Cursed Metaphors of Psychiatric Diagnosis
If psycho-analysis were to have an essential axiom—it’s good news—it is that there is no normal human behavior; like Tolstoy’s unhappy family, we are each disordered in our own particular way. The field remains ambivalent regarding the notion of cure because it is ambivalent towards the notion of illness. Is narcissism an illness? Is schizophrenia? Autism?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is a veritable mania of diagnosis. Such diagnosis by the state forms a system of capture; the bad old carceral trend that drives modernity; and now with the intent of making profit for shareholders. Every sick person is an income stream for psychiatry, for insurance companies, for big pharma. This zeal to pathologize grows pathology. Thus any diagnosis is already suspect: less a description of how a person is than an active curse for how they should be; the cure is a prescribed drug.
And yet we all live with varying degrees of complicated psychical pain. While maladies of the body have as their origin a physical representation—an infection, a tumor, an arrhythmic heart—maladies of the psyche are produced by affect and are thus subjective and contingent upon the person’s ability to locate and describe these feelings. Such language may already be contaminated by the metaphors of illness. For instance depression: an indentation from weight, a valley, a low-point, a “slough of despond”: even worse is the “black dog of depression”; who came up with that one pray tell? And yet the thing that the word “depression” is trying to describe is real. It is rarely noted in psychiatry or psychoanalysis that we are all just making this shit up as we go along. It has been observed even less so that such inventions and metaphors may have already introjected the person with a toxicity that does not belong to them. Instead of diagnosing the patient with depression—blaming the victim— why do we not diagnose our society as being depressing?
Self Portrait with Bandaged Ear, 1889, Van Gogh
