Commentary on Robert Romanyshyn’s “Diagnostic Fictions”

In the article “Diagnostic Fictions,” Robert Romanyshyn (RR) gives us a glimpse into his current work. Such a foretaste is a gift indeed, because, when it comes to RR, a mere peek can open up entirely new vistas, not unlike the remodeled world-sense readers received from Technology as Symptom and Dream (1989) when it demonstrated how the artistic development of linear perspective vision, a new technology during an earlier era, enabled humans to encounter physical space differently. At the same time, RR then encouraged his readers to examine other, more recent, technologies, and to ask how these may be changing our perspectives. Thus, being privileged to read any new piece by RR is certainly a gift. Those who have been able to explore his writings know they are beyond insightful, poignant to a degree that touches our inner core and unravels understandings lying just below the surface of our psyche, understandings that we heretofore have not quite been able to touch.

Yet reflecting on his works is not a task for the faint-hearted. Why? Because his writing takes us to places we would not otherwise have gone, and indeed from which we might even have steered away, had not we been privileged to read words that emerge from his vital and often unanticipated, psychological/philosophical/poetic presence. Sometimes it is hard to get from one sentence to the next. But that is part of the gift. We linger not because we don’t understand what we read but because we have comprehended all too well. We are handed insights; we hear music, poetic lyrics; and we are given pause. The ground on which we now stand becomes reimagined space that takes, at times, getting used to. No problem. A deep breath is sometimes needed, and we keep reading as RR takes us on journeys to lands that lie between the familiar and unfamiliar and ask to be known. There, in his words, we get a taste of what it means to better know what was previously unknown or only marginally known. His texts are, somehow, seasoned with our past and remembered. RR is a giver of gifts.

His article “Diagnostic Fictions” lives up to the anticipation of such gifts, and more. It asks us to reimagine the circumstances, the spaces, especially the overlapping therapeutic/literary/theatric spaces in which humans encounter one another and are either drawn to or required to size one another up. This sort of sizing up is deeply at play in the therapy room, where therapist and patient are present, and neither can fully break free from characterizing. And yet he asks, are not literary and theatrical characters a better representation of what is going on within humans and between humans? Thus, sizing up, when organized to the extreme is standardization of that which may not truly be amenable to systematic standardization. And the Diagnostic and Statistical Manual of Mental Disorders (DSM) is certainly an attempt to systematize. Whether the DSM succeeds or fails is not the topic of RR’s investigation, but he lays a groundwork that shows that adoption of standards exists, yet stands beside, and somehow in opposition to, lived truth. The DSM is not only fiction but is built on a composite of stories, fictions. Each DSM disorder is thus a fiction, a character on the stage of life that sees itself not as a disorder but as being-that-bears-witness to itself. Each character has a deep pull to exist in a way that is neither fictional nor DSM diagnostic code. Neither, nor. And yet, does not a “literary approach” to a revised diagnostic manual with a “philosophical foundation” make more sense for the work of psychology?

Played out on the platform of the DSM, RR takes us to the psychological building wherein stratification occurs on a daily basis, where we come to ask ourselves who one actually is, and conversely, who the other actually is, in therapeutic space. Who is the patient? Who is the therapist? The interaction is changed by that questioning, and when taking the requisite journeys on the impersonal interpersonal road that the diagnostic model of the DSM lays in our path, he asks that we reconsider exactly where it is we are really going.

RR gives us a patient’s story, in which diagnostic fictions reign. And then he asks us to consider her shared story, and a smattering of others, with an imagination that brings into play literary and psychological giants: Freud, Merleau-Ponty, James Hillman, Cervantes, Coleridge, Baudelaire, Orpheus, Keats, J. H. van den Berg, Yuval Noah Harari, John Donne, Susan Rowland, Mary Shelly, and Joyce Carol Oates. Indeed, he does not note the names of all that you can softly hear in his words, but one hears them nevertheless. And then, he begins to develop for us a reimagining of the story of Frankenstein by Shelly.

In the space of the therapy room, where patient and therapist may ask “who is the patient,” or conversely “who is the therapist,” RR gives us Victor Frankenstein on a DSM matrix, and the comparable questions “who is the monster,” “who is V. Frankenstein.” Surprisingly he does not use the word “transference,” but he nevertheless paints a kind of transferential energy wholly embedded between Frankenstein and the monster, somewhere in Europe, or, correspondingly, between patient and therapist somewhere in a therapy room. These individuals are lived fictions created by, powered by, one another.

We begin to see Victor Frankenstein reimagined within the therapy room together with the monster/therapist he somehow fictionalized into being. Frankenstein becomes painted onto the matrix of the DSM at site 301.81.: Narcissistic Personality Disorder. RR gives us the criteria through which one might justify such a coding. In the modern therapy room, the monster/therapist might even know what codes to submit to the insurance company. One therapist we know would say to his DSM-categorized narcissistic personality disorder patients, “You want perfect room service, but . . . . I never promised you perfect room service.” The perfectly behaving monster, one that would provide five-star service, never really materialized in physical space but rather became a living fiction incarnate somewhere between Victor and the monster.

And so, patients, such as those into whom RR gives us insight, similarly become living fictions, as do their therapists. The therapy room is the stage on which diagnostic fictions, such as those on the pages of the DSM, are able to play their parts, live their characters. The challenge RR presents to the diagnostic model is potentially transformative for the practicing psychologist. Why? Of course, many have suggested that diagnosis in psychology, through use of the DSM, has increased due to seepage from the corresponding medical diagnostic-prognostic-therapeutic model that has continued to overtake the medical realm, not to mention the medical–pharmaceutical relationship arena.

To a medical doctor, one cannot simply be “ill” or “well.” Rather, one must have a materialistic, literal, demonstrable diagnosis. Applied to psychology, RR shows us the underlying fictionality of DSM codifications and the “double amnesia” that results when believing them true. And returning in the main case he presents, he shows us a patient who is simply not diagnosable. No CT scan, no ultrasound, no blood work can objectify the unobjectifiable space she inhabits. Where symptoms form the substrate of diagnostic classification, à la DSM, RR shows us that symptoms are containers of the stories that form our psychological fabric. They hold fictions that are yet real and tangible. Neither persona nor naked character but living embodiments of remembered and somewhat remembered past, and perhaps future.

“DSM categories” he says, “. . . conceals what is most human about the human person: the ability to transform the biological conditions of behavior and experience into the meanings of our actions and experiences” (p. 6). Furthermore, he notes, “It is a consequence that not only creates an image that is a monstrously inadequate caricature of the human being it also shackles this image with economic, pharmaceutical and insurance chains” (p. 6).

The practicing psychologist can only welcome the journey that RR invites us on, as he asks us to examine our daily work, our use of the DSM, and to imagine a different, literary model. In taking steps along those paths, we can only anticipate the release of his even more extensive work on the topics he approaches, a book, The Frankenstein Prophesies. Many of us await that release with anticipation for the additional gifts it no doubt will bear.