DSMV reviewed as a work of dystopian literature


Grrrrr. Making prostitution a subset of “sexual acting-out” behaviors common in girls with conduct disorder infuriates me (Granted, this isn’t new to DSM 5). Minors engaged in prostitution are not acting out, they’re being preyed upon. Some of the behaviors, like running away and staying out all night at an early age, can make one more vulnerable to predators who are looking for unprotected children to abuse. But listing the selling of underage people for sex as a symptom of a certain disorder (for the underage people, not the perpetrators!) is absurd and almost… dystopian?


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.

No. That is not what it claims to be. It claims to be a scientifically validated way to diagnose mental disorders that are accepted by the medical community.

DSM-5 arranges its various strains of madness solely in terms of the behaviors exhibited.

It is not a textbook. It is a scientifically validated way to diagnose mental disorders. This is done via observations of behavior. It is designed so a clinician can use it to diagnose a condition, consult the appropriate scientific literature about the condition and treatments, and prescribe treatment based on those studies.

Unusually for what purports to be a dictionary of madness

It is not a dictionary of ‘madness’, whatever that may mean. It is a diagnostic manual.

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 is where the review starts to become disturbed. Mental illness is a disability, not a moral judgement. You can treat bipolar disorder and be a happy person just as much as you can treat diabetes or asthma and be a happy person.

The rest of the review is worthless. It just plays on stereotypes and makes jokes at the expense of people suffering from disabilities while ignoring the purpose of the work. I’m sure the author of this piece was trying for humor but didn’t realize his bigotry. Would such a dystopian work have ever been contemplated for any other medical disorder, such as skin lesions or cancer? Of course not. Disabilities are not a subject to be gawked at and used for humor.

The author obviously considers the DSM-5 to be worthless and uses these twisted arguments to sink his point home. The ‘normality’ argument is the core of the thesis. But would the author also use the ‘normality’ argument for a diagnosis of cancer or arthritis? And in the context of considering a mental illness to be a disability, wouldn’t it be counterproductive to make a definition of ‘normal’? A diagnostic manual is not supposed to define normal. It is designed to treat illnesses. Again, a mental disorder is not a moral judgement or ‘madness’, but a disability that is causing impairment. It is offensive to demand a definition of ‘normal’ in this context since this implies that there is some goal of a perfect human being instead of a goal to treat an impairment or disability.


It doesn’t say that prostitution is the result of a mental disorder; it says that females with conduct disorder are more likely to engage in prostitution than males with conduct disorder. It also explicitly states that there are all sorts of risk factors, and cultural context to take into consideration.
That said, I definitely think “Conduct Disorder” is one of the sketchier, more prone to abuse, disorders the DSM V came up with.

It’s easy to make fun of the DSM-5, but it is a necessary object. We need a way to diagnose people in a way that isn’t subject to the diagnoser’s whims and intuitions. Diagnosis can be useful for some people as a way of pinning down what is causing their suffering. But yes, it can turn into a hammer for people who see nothing but nails. But the most important reason we have the DSM-5? Insurance companies. They need a diagnosis before they’re willing to shell out the dough.

It doesn’t suggest causes; it doesn’t suggest treatments. It’s just a descriptive tool. An equally amusing dystopian novel could be made out of a phonebook, where everyone has been reduced to a name and a few numbers.


Did anyone else read this:

they’re a bunch of average Joes and Janes, he’s a misanthropic German cultural theorist with a preternaturally spherical head

And think: They fight crime!

I suspect it could be, by the type of person who thinks there’s a cancer-curing diet that Big Pharma is keeping secret. I think the type of person who would write something like this review means well, but wants easy answers. We wouldn’t have this socially-constructed “mental illness” if we just let people be free! It’s not disease that’s keeping us down, it’s the treatment! They’re pretty ideas, and can be communicated with power and sophistication, until the real world impinges on the dialogue.

You keep using that term. I do not think it means what you think it means.


Great comment. Say what you mean. Present an argument. Present a critique. Do something!

Your comment, as it stands, simply takes up space. You have not addressed why you think that the DSM-5 isn’t validated based on research. I’m not a huge fan, but I do acknowledge that it isn’t just a document drafted by random clinicians on what they thought. It is based on a significant amount of research and testing. The diagnostic criteria are based on clinical trials. The revised personality disorder section was entirely thrown out because the research wasn’t complete or conclusive. Again, I am not a great fan, but I understand that this document is based on scientific research.

