide, and that transness and schizophrenia, autism, and ADHD are all linked by brain chemistry.
And to deny that mental differences are contextual is to deny that other cultures have completely different ways of dealing with them that don’t follow what we’ve assumed to be a fool-proof, scientific American method.”
This social model of disability, long seen as part of socially progressive disability advocacy, emphasizes mental illness as maladaptive. It is the post-structural view of diagnosis. That diagnoses are a symptom of organization, must be seen as contextual, and relative to and marginalized by the normative social structure around them. One impulse contained therein in this belief, is that we might be able to destigmatize mental health struggle if we can recognize the ways in which our norms have marginalizing effects which do not equally support all members of society. It is allied with the tenet of equality for all.
In the second school (the school of social neuroscience), the terminologies of diagnosis are meant to encapsulate spectrums of disorder and despair. The emphasis is placed on the presupposition that disorder has a neurobiological logic, rooted in a biology that we all share, and that diagnosis is a measure of activation of a spectrum along which we all find ourselves. This scientism, ironically, shares similar egalitarian ideals with the post-structural school to which it finds itself opposed.
My intention is not to take a side in the debate, or even to cast judgment on the ways in which diagnoses and therapy are pursued. However it operates and despite the contradictions that arise when we take pause to interrogate it, it does lend very real benefits to very real people, and that alone is enough. These effects are not ethereal, theoretical—they are in fact very material and very real. Just as real, however, are the consequences of a lack of firm scientific consensus and constant public debates regarding the status of mental disorders leaving individuals adrift as to how to live full ethical lives while at the same time depression and anxiety often make individuals feel especially lost when it comes to being responsible for themselves and the world. It is not that conversation and debate surrounding micro-identities and classifications are somehow unnecessary—they should be part of an ongoing interrogation of the way we conceptualize ideas of the self and the individual—but there is a way in which present discursive structures privilege this debate as the matrix from which all mental health struggles emanate that produces a halting feeling for a discourse that aspires to have a progressive historical force.
The terminologies of anguish and despair are increasingly present in the American public, and this is something that we should be grateful for. But let’s also acknowledge that mental health discourse exists in chatter, in fleeting moments of bookended by “but that’s enough about me, let’s talk about something more pleasant,” in corporate training videos, in internet essays, and in Twitter replies. For individuals struggling with anxiety and depression, where both support and despair often feel uneven, periodic, and contingent, the coming and going of conversation and argument in these discourses makes individuals feel especially adrift where there are multiple conflicting sources of information and misinformation regarding mental illness and one has to then try to navigate for oneself what works as their own personal truth. This is related to Miranda Fricker’s conception of hermeneutical injustice, except hermeneutical injustice focuses specifically upon when knowledges are missing whereas being epistemically adrift can be the experience of having too many overlapping knowledges that sometimes conflict with one another. It is not just the problem that one is depressed or anxious, but one has to continuously live within a society that does not understand, speak on, accept, or make sense of these conditions. One ends up in a feedback loop of feeling lost and not finding suitable or clear narratives that can help them decide what sort of life (or even day to day life) works best.
Clinical psychologists (or psychiatrists) do not think of themselves as philosophers; in a sense, then, they get to create visions of a worldview without passing the more stringent philosophical tests with which philosophers abase themselves. Different mental health outlooks presume different value structures, and different modes of being in the world. However, because their authors are not philosophers, this may go without ever being examined; it is merely built in, like a light-switch no one notices and no one asks about.
Much of the lived experience of depression and anxiety has been likened by its sufferers to being lost at sea, drowning, having trouble navigating their lives, etc. Depression and anxiety disorders are hostile conditions, often unmanageable and unnavigable forces that compel individuals to ruminate or prevent them from living well.
Are microidentities buoys in this epistemic drift? Or are they fata morgana?