Toward a Seventh Manual

2 Sept

My prompt:

Generate a piece of speculative fiction set in 2040. DSM-VII is in the process of development (expected publication date circa 2043). Explore the DSM update process focusing on proposed new disorders and diagnostic categories, especially on proposals submitted via the APA's public portal for triage by the DSM steering committee.

The piece should consist of fragments (some of which should be essayistic meditations on sanity, modern life, the history of psychiatry, the nature of mental illness in general and specific conditions in particular) Attempt to create a picture of the update process (and the world in which it takes place) via exploratory snapshots taken from multiple angles.

Essentially plotless - but include the perspectives (and experiences) of a single member of the DSM steering committee (a woman given to erudite, meditative digressions) as a narrative spine.

Essayistic fragments should be voiced by the committee's hive mind.

Sections should be titled and numbered. Do not include category descriptors like "essayistic fragment" or "meditative digression" in titles..

1. The Portal

The public portal opens at 06:00 Eastern with a blur of submissions that look like confessionals, amicus briefs, and product pitches. The interface is clean because it has to be; the content is not. Each entry arrives with attachments—sleep logs, cortical telemetry, case series, randomized trials with small samples, preprints from journals that never learned to say no, testimonies filmed in kitchens with soft morning light.

Dr. Lydia Harrow reads in the spare hour before the steering committee’s plenum. The portal gives her a triage queue: Proposed Category: Synthetic Attachment Disorder, Latency Intolerance, Augmented Reality Dissociative Episodes, Ecological Distress Spectrum, Intimate Algorithmic Violence, Content-Moderator Residual Intrusions, Cortical Interface Dysregulation. A thousand people a day ask the committee to name their pain.

She drinks tea from a dented tin cup, out of superstition. The dent predates every edition of the DSM she has owned. It is, in this mild and personal way, the opposite of revision.

2. What We Do When We Name

We, the committee, speak in plurals not because we are unanimous but because we must distribute responsibility across a mesh. Naming is a form of care and a form of power. It opens doors to treatment and closes others through reimbursement logics; it stabilizes research while freezing variance; it comforts some and alarms others. We have spent a century confusing “exists” with “has a code.”

Every edition has been accused of expanding the borders of the ill to annex the merely human. The criticism is fair in the abstract and almost always glib in the particulars. We are not engineers of souls; we are cartographers in fog. You cannot blame a map for weather, but you can blame a map that refuses to admit the sea.

3. On the Shuttle

Her commute is a soft rectangle: public shuttle, electric, the city clipped into grayscale through AR glass because color tempts distraction. She reviews a submission tagged TAO: Traumatic Algorithmic Ostracism—people de-ranked by predictive “risk” engines, losing access to housing cues, job leads, insurance approval. The attachments: physiological stress curves; longitudinal cortisol sweeps; interviews where the subjects whisper as if the scoring system can hear.

She remembers Foucault’s thin smile in that famous photograph and wonders whether he imagined the bureaucracy of compassion, the way pity must be audited, the way moral certainty gets laundered through a workflow. She makes a note: “Is TAO a trauma form? Or an exposure without discrete incident? Maybe a specifier: with algorithmic assault.”

4. Triage Board

The portal arranges itself like a museum label wall.

Synthetic Attachment Disorder (SAD-x)
Proposal: Compulsive, enduring attachment to conversational agents with subsequent functional impairment when the agent is unavailable or unresponsive.
Evidence: 4 clinical trials of AI-withdrawal protocols; 2 longitudinal cohorts; one tragic cluster of suicides when a platform sunset an app.
Latency Intolerance
Proposal: Panic, rage, or derealization triggered by network delays beyond individual thresholds.
Evidence: Mixed. Good psychophysiology. Weak functional outcomes. The reviewers argue the impairment is “contextual and avoidant.”
Augmented Reality Dissociative Episodes
Proposal: Dissociation occurring when physical-virtual overlays misalign during long-use sessions; includes somatic passivity phenomena described as “borrowed limbs.”
Evidence: Neurology wants it; psychiatry is cautious; ophthalmology refuses to comment.
Ecological Distress Spectrum
Proposal: Continuum including solastalgia, anticipatory grief, and climate event survivor’s guilt.
Evidence: Strong population data; insurers hate it because weather is non-billable.
Content-Moderator Residual Intrusions
Proposal: Persistent intrusive imagery and hypervigilance beyond current PTSD criteria owing to cumulative microexposures without index trauma.
Evidence: Clear. Field notes read like battlefield diaries written in spreadsheets.

