boiling it down?
I've been trying to boil down what irritates me about the combination of: (1) the popularity of certain mental health diagnoses (such as ADHD and autism) in 2024, and (2) the primary importance that people give to these popular diagnoses, by which I mean, how much they talk about having them, even with strangers on the Internet.
I think it is because of the phenomenon of both high-functioning people and low-functioning people sharing the same popular diagnoses without making meaningful distinctions between how these diagnoses operate within these two different groups.
I studied psychology at both the undergraduate and graduate levels, and I've been a consumer of psychology and psychiatry at various times in my life, including everything from hospitalization to prescription drugs and therapy (including individual therapy, couples therapy, and group therapy). So I'm familiar with the field as both a student and a consumer, but not as a practitioner.
I've always been high-functioning, by which I mean I'm able to maintain long-term friendships and relationships, I'm able to hold down a job, I'm able to stay out of serious trouble with law enforcement. My one instance of hospitalization didn't last long and my employer was fine with it, as were my family and friends. I've never tried to kill myself, and I'm not physically abusive toward others.
I would describe low-functioning as having a major deficit in life skills, such as not being able to maintain relationships, not being able to hold down a job, or in trouble with law enforcement. Hospitalized due to mental illness for an indefinite period of time, or failed suicide attempts, or violence toward others. [Unfortunately a successful suicide attempt is game over, too late to intervene with diagnostic criteria and treatment modalities.]
When I studied clinical psychology and other related sub-disciplines in psychology, I was taught that the primary assessment to make of a client was whether they were high-functioning and merely distressed about something, or low-functioning and thus requiring major interventions. For example, distressed about the end of a long-term relationship (which is definitely distressing, but normal), or a physical threat to themselves or others.
What I've seen happen during the decades since I studied this stuff during the 1980s-1990s, especially with autism and ADHD, is that high-functioning people began to adopt diagnoses that were originally designed for low-functioning people, and thereby confused for everybody what it means to have these diagnoses. And then they've turned these diagnoses into identities, similar to racial or gender identities. And then they've lobbied for accommodations for their diagnoses, similar to those provided for people with disabilities, to help them get ahead in their (already successful) careers, or to give them more power in their (already successful) personal relationships.
So when a person leads with their list of mental health diagnoses as a matter of introduction, I find this to be strange behavior and a sort of affectation. But this is increasingly common among people online, in the online spaces I inhabit. And both T and I encounter it more frequently in real life also. Two of the younger people I interact with regularly are recently diagnosed with ADHD, for example, and bring it up for discussion a lot. Both of them are high-functioning adults in general, and to me it seems their responses to their ADHD diagnoses are mainly about how to become even more high-functioning, via self-organization and prescription medication.
At times I've sought therapy and medication, so I don't mean to say that high-functioning people should never do so. But when the professionals tried to give me the diagnosis of "bipolar disorder" back in 2003, I resisted adopting this diagnosis because, no, wait, I'm high-functioning, there's nothing "wrong" with me. Yes, I suffered a psychotic break, yes I did. I remember my psychiatrist telling me afterward that I had to keep taking these medications for life to avoid having another psychotic break. But that never felt correct to me, instead it felt like a scare tactic. And over time I stopped taking the medications, one by one, tapering off, then using them only as needed. And over 20 years later I've never had another psychotic break.
I do have anxiety and even panic attacks from time to time, but I've resisted applying a diagnosis to these problems. I'm not "an anxious person". Because I know I'm high-functioning, and that EVERYBODY feel anxious from time to time. I sometimes take prescription medication to help me relax when the anxiety is significantly higher than my median, or persists for too long. But I don't lead with some version of an anxious identity when I introduce myself, such as "I have an insecure attachment style" or whatever. I think identifying with my anxiety would give it too much power over me. Like everybody else, I experience human emotions, including emotions I'd rather not have so often.
I've been writing in this journal for a long time about how everybody experiences the full range of human emotions, sometimes all of them within a 24-hour period. This isn't pathology, it is normal.
