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Diagnosing Billy Pilgrim: A

Psychiatric Approach to Kurt
Vonnegut's Slaughterhouse-Five
a
Susanne Vees-Gulani
a
University of Michigan
Published online: 26 Mar 2010.

To cite this article: Susanne Vees-Gulani (2003) Diagnosing Billy Pilgrim: A Psychiatric
Approach to Kurt Vonnegut's Slaughterhouse-Five , Critique: Studies in Contemporary
Fiction, 44:2, 175-184, DOI: 10.1080/00111610309599944

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 Diagnosing Billy Pilgrim: A Psychiatric
Approach to Kurt Vonnegut’s
Slaughterhouse-Five
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SUSANNE
VEES-GULANI

“That’s the attractive thing about war,” said Rosewater.

“Absolutely everybody gets a little something.”
Slaughterhouse Five 1 I 1

Kurt Vonnegut’s Slaughterhouse-Five has been widely discussed as an antiwar

novel based on the author’s own experiences in World War 11. As a German POW,
Vonnegut witnessed the bombing and complete destruction of Dresden, and
Slaughterhouse-Five is the author’s manifestation of what he called “a process of
twenty years [. , .] of living with Dresden and the aftermath” (Allen 163). Indeed,
the words that describe the war, the Dresden events, and their effect on the peo-
ple who experienced them did not come easily to Vonnegut. In an interview in
1974, he commented on the difficulties of articulating his experiences: “I came
home in 1945, started writing about it, and wrote about it, and wrote about it, and
WROTE ABOUT IT” (Allen 163). This agony is echoed in the first chapter of
the novel:
When I got home from the Second World War twenty-three years ago, I
thought it would be easy for me to write about the destruction of Dresden,
since all I would have to do would be to report what I had seen [. . .I.
But not many words about Dresden came from my mind then. [. . .] And
not many words come now, either [. . .]. (2)

Vonnegut’s problems with articulation are evidence of the long-term conse-

quences of his witnessing those events. Although critics generally recognize that

WINTER 2003,VOL. 44, NO. 2 175

 the war, and particularly the destruction of Dresden, had a traumatizing effect on
Vonnegut, the nature of that trauma and how it manifests itself in the novel have
yet to be explored in a systematic manner. A fresh look at Slaughterhouse-Five
using psychiatric theory not only offers new insight into the work but also opens
a window on the author himself. Vonnegut’s writing of Slaughterhouse-Five can
be seen as a therapeutic process that allows him to uncover and deal with his trau-
ma. By using creative means to overcome his distress, Vonnegut makes it possi-
ble for us to trace his path to recovery. We slowly narrow in on his condition
using the novel as a conduit first to the protagonist, Billy Pilgrim, then to the nar-
rator, and finally to the author himself.
Lawrence Broer has suggested that “[plrobably no characters in contemporary
fiction are more traumatized and emotionally damaged than those of Kurt Von-
negut” (3). Billy Pilgrim in Slaughterhouse-Five certainly supports Broer’s obser-
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vation. Even his wife, Valencia, who is unaware of Billy’s psychological turmoil,
gets “a funny feeling” that he is “just full of secrets” (121). Attempting to define
Billy’s psychological state more precisely, critics have frequently associated
Slaughterhouse-Five and its protagonist with schizophrenia, most likely inspired
by the author’s own comments on the title page characterizing the novel as “some-
what in the telegraphic schizophrenic manner of tales of the planet
Tralfamadore.”’ Yet even some of the critics who describe Billy as schizophrenic
seem uneasy with that assessment. In the introduction to a recent collection of
essays on Vonnegut, for example, Harold Bloom qualifies his description of Billy
as suffering from schizophrenia with the parenthetical comment, “(to call it that)”
(1). Symptoms of schizophrenia have to be present for at least six months before
the disease can be diagnosed, and it is not caused by an external event. Schizo-
phrenics usually suffer from hallucinations,2 in most cases hearing voices, and
from social and occupational dysfunction (Diagnostic and Statistical Manual of
Mental Disorders 285). Those criteria do not apply to Billy. His problems are
directly related to his war experiences. Furthermore, after he returns home from
the war, he manages to lead, at least externally, a very functional life-having a
family, running a business, and being a respected member of society. He does not
suffer from hallucinations. Rather, Billy’s fantasies seem more the result of a vivid
imagination that he uses as a sense-making tool to deal with his war trauma.3
Psychiatry can provide tools for a systematic approach to the trauma visible in
the novel. The psychological consequences of the experience of war and espe-
cially the Dresden bombings can be readily analyzed using the criteria now
established by psychiatrists to diagnose posttraumatic stress disorder (PTSD).
Traumatic experiences have been described for centuries, but PTSD has only
been recognized as an independent psychiatric classification since its inclusion
in the 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM). Sparked by extensive research with Vietnam veterans, the 1980 Manual
for the first time provided psychiatrists with both a name and operational criteria
to assess the effects of traumatic experiences in an organized fashion and to lay

