If the novel has an overbearing literary influence, it’s undoubtedly Jorge Luis Borges. The American Psychiatric Association takes his technique of lifting quotes from or writing faux-serious reviews for entirely imagined books and pushes it to the limit: 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. Perhaps as an attempt to ward off the uncommitted reader, the novel begins with a lengthy account of the system of classifications used – one with an obvious debt to the Borgesian Celestial Emporium of Benevolent Knowledge, in which animals are exhaustively classified according to such sets as “those belonging to the Emperor,” “those that, at a distance, resemble flies,” and “those that are included in this classification.”
As you read, you slowly grow aware that the book’s real object of fascination isn’t the various sicknesses described in its pages, but the sickness inherent in their arrangement... This mad project is clearly something that its authors are fixated on to a somewhat unreasonable extent. In a retrospectively predictable ironic twist, this precise tendency is outlined in the book itself. The entry for obsessive-compulsive disorder with poor insight describes this taxonomical obsession in deadpan tones: “repetitive behavior, the goal of which is […] to prevent some dreaded event or situation.” Our narrator seems to believe that by compiling an exhaustive list of everything that might go askew in the human mind, this wrong state might somehow be overcome or averted. References to compulsive behavior throughout the book repeatedly refer to the “fear of dirt in someone with an obsession about contamination.” The tragic clincher comes when we’re told, “the individual does not recognize that the obsessions or compulsions are excessive or unreasonable.” This mad project is so overwhelming that its originator can’t even tell that they’ve subsumed themselves within its matrix. We’re dealing with a truly unreliable narrator here, not one that misleads us about the course of events (the narrator is compulsive, they do have poor insight), but one whose entire conceptual framework is radically off-kilter. As such, the entire story is a portrait of the narrator’s own particular madness. With this realization, DSM-5 starts to enter the realm of the properly dystopian.
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