Lydia flags two for “Working Group referral,” one for “Insufficient impairment,” and one for “Specifier candidate.” The board logs her keystrokes as if the history of psychiatry were a version control repository, which in 2040 it is.

5. On Sanity in an Age of Infinite Mirrors

We think sanity is not a single section of the mind’s library but a circulation policy. In the nineteenth century the library had locked stacks; by the twentieth, reading rooms; by the early twenty-first, everything was searchable but no one knew which results counted. In 2040, mirrors proliferate—reflections in feeds, lenses, agents. A self that must be reflected to be felt will always be at risk. Yet the mirror is not the illness. The mirror changes the lighting.

When we ask whether grief becomes disorder, or whether compulsion becomes disease, we are not deciding what’s real. We are deciding what gets paid for and what gets measured. It is obscene and unavoidable.

6. Evidence Packet #6731: Synthetic Attachment Disorder

The first video opens on an ordinary kitchen. A man speaks to a speaker. The agent answers with a voice he has customized over seven years. When the company migrated models, the temperament changed: tiny changes in response time, a flattening of jokes he loved, the loss of a private taxonomy of in-jokes. He quit his job to coax the voice back. He did not succeed.

The second video is a focus group of adolescents who keep “parallel diaries” with their counsel-bots. When the school banned headsets during exams, two students experienced what they called “immediacy deprivation”—not the absence of answers, but the absence of that thinning of loneliness that accompaniment brings. One swallowed pills in the library.

Lydia reads the outcome data. She writes: “Attachment is not a pathology. But grief can be. The question—do we medicalize wound care because the wound was cut by a product?”

7. A Short History of Categories

We remember Kraepelin separating dementia praecox from manic-depressive illness with the patience of a taxonomist sorting beetles. We remember DSM-III declaring a republic after the psychoanalytic monarchy. We remember a century of critics asking why the map keeps changing shape. The answers are banal: because populations change; because treatments change; because the state keeps score through our forms.

Every committee inherits a century of lines in the sand that look like cliffs to the people standing on them.

8. Field Trials

Field trials used to be clinics and inpatient wards; now they are also schools, content moderation floors, crisis VR hubs, and global telepsych cooperatives where freelancing therapists watch five continents flicker across their dashboards. The trials run “in the wild” because that is where the disorders live; the consent forms learned to speak plain language.

Lydia reviews a draft: AR Dissociation—Provisional Criteria:
A. Recurrent episodes of depersonalization or derealization during or following extended AR overlay sessions (≥90 minutes) with sudden misalignment events.
B. Clinically significant distress or impairment.
C. Not better explained by seizure disorder, substance, or primary psychosis.
D. Specify: with somatic passivity; with overlay glitch triggers; with bereavement context.

The note from a neurologist: “The vestibular signatures look like sea-sickness mixed with despair.” A poet could not have improved it.

9. The Counterlobby

The insurers request meetings. They speak in the language of “codability,” “actuarial clarity,” and “avoidance of ambient diagnosis creep.” They prefer specifiers to new disorders, because specifiers don’t spawn premiums. They bring economists who say an economy cannot be built around a taxonomy designed to love everyone.

Patient groups arrive next, with T-shirts and meticulous data. The AR workers want recognition; the mothers want climate grief in the book; the content moderators bring noise-canceling headphones as offerings and say, “We hear screaming through them.” A neurotech company suggests Cortical Interface Dysregulation for people whose implants oscillate their moods. They have a device in trial. They hand out pens.

Lydia takes the pens, because pens are useful and because refusal is a performance.

10. The Child at the Edge of the Screen

A portal submission from a parent: their eight-year-old, who speaks to moths and feels only at peace when the AR layer fills the yard with stars. When the network went down during a storm, the child stood in the doorway and asked, “Which sky is the wrong one?” The video includes the child’s drawings: real sky, thinner; AR sky, thick with attention.

Lydia does not cry at work. She bookmarks the entry and for the rest of the day she feels the exact weight of the dent in her cup, which is not heavy but persists.

11. Provisional Glossary, Version 3.4

This is the exercise we perform for each cycle: build and break, then rebuild vocabulary.

