Can The DSM Give Our Lives Meaning?
psychiatry's bible and the cult of the quantified self
Word has been circling that we are currently in the midst of a meaning crisis.
In 2019, cognitive scientist John Vervaeke posted a series of 51 lectures on YouTube about why he thinks that is. Basically:
This increasing sense of bullshit. Bullshit is on the increase, it’s more and more pervasive throughout our lives, and there’s a sense of drowning in this ocean of bullshit…So today, there’s an increase of people feeling very disconnected from themselves, from each other, from a viable and foreseeable future.
It’s a mish-mash of neuroscience and spirituality culminating in what Wheal calls “Hedonic Engineering”, which is basically taking psychedelics and having transcendental sex (two things I fully support!) but I’m pretty skeptical of Wheal’s work, seeing that he’s endorsed by such entities as the United States Navy, Google, and Goldman Sachs.
Wheal is a member of the “psychedelics will connect humanity and save the world from climate disaster” crowd, a popular narrative in Silicon Valley which critics have called “magical thinking”. But still, we need to believe in something, and individualistic, new age spirituality is rushing in to fill the gap left by our disillusion with institutional religion.
But Jess, we have science now, why do we need religion still? you may be asking. Don’t get me wrong, I love science, but a process focused on producing objectivity can never fully make sense of our subjective experiences, because meaning isn’t something you can quantify, weigh, and label.
That hasn’t stopped people from trying, though. An entire industry of self-surveillance biotech has sprung up around the “Quantified Self” community, who seek to know themselves through their personal data. The scholar Sun Ha-Hong has studied this community and written that “datafication turns bodies into facts” and can “reconfigure what counts as truth”:
The belief in raw and untainted data begets not only an excessive reliance on algorithmic factmaking but also extends the older and deeper cultural desire for sorting the world into stable and discrete pieces.
If there’s any book that “turns bodies into facts”, it’s psychiatry’s Bible. The DSM’s extensive system for categorizing emotional distress has left the medical realm and spread across the internet, becoming another way for us to understand our identities and relationships.
Critiques of these labels and the distress-as-brain-disease model they’re based on are usually met with intense anger in the comment section, and I get why. Many people use these labels to build a scaffolding of sense in their lives, and any challenge to them feels like an earthquake in their constructed foundation of self.
But my question is: can the cold quantification of the DSM really give our lives meaning?
Think about a song that deeply moves you, one you go to for comfort, or that maybe you credit with saving your life at some point — if someone gave you a checklist of factors like tempo, melody, and harmony, and asked you to count them up, score the song, and sort it into a category, would that help you understand what it means for you?
Like music, emotional suffering is also subjective. It’s an experience, often one that’s difficult to put into words. Artists have been trying to express it for centuries. Humans have used stories and myths to understand these experiences since the dawn of consciousness — and now we’re trying to nail it down with a checklist or a biotracking app?
How can there be any depth of meaning in such a quantified framework of human behavior?
In his book Diagnostic Cultures, psychologist Svend Brinkmann writes:
..when meaning systems are liquefied, along with the transformation of society into liquid modernity, humans begin to look for new ways of anchoring their experiences of suffering..
..something crucial about human subjectivity is lost if we overlook the qualitative dimensions of existence and interpret our afflictions in purely quantitative terms.
He says that DSM labels have become symbols we use for psychological development (semiotic mediators, for the wordnerds out there) and they’re used to explain, self-affirm, and exempt us from responsibility (“it’s not me, it’s my ADHD”).
We are increasingly using this individualistic, medical language for our suffering, as opposed to more collectivist languages like political or existential. Brinkmann continues:
Mary Boyle has argued that this is a process of ‘making the world go away’, which converts ‘distress and problem behaviours to ‘symptoms’ and ‘disorders’…
Detrimental work conditions were once something to be dealt with politically and collectively – centred on the work of unions – but today are increasingly met with an individualizing and pathologizing response…while workers used to engage in strike action collectively in order to protest against debilitating work conditions, people under individualized late-modern capitalism are left with the option of being sick with stress.
How are we coping with all of this? Mostly, we’re focusing on the self.
Journalist and theologian Tara Isabella Burton says we are seeing a rise of what she calls intuitional religions, a rejection of spiritual institutions in favor of listening to our own inner wisdom. Spiritual-but-not-religious describes a lot of us these days, mix-and-matching our personal faiths like they’re bespoke subscription boxes.
In her book Strange Rites, Burton argues that religion is also a kind of sense-making that “functions both individually and societally to give us a sense of our world, our place in it, and our relationships to the people around us.”
So, a religion:
Makes sense of the world
Makes sense of the self
Makes sense of our relationships
Unifies group identity
Creates a meaningful narrative
DSM labels do all of these things too, but I’d argue that the meaning they create for us is not a kind of meaning that necessarily leads to wisdom. Vervaeke says:
Wisdom is about realizing, in both senses of the word — becoming aware and making real — wisdom is about realizing meaning in life in a profound way.
But the DSM doesn’t offer us this, because a psychiatric label closes off our opportunity for deeper understanding. Instead of asking why, the disease model tells you: because you are ADHD, because you are bipolar, because you are borderline. And when you ask how, it offers you products and services as solutions. It’s the kind of meaning that justifies commodification as the answer to all your problems.
