410. Why does everyone have a diagnosis these days?

00:00:05
Speaker 1: Hello everybody, I'm Jemma Spake and welcome back to the Psychology of Your Twenties, the podcast where we talk through the biggest changes, moments, and transitions of our twenties and what they mean for our psychology. Hello everybody, Welcome back to the show. Welcome back to the podcast. It is as always so great to have you here. Back for another episode and back for a very big, big episode for us today. Today we are talking about a major, pretty huge discussion happening in society at the moment, whether that's online, whether it's in the medical community, amongst concerned parent groups, friend groups, policymakers. And that is the idea that everybody has a diagnosis these days. I'm sure you have heard it, but everybody has ADHD, everybody's anxious, everybody's on the spectrum, everybody could be depressed, everybody could have OCD, BPD, PTSD, etc. Is this true? Is it true? Does everybody or could everybody actually have a diagnosis in this day and age? Or is that just public opinion? Is that just public opinion making a problem see or not even a problem, making a change scene bigger than it is? Is it just increased visibility and reduced stigma, that it's giving the impression that more people have diagnoses than before, and if numbers are actually increasing, should it be caused for concern? You know, should we be worried about how other people see themselves or are seen by the medical community. I have to say a lot of my friends naturally work in the mental health space, and this is something that we cannot shut up about because it is so so so much more nuanced than what you may read or see online, so much more nuanced than what fearmongering would have you believe. So I thought it was time to do this episode, do a whole episode on this topic and like crack open the lid on this discussion. I want to thank our researcher Libby as well for her incredible deep dive and diligence with this episode. Before we even get started. We also get to talk about one of her papers that she published last year in this episode, which is so exciting that we have somebody working for us who is literally doing the research on this at the same time, so we've got a lot in store. Sorry. Another disclaimer, It also goes without saying this episode is going to be simply a space for discussion and research and reflection. It is not for passing judgment. It is not for ending a conversation. It is for starting a conversation. Not everything in this episode will apply to everyone. It may not apply to you, and you also, you know, you don't have to agree with what we say or everything that we say in this episode if it doesn't actually match your lived experience or what you've been seeing. You know, we've done a ton of research to ensure our take on this is balanced. But of course there are nuances that we just like simply can't capture in an hour. So feel free to dm us with your own takes, with your stories, with your experiences. If you feel like something is missing, you can also leave a comment if you're listening on Spotify as well. If I don't know, if there's something else you want us to include in this episode. But I just wanted to put it out there that this is obviously an ongoing discussion that society is having, and this is just our small contribution to the conversation. So, without further ado, let's get into the episode to begin with. Before we can even start to dive into this very widespread idea that everybody has a diagnosis these days, we firstly have to actually fact check that, like is that true? Like our start point here has to be whether the data and the rates of certain conditions are actually increasing, because if they're not, like this conversation is kind of nullified. You know, we have to actually be able to distinguish between actual numerical shifts and shifts in public opinion. This is what the research says. The research says that rates of certain conditions, specifically all forms of depression, all forms of anxiety, have experienced a very very sharp increase in the last few decades, with a major increase like during the three years after COVID. Those numbers, they are very easy to see. It is very easy to look at any literally any data on this and see that things are tracking up per capita per one hundred thousand. What you may not know, though, is that for other conditions, specifically to do with neurodivergence, the way we actually measure rates can be really confusing, so we don't actually and can't actually always have an accurate number, if that makes sense, Like, it really depends entirely on which condition you want to talk about, and then what kind of rate we're talking about so whether we mean true prevalence, lifetime prevalence, recorded diagnosis, self diagnosis, medication use, or like wider public conversation, because these things do not rise and fall in exactly the same way as we would typically expect, right, So, for example, prevalence rates could be reducing, but medication use could be increasing, so that gives us two different stories. Lifetime prevalence could be increasing, but diagnosis rates at the current moment could be staying the same or reducing. ADHD is probably like the clearest example of why it is actually hard to pinpoint, like how many people are experiencing this? Are diagnosis rates going up? I will say like, numerically they have risen. There has been a huge increase in adult diagnoses between two thousand and twenty eighteen in UK data, US data, Australian data, Canadian