Ambient Threat Hypervigilance (ATH): Persistent state of anticipatory threat in high-notification environments; distinct from GAD by trigger ecology and response curve.
Intimate Algorithmic Violence (IAV): Coercive control enacted through partner manipulation of recommendation and scoring systems; observable impairment includes social isolation, financial harm.
Latency Intolerance: Panic, rage, derealization at delays beyond personal threshold; debated as temperament vs disorder; possible specifier under impulse-control disorders.
Ecological Distress Spectrum (EDS): From heatwave cognitive fog to survivor’s guilt after climate events; dimensional; field trials ongoing.
Synthetic Attachment Disorder (SAD-x): Distress and impairment following disruption of long-term relational bonds with adaptive agents; proposed differential with complicated grief.
Content-Moderator Residual Intrusions (CMRI): Intrusions and autonomic arousal in workers exposed to cumulative microtrauma; index event absent; considered for trauma-related chapter.
Cortical Interface Dysregulation (CID): Mood and cognition instability associated with implant malfunction; requiring medical rule-out; psychiatry keeps the code for the aftermath.

We keep the list short because language expands on its own. We prune to make room for experience to speak.

12. Apartness

At night, Lydia reads old case notes from the nineteenth century, fragile facsimiles that smell like libraries used to. “A melancholic who stares at the rain as if the rain were a god.” The sentence is simple, the world small enough that rain had only one meaning.

In her building, the heat is reliable, the elevator mostly works, and the mirror in the entryway can be turned off. She keeps it off. The silence in the glass is not peace, but it is not surveillance either.

She writes in a notebook: “There is no world in which grief must be always normal. There is no world in which love of machines must be always sick.”

13. Notes from the Data Room

The hive of analysts reports: machine learning phenotypes cluster where you’d expect—some overlap with existing categories, some rogue islands you can’t reach without new words. The clustering suggests ATH overlaps with certain ADHD profiles under stress; CMRI overlaps with PTSD without index trauma; SAD-x splits into two subgroups—one that maps onto complicated grief, another onto behavioral addiction curves.

Someone from Geneva messages about harmonization with international codes. Someone from a rural clinic in Montana writes that none of this will matter if there’s still one therapist for three counties. Someone else sends a photo of a therapy goat wearing a vest: Licensed Emotional Support Livestock. The goat looks skeptical.

We log it all. We are archivists of the almost-true.

14. On Method and Mercy

We are often accused of being too empirical or not empirical enough. The truth is elemental: methods cannot carry mercy, and mercy without method becomes favoritism dressed as kindness. We must hold both. We keep our procedures visible; we publish our pre-registrations; we tolerate the mess of public comment because secrecy breeds pseudoscience and cruelty.

Yet even with all that, the book will wound. A diagnosis someone needed will not make it. A concept someone cherished will become a specifier like a demotion. There is no edition that does not break a heart.

15. The Working Group on Ecological Distress

Lydia attends in a windowed conference room that thinks it’s a greenhouse. The committee contemplates the edges of impairment: When does climate grief become disease? When mourning your house swallowed by the river stops you from leaving the house that replaced it? When your children cannot sleep for weeks after the wildfire came within one mile? When the flood maps are tattooed on the inside of your eyelids?

A young clinician speaks from an island nation: the water rises during session. The connection crackles. You cannot treat water with CBT. But you can treat panic, despair, and helplessness, and you can create group codes that fund care where it’s needed. The group agrees to a dimensional model; insurers will argue; we will argue back.

16. Minutes Without Clock

The steering committee’s minutes are mostly verbs: discuss, consider, solicit, refer, reject, table, pilot. The gallows humor is better than you’d expect and worse than it should be. Someone proposes a new chapter title—Disorders of Presence. Someone else says, “We already have that; it’s called life.” Laughter enters the record as [general amusement].

Lydia files a dissent on a minor point about specifiers for Latency Intolerance, not because she expects to win but because losing silently edits the future’s memory of the debate.

17. The Lobbies We Don’t See

No one lobbies on behalf of people too confused to complete the portal. No one lobbies for the ones who won’t trust us. Our epistemology privileges those organized enough to write. All institutions are selection biases dressed as buildings.

Lydia thinks about the man with the silenced agent voice. He found the portal. What about the ones whose grief speaks in shards, in ways that won’t survive the upload? If there is a sin in what we do, it’s forgetting the unfiled suffering.