For example, recently a friend of mine messaged me and told me that he felt like bursting into tears about something. I replied, "Then you probably need to burst into tears." Crying is normal human behavior. Getting anxious about an upcoming work task is normal. Feeling lonely when all your peeps are busy is normal. Worrying about the effects of global warming is a new kind of normal, but still normal. The world is a difficult place to live in.
I think psychology can be of great help to people who want to improve their situations, whether they're low-functioning or high-functioning. But the issue isn't really your diagnosis, it is your functioning. Your diagnosis is not supposed to become your new identity, it is supposed to help focus your treatment so you can improve your situation, and ultimately not need the diagnosis anymore. And it simply isn't possible to feel happy or calm all the time, humans experience the full range of emotions.
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On public radio recently I heard a story about the modern approach to treating schizophrenia, which is to identify people early and then intervene with a team of professionals to help people with schizophrenia to become and/or remain high-functioning: able to continue living in the community with their families while continuing with their education or careers. The problem, according to the story, is getting for-profit insurance companies to pay for these teams of professionals early on, instead of waiting for people to fall apart and end up in the hospital after losing their jobs and alienating their social support group.
Schizophrenia is not one of the more popular diagnoses, thankfully. I've never experienced somebody leading with their schizophrenia. But I loved hearing that the modern focus was on improving/maintaining functioning.
The purpose of the diagnosis is not to stamp you with an identity, but to aid in helping you to overcome whatever the issue is so that you can function as a competetent adult.
-----
To their credit, both of the people I know in real life who have been diagnosed with ADHD are working diligently to improve their situations as a result. They're using their diagnoses as tools for improvement. That's great, but they were both already high-functioning individuals. If instead I see them try to use their diagnoses as permanent excuses for anti-social behavior, I will say so out loud to them. I think my main point in writing all of this is that diagnoses shouldn't be used as permanent excuses for maladaptive behaviors, but should be used as tools for improvement.
My concern is that mental illness has fallen into our cultural identity wars as another type of racial or gender identity that people will use to divide us and thereby further obscure our common humanity. ADHD should be more like high blood pressure than like ethnicity. Take a pill and make some lifestyle changes. There's no need to tell somebody you just met that you have high blood pressure, because it's not your identity.
I think it is because of the phenomenon of both high-functioning people and low-functioning people sharing the same popular diagnoses without making meaningful distinctions between how these diagnoses operate within these two different groups.
I studied psychology at both the undergraduate and graduate levels, and I've been a consumer of psychology and psychiatry at various times in my life, including everything from hospitalization to prescription drugs and therapy (including individual therapy, couples therapy, and group therapy). So I'm familiar with the field as both a student and a consumer, but not as a practitioner.
I've always been high-functioning, by which I mean I'm able to maintain long-term friendships and relationships, I'm able to hold down a job, I'm able to stay out of serious trouble with law enforcement. My one instance of hospitalization didn't last long and my employer was fine with it, as were my family and friends. I've never tried to kill myself, and I'm not physically abusive toward others.
I would describe low-functioning as having a major deficit in life skills, such as not being able to maintain relationships, not being able to hold down a job, or in trouble with law enforcement. Hospitalized due to mental illness for an indefinite period of time, or failed suicide attempts, or violence toward others. [Unfortunately a successful suicide attempt is game over, too late to intervene with diagnostic criteria and treatment modalities.]
When I studied clinical psychology and other related sub-disciplines in psychology, I was taught that the primary assessment to make of a client was whether they were high-functioning and merely distressed about something, or low-functioning and thus requiring major interventions. For example, distressed about the end of a long-term relationship (which is definitely distressing, but normal), or a physical threat to themselves or others.
What I've seen happen during the decades since I studied this stuff during the 1980s-1990s, especially with autism and ADHD, is that high-functioning people began to adopt diagnoses that were originally designed for low-functioning people, and thereby confused for everybody what it means to have these diagnoses. And then they've turned these diagnoses into identities, similar to racial or gender identities. And then they've lobbied for accommodations for their diagnoses, similar to those provided for people with disabilities, to help them get ahead in their (already successful) careers, or to give them more power in their (already successful) personal relationships.
