7 ms·

My experience has been a mental health diagnosis, even from a professional, has the terrible byproduct of reifying the symptoms of that condition. It's perfect

My experience has been a mental health diagnosis, even from a professional, has the terrible byproduct of reifying the symptoms of that condition. It's perfectly possible that the environment that manifests something like social phobia can change, and a person who previously felt uncomfortable doing something can feel again comfortable. However, if having social anxiety becomes part of your identity, it becomes the lense that you see the world. TikTok makes it easy, but social media as a whole is identity obsessed by its nature, and as the article illustrates is making this problem worse.

djaychela 4y ago
This has been my experience, both professionally (I used to teach children at a school which specialises in those who may have some form of diagnosis), and in my personal life with 4 step children, 3 of whom have ASD diagnoses. For the vast majority who I taught, the diagnosis became their identity, rather than a way to understand their behaviour. Any disagreement with them was answered with "that's because I'm X". I can only recall one who approached it as a way to identify and understand their behaviour and experience of the world, and as a way to deeper understanding.
- bjornsing 4y ago
  So what is an identity if not “a way to understand their behaviour and experience of the world”? I think the problem the GP raises is inherent in the whole diagnosis concept, and that it’s generally a bad idea to label large parts of the personality spectrum as some kind of (incurable) illness.
  - ipython 4y ago
    Not the gp, but I think the difference lies in mindset. There’s the “victim” mindset where you know the diagnosis and it becomes a convenient scapegoat for your symptoms. “I can’t do that because I’m X.” You see yourself as unable to escape the diagnosis and enter a state of learned helplessness. The desired outcome is an enlightenment mindset. “Ah, so that’s why I act that way. Well now that I know that and have x, y and z methods for addressing it, I can overcome/adapt”. As you can imagine it’s a lot more work to achieve this mindset.
    - bjornsing 4y ago
      I don’t know… I think it’s kind of unfair to lay this on people who are already struggling, when it’s quite clear that most healthy adults are unable to adapt that mindset when it comes to (other’s) psychiatric diagnoses…
      - ipython 4y ago
        I can empathize with your position, and it would be nice if there was a way to help from the “outside”. But the truth is that the only way to make meaningful change is to internalize the change and do it yourself. I say this not as some sort of holier than thou proclamation. I struggle with this daily myself. Posting on hacker news helps reinforce what I should do to help myself :)
    - chrsig 4y ago
      > There’s the “victim” mindset where you know the diagnosis and it becomes a convenient scapegoat for your symptoms. Spend some time to think about that sentence. The diagnosis is not a "scapegoat", it's literally an explanation for the symptoms. Why should they have to try to "escape" the diagnosis?
    - MrPatan 4y ago
      Now combine this with the 21st century "victim industrial complex" and we have a recipe for disaster. Actually, I do wonder. Are these independant variables, or is the search for victimhood driving the "mental illness" trend?
- tokamak-teapot 4y ago
  You’re saying these people were able to understand one of the major aspects of their make-up and were able, after years of struggle, to at least give a name to the reason for the struggle they still had to deal with. They must have had some sense of relief when they got diagnosed. Perhaps they thought they would be given a little bit of a break by those who expected them to act like people who are literally not like them. Perhaps they found, though, that despite finally being able to show others that they weren’t just lazy, or stupid, or that they didn’t care, or they weren’t interested in paying attention, or they were just being weird, they were still expected to somehow ‘snap out of it’ and be like people who weren’t like them. After not being able to explain your behaviour for so many years, and then being expected to just somehow ‘identify and understand’ and gain some ‘deeper understanding’ would sound to them exactly like ‘you can just try to stop being yourself now you have a label, right?’ It’s exhausting. Even with - and especially with - those you love and who you see every day, including those who are on the spectrum themselves, there is still a lack of understanding and a pressure to just ‘fix’ yourself, and do so consistently. No wonder some, as soon as they get a diagnosis, default to saying ‘I did that because I am X’ and don’t want to have to bow and promise to work on themselves so that they can be a better - different - person. They are doing this every day because they feel the weight of society. They don’t need to have those closest to them be the nagging voice of that society.
  - Tijdreiziger 4y ago
    As someone who got an ASD diagnosis later in life, this is absolutely spot on.
    - prvit 4y ago
      And as someone who got an ASD and ADHD diagnosis earlier in life (which doctors are now unable to reproduce), this couldn’t be further from being spot on. So much unnecessary bullshit I had to go through because shrinks were too eager to label me as a kid. In the end my only fault was a general aversion to authority, only further intensified by this experience.
      - 4y ago
- arglebarglethr 4y ago
  When my daughter was young, my wife and I were concerned, and we took her to a place that specializes in identifying and working with autistic children. In about thirty minutes of observation, they said she's obviously autistic, and recommended that we begin bringing her for ~20 hours of intervention a week. We decided against it, because we thought it was excessive, and decided we didn't really want autism to be her entire life. Several years later, she's doing very well: good skills for life, good progress in her schoolwork, and good ability to deal with social situations. Yes, she's a little socially awkward, but she puts herself out there anyway, and makes no excuses. (She's aware of the evaluation and after reading a couple books about autism, thinks, yeah, that's probably what's up.) I know that's an anecdote, but can anyone imagine that she would have gained more from 20 hours per week of being told she has special problems with a special name, and needs professional help to overcome her many, many obstacles? I certainly can't.
  - idontknowifican 4y ago
    this is a reflection on you, not your child. i was diagnosed with an ASD issue. my father was devastated, i can’t be “broken” because he clearly isn’t. i was shown by my fathers actions that my “affliction” wasn’t ok. if i was broken, he was, and that didn’t work for him. i said what my dad wanted to hear WRT if i had had more classes to cope, “a total waste” i agreed. in the end i spent half a decade in these classes learning how to understand what the other person is trying to say, not what their actions and subtext scream out. i did this as an adult, against my father thinking it was needed. after five years i can finally manage my emotions well enough and with enough expertise that it no longer causes me to loose friends and ostracize coworkers. think about the impact that your clear disdain for the “condition” and down playing of the value if the courses. imagine your daughter not “still struggling” and instead “able to deal with emotions in a non familial situation”. your fear is harming your perspective