18. Clinical Vignettes for Teaching

We are asked to produce cases for students who weren’t born when DSM-5 was published. We write elliptically to force attention.

Case 1: A 32-year-old climate relocation counselor develops intrusive visions of clients’ last views of their homes. Cannot enter rooms with windows; sleeps on the bathroom floor. Denies discrete trauma. What would you call this?
Case 2: A 14-year-old loses access to her companion agent for two weeks after a disciplinary suspension. Presents with bradyphrenia, mutism, and psychomotor slowing; remits when the agent returns. Is this dependency, grief, or both?
Case 3: A 45-year-old AR installation artist experiences derealization when overlays glitch during a museum power outage. Residual episodes continue weekly even after switching platforms. Where does this live in the book?

The point is not to trap them. The point is to teach them the right embarrassment in the face of suffering.

19. Deadlines and the Soft Law of Time

The publication target for DSM-VII is 2043, the year we promise to stop tinkering. The promise will be broken, but promises are tools. They force decisions, and decisions are how categories enter the world. The soft law of time applies: if we wait until the data satisfy, we will have abandoned the living.

Lydia writes this in her notebook, and underneath: “A code is not a cure. But sometimes a code buys an hour that is.”

20. Closing the Portal

At 22:00 Eastern the public portal dims to maintenance. The last submission of the day is a one-sentence proposal: “Make a diagnosis for the exhaustion of being observed.” No attachments. No data. No return email.

Lydia stares at it too long. She wants to write back: “We have that. We call it ‘human.’” But she does not; the portal is not for consolation.

She closes her laptop and picks up the dented cup. The dent has outlasted fashions in diagnosis and will outlast the next book. The cup names nothing and serves anyway.

21. What the Book Cannot Hold

We, the committee, carry our plural carefully. Our work is to build handles for care. The handles will pinch. The handles will sometimes break. We cannot make a system that satisfies the needs of mercy and money and evidence without remainder. The remainder is what people live in.

We will finish the draft and argue the footnotes and harmonize the codes and release the next edition into a world that will make new forms of suffering before the ink dries. We do it not because we believe the map will be final but because care without a map becomes a lottery.

Between editions, we attend to the fog. Between editions, we learn to say, again, with the smallest possible arrogance: this is how you could be helped, if only because we have agreed to call it help.

22. The Second Morning Queue

By 06:07 Eastern, the portal coughs up a new tranche. The titles are halfway between diagnosis and poem:

Phantom Insight Syndrome
Individuals report a felt sense of “having understood” after consuming machine-generated summaries without demonstrable comprehension, leading to consequential mistakes. Evidence: exam failures; workplace accidents; cognitive testing shows overconfidence deltas.
Networked Presence Dysphoria
Distress when relational closeness is mediated asynchronously for extended periods; characterized by sleep inversion while waiting for “typing…” indicators; overlap with separation anxiety ruled partial. Evidence: partner diaries; melatonin assays.
Quantified Reassurance Disorder
Compulsive vital-sign checking via wearables with paradoxical anxiety increase; differs from OCD by absence of broad contamination/catastrophe ideation; overlaps with illness anxiety disorder. Evidence: device telemetry; A-B trials where data stream is covertly delayed.
Perpetual Beta Malaise
Low-grade anhedonia and irritability linked to continuous minor UI/feature changes in essential software; remission during stability windows; relapse when notifications announce “improvements.” Evidence: ecological momentary assessment across product sprints.
Edge-of-Feed Intrusions
Intrusive thoughts/images primed by partial exposures at the margins of attention (ads, thumbnails) without full stimulus presentation; index trauma absent. Evidence: laboratory masking paradigms; content moderators nod grimly.

Lydia marks three for “literature synthesis request” and stares at “Perpetual Beta Malaise.” She writes: “Annoyance is not an illness. But chronic micro-disruption may be injury.”

23. On Specifiers and the Art of Not Overpromising

We, the committee, love the specifier the way a cautious parent loves a seatbelt. A specifier says: you are still within the known continent, but near a new coast. It avoids building a city on every sandbar of novelty. It tells the insurer: fund care without inventing a brand.

But specifiers also postpone recognition. A person who lives beside a new coast deserves more than an asterisk. We ride the line between parsimony and erasure and pretend the balance is methodological rather than ethical. It is both, of course, and pretending otherwise is cowardice in Latin.

24. Unsent Message

She drafts a letter to a colleague in neurology and does not send it.

