To Diagnose or Not to Diagnose

In the realm of fiction, diagnosis serves no worthy purpose. In fact, it may even undermine the goal of character exploration.
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I am a psychologist, so I shouldn't be surprised when readers of my novel ask me to diagnose its wily protagonist. Is the heroine of Parlor Games, they wonder, a classic example of a sociopath? Might she be some variant, such as a narcissist? Or is she different from a "normal" person only by a few shades? But the question always unsettles me, and I typically respond: Since readers have such varied reactions to May, the matter of her psychology must be more a reflection of personal perspective than anything else.

But the astute reader recognizes this as the dodge it is and presses ahead: What do you, author and clinical psychologist, have to say about your character, your own creation? And now, with the American Psychiatric Association releasing the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (aka, the bible of psychiatrists and psychologists), I feel compelled to respond to the question.

But first I want to ask: What do we gain by diagnosing a person? When it comes to the real and present world (and not the fictitious and past), I will grant that there are benefits. The system of categorization facilitates research and may thus benefit those who suffer from debilitating conditions. And then there's the matter of reassuring insurance companies that they are in fact paying for treatment of "legitimate" disorders. But I can't leave it at that, for this system of labeling deviation is, at best, arbitrary and, at worst, stigmatizing: Witness the ever-shifting lists of disorders with each new edition or the insistence, for so many shameful years, on labeling homosexuality a pathology.

In my opinion, diagnosis has its place -- in the medical world. But I do not believe that place is in the annals of fiction, or even the work-a-day world. So I am disinclined to assign a diagnosis to any fiction character or, for that matter, person on the street. You see, no individual can be reduced to a psychiatric diagnosis, and I hold this not only as the maker of May (or at least my version of this real person) but as a psychologist. All those categories contained in the Diagnostic Manual are only categories, constructions made by those who would plunk their subjects into neat and discrete pigeonholes. They are, in a word, dehumanizing.

If we take the lot of individuals who may be labeled sociopaths and line them up side by side will we see any similarities in their appearance? No, for they will be men and women of varied ages and body types and dress. Will they resemble each other in actions? To some extent, for that is really how sociopaths are labeled -- by their deeds and, when one queries them, their somewhat cavalier attitude toward these deeds. But who can deny that each and every one of them will have a different life story, a different set of experiences, and different schemes and foibles? So, really, does giving them a diagnosis accomplish much? When one considers the fiction writer's goal -- to create uniquely compelling characters -- I think not.

I contend that, in the realm of fiction, diagnosis serves no worthy purpose. In fact, it may even undermine the goal of character exploration, for it is a shortcut that can gloss over the curiosity that should drive the writer to delve ever deeper into his/her characters. It can make reader and writer alike lazy: "Oh, well, what do you expect from May? She's such a sociopath." Shouldn't we as readers and writers seek to understand the individual in all his or her glory and failings? And shouldn't we as human beings regard our neighbors and coworkers and even the residents of psychiatric hospitals as human beings first? Isn't that what the journey of living alongside our fellow creatures demands?

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