Harvard University Press Blog

The DSM and the Mind

This week marks the publication of the much anticipated—and much maligned—DSM-5, the latest full revision to psychiatry’s diagnostic handbook. Each new iteration of the DSM alters the official stance on so many conditions that discussion often centers on the introduction or dismissal of particular disorders, virtually naturalizing the philosophy underlying the manual’s overall perspective. In an effort to unsettle that reception, we asked Liah Greenfeld, author of Mind, Modernity, Madness, what single point about the DSM-5 and its diagnostic approach she would most want to convey to the general public, if given the chance. Her response follows.

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I would use this opportunity to point out that DSM-V, and DSM in general, is just an expression of the increasing confusion in the mental health community (including both researchers and clinicians, and both psychiatry and psychology with their neuroscience contingents) in regard to the nature of the human mental processes—or the mind—altogether. Before this confusion is cleared, none of the problems with the DSM and the resulting mental health practice can be resolved. And the criticism of the DSM should in all fairness apply also to its critics and judges, such as the NIMH.

One might expect me, as a social scientist, to attack today’s mental health community for its nearly exclusive biological focus. But the source of its confusion in regard to the nature of the mind lies deeper than the equation of the mind and the brain. Psychiatry and psychology consider the human individual as their subject. In this they sharply distinguish themselves from biology, which studies the organic world. The most important causal factor in biology is the environment in which organisms find themselves (think of natural selection) and no specialization in this mighty science, among the sub-disciplines of which neuropsychiatry and neuropsychology, at least, would like to range themselves, would limit itself to the study of a form of life in isolation from the environment. Consider, for example, medical (i.e., applied biological) specializations such as gastroenterology or pulmonology: is it possible to imagine a physician who would be unaware that the process of digestion is necessarily affected by the nature and quantity of food the stomach digests, or the process of breathing by the nature and quantity of the air inhaled? No, because this is what our organs do: they process intakes from the environment, and these intakes have at least as much to do with our health and illness as the structure and physiology of the organs which process them. Yet, we forget this when it comes to the brain and mental processing—the mind.

The environment of the human brain is far more complex than that of the stomach and lungs, or than the environment of the brains of other animals. Most of its intakes come not from the organic and physical world, but, instead, from the world of meanings and symbolic systems which convey them, that is, culture. If digestion can be defined as what happens to food in, and what food does to, the stomach, the mind, by analogy, can be conceptualized as what happens to culture in, and what culture does to, the (human) brain. It is very likely that most mental diseases (just like most gastrointestinal or pulmonary ones) come from the intake of the processing organ, rather than from the organ itself, i.e., it is likely that they are caused by culture. Mental health professions pay no attention to it, and no revision of the DSM will make them improve their ability to help the mentally ill.

Related articles

Identity Construction and Cultural Madness

Cicadas Cicadas Cicadas

It’s just about cicada time here on the East Coast, when millions (billions?) of these strange, noisy creatures will make their way up through the dirt, looking for love. They’ve been waiting down there in wingless nymph form, feeding on the dilute sap of plant roots while they undergo the longest juvenile developmental period of any insect. When the ground reaches 64 degrees and they emerge, outnumbering humans hundreds-to-one and nearly deafening us for our troubles, well, it’s gonna get a bit freaky. Not for nothing did the colonists at Plymouth in 1634 dub them locusts, despite little resemblance to the Biblical grasshoppers.

As entomologist May Berenbaum assures, though, there’s nothing to worry about. “It’s not like these hordes of cicadas suck blood or zombify people,” she says. It’s just such mistaken attribution of outlandish abilities that inspired Berenbaum’s “modern bestiary,” The Earwig’s Tail. She’d come to realize, she writes in the book’s Preface, that “the majority of the most bandied-about insect facts familiar to the general public aren’t facts at all.” In The Earwig’s Tail she takes on twenty-six of “the most firmly entrenched modern mythical insects,” and, in many cases, leaves us with an even more fantastic truth.