    - robocat 4y ago
      That sounds like you are denying their lived reality, perhaps even “projecting” your golden experience, saying that others can’t find different paths through complex human topics. Your opinion is fine, but denying the opinion of others is not. Here are two things that I have commonly seen: 1: getting labelled often leads to negative outcomes, in particular when others judge by a person’s label and not the person, and 2: psychologists and counsellors can sometimes create victims, trained codependency, and a variety of very negative outcomes. In this case the OP judged the cost of 20 hours per week of professional help to be high cost/risk, and they tentatively said it seems to be a reasonably good outcome (fantastic - given the diagnosis). Professional “help” can easily be harmful, and I think you should acknowledge that fact. Of course the opposite can happen when people ignore help, or deny problems, and then hurt themselves or others. The key point is that there is no golden standard where you can predict if professional help will work, or harm. PS: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- hnews_account_1 4y ago
  This is so true. My friend got a ADHD diagnosis very late in life and it became so much of his fucking identity. Thankfully, he was smart enough to know the dangers of abusing adderall so he took it in moderation. But he refused to listen to my assessment that it was not helping him at all. The worst part of it was that he was convinced that his academic failures in life were due to his ADHD. Now we are both successful people in general. He's a software engineer in a major company. But since he couldn't figure out some simple math shit that was obvious to me, he thought he was being handicapped by his disorder. He refused to listen to my claim that everyone has a lot of stuff in math they just do by the rules they were taught and only realize later in life that there's an underlying concept. It is kinda the point of our education system because our young brains take more time to grasp the basics so we cram the rules and wait for the rest of cognition to catch up before teaching the basics. He stopped taking the meds a while ago when he realized it wasn't doing him much good and realized that there's a limit to how smart people get and it is ok to not be born as next Terry Tao or something.
  - chrsig 4y ago
    > He refused to listen to my claim that everyone has a lot of stuff in math they just do by the rules they were taught and only realize later in life that there's an underlying concept. You're probably misinterpreting "refusal" as "unable". After a lifetime of being told "if you would just apply yourself...", you start to get a distorted impression on what the average experience is. Obviously, he's just coming to understand something that everyone else had appreciated since they first learned it, because they applied themselves. Maybe I'm projecting -- I'm in a similar spot, but I've been diagnosed since high school, and it wasn't exactly a shocker then. What you're describing really sounds like the secondary depression[0] that usually comes with adhd. That is, he's probably is being handicapped by the disorder -- it can be a real slog to read math, and very hard to practice it, even when it's interesting. But it sounds like you were coming face to face with depression caused by a lifetime of not feeling good enough. Frustration that you can't apply yourself harder. Being gaslit into believing that you weren't trying.
    - hnews_account_1 4y ago
- deleted 4y ago
  [deleted]
- agumonkey 4y ago
  I fear that exposing teens to self educating on too personal and too complex topics is gonna backfire. They're extremely quick to accept theories and blend in with it to make it an instant reality. ps: not helped by online groups or bubbles (twitter, discord) where they can all reinforce their own beliefs in a joyful mayhem.
pxc 4y ago
tl;dr: get yourself a therapist who understands that the most important questions for you w/r/t to your mental and emotional well-being are not whether you ‘really have’ social anxiety, or whether autism ‘really is’ just a disorder, or whatever. > However, if having social anxiety becomes part of your identity, it becomes the lense that you see the world. TikTok makes it easy, but social media as a whole is identity obsessed by its nature, I think this is as much a feature of that stage of personal development as it is of social media. Adolescence and early adulthood are periods in life when there's naturally a lot of focus on identity formation. I think the issue with diagnosis being taken as identity formation comes out of that background more than it does the nature of social media or out of medical diagnoses themselves. It also (imo) comes from a scientistic approach to psychology: it starts with the premise that the diagnostic categories one finds in diagnostic manuals all correspond to real conditions in the world (realism) which divide the population into kinds of people (essentialism). But that forgets the purpose of those diagnostic manuals and their contents (to help mental health clinicians guide treatment plans) and the nature of the science and clinical practice here, which is driven almost exclusively using hypothetical entities we can't directly observe. The DSM's purpose is not to provide an ontology, or to identify essential features of the human mind, and certainly not to do so in a way with any kind of finality. The other thing to think about is the kind of profound validation and relief that can come with gaining a ‘label’ for one's struggles, a framework for thinking about them, and references to communities where you can learn from other people dealing with the same things. That is huge, and it's really important to a lot of people when they first get diagnosed (whether with mental health or a chronic physical condition, for that matter). And it's natural for that to push one to see their diagnosis or the label associated with it as defining part of who they are. That said, there are psychologists and psychiatrists who are also troubled by this, who are critical of ontologizing or essentializing approaches to their own fields. Go in with an attitude that you're looking for labels that are useful regardless of whether they're true, with an understanding that mental health exists not just in the patient but in their social relations to the whole of their society, that our diagnostic categories in 10 or 50 or 100 years will likely be quite different from the ones we have now, that many conditions with similar symptoms may be related or distinct in ways we don't yet understand, that as you work on things you might shed just enough symptoms of this or that thing to go from qualifying for diagnosis to no longer qualifying (despite the clear continuity in who you are, your personality and traits, etc.) and so on. You can find therapists who are comfortable taking an anti-realist, anti-essentialist approach which resists that mental habit of reification.
deleted 4y ago
[deleted]