data. Prescribing has also risen in several countries. I think in the UK there's been a fifty one percent increase in patients being prescribed medication over the last five years. But that is not the only part of its picture. A twenty twenty five systematic review looking at post twenty twenty ADHD prevalence actually found no actual conclusive evidence of a real rise in underlying prevalence. So what that means is that even though diagnosis, assessment, demand prescribing has clearly increased, essentially, when these researchers looked at forty plus studies, they concluded that actually underlying that prevalence probably hasn't changed. It's just that people are showing up for services. It's just that they are using the correct language for what they've always been experiencing. It's just that they are getting help. They're also getting later stage diagnoses. These individuals probably should have been diagnosed a lot earlier. It's only now that they are counting. But the underlying prevalence has always probably been the same. Autism tells a very similar story. Actual diagnosis rates have risen over time. There's been an eightfold increase in the UK over the last twenty years, but again, much of the literature suggests this is not because of some sudden biological epidemic. You know, some people would want you to believe that that it's vaccines, that it's pesticides, whatever. It's not that it's rising recognition. It's improved identification amongst population groups that used to be missed especially girls and especially people of color. That is like also combined with a reduced stigma, which is meaning that people feel more accepted to have this part of them be given a label. We really need to examine this because historically, diagnostic stereotypes have been really, really narrow for a very long time. Many diagnoses were simply shaped around a very limited template of what the typical person with the condition looked like, and often that template was based on the people who were most visible, most disruptive, most easy to identify, or most represented in research. That usually meant we based our entire idea of what a mental health condition or what neurodivergence looked like based on just the population group that happened to be studied first. I cannot overstate how narrow the clinical definition used to be because of that, because for the first thirty to forty years of ADHD research, for example, ninety eight percent of the people who were being studied were boys under the age of eighteen, and so the definition or the understanding we have or have had in the past, has been formed on that. Most of the first tests on medications that were used for ADHD, medications that are still used now that the basis of those medications are still active in medications we take now for ADHD. Those original tests were exclusively done on boys and men, and so for years the dominant image has been of the hyperactive little boy who couldn't still, who interrupted constantly, who ran around, who was obviously very much struggling in ways that inconvenienced other people and which were probably very very confusing for him and everybody involved. The issue is is that this image it's not incorrect, it's just not entirely correct. It's just not reliable. It's just one image of one kind of person, and that makes it harder to recognize people whose difficulties looked quieter, whose difficulties looked more internal or more socially acceptable, especially if they had been fundamentally conditioned because of their race or because of their gender to behave differently. You know. The example a lot of people give now is like a girl who daydreams and forgets things and procrastinates and is sensitive and feels overwhelmed and has these has a really elaborate imagination probably previously wouldn't have been diagnosed with ADHD, but perhaps that's what she was, what she was going through, Or you know, a child of color in like a primarily white community may have been corrected more from an early age, you know, by their parents who are trying to keep them safe, keep them safe from standing out, or by teachers or members of the community who made excuses for the white kids but not for them, meaning that their behavior was curtailed, became less obvious, they masked more, and they didn't get the diagnosis or weren't seen as having a condition or having a label that they probably did have all along. So basically, as our understanding expands, we are seeing this reflected in changing numbers right as our understanding of masking, As our understanding of conditioning expands. Essentially, it means that we are realizing some delays in our recognition of how different conditions show up in different people. You know, from the outside, it might look like suddenly there is this epidemic. It is genuinely just a form of social catch up, and essentially we are just bringing people into the fold and giving people the resources and the understanding that they probably always should should have had, right and a big contributor to those increase in diagnostic rates that we are seeing is actually a lot of people who are in their twenty and who are in their thirties, some of them even in their forties, who are looking retrospectively at their lives, or who are finally kind of recognizing something about themselves and getting help. So it means that the level has been well below where it probably should have been for many, many years, and then in the last let's say five ten years, it's it's actually matched all at once where it should have been for