When she gets to cicadas, Berenbaum turns to politics and Washington D.C., where the emergence of “Brood X” (the various populations of cicadas run on different schedules and are given roman numeral names) coincides with a presidential election every sixty-eight years, most recently in 2004.

Here’s Berenbaum:

First to take metaphorical advantage of the infestation was the Republican National Committee. On May 14, 2004, at the height of the emergence, 700,000 registered Republicans received an email attachment from the Republican National Committee. A narrator intoned, “Every 17 years, cicadas emerge, morph out of their shell, and change their appearance. The shells they leave behind are the only evidence they were here. Like a cicada, Senator Kerry would like to shed his Senate career and morph into a fiscal conservative, a centrist Democrat opposed to taxes, strong on defense . . . But, he leaves his record behind . . . when the cicadas emerge, they make a lot of noise. But they always revert to form, before disappearing again.” The voiceover accompanies a time-lapse film of a cicada eclosing and expanding its wings and ends with an animated cicada morphing into John Kerry.

The Kerry campaign’s retort? “Maybe, if given another 17 years, President Bush could create a job in Ohio.” Cicada burn.

Cicadas also had a cameo in presidential politics in 1902, Berenbaum reports, when President Theodore Roosevelt “was practically drowned out while trying to give a Memorial Day speech defending national policy to impose ‘orderly freedom’ in the Philippines.” The experience of inundation seems not to have adversely affected his feelings on colonialism.

We’ll wait to see what metaphors are made of this coming return.

The Fracturing of the American Corporate Elite

Like many Americans, Mark Mizruchi had grown increasingly distressed by the state of our politics. He was unhappy with the gridlock in Washington, the inability to accomplish even the most routine tasks of government, and the intransigence of those who have managed to hold the nation hostage to their extreme views. In trying to understand the problem’s roots, Mizruchi came to see the issue as a lack of national leadership from a group that had previously played a major and constructive role in developing solutions to new problems and keeping American politics mostly centric: the leaders of large American corporations. His goal in The Fracturing of the American Corporate Elite, new this month, is to explain how this relatively cohesive group emerged, what sustained it, how it declined, and the consequences of its demise. In the book excerpt and video below, he outlines his argument.

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I argue that the leaders of the largest American corporations, to whom I refer as the American corporate elite, once played an important role in addressing, if not resolving, the needs of the larger society. Since the 1970s, the members of this group have largely abandoned their concern with issues beyond those of their individual firms. This abandonment, I suggest, is one of the primary causes of the economic, political, and social disarray that American society has experienced in the twenty-first century. In earlier decades, the United States had a corporate elite that, however imperfect, was willing to see beyond the short-term interests of the firms that its members directed. Today this is no longer the case. The corporate elite that exists today is a disorganized, largely ineffectual group. Paradoxically, I argue, individual American corporations have more political power in the early twenty-first century than at any time since the 1920s. As a group, they are fragmented, however. Unlike their predecessors in earlier decades, they are either unwilling or unable to mount any systematic approach to addressing even the problems of their own community, let alone those of the larger society.

In this book I examine the rise and fall of the American corporate elite, from its pinnacle in the 1945–1973 period, through its period of turmoil and transition in the 1970s and 1980s, to its present state, in which the group is only a shadow of its former self. I argue that the decline of this elite is a significant source of the current crisis of American democracy and a major cause of the predicament in which the twenty-first-century United States finds itself.

In making this claim, I do not want to imply that the corporate elite of the postwar period was uniformly altruistic or public spirited. On the contrary, business leaders during that age were strongly protective of their interests, as they have been in every historical era. Nor am I suggesting that postwar America was a society that we should attempt to emulate in every respect. Social and cultural norms have become far less oppressive since that time. Our society today is far more tolerant and accepting of difference than it was half a century ago. Innovation, especially in the area of information technology, has improved peoples’ lives in many, albeit not all, respects. Consumer products in general are more plentiful and less expensive than in earlier years. There is no returning to the past, nor should this be an ideal to pursue. Yet for all its problems, the postwar United States had a number of qualities that are lacking today: an expanding economy with a high level of upward mobility, declining inequality, a relatively high level of security, a well-functioning political system, and a widespread belief that problems were solvable. And underpinning these forces was a corporate elite that provided a degree of leadership and vision that are not in evidence today.