176 CRITIQUE
 to rest a variety of earlier theories and labels, such as “Soldiers Imtable Heart,”
“Schreckneurose,” “shell shock,” or “combat neurosis” (Saigh and Bremner
1-2). In general, PTSD stems from “an inadequate way of coping with extreme
stress” (Kleber, Figley, and Gersons 234). The most recent edition of the Munu-
ul (1994) describes PTSD as the result of a “person experienc[ing], witness[ing],
or [being] confronted with an event or events that involved actual or threatened
death or serious injury, or a threat to the physical integrity of self or others” (427)
and to which he or she responds with “intense fear, helplessness, or horror”
(428). The exposure to the trauma results in symptoms such as persistently re-
experiencing the events “in the form of distressing images, thoughts, perceptions,
dreams, or reliving [them]. ” Being reminded of the event can also trigger “psy-
chological or physiological reactivity” (Kaplan and Sadock 1227). Furthermore,
a diagnosis of PTSD requires symptoms of “persistent avoidance of stimuli asso-
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ciated with the trauma and numbing of general responsiveness” as well as “per-
sistent symptoms of increased arousal” (DSM424).
These criteria for the diagnosis of PTSD help to explain and summarize the
different facets of Billy’s state of mind in the novel. One important insight is that
PTSD is believed to be caused not only by the traumatizing events themselves;
the “psychosocial atmosphere in a society is clearly a factor that facilitates or
hinders the process of coping with stressful life events” (Kleber, Figley, and Ger-
sons 2). This can also be observed in the novel. When Billy returns home, Amer-
ica does not provide him with the possibility of working through his war experi-
ences, particularly the bombing of Dresden, and thus occassions Billy’s chronic
suffering. The most striking symptom of Billy’s condition is his altered percep-
tion of time. He sees himself as having “come unstuck in time”:

Billy has gone to sleep a senile widower and awakened on his wedding day.
He has walked through a door in 1955 and come out another one in 1941. He
has gone back through that door to find himself in 1963. He has seen his
birth and death many times, he says, and pays random visits to all the events
in between.
He says.
Billy is spastic in time, has no control over where he is going next, and the
trips aren’t necessarily fun. (23)

Being “spastic in time” thus is a metaphor for Billy’s repeatedly re-experiencing

the traumatic events he went through in the war, particularly as a POW during the
Dresden bombings. Psychologically, Billy has never fully left World War 11;
instead, in Jerome Klinkowitz’s words, he lives in a “continual present” (55). In
Trauma and Recovery, Judith Herman describes a similar situation with regard to
former captives suffering from PTSD. While imprisoned, they “are eventually
reduced to living in an endless present” (89). After their release, they “may give
the appearance of returning to ordinary time, while psychologically remaining
bound in the timelessness of the prison” (89). It has also been observed that a for-