Vervaeke challenges the disease model by discussing a process called “reciprocal narrowing”. Here he is on the Musing Mind podcast explaining what that means in the context of addiction:
I drink some booze and I’m drunk, so I lose a lot of cognitive machinery, my problem solving abilities degrade, right? Of course they do. Now I do it because it’s alleviating some stressors, but I pay a price for that. My cognitive flexibility, my problem solving degrades. Now, as I lose cognitive flexibility…the options in the world that become available to me, I lose some of those options. That narrows the world. As I start to see the world as more narrow, as having fewer options, I start to lose cognitive flexibility. I start to go into a kind of scarcity mentality, I’m losing options, when people go into scarcity…they start to be more short-term in their thinking…as I lose more of my cognitive agency, the world’s options shrink, until eventually, I shrink so much and the world shrinks so much I can’t see any other world possible than the one I’m in, and I can’t see any other self than the one I am. And that’s to be the addict.
Vervaeke extends this analysis to society at large, saying that the scarcity of capitalism has also narrowed our options. We are constantly living in a scarcity mentality and competing with each other for basic survival resources, and that takes a toll on our cognition.
Host Oshan Jarow responds:
When we feel a scarcity of meaning, when we don’t see avenues to generate and participate in these more meaningful ways of living, we cling to the slender sources that we currently have…the more difficult it becomes to realistically entertain alternatives, the more we are driven to cling to what we have already.
If the DSM is that “slender source” of meaning for people’s emotional suffering, it makes sense why many cling to it so hard. But this scarcity of meaning is actually good for capitalism, because it closes down our ability to conceive of different possibilities. (Yes, the time has come to quote Capitalist Realism.)
Mark Fisher wrote:
Needless to say, what counts as ‘realistic’, what seems possible at any point in the social field, is defined by a series of political determinations. An ideological position can never be really successful until it is naturalized, and it cannot be naturalized while it is still thought of as a value rather than a fact. Accordingly, neoliberalism has sought to eliminate the very category of value in the ethical sense. Over the past thirty years, capitalist realism has successfully installed a 'business ontology' in which it is simply obvious that everything in society, including healthcare and education, should be run as a business.
Businesses run on quantification — on quantified selves — and because we’ve come to view the DSM and its categories as facts, rather than value judgements we’ve made about normality, we struggle to come up with alternatives.
We think, this is just the way it is, but we don’t see the process that turned those values into facts — the decades of political interests, cultural ideologies, and profit motives that created those diagnoses.
The philosopher and “recovering psychologist” Bayo Akomolafe might call this a part of “the delusion of modernity”. Here’s how he describes it:
Modernity has a story, a myth that we are all safe, that we’re all true, that there is no problem at all…Let me boil it down to three myths. There is one that says we’re stable, we’re found, and we’re coherent…
…we’re indebted to nothing, we need to give thanks for nothing, all we need to do is look at each other and appease each other and worship each other’s images, and there is nothing more to be done.
It’s remarkably easy for most of us born in sedentary civilization to forget how precarious things really are, how lost we really are, how sustained we are by a trick. We take it for granted that we’re at home, that we’re stable, that all we need to do is keep progressing along rationalistic, technobureaucratic lines, all we need to do is depend on our genius, and then everything will be fine. The future is out there, all we need to do is apply determination and we’ll get to it..
These are the ideas packaged into this political theory called liberal humanism. We’re free. We’re free from debt, we’re free from entanglements, we’re dissociated from the ground. We don’t need to give honor to ancestors, we don’t need to pay homage or have rites of passage, we don’t need any of that, because we’re modern, we’re free, we’re sophisticated, we’ve arrived.
Once in a while we’re reminded how things fall apart…We’re reminded in times like these times, when a pandemic strikes, and we don’t know exactly what to do. When the language with which we frame the future feels exhausted…nothing makes sense anymore, when cracks appear in the ground and there’s no walking forward anymore, there’s no progress…these times allow us the gift of noticing how indebted we are to the ground that we imagine we’ve left behind…and that’s where the idea of slowing down in times of urgency comes from.
The times are urgent, let us slow down. It doesn’t mean reducing one’s speed…slowing down is more an issue of touching our indebtedness, touching the entangling threads, the tentacularity that connect us to the earth, that connect us to ancestry, that connect us to the modern human, the nonhuman, the yet-to-be human. You know, the idea that we are free gets in the way of freedom.
The idea that we are complete, coherent, always intelligible, at heart rational, puritan, these are frames of whiteness, these are white tropes. By whiteness, I don’t mean white-identified bodies, I mean an earth-forming strategy that frames human selves as superior to all other kinds of bodies, that suggests that we need not turn to understand where we come from, what we’re indebted to, we need not turn to the world around us, we should only turn inwards.
Making meaning with the DSM is a form of this inward-turning that assumes we are “free from entanglements”, as Akomolafe said, a kind of “making the world go away”, a la Mary Boyle.
If we’re operating on the assumption that we’re all “stable and coherent”, then any incoherence, any slip of “sanity”, is seen as a sign of disorder in the self, not the world around us, because we are supposedly “free” from that world, disconnected and unaffected by it.
The DSM and its disease model of suffering pulls us further and further into ourselves, separating us from the earth and the society around us that desperately need our attention and care now, more than ever.
When it comes to addressing our meaning crisis, humans need more than a checklist and a chart and a pill. We need a reason to stay alive, a purpose. We need meaningful work, deep connections, something larger than ourselves to fight for, even if we don’t see the end of that fight in our lifetimes.
I’ll leave you with a paragraph that’s been stuck in my brain ever since I read it, from an interview with Hans Skott-Mhyre:
The struggle for liberation under systems of really pernicious oppression is life-affirming in and of itself. You don’t have to get to the end of it for it to be life-affirming. The mistake people make with burnout is that they burn out because they’re constantly expecting it to get better. They don’t understand that what’s getting better is your ability to affirm your life, affirm your living self, affirm your relationships, love, and care.