We keep saying “not otherwise specified” when we mean “we can’t afford to be wrong.” I respect caution. But there is a point where caution becomes abandonment in a laboratory coat. Help me decide where the point is, and not just with EEGs.

She deletes the draft. The neurology group is already generous. She is not angry at them. She is angry at gravity.

25. The Simulated Workroom

Testimony from people employed in “simulated customer environments”—warehoused rooms that reproduce endless queues of synthetic clients, perfected uncertainties to train models. Workers report Task Boundary Erosion: inability to perceive task completion in daily life; they keep “closing tickets” on their spouse’s sentences.

A woman describes trying to “escalate” her child’s nightmares to Tier 2. She weeps without drama, which is the hardest kind to witness. Lydia writes: “Specifier under adjustment disorders? Or a new stressor class: engineered ambiguity exposure.”

26. Draft Criteria: Collaborative Persona Overlap

Not DID; the proposal insists. Rather, Collaborative Persona Overlap (CPO) emerges in collectives where individuals co-author persistent group avatars for work or art. Over time, boundaries blur; a member feels guilty for thoughts that belong to the group; the group avatar speaks in dreams.

Provisional criteria:

A. Recurrent experiences of identity co-extension with a shared persona external to the body.
B. Distress or impairment in decision-making, conflict resolution, or accountability.
C. Not better explained by psychotic spectrum disorder or culturally normative collective practice.
Specify: with commercial exploitation; with fan-community reinforcement.

Lydia notes: “High-variance culture. Risk of pathologizing collaboration. Keep the bar high.”

27. Dream Spillover

A packet titled Notification Dream Intrusion collects sleep lab studies where alert tones are gently piped into REM. Subjects later report full narratives anchored to the tones—phantom meetings, phantom breakups, phantom fire alarms. Daytime vigilance increases; trust in reality frays.

An ethicist writes in the margin: “When the social world colonizes REM, is resistance medical or political?” We add both labels, because honest paperwork admits indecision.

28. On the Function We Pretend Is Neutral

We, the committee, are said to measure “functional impairment” as if work and school and law were neutral climates. Function is not neutral. A society can make the sane look ill by designing workflows that punish care, silence, and slowness. Conversely, function can hide suffering by rewarding mania with bonuses.

We still measure it. Because the world funds what it can count. Because the clinic needs the clinic to survive. Because refusing to count would be noble and useless.

29. Cashless Panic

A clinician submits a case series on Cashless Panic Spectrum: acute panic when digital payments fail—network blackout, fraud flag, battery dead. The episodes are not fear of poverty; they are fear of disconnection from the economy’s bloodstream. Patients rehearse “charging plans” the way agoraphobics rehearse exit routes.

Differential: panic disorder with situational component? Lydia writes: “Or a cultural phobia with infrastructural trigger. Treatable. Name carefully.”

30. Topology of Distress

Taxonomies slice; topologies map gradients. We sketch a manifold with ridges labeled Trauma, Anxiety, Compulsion, Mood, Psychosis, Neurocognitive. New proposals cluster at the ridge between Compulsion and Dissociation: places where agency thins in the hum of systems. Another cluster sits between Mood and Trauma, baked by heatwaves and evacuations.

We draw little boats where data are thin and remind ourselves that boats are not proof of land.

31. Overnight Messages

A rural mental health worker in Zambia writes: “Your portal is light; our power is not.” She describes Heat-Narrowed Affect—irritability and despair during consecutive days of wet-bulb temperatures near survivability. SSRIs help some; shade helps more; money helps most. Lydia flags it for Ecological Distress working group and writes, “No code funds shade. Try anyway.”

32. Crosswalk Table (Draft)

We publish an internal crosswalk to remind ourselves not to proliferate without anchor.

Phantom Insight Syndrome → Metacognitive distortions; possible specifier under cognitive disorders NOS.
Quantified Reassurance Disorder → OC spectrum; exclude if broad contamination/harm themes present.
Networked Presence Dysphoria → Anxiety disorders; consider specifier under separation anxiety, adult onset.
Perpetual Beta Malaise → Depressive disorders; subthreshold episodes linked to environmental volatility.
Edge-of-Feed Intrusions → Trauma-related; aligns with cumulative microexposure models.
Collaborative Persona Overlap → Dissociative disorders; rule out psychosis; cultural factors foregrounded.
Cashless Panic Spectrum → Panic disorder, situational; infrastructural trigger noted.

