Guest post: Compulsive Ranting Disorder
Originally a comment by Screechy Monkey at Miscellany Room.
Interesting, if a little slow-developing, article in the New Yorker on how psychiatric labels (such as autism, sociopathy, borderline personality disorder) have become entire identities. For example:
Just as personality tests (see, I’m an introvert!), astrological signs (I’m a Libra!), and generational monikers (I’m Gen Z!) are used to aid self-understanding, so are psychiatric diagnoses. When Paige Layle was fifteen, a psychiatrist told her that she had autism spectrum disorder. She describes the rush of clarity she experienced when hearing the DSM-5 criteria: “I’m not crazy. I’m not making it up. I’m not manipulative or trying to fake anything. . . . There’s a reason why I’m the way that I am.”
What I took from the article is that both patients and practitioners are putting a lot of weight on DSM categories that just aren’t that firm to begin with.
A related phenomenon that’s been irritating me is that I see the following progression:
1. Anti-social behavior X is an indication of mental health condition A.
2. Therefore, someone who does X may very well have A.
3. It is wrong to criticize anyone for anything that is caused by a mental health condition.
4. Therefore, if you complain about someone doing X, you’re an ableist jerk.
For example, read any advice column or discussion group where someone complains about how their friend Sally is consistently an hour or more late every time they try to make plans. Dinner reservations and theatre tickets go to waste, people sit around for half the evening wondering when she’ll show up, etc.
It won’t be long before someone will pop up in the comments to say that it’s the letter writer, not Sally, who’s an asshole. Sally probably has “time blindness,” which is a symptom of ADHD, you ableist jerk!
This, to me, turns the whole fucking thing on its head. People typically seek mental health treatment because they’re having problems regulating their behavior or emotions. Diagnostic categories were supposed to be to help define treatment methods (and, of course, to make sure insurance companies will pay for it). But many people — I should stress that I see this more from laypeople than actual professionals — want to say “oh, here’s this label, and it explains why you are the way you are, and now that you know, there is no reason for change because (clap) you (clap) are (clap) fine (clap) as you are (clap clap clap).”
Which — no. Sally is a fucking pain in the ass who nobody wants to be friends with, including, I’ll bet, all the people insisting that she’s wonderful as she is. It’s like someone throwing their empty whisky bottle at your head, cracking open a second bottle, and shrugging it off with “hey, I’m an alcoholic, this is what I do!”
Whew. Sorry, that rant got away from me for a bit. I can’t help it, I have Compulsive Internet Ranting Disorder, it’s just the way that I am, and you all need to indulge me.
One final bit of snark:
In 2020, she posted a video on TikTok slamming a trend that used “autistic” to mean “dumb.” It went viral. With a bluntness easily mistaken for vanity, she told the camera, “Hi, there, I’m autistic. I’m also the smartest person I’ve ever met, O.K.?”
Yes, “mistaken” for vanity. Indeed!
As someone with a severe porn addiction*. I can sympathize O!
*. I am addicted to Outrage Porn. Read too much stuff that outrages me..(am kidding…but maybe not?)
Rather incredible that an article about how psychiatric disorders from the DSM are turning into identities fails to mention the biggest psychiatric disorder-turned-identity of them all: gender identity disorder. It’s still a psychiatric disorder, despite the name change to “gender dysphoria,” because all that medical treatment wouldn’t be covered by insurance if it were merely cosmetic. I scanned the piece for the words gender, trans, and queer and I found no results. That has to be a deliberate omission. Too hot, that particular potato. Best not to mention it at all…
Statistically she’s probably right assuming she got the “good” kind of autism that doesn’t make you a moron (do they make autists with a statistically average IQ?).
To go for a more extreme example though: if a schizophrenic pilot thinks he’s being chased by UFOs and then crashes into a mountain while evading then, several hundred people are still dead. He couldn’t change what he was (meds help but can vary from person to person and the side effects *suck*) so there was always a risk.
And of course, this tendency can be very dangerous. I remember many years back when some idiots started pushing the idea that anorexics shouldn’t be treated as if mentally ill. Fortunately, the fad died out pretty fast, but I’m sure at least a few sufferers delayed treatment because of the well-meant idiotic ‘support’.
I remember when a diagnosis was an aid to working out how best to approach problems in a way which made them more likely to be solved, not an excuse for indulging them. It also really doesn’t help when people who are simply arseholes claim to have a mental disorder as a ‘get out of jail free’ card. When disability becomes identity, predators always take advantage. As for anorexia, I really hope that the online groups encouraging it have disbanded.
By the way, autism is a result of having a brain which is wired differently. Autistic people have the same range of intelligence, from genius to profound learning difficulties, as otherwise normal people do. Unless otherwise mentally impaired, autistic people can learn to be as socially adept with non-autistic people as normal people are, but we have to make a conscious effort. When it comes to the unwritten rules, we don’t ‘pick it up as we go’ as I was assured by friends my children would, without needing the detailed reasons and explanations I was giving them. I, of course, thought that my friends were bonkers. How did they expect their tiny children to learn how to behave if they weren’t told why it is optimal? I had to learn by being taught how and why, so of course I taught my children!
Interestingly, I don’t have to put in any mental energy whatsoever to socialise with other spectrumites. Non-verbal communication is simply not the problem it is with people who behave so very differently to us.
This is one of my biggest “old man yells at clouds” issues because my mother has repeatedly mentioned that she probably could have gotten me an autism diagnosis but she didn’t because she didn’t want the school to track me in that way. And she was probably right. I got the 90s style “stop being weird” treatment, and that was fine. I’m a white collar professional in a job that involves both technical analysis as well as customer interaction, education, and rapport-building. I’m good at it. The fact that I have one or two traits that are in the autistic direction doesn’t mean I have enough of them that catering to me or adjusting your expectations of me would have been healthy.
