A therapist grapples with diagnosis culture

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From Mental Hellth: “For some critics, the face of the social media-based self-diagnostician is a privileged white woman who wants status and attention for what might better be thought of as personality quirks. But much more often, at least in the population I work with, a biology-based explanation is a way of side-stepping facing what they’ve actually lived through. I think of the young man who thought he might have Oppositional Personality Disorder or Autophobia (‘fear of loneliness’). This came after we’d worked together long enough for him to reveal his mother’s long battle with cancer during his elementary school years, his father’s betrayal of them during this time, and all the anger and mistrust he feels in relationships now. ‘The past is in the past, it doesn’t affect me,’ he’d say. I think of a young woman whose family was for years violently targeted for political persecution, then moved to the U.S. to get her life-saving medical treatment, only to encounter a fresh new batch of emergencies. She reported feeling on edge, vigilant, and distracted, and wondered if she had ADHD.

I find in most of the young people I work with, a powerful desire to minimize what has happened to them and how they’ve been hurt. Their past is a haunted, lonely, senseless cave. Diagnosis is a shareable infographic. Of course, these dynamics collude with the society-wide political incentives toward medicalization, which, as Danielle Carr writes, put ‘the focus on the individual as a biological body, at the expense of factoring in systemic and infrastructural conditions.’

Though diagnosis is approachable for young people and seems to offer something tangible, I think there is something crucially ambiguous about what exactly it confirms. That ambiguity seems perfectly suited to this age group. Does it confirm that there is a problem, or that I am a problem? Is diagnosis an exoneration, or is it an indictment? It’s a loop they get caught in, which is maybe the same loop all adolescents are in as they struggle to differentiate from their caregivers. Who is right and who is wrong? Does diagnosis mean they’re right and I’m defective? Or does it mean that they are wrong for blaming me so the blame is on them? Diagnosis can’t answer this question, it can only ask it.

. . . I see the craving for diagnosis against the larger backdrop of our time. The adolescents I work with seem to want an explanation that feels real in a stable way. The news, politics, religion, family, gender, the future of the planet, what bodies look like; there’s no unquestionable legitimacy in any of it. With this comes greater possibilities for freedom and authenticity. But it also makes us desperate for something more credible than our own disorganized thoughts and feelings.”

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MITUK’s mission is to serve as a catalyst for fundamentally re-thinking theory and practice in the field of mental health in the UK, and promoting positive change. We believe that the current diagnostically-based paradigm of care has comprehensively failed, and that the future lies in non-medical alternatives which explicitly acknowledge the causal role of social and relational conflicts, abuses, adversities and injustices.