djaychela 4y ago

This has been my experience, both professionally (I used to teach children at a school which specialises in those who may have some form of diagnosis), and in my personal life with 4 step children, 3 of whom have ASD diagnoses. For the vast majority who I taught, the diagnosis became their identity, rather than a way to understand their behaviour. Any disagreement with them was answered with "that's because I'm X". I can only recall one who approached it as a way to identify and understand their behaviour and experience of the world, and as a way to deeper understanding.

bjornsing 4y ago
So what is an identity if not “a way to understand their behaviour and experience of the world”? I think the problem the GP raises is inherent in the whole diagnosis concept, and that it’s generally a bad idea to label large parts of the personality spectrum as some kind of (incurable) illness.
- ipython 4y ago
  Not the gp, but I think the difference lies in mindset. There’s the “victim” mindset where you know the diagnosis and it becomes a convenient scapegoat for your symptoms. “I can’t do that because I’m X.” You see yourself as unable to escape the diagnosis and enter a state of learned helplessness. The desired outcome is an enlightenment mindset. “Ah, so that’s why I act that way. Well now that I know that and have x, y and z methods for addressing it, I can overcome/adapt”. As you can imagine it’s a lot more work to achieve this mindset.
  - bjornsing 4y ago
    I don’t know… I think it’s kind of unfair to lay this on people who are already struggling, when it’s quite clear that most healthy adults are unable to adapt that mindset when it comes to (other’s) psychiatric diagnoses…
    - ipython 4y ago
      I can empathize with your position, and it would be nice if there was a way to help from the “outside”. But the truth is that the only way to make meaningful change is to internalize the change and do it yourself. I say this not as some sort of holier than thou proclamation. I struggle with this daily myself. Posting on hacker news helps reinforce what I should do to help myself :)
  - chrsig 4y ago
    > There’s the “victim” mindset where you know the diagnosis and it becomes a convenient scapegoat for your symptoms. Spend some time to think about that sentence. The diagnosis is not a "scapegoat", it's literally an explanation for the symptoms. Why should they have to try to "escape" the diagnosis?
  - MrPatan 4y ago
    Now combine this with the 21st century "victim industrial complex" and we have a recipe for disaster. Actually, I do wonder. Are these independant variables, or is the search for victimhood driving the "mental illness" trend?
tokamak-teapot 4y ago
You’re saying these people were able to understand one of the major aspects of their make-up and were able, after years of struggle, to at least give a name to the reason for the struggle they still had to deal with. They must have had some sense of relief when they got diagnosed. Perhaps they thought they would be given a little bit of a break by those who expected them to act like people who are literally not like them. Perhaps they found, though, that despite finally being able to show others that they weren’t just lazy, or stupid, or that they didn’t care, or they weren’t interested in paying attention, or they were just being weird, they were still expected to somehow ‘snap out of it’ and be like people who weren’t like them. After not being able to explain your behaviour for so many years, and then being expected to just somehow ‘identify and understand’ and gain some ‘deeper understanding’ would sound to them exactly like ‘you can just try to stop being yourself now you have a label, right?’ It’s exhausting. Even with - and especially with - those you love and who you see every day, including those who are on the spectrum themselves, there is still a lack of understanding and a pressure to just ‘fix’ yourself, and do so consistently. No wonder some, as soon as they get a diagnosis, default to saying ‘I did that because I am X’ and don’t want to have to bow and promise to work on themselves so that they can be a better - different - person. They are doing this every day because they feel the weight of society. They don’t need to have those closest to them be the nagging voice of that society.
- Tijdreiziger 4y ago
  As someone who got an ASD diagnosis later in life, this is absolutely spot on.
  - prvit 4y ago
    And as someone who got an ASD and ADHD diagnosis earlier in life (which doctors are now unable to reproduce), this couldn’t be further from being spot on. So much unnecessary bullshit I had to go through because shrinks were too eager to label me as a kid. In the end my only fault was a general aversion to authority, only further intensified by this experience.
    - 4y ago
arglebarglethr 4y ago
When my daughter was young, my wife and I were concerned, and we took her to a place that specializes in identifying and working with autistic children. In about thirty minutes of observation, they said she's obviously autistic, and recommended that we begin bringing her for ~20 hours of intervention a week. We decided against it, because we thought it was excessive, and decided we didn't really want autism to be her entire life. Several years later, she's doing very well: good skills for life, good progress in her schoolwork, and good ability to deal with social situations. Yes, she's a little socially awkward, but she puts herself out there anyway, and makes no excuses. (She's aware of the evaluation and after reading a couple books about autism, thinks, yeah, that's probably what's up.) I know that's an anecdote, but can anyone imagine that she would have gained more from 20 hours per week of being told she has special problems with a special name, and needs professional help to overcome her many, many obstacles? I certainly can't.