Is the Financial Crisis Over?

Gérard Duménil and Dominique Lévy are the authors of The Crisis of Neoliberalism, which is new in paperback this spring. The book examines the financial crisis in the context of neoliberal globalization, arguing that repairing our economy will require a dramatic reversal of the free market ethos that’s enveloped most of the world over the past few decades. Below, the authors take stock of the movement toward “recovery” since their book’s original 2011 publication.

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The last quarter of 2008 was a key period in the progress of the current crisis in the United States and Europe. It marked the culmination of the financial component of the crisis, with the failure of major institutions in the United States, the beginning of the “great contraction,” and the export of the crisis worldwide. The trough was reached in the second quarter of 2009, a 4.6 percent fall of GDP in the United States (from the second quarter of 2008 to the second quarter of 2009), and 5.1 percent in the euro zone (from the first quarter of 2008 to the second quarter of 2009). The slow recovery of output that followed is commonly interpreted as the final stage of “the crisis.” This optimistic assessment is, we believe, erroneous.

A first observation is that the recovery was obtained at the cost of dramatic government deficits, 8.6 percent of GDP in the United States (for the third quarter of 2012), much less in the euro zone, but still 4.4 percent. Beginning with the contraction of output, then, the crisis entered a second phase, the “crisis of sovereign debts.” The growth of these debts peaked at 40 percent (annualized rate) in the third quarter of 2008 in the United States, and 18 percent in the third quarter of 2009 in the euro zone. At the end of 2012, in the United States, this growth rate was still larger than 10 percent, much more than the growth rate of GDP.

But the worst of everything is that the distinct paths in the two regions testify to the relationship between the levels of deficits and the levels of growth rates. Only government deficits can support demand levels. In the United States, consumer borrowing (which sustains the consumer spending that drives so much of the economy) is still nearly negligible compared to the average 8.9 percent of GDP it represented between 2003 and 2006, and the rate of default in households’ mortgages did not significantly decline from its peak value. In Europe, government deficits are much lower and a deflationary policy is conducted to further reduce them. Thus, instead of the low growth rates (1.5 percent for 2012) in the United States, the euro zone is entering into recession (-0.9 percent in 2012). Practically the entire zone is affected. Unemployment is soaring and the political situation is deteriorating. Overall, the alternative is between the U.S. model thus far, namely the preservation of (poor) growth rates thanks to record expansion rates of sovereign debts or, the euro model, the contraction of deficits and the new plunge.

Who Pays the Price for the College Party Scene?

After a five-year study of a flagship Midwestern public university, sociologists Elizabeth A. Armstrong and Laura T. Hamilton found that the social and academic infrastructure of the school seemed to prioritize a particular type of affluent, socially oriented student. A “party pathway”—built around an implicit agreement between the university and students to demand little of each other—was impossible to avoid, and for students who couldn’t or wouldn’t join the fun it served as a constant reminder of their place as outsiders. Armstrong and Hamilton’s Paying for the Party: How College Maintains Inequality exposes the unmet obligations and misplaced priorities of public universities whose students leave college with so little to show for it. Below, the authors contrast the experience of thriving on the party pathway with the far more common experience of being failed by it.

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Naomi and Karen started college the same year at a mid-tier public university in the Midwest. They lived on the same residence hall floor and shared a taste for partying. Both majored in sports broadcasting. Neither performed well academically, earning GPAs below 3.0. Yet Naomi graduated in four years, moved to New York City, and quickly secured a desirable entry-level job in a media firm. Karen, on the other hand, had changed her major to education, transferred to a regional branch campus, and was struggling to graduate within six years.

