By Joseph Randolph

Self-attachment is the first sign of madness, but it is because man is attached to himself that he accepts error as truth, lies as reality, violence and ugliness as beauty and justice. Michel Foucault, Madness and Civilization (1961)

In 1952, the American Psychiatric Association released a small, spiral-bound booklet titled The Diagnostic and Statistical Manual of Mental Disorders. It ran 130 pages and read like a hybrid of battlefield inventory and scholastic confession manual. Its authors—primarily military psychiatrists trained in wartime triage—approached psychic distress with the detached pragmatism one might apply to a malfunctioning radio: the issue concerned interference rather than meaning. Categories included now-defunct curiosities like “dysphrenia” and “passive-aggressive personality,” the latter a diagnosis first devised to account for soldiers who followed orders without enough visible enthusiasm. The general ethos remained simple and quietly totalitarian: suffering was a deviation from optimal function, and optimal function was presumed self-evident. The madman was neither tragic nor transcendent, merely inefficient.

By 2013, with the publication of DSM-5—still the dominant diagnostic framework more than a decade later—the manual had metastasized to nearly 1,000 pages. Its list of disorders multiplied, then fractalized: sadness could now be disaggregated into major depressive disorder, dysthymia, adjustment disorder with depressed mood, or—if hormonally timed—premenstrual dysphoric disorder. The boundary between impulse and illness had collapsed into categories like Internet Gaming Disorder and Attenuated Psychosis Syndrome, the latter a diagnosis for people who merely seemed likely to become mentally ill. What began as a wartime logistics tool had become a baroque and unaccountable taxonomy—less a science than an ever-expanding clerical apparatus. By this stage, the text no longer sought to understand emotional life; it pursued classification into procedural codes, like a lost Borges story rewritten by actuarial software. One thinks especially of “The Analytical Language of John Wilkins,” where Borges mocks a taxonomy—the Celestial Emporium of Benevolent Knowledge—in which animals are divided into “(a) belonging to the Emperor, (b) embalmed, (c) tame, (d) suckling pigs, (e) Sirens,” and so on. The DSM is psychiatry’s Wilkinsian masterpiece: absurd not because it is imprecise, but because its very premise—that emotional life can be disassembled into clinically distinct units—is a metaphysical category error. It fails to map reality. It constructs a world in which reality must submit to mapping.

At the heart of this expansion stands a premise so large it nearly disappears from view: that human affect can, and indeed should, be rendered fully legible. The point is neither interpretation nor witness, nor any slow metabolizing through myth or reflection, but systematization, abstraction, computational tractability. The DSM does not describe symptoms in the colloquial sense; it indexes deviations from a norm it cannot define, because it must not—its authority depends on the illusion that this norm exists in plain sight, like the king’s body in medieval political theology. It is a strange book: one part logistics manual, one part scholastic taxonomy, one part theological ledger. Less a mirror of the psyche than an engine for producing psychic regularity, it stands in a long lineage of administrative mysticisms—the libri poenitentiales of the early Church, which assigned calibrated penance to inward deviation (“three days fasting for impure thoughts,” “seven for envy without action”), or early modern physiognomy, which sought moral legibility in facial proportion and later informed biometric classifications in colonial bureaucracies. It reads, at times, like an alchemical grimoire: full of ambiguous categories, nested hierarchies, provisional clauses, and invisible referents. Modern psychiatry inherits this logic and enforces it at scale. If scripture once promised salvation through confession, the DSM promises reintegration through compliance. The sacrament is paperwork. And like all rituals of interpretive control, its aim is formatting rather than illumination—to ensure that whatever cannot be directly managed may at least be assigned a code. It offers a language of diagnosis designed for institutions: insurance companies, schools, employers, courts, pharmaceutical trials. A feeling becomes intelligible only once it becomes codifiable. Suffering becomes actionable only once it becomes classifiable. The metaphor of “mental health” itself smuggles in an infrastructural ideal: the mind as system, the psyche as machine, the person as serviceable unit. The result is a world where moods do not primarily belong to meaning, ritual, or fate, but to management.