In any case, I think you need to be careful on criticizing someone on their understanding of scientific validity. It is just possible that the person you are criticizing has studied the issue with far more depth than you.

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It claims to be a scientifically validated way to diagnose mental disorders that are accepted by the medical community.

Do you not see a contradiction between “scientifically validated” and “accepted by the medical community”? When homosexuality was accepted as an illness by the medical community, was its inclusion in an earlier DSM also “scientific validation”?

It is a scientifically validated way to diagnose mental disorders.

It is the outcome of a process of lobbying and negotiation within an ad hoc committee of interested parties. The main criterion for inclusion of a disease construct within each edition of the DSM has always been whether a large enough group of practitioners are offering treatment for that label, and want official acceptance of their practices. If they want their therapies to be covered by health insurance, they need DSM acceptance.

Mental illness is a disability, not a moral judgement.

Where are you getting the “moral judgement” from? Certainly not the passage you cite, which uses non-judgemental metaphors of physical disability.

Would such a dystopian work have ever been contemplated for any other medical disorder, such as skin lesions or cancer? Of course not.

Skin lesions and cancer have an objective reality, rather than being defined by a committee. For a closer analogy we must turn to J. G. Ballard and “The Atrocity Exhibition”, where a dystopian work of the form you seek is indeed described:
“Bernouli’s Encyclopaedia of Imaginary Diseases was compiled during his period as a privat-dozent in Frankfurt. Beginning with the imaginary diseases of the larynx, he proceeded to a number of fictional malfunctions of the respiratory and cardio-vascular systems. Within a few years, as he added the cerebro-spinal system to his encyclopaedia, a substantial invented pathology had been catalogued…”

You know, I don’t particularly disagree (or agree, necessarily) with you in your actual argument with Mr. Serious up there, but I have to say that I am royally sick of this line being used to tell someone that they’re mistaken in their usage of a word (or phrase in this case).
I’d love to go back in time and cut it out of the Princess Bride script to prevent all the smug comments using it from ever happening.

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Thank you for posting this.

People have no clue what the DSM is. I do disagree with your assessment as a ‘Text Book’…since the IV-TR ('text revision), it has striven to be as useful in the classroom as it is in the field. The V is no different. That said, it isn’t intended to be the sole text book, which confuses the hell out of people that think they can just pick it up and start diagnosing. The #1 thing most of us are taught in grad school is that if actions / thoughts are not affecting the person or those around them negatively, it ain’t a disorder. And even then…how bad does it affect someone? Sometimes a quirk is a quirk. Someone that is eccentric with a support network of their choosing that keeps them running is not the same as a person with the same traits and no resources to deal with it.

However, folks with no training will read the book and make judgements without any real understanding of the field of mental health.

Again, thank you for writing this. There are too many people with uninformed ‘opinions’ of the field. (That said, I don’t work directly in the industry despite graduate degrees in it…I do think the industry is at times preoccupied with defining normal instead of getting people to embrace their own crazy so long as it isn’t hurting anyone).


Is that one for folks that can’t be harpooned with “oppositional defiant disorder”, but the cut of their jib is still viewed askance, d’you think?

I think calling the DSM a scientific document is a bit of a stretch. It seems to me that psychiatry in general is questionable in regards to its scientific legitimacy. It’s no doubt necessary, but I think the DSM diagnoses certain traits as “disorders” when they may simply be natural deviations in human personality. We don’t know enough about the brain to accurately determine what is and is not a “disorder”. A drug may be effective in regulating certain traits in a person, but those traits may or may not be worth regulating. I’ll admit I don’t know that much about this subject, but the DSM-V has been criticized by quite a few professionals.

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Maybe the part of the review that says, “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.”

I think the review begins as good, funny satire that could be appreciated by people with different views on the DSM. But by the end it’s just polemic – a bitter, absolute, and apparently serious attack on its authors.

But that is not a moral judgement on the part of the review, but one that the reviewer sees in the DSM-V.

Right. I think that’s what bzishi meant – that the review was wrongly claiming that the authors of the DSM view mental illness as a moral failure.

Dude, you sure showed that satirical essay who’s the boss.

This is entirely serious? Is there some level of meta criticism going on that I just don’t get? You understand this was meant to be sardonic, right?