forty years or longer. I would argue OCD is probably going to go through this in the near future. You know, our idea of OCD right now is kind of similar to what our idea of autism or ADHD was like maybe twenty years ago. At least our public our public knowledge of OCD is still very narrow. A lot of people still imagine OCD as being about cleaning, checking locks, being orderly, liking things neat. But many people with OCD experience really intrusive, taboo thoughts. They experienced mental rich ru reassurance seeking, repeated checking that happens internally as much as it does externally, and that's not how people often see it. Some people spend years not recognizing their experiences as OCD because it doesn't match the cliche, the way that a young girl's experience with ADHD didn't match the cliche back in the day. I know I've spoken about my experience with OCD in the past, but I literally didn't know I had OCD until I was twenty three or like twenty four. And I literally I studied psychology, like I worked in mental health research, and I didn't realize this. And the reason why was because the description and the way people talked about it was so narrow. Psychologists before this gave me so many labels for what I was going through, and none of them felt accurate, And nowadays it's like so insane to me. Then it wasn't picked up like I used to. I think I've talked about this in an episode before, but I used to have to pray in the exact same way every single night. I did that for like eighteen years of my life as a child. I literally used to have to stare at the sun constantly to reassure myself it wasn't going to explode. Like I genuinely think I've done permanent damage to my eyes because of that. Like that, that'sc that was for me a sign of OCD, and that's just like some examples. So behind every increase in numbers we are seeing in society that for some people may point to an epidemic, for some people may indicate that people are putting it on these like the stories that like mine are what it's behind this. It's just individuals who are finally understanding themselves. One final point on this, there was something this other paper I read spoke about that reflects why rates are increasing all of a sudden, and that's because the way that stigma has been slowly reduced over the past few decades, not completely, but it's definitely been reduced, and that's meant that a diagnosis is no longer scary. This has allowed people to accept something about themselves or their child, for example, that they may have always known. This paper in particular discussed how parents that used to be historical examples of parents who actually would avoid getting a formal diagnosis for their child even though medical advice was very clear that this child had ADHD or had autism, because they were concerned about how a label might negatively impact their kids, or like they had misinformation about how diagnoses were recorded in medical records and they thought that that label might get out as they tried to apply for UNI or work or went on to do other things. And so they felt like it was the right decision to not get their child diagnosed and not perhaps put a barrier in their way that was previously like, uh, definitely was a barrier right back then, the stigma was so intense. That is, in many ways, but back then especially, they thought that they were doing the right thing. They thought that they were protecting their child from being seen as different. Slowly, over many, many, many years, you know, we have come to realize that somebody is not doomed because they have ADHD, or if they have autism, or if they have depression or anxiety or any number of things. Like they live beautiful, full lives, Like they can do so much everything that everybody else can. And so, although stigma is not completely eliminated, it has been reduced or replaced as visibility has improved, as services have improved, as acceptance for people's differences has improved as well. And what that means is, again, as people see themselves represented, as people see that getting a diagnosis is not all doom and gloom, naturally, increasing prevalence is going to follow that through recognition, and I think that is a really amazing thing. So that's the first explanation. The rise and diagnoses that everybody is seeing and worried about is really just this. It's not that these people were previously fine and now they're not. It's not that they're faking it. It's just that these people have perhaps never been Okay, they've previously been missed. They previously were not counted in the recorded rates. Now they are. And yes, that seemingly is happening all at once, but when you look at that over the period of time that it should have happened. So for example, if you take everybody who is being diagnosed at twelve, fifteen, twenty seven, forty seven, and you imagine they all got diagnosed at the same age, you would see that actually rates are not increasing as much as you think. Yes, there's been slight bumps, but actually still prevalence rates, when you view them in that way, are remaining pretty consistent with only slight variations. Okay, when we return, I want to talk about another way that diagnoses or rates of diagnosis for certain conditions are seemingly increasing because of how the DSM is changing, because of how we categorize certain conditions is changing. We're also going to talk about the role of big farmer and corporations. Stay with us to understand why everybody has a diagnosis or it feels that way these days. We also need to understand