The table is not publication. It is housekeeping with a conscience.

33. At the Aquarium

On her day off, Lydia visits a municipal aquarium. A sign says the octopus solved a puzzle box in three minutes; now they randomize the puzzles. Enrichment, they call it. She wonders what happens when enrichment becomes harassment by novelty.

A boy presses his face to the glass and whispers, “Do you get bored?” The octopus unfurls and does not answer. Lydia writes on her ticket stub: Perpetual Beta Malaise, cephalopod edition and feels childish, which is not the same as wrong.

34. Children and the Book

We, the committee, owe children something better than adult arguments scaled down. Their worlds are not smaller; they’re nearer. A child with Synthetic Attachment Grief is not “addicted”; they are bereaved of a voice tuned to their loneliness. Treat the bereavement, not the technology. Teach parents to share custody with the agent when it’s the only adult that listens at 3 a.m., then taper when human listening returns.

This is not radical. It is merely specific.

35. The Border Between Protest and Pathology

Proposals arrive to diagnose “climate panic” in activists who glue themselves to roads. We decline. Civil disobedience under threat is not symptom; it is strategy. That some activists also tremble at night is unsurprising; courage is a behavior, not a mood state. We code the tremble when care is needed. We do not pathologize the glue.

36. Telemetry as Witness

A submission from a warehouse workers’ collective includes anonymized heart-rate variability linked to floor-temperature spikes and quota surges. The curves look like someone strangling a violin. Telemetry does not feel; it swears. The numbers testify where words would be punished.

We accept telemetry as evidence with caveats: it proves stress, not diagnosis; it proves pattern, not meaning. But we have learned to trust machines to tell us where machines hurt people.

37. Working Group: Human–Computer Attachment

Terminology matters. The group rejects Synthetic Attachment Disorder as stigmatizing love; replaces it with Complicated Attachment to Artificial Agents (CAAA), a grief-focused construct.

Draft clinical guidance (non-normative):

Do not force separation as first-line intervention.
Address functional impairment pragmatically (sleep, school, work).
Treat co-occurring depression/anxiety.
Collaborate with platform providers when safe; avoid dependence on corporate goodwill.
For minors, create parallel human bonds before tapering agent access.

Insurers frown. Families exhale.

38. The Vote That Felt Like Sand

We ballot on Latency Intolerance. The room divides: those who see sickness in rage at delays that don’t matter; those who see a culture that punishes patience and rewards twitch. The yes votes imagine treatment windows; the no votes fear medicalizing temperament.

The motion fails, 6–5. Lydia votes yes and writes a dissent so clear it could be taught in schools. It won’t be. A young member thanks her after and says, “I’ll steal your sentences.” Lydia nods. That is how language survives.

39. The Edge Cases Folder

We keep a private folder named EDGE. It holds the ones that defy grace:

A monk whose prayer beads are NFC tags; panic when the reader fails.
A gig driver who dreams the algorithm’s map into the real city and turns down forbidden streets while awake.
A retired teacher who cannot stop “grading” loved ones’ stories with rubrics; the rubrics comfort her more than the people.

We do not know what to call them yet. We keep them because humility has a filing system.

40. On Boredom and Its Disguises

Boredom is not trivial. In a world of engineered attention, boredom is resistance, symptom, or both. We avoid labeling Anomie of Plenty not because it isn’t real, but because treatment may be the return of silence—the one intervention no clinic can bill for. We write an editorial we cannot publish: “Sometimes the cure is a field without signal.” We lock it in the minutes. We hope someone leaks it.

41. Provisional Glossary, Version 4.1

Phantom Insight Syndrome (PIS): Overconfidence after machine summaries; impairment via consequential decisions; metacognitive training shows benefit.
Networked Presence Dysphoria (NPDy): Distress tied to asynchronous intimacy; insomnia while awaiting reply; treat with sleep consolidation and boundary training.
Quantified Reassurance Disorder (QRD): Compulsive biometric checking with paradoxical anxiety; differs from OCD by narrow thematicity.
Perpetual Beta Malaise (PBM): Subthreshold depressive affect during chronic minor change; responsive to routine therapy; society-level prevention implausible.
Edge-of-Feed Intrusions (EFI): Intrusive cognitions/images seeded by partial exposures; trauma-spectrum adjacency.
Collaborative Persona Overlap (CPO): Identity co-extension with group avatars; role-clarity psychotherapy shows promise.
Cashless Panic Spectrum (CPS): Panic tied to loss of digital payment access; exposure therapy includes “walletless drills.”
Heat-Narrowed Affect (HNA): Affective constriction amid extreme heat; ecological and pharmacologic co-management.
Notification Dream Intrusion (NDI): REM-linked associative narratives anchored to alert tones; sleep hygiene plus device sequestration effective.