In an era of skyrocketing tuition and concern over the value of college, these divergent outcomes matter. In Paying for the Party: How College Maintains Inequality, we trace a dormitory floor of fifty-three women, including Naomi and Karen, from the day they arrived on campus to a year after they were slated to graduate. The women were similar in many respects; however, they came from a wide range of social class backgrounds.

Based on this research we argue that how this university—and many other large state schools—organizes the college experience systematically disadvantages all but the affluent. The university supported a robust “party pathway”—a social and academic infrastructure with a powerful Greek system at its heart, and an array of easy majors on offer. Naomi—an out-of-state student whose father owned a successful business—was well served by the party pathway. Karen—a middle-class woman from in-state—was not.

Naomi and Karen—like one third of the incoming freshman class—were assigned to a “party dorm.” Little partying took place in the heavily-policed residence halls, but party dorms served as a pipeline into the under-aged party scene housed in the Greek system, which both women joined.

A Look Ahead to Fall

Okay, it’s only just barely started pretending to be spring here in New England, which means our handsome fall catalog is out and about. It’s a strong list for political and moral philosophy, led off by Martha Nussbaum’s Political Emotions: Why Love Matters for Justice, and Ronald Dworkin’s final book, Religion without God. Howard Eiland and Michael Jennings, who’ve done so much to bring Walter Benjamin’s writings to English-language readers, now offer the first full critical biography of Benjamin in any language. The Falling Sky is the remarkable story of the endangered Brazilian Yanomami people, told by a shaman who’s become their global ambassador. Estelle Freedman documents how America’s changing definition of rape has depended on dynamics of political power and social privilege. John Lukacs gives us A Short History of the Twentieth Century. And that gets us through page nine.

Won’t you have a look?

 

Empire, 2000

“Empire is materializing before our very eyes.” So begins Michael Hardt and Antonio Negri’s Empire, one of the 100 significant works we’ve chosen to highlight as we celebrate our centennial. You can read an excerpt from Empire at our centennial site, and, below, a look back on the book’s reinvigoration of the left by HUP sales representative John Eklund.

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I’ve been representing university press books for fifteen years now and I’ve noticed two kinds of scholarship.

One approach tackles a big subject by nibbling away at the edges, hoping to find the loose strand that will unravel the whole project. Every season we publish many books of this type and I love them for their patient, long-term, sometimes-stealthy style of argument.

But the other kind of book I enjoy selling is the full-blown, frontal assault, big idea book. These are scarcer, but when they happen it’s as if you can feel the unacknowledged givens, our invisible social and political assumptions, shift beneath your feet. Like the writings of Herbert Marcuse in the late sixties, which were anxiously awaited and debated with relish, everyone who cares about social progress has to grapple with books of this sort when they appear. Such a book was the 2000 cri de coeur by an Italian revolutionary and an American scholar, Empire.

A decade before its release, the non-capitalist world collapsed and evaporated. Even committed leftists sat shiva for socialism, and the ideological cheerleaders of global empire gleefully declared the case closed. The triumph of market capitalism seemed complete.

But along came Hardt and Negri to argue that the diffusion of power we’ve come to know as globalization is not necessarily the savior of capital but its gravedigger; that Marx was right, there is a forward momentum to history, and that it arcs toward throwing off oppression; and, perhaps most surprisingly for readers of left criticism accustomed to turgid, joyless polemics, that the rebuilding of a revolutionary movement can be accomplished in a spirit of romance and optimism. In the beautiful final pages of Empire, we are warned “against sadness.”

But wait! What’s really new and big about this argument? Aren’t Hardt & Negri simply riffing on an old and very well known ideology? What’s really being overturned? What’s staler than the assorted leftovers of a failed worldview?