This shift reshapes the very concept of illness. In older models—religious, philosophical, even literary—madness could be read as revelation, curse, punishment, possession, prophetic fire. Diagnosis, in that sense, carried metaphysical stakes. Theology once approached affliction as a site of divine encounter, a furnace in which the soul was tested, refined, judged. Classical tragedy framed mental disturbance as fate’s visitation. Romanticism framed it as genius turned inward. Even modernist literature retained the intuition that psychic rupture might illuminate a world too narrow for ordinary perception. The Psalms, Greek chorus, Hölderlin’s fragments, Hildegard’s visions, Bach’s Passions—these were ontological instruments: ways of making the unmanageable bearable, nameable, heard. The DSM, by contrast, approaches distress as an administrative irregularity. Its logic begins with an assumption about normal function and works backward to label deviation. The soul no longer appears as something to render beautiful or even tragic—it appears only as a malfunction to be standardized. The crisis here is less that suffering exists than that we have ceased to imagine what suffering is for.

Once suffering enters an institution, the question shifts from meaning to management, and the rest follows with terrible calm. What makes this shift more than a tragedy—what renders it perverse—is that those now charged with regulating psychic life often have no knowledge that any other grammar ever existed. The clinician dispensing antipsychotics may be acting with care, even urgency. But the instruments they rely on are blind to the symbolic lineage they have displaced. Rather than rejecting art, theology, or poetics, the system simply ceases to register them as forms of knowledge. The soul is no longer contested terrain; it has been quietly decommissioned. Those who now manage its symptoms do so without recognizing what has been overwritten. Meaning persists only as an afterthought, its necessity quietly revoked. 

What is most striking about those older interpreters—the priest, the poet, the prophet—is their acceptance that suffering might resist comprehension altogether. Their posture was one of reverence rather than resolution. Job’s friends sat in silence for seven days before speaking; the Psalmist cried out without expecting a reply; even the early mystics, steeped in metaphysical systems, knew that affliction might exceed articulation. They understood that any diagram of the soul would introduce distortion. Interpretation was a risk. Language was always asymptotic. But this asymmetry was itself ethical—it preserved mystery, and with it, a kind of respect. By contrast, the modern diagnostic gaze proceeds without hesitation. It moves directly to classification. Intervention arrives immediately, as though the depth of suffering were commensurate with the speed of its codification.

The shift is both epistemic and operational. You can walk into a clinic, complete a generic intake form—“Do you have trouble sleeping?” “Do you experience flashbacks?”—and walk out with a diagnosis of PTSD. Your suffering, whatever its texture, duration, or symbolic charge, is now indexed to a billing code. And the person assigning that code may be kind, attentive, well-intentioned. But they may also be a 27-year-old clinician who grew up in the suburbs, trained in a fast-track MSW program, and has never read Lacan, Job, or a single line of poetry that did not come from a mindfulness app. This reflects structural design rather than individual failure: a system optimized to convert existential disquiet into administrative throughput. And the consequence is not benign. You may be prescribed a medication that alters your sleep, appetite, libido, cognition, metabolism, and personality—often within days. These are not mild interventions. They are neurochemical restructurings of your inner life, undertaken before any deeper interpretive frame has been attempted. No priest, poet, or philosopher is consulted. No dreamwork. No art. No communal ritual. No somatic practice or exercise. Only the pill. Every other mode has already been rendered unviable. The folly is not that medication is offered. It is that it is offered first.

The classificatory impulse that animates the DSM predates its contemporary branding. Its lineage stretches from the demonological treatises of the Inquisition, in which errant thoughts were sorted into taxonomies of infernal influence, to the melancholy typologies of Renaissance medicine, where sadness could be assigned to Saturnine imbalance, divine punishment, or excess black bile. In both frameworks, affective irregularity registered as moral index and temporal structure: acedia (spiritual torpor) as a sin against divine order, ecstasy as either divine seizure or satanic trespass, depending on the witness. The DSM inherits this logic wholesale. It reformats what was once spiritual divergence into neurochemical asymmetry, replacing demons with dopamine and spirits with serotonin transporters. Its diagnoses, like inquisitorial exorcisms, rely on a foundational premise: that to name is to neutralize. The naming is never descriptive—it is disciplinary. To call a thought “intrusive,” or a mood “hypomanic,” routes experience into an indexed system of intervention.