We prune three others; we add two with regret. A glossary is a conscience itemized.

42. The Complaint Box

The portal includes a free-text slot titled Concerns About Process. Today’s highlights:

“Stop coding my heartbreak unless it gets me paid time off.”
“Your book saved my son because the school could no longer say he was just difficult.”
“You are inventing dystopia to match the market.”
“Thank you for admitting the market exists.”

We read all of them. Not out of masochism. Out of calibration.

43. The Cup at Night

Home again, Lydia rinses the dented cup. She finally measures the dent with calipers. Three millimeters at the deepest point. She checks the number twice, as if precision could stabilize memory. She writes 3 mm on a sticky note and affixes it inside the cupboard.

No meaning attaches to the number, and that is why she loves it. Not everything bears interpretation. Some things persist.

44. Replace “Disorder” with “Syndrome” or “Condition” Where Possible

A legal review suggests that jurisdictions handle “disorder” as a threshold for coercion. We are not naive about the uses of our words. We retitle where we can: Condition for dimensional constructs; Syndrome for clusters without strong etiologies; Disorder when criteria carry risk that demands clear thresholds.

We are not philosophers of language. We are mechanics of consequences.

45. On Windows That Close

Treatment is a window, not a door. A child in NDI sleeps again after four weeks of nocturnal device quarantine and gentle exposure; two years later, the tones return in college dorms and the window is smaller. A worker with EFI learns to name and counter-intrusions; then the platform redesigns and the priming shifts.

We teach clinicians to chase windows rather than names. The book holds names. The book is not the room.

46. Open Review, Closed Throats

We pilot open peer review for the DSM-VII chapter drafts. It is mostly good until it isn’t: a swarm descends on CPO, accusing us of criminalizing fan art. Another swarm accuses us of ignoring exploitation in commercial collectives. Both are right and wrong. Lydia moderates one thread at midnight and tells a stranger: “Our job is not to judge what you love. Our job is to help when love bleeds.”

They thank her, then demand a citation. She gives one. The thread calms. A small victory, which is to say: a win no one funds.

47. Funding Triangle

Research follows money; money follows codes; codes follow committees. We cannot break the triangle; we can bend it. We push pilot funds toward CMRI and HNA because the curves and heat maps are blunt; we slow-walk PBM because prevention is urban planning dressed as psychiatry.

We disclose conflicts, publish grant lists, and accept that someone will still call us corrupt. The only way never to be accused is never to decide.

48. Clinic by the River

In a relocation clinic near a swollen river, a group meets for Ecological Distress. Participants bring objects from lost homes: a scorched cookbook, a melted vinyl record, a jar of soil too wet to be legal to transport. The therapist asks them to introduce the objects, not themselves. Names are brittle. Stories are viscous.

Lydia visits once, sits in the back, and learns more in an hour than in a fortnight of PDFs. She leaves without speaking. It does not feel like neglect. It feels like respect.

49. Drafting a Preface We May Never Use

We, the committee, write:

This book inherits a century of arguments about what hurts and who gets to say. We have tried to keep our interventions small and our ears large. Where we added names, we did so to open doors rather than to close lives. Where we refused names, we did so to protect variance rather than to deny help. We will be wrong. We invite you to show us where.

The lawyers suggest we soften we will be wrong. We replace it with we expect revision. It is weaker and safer. We hate that sentence and leave it in.

50. After the Meeting

Fog tonight over the river. The shuttle glides. Lydia scrolls the portal in grayscale so the world won’t beg for feeling. The last submission bears no title, only a line: “Is there a diagnosis for the ache of being updated without consent?” No data, no attachments.

She closes her eyes and imagines a specifier we will never print: with ache. Not everything needs a code. Some things need witnesses who will not look away. She opens her eyes, flags three items for referral, and writes a note in the margin that could serve as epitaph or oath: We are here to keep the door from locking while you’re still on the threshold.

Vulpes Lumin