Identity Construction and Cultural Madness

It sometimes seems as if each day brings a new raft of articles proclaiming yet another biological or genetic explanation for human behavior and activity. To Liah Greenfeld, that barrage is just a new bubble, and in Mind, Modernity, Madness: The Impact of Culture on Human Experience, she does her best to burst it. While not entirely dismissing biological factors in mental illness, Greenfeld argues that the phenomenon that was for a long time called simply “madness”—today’s schizophrenia, bipolar disorder, and major depression—is actually a symptom of modernity, an effect of our cultural environment.

To Greenfeld, “madness” is a disease not of the brain but of the mind, of consciousness, which itself is a cultural phenomenon, the product of nationalism, a subject on which Greenfeld has now produced a trilogy. As the cultural framework of modernity, nationalism insists on the dignity, creativity, and equality of man, the value of each human life, and the right and capacity for all to construct their own destinies, to love, and to be happy. Psychotic disease, she argues, is fundamentally a malfunction of the “acting self,” experienced as a loss of the familiar self and as a loss of control over one’s physical and mental activity, a response to the cultural demands of selfhood.

From Mind, Modernity, Madness:

The reason for the dysfunction of the acting self lies in the malformation of identity. It is possible that the complexity of the original identity problem (the depth and number of inconsistencies in the relationally constituted self) contributes to the complexity of the disease; for instance, in a case of dissatisfaction with one’s nevertheless clearly experienced identity causing depression, and in a case of no clearly experienced identity, combined with numerous competing possibilities, producing schizophrenia. It is modern culture—specifically the presumed equality of all the members of the society, secularism, and choice in self-definition, implied in the national consciousness—that makes the formation of the individual identity difficult. A member of a nation can no longer learn who or what s/he is from the environment. Instead of prescribing to us our identities, as do religious and in principle nonegalitarian cultures, modern culture leaves us free to decide what to be and to make ourselves. It is this cultural laxity that is anomie—the inability of a culture to provide the individuals within it with consistent guidance (already in the beginning of the twentieth century, recognized by Durkheim as the most dangerous problem of modernity). Paradoxically, in effect placed in control over our destiny, we are far more likely to be dissatisfied with it, than would be a person deprived of any such control: not having a choice, such a person would try to do the best with what one has and enjoy it as far as possible. A truly believing person would also feel s/he has no right to find fault with the order of things created by God, much less to try and change it to one’s own liking—one’s situation in life would be perceived as both unchangeable and just. Conversely, the presence of choice, the very ability to imagine oneself in a position different from one currently occupied or that of one’s parents, and the idea that social orders in general are created by people and may be changed make one suspect that one’s current situation is not the best one can have and to strive for a better one. The more choices one has, the less secure one becomes in the choices already made (by one or for one) and making up one’s mind—literally, in the sense of constructing one’s identity—grows increasingly difficult. It is for this reason that the malformation of the mind—quite independent of any disease of the brain—becomes a mark of nations.

Launch of the Digital Public Library of America

The Digital Public Library of America launches today, having gone from concept to concrete more swiftly than anyone could have hoped. As has been envisioned from the beginning, the DPLA is “an open, distributed network of comprehensive online resources that draws on the nation’s living heritage from libraries, universities, archives, and museums in order to educate, inform, and empower everyone in the current and future generations.” The DPLA begins with an already-impressive array of materials, but has even bolder ambitions, along with an encouraging concern with sustainability.

No individual has been as important to the DPLA’s trajectory as Harvard’s University Librarian (and many-time HUP author) Robert Darnton, who has tracked the project’s progress in a series of articles for the New York Review of Books. In his most recent, he recaps the initiative’s brief history and explains its intentions:

How to think of it? Not as a great edifice topped with a dome and standing on a gigantic database. The DPLA will be a distributed system of electronic content that will make the holdings of public and research libraries, archives, museums, and historical societies available, effortlessly and free of charge, to readers located at every connecting point of the Web. To make it work, we must think big and begin small. At first, the DPLA’s offering will be limited to a rich variety of collections—books, manuscripts, and works of art—that have already been digitized in cultural institutions throughout the country. Around this core it will grow, gradually accumulating material of all kinds until it will function as a national digital library.