There are a couple skepticism related points here.
One is that you can’t trust a medical diagnosis if you don’t know how it was obtained.
If someone got a diagnosis by going to one doctor, honestly reporting their situation, and accepting the results, that’s probably reliable. More so than me second guessing it at least.
What if they did that, got an answer they didn’t like, did it again with another doctor, and repeated the process a half dozen times until they got the answer they wanted? Then the results are unreliable because what you’re seeing will just be the final positive diagnosis, and not the aggregate.
The same thing is true of diagnoses obtained by seeking out doctors with known reputations for always reaching a particular conclusion. Or, before going to a doctor, talking online with others about what you need to say to get the diagnosis you want. Or doing all three.
The big offenders here are diagnoses that 1) get you medical marijuana, 2) might help you in court, 3) get you a disability check, 4) get you an IEP or exempt you from school discipline, or 5) let you access otherwise restricted medications.
I occasionally see clips from a TV show called The Good Doctor. The show centers on the life of Dr Shaun Murphy, a brilliant surgeon who has autism spectrum disorder. One of the story lines involves a woman who joins his team as an intern; she also has autism spectrum disorder, and his story inspired her to go into surgery. Murphy had numerous difficulties and had to make many adjustments to learn to function in his job; people around him also had to make some accommodations. In contrast with Murphy, the intern keeps harping about ASD being a disability and insisting that everybody around her needs to accommodate her needs; she refuses to accept that she needs to do anything. This leads to many conflicts with Murphy.
It’s fiction, but it is well done and it raises a lot of good issues. My understanding is that the show is received well by people who are experts in autism.
Patrick:
I will add a caveat that at the earlier stages of a particular malady’s awareness in the medical profession, ‘visiting multiple doctors’ is often a necessary step to receiving a diagnosis. This is particularly the case in conditions that are essentially diagnoses of exclusion, like fibromyalgia.
Patrick @6,
Or worse yet, people who didn’t get their diagnosis from any doctor at all.
I can understand someone like you who suspects they are on the spectrum but never had a need for a diagnosis. What baffles/frustrates me are the people who go on and on about how their condition (whether it’s autism or ADHD or whatever) is a fundamental truth about them that has made their entire life make sense and that “neurotypicals” NEED to understand and take into account in dealing with them (invariably by cutting them slack that others wouldn’t get), but couldn’t be bothered to get a professional diagnosis. Yes, go ahead and base your life and demand that others accommodate you based on an online quiz you once took.
I don’t know about the rest of you but I’m learning a lot from this discussion. Keep going.
That thing tigger said @ 5 about giving children detailed reasons and explanations for social rules…it seems to me it’s a good idea to give detailed reasons and explanations in general, autism or no autism. Reasons are motivating. Sometimes the rules are just arbitrary, and that’s worth explaining too.
Like Patrick, I have some characteristics that would put me on the autism spectrum. Growing up in the 1960s and 1970s means I was not misdiagnosed in such a way. Years of treatment for depression and anxiety disorders have led to more appropriate treatment, without the special needs of everyone being careful around me. I lack social skills; that seems largely to be that my mother had few to no social skills so I did not learn them. I have gained a few as an adult, but am still socially extremely awkward. That isn’t autism, it’s just personality.
My son came of age during the ADHD craze. He had a lot of energy when he started school, so the teacher had his father (who had custody at the time) take him to a particular doctor who diagnosed him ADHD and seizure disorder. It took years for me to get him off the medicine (because I was non-custodial, though I had the child and was doing all the raising; my ex had only the check Social Security sent for my son because I was on disability). The medication turned him into a zombie, and the teacher that two weeks before was complaining that he had too much energy started complaining he was sleeping in class. Neither she nor his father would consider taking him off the medicine; both wanted him to just sit quiet so they could ignore him.
Of the reasons Patrick gave for seeking a diagnosis, I have people representatives of all of them (except number 1) in my family. If every pulmonologist in the city tests you and says you don’t have asthma, then you go to a GP who tests you, says you don’t have asthma, and when you argue, she says you may have an atypical form of asthma, at that point, you’re probably diagnosis seeking. That doctor made a lot of money off her willingness to diagnose my sister with asthma, and all her children with whatever disease she wanted them to have.
I’m hardly the first to point this out, but according to the prevailing ”intersectional” analysis there is a fixed hierarchy of power and privilege. Your place in the hierarchy is entirely determined by the intersecting identity categories you can lay claim to. There is also a moral hierarchy. Your position in the latter hierarchy is the exact inverse your position in the former. The more privileged the less virtuous, and vice versa. If your intersecting identity categories put you in the ”privileged” box, you are an ”oppressor” by virtue of existing (regardless of the actual circumstances of your life), which means everybody else has a blank check to attack you (in the name of ”punching up”), and you don’t have a right to defend yourself. If you’re a straight, white, able-bodied* kid the only way to identify out the oppressor category (and not end up as a permanent punching bag) is to adopt one of the letters of the alphabet soup, or some kind of mental diagnosis, or both.
So while I don’t doubt that many things play into the current mental health crisis, especially among young people – bad therapy, over-protective parents, toxic social media, the fact that the world really does suck etc. – I don’t think it is possible to truly understand what’s going on without also taking into account this active pressure to identfy as sick, ”traumatized” etc. as well as the punishments for not doing so.
* I nearly wrote ”male” out of old habit, but I don’t really think there are any particular oppression points for being biologically female (as opposed to ”identifying” as a ”woman” – especially if biologically male) these days.