In her ethnography of manic depression Bipolar Explorations: Mania and Depression in American Culture, anthropologist Emily Martin notes that in the various support groups in which she participated for her study, people used the DSM (Diagnostic and Statistical Manual of Mental Disorders) categories to talk about their illnesses rather than talking about their inner psychic states. Martin, herself “living under the description of bipolar,” realizes that while she has had years of regular one-on-one conversations with psychiatrists and social workers who taught her to recognize and describe the nuances of her psychological experiences, the people in the support groups have not. Most insurance does not pay for long-term psychotherapy and most people do not have the resources to pay for it privately. Deprived of the opportunity to explore their inner psychic states, the people she encountered in the support groups had only the language and categories of the DSM to talk about themselves. “Exploration of inner experience has the potential to challenge the uniform and bureaucratic language of the DSM. Insofar as people use DSM categories instead of exploring the phenomena of their experience firsthand, they may have only the illusion of communicating with other people what it is like to be, say, manic” (142).

One important consequence of this is that without people telling us what it is like for them, there is a failure on the part of the rest of us to understand them as people — their conditions seem to be malfunctions rather than understandable experiences. To be able to empathize with others we first have to have a sense of what it is like for them. How are we to do this if people do not have the language with which to do it, if instead all they have is the language of the DSM?

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So we have three highly functional women (successful by anyone’s standard of success), with longstanding DSM diagnoses who have been helped by something to which most people do not have access and which Martin believes “has the potential to challenge the uniform and bureaucratic language of the DSM” (142) Further, by not giving people access to psychotherapy that would allow them to explore their inner states and experience, the current system not only reinforces itself, but reinforces certain prejudices against the mentally ill — we see them as malfunctioning and unpredictable instead of understanding them as persons with particular unusual experiences that we can come to understand. All we have is what Martin calls the “dubious science of the DSM” which leaves out subjective experience altogether and in doing so denies the ethical personhood of those who fall under its diagnostic categories. Saks says, “the humanity we all share is more important than the mental illness we may not” (336). Yet denying people the resources that will allow them to develop the ability to articulate to themselves and to others what it is like to live with their experiences, as our current system does to all but the fortunate few, means that neither they nor we can have the opportunity to see that “humanity we all share.” We are left instead with the view chillingly articulated by a mental health professional quoted in Saks’ memoir who was unaware that she lived under a psychiatric diagnosis: “These people [the mentally ill] are different from you and me…It [physical restraint] doesn’t affect them the way it would affect us” (212).