This pathologization of emotional variability follows a long theological and imperial tradition in which the invisible—be it spirit, ether, aura, or now neurotransmitter—must submit to legibility. It converts interior life into misalignment, into deviation from a constructed mean. The metaphysical substrate remains shockingly stable: suffering appears as system error; volatility reads as internal malfunction; and the solution takes the form of ritual classification. Change emerges at the level of scale rather than logic. Once reserved for mystics, heretics, or the visibly mad—those occasionally inconvenient outliers at the edge of the social script—the classificatory regime now applies universally. You do not need to hear voices or see visions to be diagnostically captured; you need only drift out of rhythm. Deviance gives way to fluctuation as the governing concern. In a spiritually indifferent and economically saturated culture, mood becomes an index of risk exposure rather than interior life. It is volatility with no market logic. And like any derivative with uncertain yield, it must be hedged, compressed, or absorbed into the actuarial language of disorder. The question is less how you feel than how predictably you feel it.

Consider bipolar disorder. The diagnosis now spans an enormous range—from acute manic psychosis requiring hospitalization to what the DSM and ICD label cyclothymic temperament, defined by periodic “elevated mood” and “depressive symptoms” that fall short of full episodes yet persist across years. In other centuries, these fluctuations might have been interpreted as eccentricity, prophetic temperament, divine enthusiasm, or melancholic genius. In ours, they are coded as F34.0. That is the numerical designation for cyclothymia in the ICD-10, the international diagnostic standard that allows clinicians and insurers to jointly interpret the soul. The result is a diagnosis whose conceptual center grows porous. A word meant to name crisis becomes a net for variability.

And yet the biology remains conspicuously absent. There is no definitive blood marker, no PET scan irregularity, no Mendelian gene. What psychiatry possesses instead is a pattern—a temporal irregularity, a misalignment between inner pacing and institutional time. Hypomania is marked by neither violence nor hallucination, but by a particular urgency: accelerated thought, expanded speech, heightened perception, an almost excessive coherence. For a brief period, the patient may even appear too functional. This, of course, is intolerable. What draws sanction is neither belief nor behavior, but cadence—the rate, the pace, the sustained elevation that refuses resolution. Volatility, in this schema, is no longer just a psychiatric variable—it becomes a metaphysical misdemeanor, a moral irregularity with no permissible lucrative function. This is the true innovation of the psychiatric-industrial system—it transforms variability itself into pathology. What appears as mood is treated as threat, not because it imperils others, but because it interrupts the choreography of compliance. The crime is unscheduled feeling rather than madness.

This volatility—temporal, emotional, affective—becomes more intelligible when placed against the rise of industrial time-discipline in the late 19th century. As factories replaced fields and clocks replaced seasons, modern economies no longer required just bodies—they required bodies in sync. Labor was mechanized, and so the worker’s psyche had to become a metronome: standardized, punctual, anticipatory. Frederick Winslow Taylor’s Principles of Scientific Management (1911) laid out the new mandate: break all tasks into discrete units, eliminate inefficiency, punish irregularity. Composure became an economic virtue. Restlessness became a liability. A mood flies neither too high nor too low in any absolute sense; it simply defies schedule. Machines require torque without slippage; variance appears as friction.

Enter Emil Kraepelin, German psychiatrist of Wilhelmine Germany’s industrial acceleration. Often credited with building the nosological foundation of modern psychiatry, Kraepelin restructured mental illness as a series of temporal sequences, especially manic-depressive insanity, which he defined through cyclical recurrence rather than thematic content. His focus fell less on what the patient believed than on the regularity of return to particular states. Madness drifted away from singular estrangement and toward patterned deviation. The metaphysical figure of the madman—tragic, inspired, cursed—yielded to the statistical deviant tracked over time. Kraepelin’s diagnostic model—explicitly modeled on actuarial tables and time-series data—anticipated both the logic of the DSM and the managerial rhythms of Taylorized labor. His innovation was calendrical rather than interpretive.

Within that frame, hypomania—a state once linked to eccentricity or inspiration—becomes clinically meaningful through its pattern and its interference. The diagnosis hinges on duration: four days of elevated mood, three symptoms out of a list, observable change. The rubric transforms energy into measurable deviation. It formats pathos into criteria. A life becomes legible through temporal segments. In this sense, the DSM functions less as a medical text than as a chronometric ledger—a document preoccupied more with timestamping suffering than understanding it. Like the penitential tables of early Christianity, which assigned durations of fasting or flagellation to internal temptations (“three days for envy, five for lust without action”), or the humoral charts of Galenic medicine, which prescribed seasonal balances of bile and blood, the DSM operates as a ritual apparatus: it modulates the soul through numeric thresholds. “Five of nine symptoms must persist for two weeks.” This clause performs a soteriological accounting equation—a spreadsheet of the spirit. These metrics are not neutral. They are acts of calibration. Administrative time flows into experience and reorganizes it. Suffering gains institutional legibility only after durational verification and statistical ratification. The prose is antiseptic, yet the structure is Talmudic—significance clings less to meaning than to compliance with criteria. The DSM’s categories are spiritual in form even when they deny spiritual stakes. It resembles a modern confessional tariff: sin becomes symptom, confession becomes intake, absolution becomes medication.