WINTER 2003.VOL. 44, NO. 2 177

 mer prisoner “even years after liberation, [. . .] continues to practice doublethink
and to exist simultaneously in two realities, two points in time” (89-90).
Billy’s situation is comparable to that of the soldiers Herman describes.
Although he is “outwardly normal” (173, the traumatic memories persistently
intrude on him in forms typical to people suffering from PTSD. At times Billy
also finds himself simultaneously at two different points of his life, for example,
“simultaneously on foot in Germany in 1944 and riding his Cadillac in 1967”
(58). Billy frequently relives the past through his dreams, distressing recollec-
tions, and flashback episodes. Often certain “internal or external cues that sym-
bolize or resemble an aspect of the traumatic event” (DSM428) trigger painful
memories or cause Billy to re-live the war episodes. Psychiatrists note specifi-
cally that “sensory phenomena, such as sights, sounds, and smell that are cir-
cumstantially related to the traumatic event [. . .] reactivate traumatic memories
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and flashbacks” in PTSD sufferers (Miller 18). This symptom is readily observed
in the protagonist and explains the novel’s abundance of both psychological and
structural “linking devices” between different scenes of Billy’s life (Klinkowitz
78). For instance, the novel repeatedly mentions certain colors (“ivory and blue,”
“orange and black”) or smells (“mustard gas and roses”) that carry significance
in Billy’s past.4 Other triggers include sounds, such as a siren (57, 1@), which
Billy associates with the Dresden air raid alarms: It “scared the hell out of him”
(57) and “he was expecting World War Three at any time” (57). Not surprising-
ly, seconds later he is “back in World War Two again” (58). In another episode,
the sight of men physically crippled by war going from door to door selling mag-
azines immediately causes great distress to Billy, himself mentally crippled by
the war:

Billy went on weeping as he contemplated the cripples and their boss. His
doorchimes clanged hellishly.
He closed his eyes, and opened them again. He was still weeping, but he
was back in Luxembourg again. He was marching with a lot of other pris-
oners. It was a winter wind that was bringing tears to his eyes. (63)

A barbershop quartet that performs at his anniversary party causes a strong

response in Billy because they remind him of the four German guards in Dres-
den who, when they saw the destruction of their hometown, “in their astonish-
ment and grief, resembled a barbershop quartet” (179). The memory of the Ger-
man guards lies at the center of Billy’s trauma, the destruction of Dresden. In this
case Billy first responds with physical symptoms, looking as if “he might have
been having a heart attack” (173). Finally, away from the guests, Billy “remem-
bered it shimmeringly” (177) but does not revisit that event. The Dresden bomb-
ings and their effect are too painful to relive and at first even too frightening to
remember. Thus the strong physical and psychological reaction to the barbershop
quartet, which even disturbs Billy’s usually normal outward appearance, shows
how deeply Billy has buried his Dresden memories.

178 CRITIQUE
 Suppression of parts of the trauma goes hand-in-hand with other techniques of
evading the trauma, such as avoiding “thoughts, feelings, or conversations asso-
ciated with [it],” as well as “activities, places, or people that arouse recollections”
(DSM 428). Billy displays all of these symptoms prominently. He hardly ever
talks about his experiences in the war, even eluding the topic when his wife ques-
tions him about it (121-23). This behavior accords with studies of prisoners of
war that “report with astonishment that the men never discussed their experi-
ences with anyone. Often those who married after liberation never told even their
wives or children that they had been prisoners” (Herman 89).
Another striking feature of Billy’s behavior that connects with the symptom of
avoidance and also is among the criteria for PTSD is his diminished responsive-
ness to the world around him. He is described as one who “never got mad at any-
thing” (30) and bears everything without reaction, because “[elverything was
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pretty much all right with Billy” (157). Throughout the novel Billy’s range of
affect is severely restricted, shown most prominently in the much repeated phrase
“So it goes,” his passive and emotionless reaction to tragedy and death. Robert J.
Lifton observed similar reactions toward death in survivors of the Hiroshima
bombing, reactions he labeled “psychic numbing” (1 15) or “psychic closing-off’
(125)? For Billy, avoidance and “psychic numbing” are protective shields, offer-
ing him the possibility to live an “outwardly normal” (175) life.
However, it is impossible for Billy to stop the intrusion of his memories com-
pletely because the events have destroyed him inside, which now mirrors the
ruins he saw in Dresden. At first he seeks help by committing himself to a men-
tal hospital because he felt “that he was going crazy” (100). Yet just as main-
stream American society does not provide an atmosphere conducive to recovery
from the horrors of war, the psychiatric establishment also fails Billy. By neither
providing an accurate diagnosis nor offering any coping mechanisms, it proves
itself completely separated from true world experience. When Billy checks him-
self in, “the doctors agreed: He was going crazy” (loo), but “[tlhey didn’t think
it had anything to do with the war. They were sure Billy was going to pieces
because his father had thrown him into the deep end of the Y.M.C.A. swimming
pool when he was a little boy and had then taken him to the rim of the Grand
Canyon” (100). Billy thus falls victim to the previous tendency in psychiatry to
underestimate the role of “an external factor, something outside the person” in
causing trauma and to focus instead only on “individual vulnerability as the rea-
son for people’s suffering” (Kleber, Figley, and Gersons l l , 13).
Billy and his roommate, fellow war veteran Rosewater, thus embark on their
own path of “trying to re-invent themselves and their universe” (101) in order to
cope with the war events. In what has been referred to as “a desperate attempt to
rationalize chaos” (Merrill and Scholl 69). they resort to science fiction. Billy
claims that he was kidnapped by aliens from the planet Tralfamadore and dis-
played there in a zoo. Tralfamadorian philosophy, which opposes trying to make
sense out of occurrences, helps Billy deal with the horrible events and their con-