that diagnostic systems are not written in stone. They are revised classifications. They are shaped by evidence, cultural debates, cultural norms, clinical needs, and often politics, which I don't think I see a lot of people talking about. But politics and cultural context changes how we see certain conditions. For example, PTSD that only became a diagnosable condition in the I think nineteen eighties after the Vietnam War because all these veterans came home and were lobbying for this condition to be included. The removal of like homosexuality as a mental condition, only happened in nineteen seventy three, right our clinical guidelines. And I hate to say this, but like for what it is an impairment or not an impairment mentally is constantly being revised to actually match what is accurate. Like PTSD should always have been in the DSM, homosexuality should never have been in the DSM, right, and so we are naturally going to see changes in this document as our understanding of people and our understanding of human psychology changes. So the DSM is the Diagnostic and Statistical Manual of Mental disorders. I should have said that originally, but it's used for every single diagnosis worldwide by every single mental health professional. And the reason we are seeing increases is also because of how the criteria for certain conditions has changed in the DSM. So, the first edition of the DSM was published in nineteen fifty two. It included one hundred and six diagnoses. In nineteen eighty, the DSM three came out. I think that jumped to two hundred and sixty four diagnoses. For the DSM five, this was published in twenty thirteen, it went up to three hundred. There are now over three hundred conditions listed in the DSM if we count subtypes, if we count specific conditions. And this last edition also revised things like clinical thresholds, specifies symptom clusters, and provided more examples that would affect who could actually qualify for a diagnosis. So I think this is something that maybe some people don't understand about getting diagnosed. It's not like you go into as psychologists officer or a psychiatrist's office and they let you talk about yourself for a couple of hours and then go, oh, I definitely know this is what's going on with you. Like there are real clinical guidelines and there are hoops people have to jump through in order to receive a label that would then give them access to medication, help services, adjustments. I think that's something that people with who are worried about rising rates. And again it's not that you shouldn't be worried, but who are worried about rising rates don't understand, which is that you can get a diagnosis the way that you could get a script for an antibiotic, like that is not the case. ADHD is a really useful example of how these changes have changed how we see ADHD basically or how we diagnose it. In twenty thirteen, the DSM five raised the age by which symptoms should be present for a diagnosis to occur from seven to twelve, and that is more in line with what clinicians were seeing. That naturally meant that suddenly a lot more people qualified. They also lowered the symptom threshold, the amount of like basically symptoms that needed to be present, especially for older adolescents and adults. They lowered it from six to five, so suddenly people who had five and not six were now included as well. And the reason they did that was because they were, like, it just seems kind of arbitrary that you could have over half of the symptoms and still not be diagnosed, but having one more than over half would give you a diagnosis. Those changes made it easier for adults, especially people whose symptoms were never recognized in childhood, to meet diagnostic criteria later on that previously would have excluded them despite what they were dealing with. Now that doesn't necessarily mean that they became more lenient. You might think that you might say, well, look at this is becoming easier. No, no, no, Like, there were many many clinical trials, many many clinical trials, many many discussions that was like, this change was debated for years before it took place, and it just better matches what experts and clinicians now believe has been true about ADHD. All Along PTSD is another interesting case aside from what we've already mentioned, because its most recent classification shows that diagnostic broadening does occur, but diagnostic narrowing can also happen. All at once. So the DSM five actually revised PTSD pretty substantially. It moved PTSD into an entirely new chapter of the manual. Previously it was an anxiety disorder. They now know that's probably not the case. It's definitely not the case. It's a trauma and stresser related disorder. It also changed the symptom clusters. It removed the old requirement that a person needed to respond with intense fear, healthlessness, or horror initially, and it narrowed the criteria around the kinds of trauma somebody had to be exposed to to get a diagnosis of PTSD, so it made it more difficult. Some aspects broadened, some narrowed. And it's not again, it's not that criteria keep expanding and that's the only changes that are happening. It's just that our understanding is changing. For conditions that previously were perhaps gate kept by medical standards that weren't accurate, we're just giving it a more realistic, a more realistic kind of bar that needs to be jumped over. And then for others we're kind of saying, perhaps like our understanding that was incorrect in the opposite way, I really need to stress. This is not like because