This logic exemplifies what E.P. Thompson termed “time-discipline” and later what Elizabeth Freeman called “chrononormativity”: the cultural enforcement of temporal regularity as a moral good. In its original formulation, Thompson was describing how industrial capitalism restructured working-class life around factory bells and hourly wages. But the principle extends inward. To be emotionally well is, under this regime, to be rhythmically obedient and available to productive capture. Neither happy nor fulfilled—simply predictable and sufficiently industrious. But the psyche has never been a factory organ. It lingers, surges, retreats. It mourns out of season. It remembers ecstatically and forgets irrationally. It exults at 3 a.m. and falters on holidays. The DSM’s function is to discipline this unruliness. Emotional states that once belonged to poetry, prayer, or dream are now rerouted through the logic of noncompliance. The diagnostic code becomes a temporal warrant—permission to intervene in the name of realignment. That intervention is pharmacological. Mood stabilizers, antidepressants, antipsychotics: these are as much technologies for temporal smoothing as they are treatments for psychic suffering. They dampen the spikes, buoy the lows, and suppress the awkward syncopations of the inner life that interfere with calendrical function. This is behavioral harmonization rather than medicine in the classical sense. The goal is less serenity than compatibility: with office hours, deadlines, payroll cycles, insurance assessments, and the abstract rhythms of institutional time.

Consider, as a brief counterpoint, the figure of the artist. Not the mythologized bohemian, but the working creator whose life, by necessity, violates the rhythms enforced by psychiatric metrics. What, exactly, would the DSM do with James Joyce, whose writing process spanned seventeen years of nocturnal delirium, optical disorientation, and linguistic fugue states? Who dictated portions of Finnegans Wake from a horizontal position in the voice of a river, edited in multicolored crayons, and insisted on the semi-divine nature of typographical error? By diagnostic standards, this is cyclothymic dysfunction with obsessive-compulsive features and possible psychosis NOS. And yet what emerges is one of the most formally advanced artifacts of human consciousness ever recorded. The DSM has no field for this. It cannot metabolize nonlinear genius, because it confuses temporal variance with failure. It is a system in which the only kind of brilliance that makes sense is punctual brilliance—brilliance that shows up to the meeting on time, turns in drafts according to schedule, and recovers neatly by Q4. And Joyce is not an exception. He is simply an elegant demonstration of where the DSM catastrophically fails. Past a certain threshold, the entire diagnostic framework begins to disintegrate because it has no language for value outside synchronization. It can catalog symptoms, but it cannot recognize structure. It can count days, but it cannot understand rhythm. What it calls dysfunction is often the necessary architecture of meaning-making—temporal plasticity, reflexive cognition, intensified perception. The system assumes that what deviates from the median must be corrected, but past a certain level of complexity, the median becomes irrelevant.

This is not an argument for romanticizing madness. It is a statement of categorical incompatibility. The DSM cannot distinguish between a panic attack and a mystical vision, between a schizotypal loop and a poetic structure, because it does not possess a theory of meaning—only a theory of disruption. And when meaning itself requires disruption—as it does in art, in science, in prophecy, in love—the entire psychiatric apparatus reveals itself as a mismeasured theology, one that has retained its rituals but lost its God. That is the real tragedy. Not that the DSM pathologizes genius, but that it cannot recognize when it is in the presence of something sacred. Its ontology stops at compliance. Its ethics are managerial. It is a system built to detect error rather than revelation.