WINTER 2003,VOL. 44,NO. 2 179

 sequences by reinterpreting their meaning. When he asks the Tralfamadorians
why they chose to abduct him, they tell him: “’Why you? Why us for that mat-
ter? Why anything? Because this moment simply is. [. . .] There is no why”’
(76-77). These beliefs enable Billy to avoid some of the distress he feels when
facing death:

“When a Tralfamadorian sees a corpse, all he thinks is that the dead person
is in bad condition in that particular moment, but that the same person is just
fine in plenty of other moments. Now, when I myself hear that somebody is
dead, I simply shrug and say what the Tralfamadorians say about dead peo-
ple, which is ‘So it goes.”’ (27)

Although the idea of Tralfamadore as a coping mechanism may strike one as

bizarre, it seems to Billy the only option in a world that fails to provide him with
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a different path. As Leonard Mustazza points out, Vonnegut, by indirectly

identifying Kilgore Trout’s science fiction novels as the source of Billy’s ideas,
“takes pains to show whence Billy’s fantasy derives, and, in this regard, the novel
proves to be quite realistic, a portrait of one of life’s (especially war’s) victims”
(302). With the help of his Tralfamadorian fantasy and his idea of time travel,
Billy conquers his trauma in a way that enables him to function. He controls his
anxiety, so that nothing can surprise or scare him; and his symptoms of arousal
are confined to his trouble sleeping and his occasional bouts of weeping (61).
However, Herman points out that “the appearance of normal functioning [. . .]
should not be mistaken for full recovery, for the integration of the trauma has not
been accomplished” (165). The price Billy pays for appearing normal is high.
Not only is he bound to a life of indifference, passivity, and a science fiction fan-
tasy, but also he can never fully escape from the trauma that continues to intrude
into his life.
The story of Billy’s trauma is not the only one in the novel; it is framed by that
of the narrator, who is a fictionalized version of Vonnegut himself. Although sep-
arated from Billy’s story, some of the “linking devices” (Klinkowitz 78) found
there, the Tralfamadorian “so it goes,” the smell of “mustard gas and roses” (4,
7), and even a “Three Musketeers Candy Bar” (9), also appear in the first chap-
ter.6At the same time, the narrator interrupts Billy’s story on several occasions to
authenticate the events. The text implies that because the horrible consequences
of the bombing of Dresden truly happened but are too far removed from normal
experience to be easily reported, they can neither be completely fictionalized nor
simply repeated through an eyewitness account. The novel thus becomes a mix-
ture of autobiography and fiction that simultaneously binds Vonnegut to and dis-
tances him from the text and its implications.
Traumatic memories are usually not verbal, but surface as visual images (de
Silva and Marks 166). Before they can be shared with others, they first have to
be translated into language-a task that, difficult in itself, is complicated by
avoidance and denial. FTSD sufferers are often unable to recall important aspects

180 CRITIQUE
 of the trauma (DSM428). This is a problem the narrator faces when he simply
cannot remember much about the war (14). Even though he continually tries to
write the novel, he feels unable to do so. On finishing the book after nearly a
quarter of a century, he considers it “a failure” (22). In fact, as Peter Freese points
out, “the thematic center of his novel [Dresden] is endlessly circumnavigated but
never fully encountered” (221). This aspect of the novel is what Herman calls
“the central dialectic of psychological trauma”: “the conflict between the will to
deny horrible events and the will to proclaim them aloud” (1).
This difficulty of expressing the events is enhanced by the political and soci-
etal denial surrounding them. The narrator shares Billy’s experience that Amer-
ica does not offer an atmosphere that easily allows recovery. Because there is
no forum for a discussion of the events, “I wrote the Air Force back then, ask-
ing for details about the raid on Dresden, who ordered it, how many planes did
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it, why they did it, what desirable results there had been and so on. I was
answered by a man who [. . .] said that he was sorry, but that the information
was top secret still” (1 1). Just as there is no public discussion of the events,
there is also no discussion of them in private conversation. Most of the victims
of the air raids were Germans, the aggressors and major victimizers of the war.
Therefore, the question of whether it is even legitimate to talk about the horri-
ble and traumatizing aspects of the bombings is part of every discussion of the
bombings:

I happened to tell a University of Chicago professor at a cocktail party

about the raid as I had seen it, about the book I would write. He was a mem-
ber of a thing called The Committee on Social Thought. And he told me
about the concentration camps, and about how the Germans had made soap
and candles out of the fat of dead Jews and so on.
All I could say was, “I know, I know. I know.” (10)

The desperate “’I know, I know. I know’” seems by no means Vonnegut’s

“expression of his exasperation at having to hear, once again, about the horror of
the death camps” (275), as Philip Watts contends. Rather it is an acknowledg-
ment of the difficulty and inability to talk or write about a topic that deeply
affected one’s psychology, but which at the same time cannot be separated from
questions of guilt, because it necessarily includes portraying the victimizers of
the war, the Germans, as suffering during the bombings. Consequently one needs
to design one’s own coping strategies and path of healing to deal with the horror
of the Dresden air raids.
For Vonnegut, the recovery process is bound to literary production, so he
understands his works as “therapy” (Allen 109). His war and particularly his
Dresden experience have not left him scarless. What we learn in the novel is cor-
roborated by comments that the author has made in interviews; the two together
point to an underlying trauma. Vonnegut especially emphasizes his amnesia
about Dresden:

WINTER 2003,VOL. 44, NO. 2 181

 [Tlhe book was largely a found object. It was what was in my head, and I
was able to get it out, but one of the characteristics about this object was that
there was a complete blank where the bombing of Dresden took place,
because I don’t remember. And I looked up several of my war buddies and
they didn’t remember, either. They didn’t want to talk about it. There was a
complete forgetting of what it was like. There were all kinds of information
surrounding the event, but as far as my memory bank was concerned, the
center had been pulled right out of the story. (Allen 94)

Writing Slaughterhouse-Five meant the long and painful process of uncov-

ering what Vonnegut had pushed out of his consciousness. Even though it is
painful, psychiatrists see the telling of the story of one’s trauma as an impor-
tant step in the recovery from PTSD (Herman 177). Herman stresses how dif-
ficult it is “to come face-to-face with the horrors on the other side of the amne-
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siac barrier” (184). Successful therapy requires a balancing act, because

“[alvoiding the traumatic memories leads to stagnation in the recovery process,
while approaching them too precipitately leads to a fruitless and damaging
reliving of the trauma” (Herman 176). Vonnegut tries not to face his suppressed
memories directly but to get to the core by slowly uncovering layer after layer.
The novel reflects this process of narrowing in on himself through the two trau-
ma stories. Billy’s story allows an indirect and detached exploration of the
effects of the Dresden bombing because the character is mostly fictional. The
narrator’s story parallels Vonnegut’s on one level, but on another level, it is an
integral part of a work of fiction. Removing himself from the factual to the fic-
tional plane by creating the narrator allows Vonnegut a degree of distance from
himself and his experiences. Consequently, the final point of recovery in this
process of self-therapy is not achieved in the novel but rather comes with its
completion:
I felt after I finished Slaughterhouse-Five that I didn’t have to write at all
anymore if I didn’t want to. It was the end of some sort of career. I don’t
know why, exactly. I suppose that flowers, when they’re through blooming,
have some sort of awareness of some purpose having been served. Flowers
didn’t ask to be flowers and I didn’t ask to be me. At the end of Slaughter-
house-Five, [. . .] I had a shutting-off feeling, [. . .] that I had done what I
was supposed to do and everything was OK. (Allen 107)

However, although Slaughterhouse-Five is the result of a successful self-treat-

ment, telling the story does not mean that the trauma can then be forgotten. As in
psychotherapy, which aims at “integration, not exorcism” (Herman 18 1) of trau-
ma, the Dresden experience does not lose its important position in Vonnegut’s life
after he completes the novel; but it can now be adequately integrated into the
author’s past. The events may no longer paralyze the writer, but they are still
available for further creative exploration, thus continuing as “the informing
structure of all his novels” (Leeds 92). Yet Vonnegut has done more than cure
himself. As Herman points out:

182 CRITIQUE
 In the telling, the trauma story becomes a testimony. [. . .] Testimony has
both a private dimension, which is confessional and spiritual, and a public
aspect, which is political and judicial. The use of the word testimony links
both meanings, giving a new and larger dimension to the patient’s individual
experience. (181)

By publishing Slaughterhouse-Five, which draws the reader into the path of

healing, the stories of Billy, the narrator, and consequently Vonnegut take on a
public dimension. They draw attention to something that we often prefer to sup-
press and deny although it is important to remember, namely, the crippling nature
of war and the terrible toll that modem warfare extracts from those forced to live
through it.

UNIVERSITY OF MICHIGAN
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NOTES
The author would like to thank Prof. Sari Gilman Aronson, M.D. and Vikas Gulani. M.D., Ph.D.,
University of Illinois, College of Medicine at Urbana, for their insightful comments and encourage-
ment in the preparation of this manuscript.
1. A few of the many examples include Leonard Mustazza (“Vonnegut’s Tralfamadore and
Milton’s Eden”) who refers to Billy as “schizophrenic” (302); Lawrence R. Broer (Sanity Plea ), who
characterizes Billy’s state as “schizophrenic deterioration” (91); Peter Freese (“Sluughferhouse-Five
or, How to Storify an Atrocity”), who describes Billy’s story as sounding “suspiciously like the biog-
raphy of a man who develops schizophrenia” (212).
2. Hallucinations are defined as “a sensory perception that has the compelling sense of reali-
ty of a true perception but that occurs without external stimulation of the relevant sensory organ”
(DSM 767, emphasis added).
3. Billy’s more externally observable erratic behavior after the plane crash and his wife’s death
by carbon-monoxide poisoning also does not comply with the criteria for the diagnosis of schizo-
phrenia. Rather, it seems consistent with the consequences of a head trauma he might have suffered
in the crash, adding to Billy’s traumatized state by worsening his psychic condition even further.
4. The combination “ivory and blue” appears throughout the novel, usually as a reference to
bare feet and implying cold or death. The image originates in the war when Billy sees “corpses with
bare feet that were blue and ivory” (65). The significance of the colors “orange and black,” which
reappear in the striped pattern of a tent put up for his daughter’s wedding (72). is connected to the
POW train Billy rides during the war, which was “marked with a striped banner of orange and black”
(69). The recurring smell of “mustard gas and roses” is also connected to death. Its significance aris-
es from Billy’s experience of having to dig out victims from under the Dresden ruins after the raids:
“They didn’t smell bad at first, were wax museums. But then the bodies rotted and liquefied, and the
stink was like roses and mustard gas” (214).
5. Donald Greiner was the first to note the applicability of Lifton’s ideas to Vonnegut’s text.
For further detail see Donald Greiner’s 1973 essay “Vonnegut’s Slaughterhouse-Five and the Fiction
of Atrocity.”
6. The “Three Musketeers Candy Bar” is directly related to a scene in which Billy’s wife
Valencia visits Billy in the mental hospital a few years after the war and eats a “Three Musketeers
Candy Bar” (107). The significance of the image, however, lies in the time of the war. After the Bat-
tle of the Bulge, Billy is part of a group of soldiers, called by one of them, Weary, “the Three Mus-
keteers” (48). Weary later blames Billy for breaking up the (completely imagined) great union of the
Three Musketeers and becomes obsessed with wanting Billy dead.

WINTER 2003,VOL. 44,NO. 2 183

 WORKS CITED
Allen, William Rodney, ed. Conversations with Kurt Vonnegut. Literary Conversations Series. Jack-
son: UP of Mississippi, 1988.
Bloom, Harold. Introduction. Kurt Vonnegut. Ed. Harold Bloom. Modern Critical Views. Broomall:
Chelsea, 2000. 1-2.
Broer, Lawrence R. Sanity Plea: Schizophrenia in the Novels of Kurt Vonnegut. Rev. ed. Tuscaloosa:
U of Alabama P, 1994.
Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington: American Psychiatric
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