So when a person leads with their list of mental health diagnoses as a matter of introduction, I find this to be strange behavior and a sort of affectation. But this is increasingly common among people online, in the online spaces I inhabit. And both T and I encounter it more frequently in real life also. Two of the younger people I interact with regularly are recently diagnosed with ADHD, for example, and bring it up for discussion a lot. Both of them are high-functioning adults in general, and to me it seems their responses to their ADHD diagnoses are mainly about how to become even more high-functioning, via self-organization and prescription medication.
At times I've sought therapy and medication, so I don't mean to say that high-functioning people should never do so. But when the professionals tried to give me the diagnosis of "bipolar disorder" back in 2003, I resisted adopting this diagnosis because, no, wait, I'm high-functioning, there's nothing "wrong" with me. Yes, I suffered a psychotic break, yes I did. I remember my psychiatrist telling me afterward that I had to keep taking these medications for life to avoid having another psychotic break. But that never felt correct to me, instead it felt like a scare tactic. And over time I stopped taking the medications, one by one, tapering off, then using them only as needed. And over 20 years later I've never had another psychotic break.
I do have anxiety and even panic attacks from time to time, but I've resisted applying a diagnosis to these problems. I'm not "an anxious person". Because I know I'm high-functioning, and that EVERYBODY feel anxious from time to time. I sometimes take prescription medication to help me relax when the anxiety is significantly higher than my median, or persists for too long. But I don't lead with some version of an anxious identity when I introduce myself, such as "I have an insecure attachment style" or whatever. I think identifying with my anxiety would give it too much power over me. Like everybody else, I experience human emotions, including emotions I'd rather not have so often.
I've been writing in this journal for a long time about how everybody experiences the full range of human emotions, sometimes all of them within a 24-hour period. This isn't pathology, it is normal.
For example, recently a friend of mine messaged me and told me that he felt like bursting into tears about something. I replied, "Then you probably need to burst into tears." Crying is normal human behavior. Getting anxious about an upcoming work task is normal. Feeling lonely when all your peeps are busy is normal. Worrying about the effects of global warming is a new kind of normal, but still normal. The world is a difficult place to live in.
I think psychology can be of great help to people who want to improve their situations, whether they're low-functioning or high-functioning. But the issue isn't really your diagnosis, it is your functioning. Your diagnosis is not supposed to become your new identity, it is supposed to help focus your treatment so you can improve your situation, and ultimately not need the diagnosis anymore. And it simply isn't possible to feel happy or calm all the time, humans experience the full range of emotions.
-----
On public radio recently I heard a story about the modern approach to treating schizophrenia, which is to identify people early and then intervene with a team of professionals to help people with schizophrenia to become and/or remain high-functioning: able to continue living in the community with their families while continuing with their education or careers. The problem, according to the story, is getting for-profit insurance companies to pay for these teams of professionals early on, instead of waiting for people to fall apart and end up in the hospital after losing their jobs and alienating their social support group.
Schizophrenia is not one of the more popular diagnoses, thankfully. I've never experienced somebody leading with their schizophrenia. But I loved hearing that the modern focus was on improving/maintaining functioning.
The purpose of the diagnosis is not to stamp you with an identity, but to aid in helping you to overcome whatever the issue is so that you can function as a competetent adult.
-----
To their credit, both of the people I know in real life who have been diagnosed with ADHD are working diligently to improve their situations as a result. They're using their diagnoses as tools for improvement. That's great, but they were both already high-functioning individuals. If instead I see them try to use their diagnoses as permanent excuses for anti-social behavior, I will say so out loud to them. I think my main point in writing all of this is that diagnoses shouldn't be used as permanent excuses for maladaptive behaviors, but should be used as tools for improvement.
My concern is that mental illness has fallen into our cultural identity wars as another type of racial or gender identity that people will use to divide us and thereby further obscure our common humanity. ADHD should be more like high blood pressure than like ethnicity. Take a pill and make some lifestyle changes. There's no need to tell somebody you just met that you have high blood pressure, because it's not your identity.