- idontknowifican 4y ago
  this is a reflection on you, not your child. i was diagnosed with an ASD issue. my father was devastated, i can’t be “broken” because he clearly isn’t. i was shown by my fathers actions that my “affliction” wasn’t ok. if i was broken, he was, and that didn’t work for him. i said what my dad wanted to hear WRT if i had had more classes to cope, “a total waste” i agreed. in the end i spent half a decade in these classes learning how to understand what the other person is trying to say, not what their actions and subtext scream out. i did this as an adult, against my father thinking it was needed. after five years i can finally manage my emotions well enough and with enough expertise that it no longer causes me to loose friends and ostracize coworkers. think about the impact that your clear disdain for the “condition” and down playing of the value if the courses. imagine your daughter not “still struggling” and instead “able to deal with emotions in a non familial situation”. your fear is harming your perspective
  - robocat 4y ago
    That sounds like you are denying their lived reality, perhaps even “projecting” your golden experience, saying that others can’t find different paths through complex human topics. Your opinion is fine, but denying the opinion of others is not. Here are two things that I have commonly seen: 1: getting labelled often leads to negative outcomes, in particular when others judge by a person’s label and not the person, and 2: psychologists and counsellors can sometimes create victims, trained codependency, and a variety of very negative outcomes. In this case the OP judged the cost of 20 hours per week of professional help to be high cost/risk, and they tentatively said it seems to be a reasonably good outcome (fantastic - given the diagnosis). Professional “help” can easily be harmful, and I think you should acknowledge that fact. Of course the opposite can happen when people ignore help, or deny problems, and then hurt themselves or others. The key point is that there is no golden standard where you can predict if professional help will work, or harm. PS: https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
hnews_account_1 4y ago
This is so true. My friend got a ADHD diagnosis very late in life and it became so much of his fucking identity. Thankfully, he was smart enough to know the dangers of abusing adderall so he took it in moderation. But he refused to listen to my assessment that it was not helping him at all. The worst part of it was that he was convinced that his academic failures in life were due to his ADHD. Now we are both successful people in general. He's a software engineer in a major company. But since he couldn't figure out some simple math shit that was obvious to me, he thought he was being handicapped by his disorder. He refused to listen to my claim that everyone has a lot of stuff in math they just do by the rules they were taught and only realize later in life that there's an underlying concept. It is kinda the point of our education system because our young brains take more time to grasp the basics so we cram the rules and wait for the rest of cognition to catch up before teaching the basics. He stopped taking the meds a while ago when he realized it wasn't doing him much good and realized that there's a limit to how smart people get and it is ok to not be born as next Terry Tao or something.
- chrsig 4y ago
  > He refused to listen to my claim that everyone has a lot of stuff in math they just do by the rules they were taught and only realize later in life that there's an underlying concept. You're probably misinterpreting "refusal" as "unable". After a lifetime of being told "if you would just apply yourself...", you start to get a distorted impression on what the average experience is. Obviously, he's just coming to understand something that everyone else had appreciated since they first learned it, because they applied themselves. Maybe I'm projecting -- I'm in a similar spot, but I've been diagnosed since high school, and it wasn't exactly a shocker then. What you're describing really sounds like the secondary depression[0] that usually comes with adhd. That is, he's probably is being handicapped by the disorder -- it can be a real slog to read math, and very hard to practice it, even when it's interesting. But it sounds like you were coming face to face with depression caused by a lifetime of not feeling good enough. Frustration that you can't apply yourself harder. Being gaslit into believing that you weren't trying.
  - hnews_account_1 4y ago
deleted 4y ago
[deleted]
agumonkey 4y ago
I fear that exposing teens to self educating on too personal and too complex topics is gonna backfire. They're extremely quick to accept theories and blend in with it to make it an instant reality. ps: not helped by online groups or bubbles (twitter, discord) where they can all reinforce their own beliefs in a joyful mayhem.