Darnton goes on to detail a DPLA-affiliated project that is particularly exciting for us here at the Press:

At one time or other, nearly every student comes in contact with a poem by Emily Dickinson, who probably qualifies as America’s favorite poet. But Dickinson’s poems are especially problematic. Only a few of them, horribly mangled, were published in her lifetime.

As Darnton notes, the manuscript copies of Dickinson’s poems “pose important puzzles, because they contain quirky punctuation, capitalization, spacing, and other touches that have profound implications for their meaning.” The originals, which are held in a few invaluable collections—notably at Amherst College Library, the Boston Public Library, and Harvard’s Houghton Library—have now been digitized and combined with printed editions edited by Thomas H. Johnson in 1955 and by Ralph W. Franklin in 1981, both of which are jewels of HUP’s own catalog. The manuscripts and printed poems will be brought together with a wealth of other supplementary documentation to create an Emily Dickinson Archive. Brigham Young University has also partnered with Amherst College, the BPL, Harvard, HUP, and the DPLA in this project that will greatly expand access to our collective knowledge of one of the country’s great literary icons while also inspiring new scholarship and discourse on her life and work.

The Copley branch of the BPL—the first large free municipal library in the United States—was to host a gala launch for the DPLA today. The Copley library is now at the center of a crime scene, though, directly beside the terrible and tragic Boston Marathon explosions, and so today’s events have been cancelled. In his statement on the cancellation, DPLA Executive Director Dan Cohen called the building of a new library “one of the greatest examples of what humans can do together to extend the light against darkness,” and the site’s launch will proceed today as planned. An even larger event to properly celebrate the creation of the DPLA is now in the works for this fall.

A Theory of Justice, 1971

In 1971 Harvard University Press published several books of unusual importance, including E. O. Wilson’s The Insect Societies (his first book with the Press) and the landmark Notable American Women, Volumes 1-3. That year also saw the publication of John Rawls’s A Theory of Justice, one of the most influential works in our history, and one of the 100 significant works we’ve selected to commemorate our centennial. Below, HUP Executive Editor-at-Large Ian Malcolm considers the book’s initial impact and enduring significance.

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John Rawls’s A Theory of Justice has sold well over three hundred thousand copies since its publication in 1971. It’s an astonishing number for any academic book, let alone a 600-page work of abstract and uncompromising philosophy. It’s a rare book, though, that has had such a transformative effect on its field. Reviewers immediately recognised the book as a masterpiece, the most significant work in political philosophy since the nineteenth century, and it has been indispensable reading ever since. Its future looks assured too: in a 2010 poll, philosophers voted Rawls the contemporary most likely to be read in a hundred years. Not bad for a book that Rawls thought would be of interest only to a small circle of colleagues.

When Rawls (1921–2002) wrote the book, political philosophy was in a moribund state. It was dominated by old utilitarian ideas about achieving the greatest good for the greatest number, with Marxism running a distant second. There had been no important systematic works in the field for decades. A Theory of Justice, a comprehensive defence of liberal egalitarianism, galvanized the subject. It did so in part by returning to the social contract tradition that utilitarianism had displaced, a tradition according to which political legitimacy arises from some sort of agreement between governors and the governed. But the book was no mere variation on the tradition, a modest reworking of Locke, Rousseau, or Kant. Rawls drew on the resources of modern analytic philosophy to take, step by careful step, a new approach to the moral foundations of political life, working out the implications of a thought experiment about the kind of society people would design if they had no idea where in that society they would end up. A society designed under such a “veil of ignorance,” he wrote, would guarantee that “each person possesses an inviolability founded on justice that even the welfare of society as a whole cannot override.” Every person would have the right to as much liberty as is compatible with the liberty of others. Social and economic arrangements would be designed to benefit everyone: inequalities would be acceptable only if they are unavoidable in a system that, overall, raises the conditions of the worst off.