The DSM’s power thus emerges more from its infrastructural role than its truth claims. It functions as a routing protocol for the soul: a standardized language through which institutions and individuals coordinate intervention. Psychiatry shifts from healing art to managerial technology. It supplies codes rather than cures. Committees of appointed experts update those codes every decade or so behind closed doors, sealing proceedings, withholding minutes, and presenting criteria without full history of deliberation. No published minutes, no footnotes. Once ratified, the structure of each revision takes on canonical force. Every edition rewrites the soul’s taxonomy in private and enforces the revision in public. What the DSM displaces are mythic frameworks that located suffering within an order of being, where it possessed ontological standing rather than pathological deformation. The manual declines to explain why anguish arises; it supplies methods for indexing anguish, phrasing it for reimbursement, narrating it in ways that satisfy bureaucratic prose. In that sense, the DSM outflanks religion rather than destroying it. It demands submission rather than belief, adjustment rather than redemption. Its operative “soul” equals whatever can be rendered legible and bent toward compliance. It defines illness through temporal variance, health through schedule, personhood through consistency.

This reading proposes no shadowy cabal. Psychiatry as a profession contains many sincere clinicians who seek to relieve suffering. Conspiracy becomes unnecessary; the structure itself carries pressure. Once such a system settles into place, its logic reinforces itself. Diagnosis becomes required for accommodation. Accommodation becomes required for survival. Survival becomes required for participation in institutions that demand compliance. The categories proliferate because they are useful. They spread because they solve administrative problems. Their truth becomes secondary to their function.

In seeking to manage mood, however, we have forfeited something quieter, but no less vital: the right to emotional pacing, the right to be out of sync, the right to treat our own interiority as a space of interpretation rather than compliance. This is neither nostalgia nor mysticism. It is a plain recognition of scale. A culture that cannot accommodate temporal irregularity cannot accommodate phenomenal heterogeneity. And a psychiatric system that treats unpredictability as pathology will inevitably misdiagnose not only suffering, but personhood itself. No system of classification can exhaust the phenomena it describes. The DSM can assign terms, durations, and thresholds, but it cannot account for why the same pattern in two lives yields opposite meanings, or why some forms of distress generate insight while others generate only noise. It cannot account for interpretation. That is its limit. And that limit is formal rather than accidental. That it functions this way is not inevitable. It is a historical choice—contingent, constructed, and in many respects, barbaric. We are living through a historical moment in which the dominant framework for understanding human interiority is a billing instrument, and this—however clinically normalized—constitutes a disaster at the level of existential plurality and dignity. Not because it fails in its design, but because we have allowed it to define the entire architecture of psychic legibility. It did not have to be this way. That it is, is both an index of our poverty and of our tolerance for it. Not a conspiracy, but a rational outcome. When the goal is efficiency, this is the system you get.

And once that system is in place, its logic becomes self-reinforcing. A system that classifies inner experience without interpreting it will default to control. A system that medicalizes volatility without contextualizing it will treat unpredictability as pathology. A system that encodes suffering without meaning will produce categories that function, by design, as tools of normalization. If the metric is stability, then deviation will always appear disordered. If the goal is legibility, then ambiguity will always appear as threat. These are not failures of psychiatry. They are the mathematical consequences of its premises—a closed system encountering its Gödelian limit: unable to account for that which exceeds its own syntax, yet structurally compelled to suppress it.

It is worth remembering that there are other ways of knowing. The interior life need not be rendered in diagnostic language. One is not required to think of oneself in psychiatric terms. Before the invention of symptom clusters and codebooks, people turned to scripture, poetry, metaphysics—to frameworks that treated psychic pain as legible, but not classifiable. The Book of Job offered no diagnosis, only the dignity of unanswered suffering. Hölderlin wrote through madness without evacuating meaning. Weil treated affliction as a form of metaphysical gravity. Bachelard described the soul as a space rather than a dysfunctioning organ—elastic, involuted, resistant to quantification. These traditions did not offer solutions, but they made space. They treated sorrow as a phenomenon to be interpreted rather than corrected. That lineage is not obsolete. It is simply illegible to systems that confuse compliance with health. One is still permitted—not legally, but ontologically—to describe one’s experience without recourse to code. Not everything that resists diagnosis is confused. Some things are simply beyond it. The map is not the territory. And the code is not the self.

Author bio: Joseph Randolph is a multidisciplinary artist and professor from the Midwest. He is the author of Vacua Vita (philosophy) and Sum: A Lyric Parody (poetry), and his debut novel Genius & Irrelevance is currently under review. His writing has appeared or is forthcoming in Action, Spectacle, The Penn Review, Night Picnic, and elsewhere, and he received second place in the 2025 Bath Flash Fiction Award. His music is available on streaming platforms, and his paintings can be found on Instagram @jtrndph.