pxc 4y ago

tl;dr: get yourself a therapist who understands that the most important questions for you w/r/t to your mental and emotional well-being are not whether you ‘really have’ social anxiety, or whether autism ‘really is’ just a disorder, or whatever. > However, if having social anxiety becomes part of your identity, it becomes the lense that you see the world. TikTok makes it easy, but social media as a whole is identity obsessed by its nature, I think this is as much a feature of that stage of personal development as it is of social media. Adolescence and early adulthood are periods in life when there's naturally a lot of focus on identity formation. I think the issue with diagnosis being taken as identity formation comes out of that background more than it does the nature of social media or out of medical diagnoses themselves. It also (imo) comes from a scientistic approach to psychology: it starts with the premise that the diagnostic categories one finds in diagnostic manuals all correspond to real conditions in the world (realism) which divide the population into kinds of people (essentialism). But that forgets the purpose of those diagnostic manuals and their contents (to help mental health clinicians guide treatment plans) and the nature of the science and clinical practice here, which is driven almost exclusively using hypothetical entities we can't directly observe. The DSM's purpose is not to provide an ontology, or to identify essential features of the human mind, and certainly not to do so in a way with any kind of finality. The other thing to think about is the kind of profound validation and relief that can come with gaining a ‘label’ for one's struggles, a framework for thinking about them, and references to communities where you can learn from other people dealing with the same things. That is huge, and it's really important to a lot of people when they first get diagnosed (whether with mental health or a chronic physical condition, for that matter). And it's natural for that to push one to see their diagnosis or the label associated with it as defining part of who they are. That said, there are psychologists and psychiatrists who are also troubled by this, who are critical of ontologizing or essentializing approaches to their own fields. Go in with an attitude that you're looking for labels that are useful regardless of whether they're true, with an understanding that mental health exists not just in the patient but in their social relations to the whole of their society, that our diagnostic categories in 10 or 50 or 100 years will likely be quite different from the ones we have now, that many conditions with similar symptoms may be related or distinct in ways we don't yet understand, that as you work on things you might shed just enough symptoms of this or that thing to go from qualifying for diagnosis to no longer qualifying (despite the clear continuity in who you are, your personality and traits, etc.) and so on. You can find therapists who are comfortable taking an anti-realist, anti-essentialist approach which resists that mental habit of reification.

deleted 4y ago

[deleted]