Language, Gender, Nosology

vivianimbriotis | June 20, 2020, 1:47 p.m.

Observe: as the camera pans across the softly-lit office to the daybed, where reclines a patient with long white beard and flowing white toga, the door swings open and there enters, stage left, a man with a toga of his own and a head mirror above his left eye. This doctor clears his throat, pulls up a chair, and says the spiel that has fallen from his lips uncountable times before:

“Good morning, my name is Doctor Diogenes. I’m a psychiatrist here at Academy Hospital of Greece. What can I do for you today?”

Observe as the patient shifts, remains quiet, exhales, looks right, and speaks.

“Doctor Diogenes, I need help.”

“That is what I am here for, Mr. Socrates. What is going on?”

“Doctor, what does it mean to be a human?”

The doctor is taken aback. “I’m not altogether sure what you mean.”

“Doctor, please. What is it to be a human?”

“Well…there are many things that humans do that non-humans don’t. Poetry, mathematics, writing systems.”

“So, what is means to be human is to be something that can write poetry, Doctor?”

“I can see here in your chart that you are a philosopher, Mr. Socrates. Why do you ask this of me?”

“Well Doctor, I am always telling my students they should try doubting their knowledge. But this is one thing I think I have solved, what it really means to be a human. Got the idea from one of my students.”

“I don’t see how this is relevant to your, ah, diagnosis, Mr. Socrates.”

“Of course it’s relevant, I’m still a human, no?”

“Certainly…Well, what is your answer? What is a human?”

“A featherless biped.”

Observe the doctor stare quietly.

“A featherless biped?”

“A featherless biped.”

“One moment.”

The patient reclines in his daybed and has a brief siesta; he dreams of Athena and starless skies. He is awoken by high-pitched, panicked screeching. The doctor stumbles into frame, stage right.

“I have brought you a man!” he cries, holding up a struggling chicken for a moment, before its flapping and scrabbling frees it from his grasp. It has been plucked clean.

“Oh, good point,” says the patient, “surely then, man is a featherless biped with flat nails.”

“No, Mr. Socrates, I mean not to point out that this particular definition that you have created is poor, but that humanness resists formalization of this kind, because you are trying to retrofit a formal definition to a non-formal concept. The way the world really works, the laws of physics, appear to create no distinction between things-that-are-humans and things-that-are-not-humans. Humanness exists in the map, not the territory.”

“I do not understand what you mean, Doctor. What are these laws of physics? Do you mean my friend Heraclitus’s theory that all is made of fire?”

“Oh, uh, ignore that then. Consider this map of Europe upon my wall, Mr. Socrates. Do you believe that this map contains the true detail of Europe?”

“No doctor. It is a simplified and false representation, because it must be; if it corresponded exactly with Europe it would, by necessity, be as large as Europe is, and no longer be a useful map.”

“And if we changed the borders on the map, what effect would that have on the world itself?”

“None.”

“But the existence of those borders on the map makes it much easier to locate a certain place in the actual world, yes? To say that one is in Persia rather than in Greece is informative.”

“Certainly, doctor, but that doesn’t mean that the land of Greece is distinct in any true sense from the land of Persia.”

“Such it is with humanness. We recognize a bipartite clustering of things-in-the-world along several axes – one cluster of things that can talk and write and do mathematics and yes, have two legs and no feathers, and then another cluster containing everything else, and we give this first cluster a name – but it is a cluster, not a definitional category. Existence precedes essence. The definition of the category comes after we recognise it, unlike in mathematics, where definition creates recognition.”

“I’m still confused, doctor. Could you give me another example?”

“Well at the risk of getting political – and we wouldn’t want that, would we Mr. Plato – gender is a great example. It’s a bimodal distribution across people-space. Gender is like health, Mr. Plato; it is a collection of things, a loose association, a fragile shared understanding that wilts under scrutiny. Just as humanness was characterized by fuzzy and somewhat arbitrarily borders in thing-space, gender is so characterized in person-space.”

Socrates nods, brow furrowed.

“So my diagnosis.”

“Yes.”

“You tell me I have major depressive disorder?”

“That’s correct.”

“How do you know?”

“Well, you fulfill certain criteria, Mr. Socrates. Here, my copy of the DSM-V lists them,” and the doctor beings to read aloud, “One: depressed mood most of the day. Two: diminished interest or pleasure in activities. Three: Significant weight loss or weight gain, or decrease or increase in appetite. Four: A slowing down of thought and a reduction of physical movement. Five: Fatigue or loss of energy. Six: Feelings of worthlessness or inappropriate guilt. Seven: Diminished ability to think or concentrate. Eight: suicidality.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition.”

“Ah. In the same way you have two legs and no feathers, and are thus a man, if I satisfy these conditions that that means in reality, in the territory, I am a depressed man?”

“I see what you are getting at, Mr Socrates, but one of these criteria is special – it states that your condition must be inhibiting your normal functioning.”

“And what is normal functioning?”

“I guess it means to live a normal life.”

“So mental illness just means to be unable to live the kind of life I have been prescribed by the society in which I live?”

“On second thought, maybe ‘normal functioning’ is just however you would like to live your life.”

“Well almost everyone is prevented from living the kind of life they want to live by feelings of fatigue. Many people wish not to gain weight, and do regardless, and that prevents them from living the life that they wish to live!”

“Yes, but in order to be depressed one must fulfill at least five of these criteria. When these things cluster together, just like when aspects of maleness or humanness cluster together, we recognize that as mental illness.”

“Why five?”

“I’m sorry?”

“Why at least five of these criteria, and not at least four, or at least six?”

“I guess I’ve never thought about it.”

Observe as Socrates stands, and faces the window, and says: “What really is a mental illness, doctor? Not these criteria – they are like the borders on your map. What distinguishes mental illness from the other kinds of distressed mental states that a person may experience – like despair at a life without meaning, or at a life genuinely wasted?”

“Like I said, Mr. Socrates, you’re the philosopher. I just went to medical school.”

At the end of the day, we must ask ourselves: what schema do we use to draw the lines where we draw them? What brought us to use that schema?

Further reading:

The great psychotherapy debate by Wampold and Imel

Wittgenstein’s Language-Game on SEP

Gender uniformity on SEP