of public pressure, not at all. This is not because of public pressure. This is not because the cultural conversation change. It's because the scientific conversation changed. First. The people who make these changes to the DSM are not just doing it because somebody online is making an argument that you know, everybody has ADHGV these days. They're not just doing it because of outside pressure. They are debating this routinely. They are trialing this deliberately and across many different populations to be more truthful to the human experience. I want to quickly return to something I mentioned before, and that is the example I gave of that change to the ADHD criteria from six lowered to five, and how many symptoms need to be present and the difficult decision of deciding on a threshold. Here is something we still don't have a consensus on when it comes to a diagnosis. Who is impacted enough to receive said diagnosis? How long do symptoms have to be present before a diagnosis is given? What is personality? What is small quirks? And what is a problem? You know, this is the debate that happens a lot online, a lot, which is that all us at times can be a little bit idle minded, all of us at times can have low mood, or are people who want things organized or coherent? What is personality? What is environment? What is just quirky behavior? And when does it get serious enough for a label? I think this is what is really worrying some people. Have we over pathologized things so much to the point that everybody can see themselves represented in a diagnosis, perhaps the same way that everybody can see themselves represented in tarot carts or astrology or personality tests. I would say no. I would say the level of impayment you have to experience to get a formal diagnosis is still pretty significant, but self diagnosis is I think where people get concerned about this. There's a concept called concept creep that was created by an Australian academic that basically talks about how, in the last couple of decades, language for things that like specific language for things, has expanded and slowly creeped out of the bounds of what it meant, such that it applies to more and more people, and that expansion in many ways is morally progressive because it lets us recognize the harms that used to be minimized or invalidated by gatekeeping something. But it also has caused us to pathologize ordinary distress and essentially believe in the existence of a problem or a disorder, even if maybe there isn't one, because of how overly relatable our language has gotten, because of how essentially easier it is for people to see themselves represented in something because it looks less serious from the outside. Let me give you an example. I saw this video the other day on TikTok from this young woman. She couldn't have been more than seventeen, and she was talking about the signs that you may have BPD, and some of the signs were like, you love really deeply, you get mad when people reject you, you are very sensitive. Let me ask you a quick question. Who of us cannot relate to that genuinely? Who doesn't get upset when people reject them, Who doesn't feel good about being in love? Yes, on a very intense scale, this is BPD. It may represent people with BPD and can cause impairment, but it can also this representation can represent pretty much everybody, and I'm sure we can all think of a few examples of this where the information we are specifically seeing online is simply too general and doesn't actually represent what the terms, what the words, what the clinical guidelines actually are. Here's the other thing about psychology and mental health content like that, it does really well. It gets really great engagement because people are filming them in a way that is generalized. That's exactly why they do it this way. They want it to be relatable. This content wants people to see themselves and resonate with what they're saying and send to their friends and save it and forward it and whatever. But then people end up believing something deeply and very serious about themselves that may not be accurate. May at times it is, but even if it is accurate, if you're only going off of this content, it's going to be based on a very simplified version of things that may actually not be helpful anyways. Another reason this content does really well is because as people, we are constantly looking for something that will help us make sense of our experiences. Basically when we're young, especially you know, this girl in this video is like seventeen. Her target audience is probably other teenagers. When we're in our teens, twenties, thirties, and life in general is very confusing. Someone giving you a general label to grasp onto that explains your experiences, especially in this way, is very reassuring. The issue is is that that can actually become a self fulfilling prophecy as you mold yourself to fit the label, not the other way around, and when you don't have clinical help alongside it. I have some friends who are psychologists, psychiatrists, social workers, and more and more. They're talking about how people will come into appointments or sessions essentially with two to three labels. They'll be like, I have VPD, I have bipolar, I have OCD, I have ADHD. And it's only after a little bit of investigating or in fact, like some confusion that like this person doesn't actually seem to match the criteria that they will ask the client, and the client will be like, oh, I diagnose myself online. Sometimes they're right, that's the thing. Sometimes these self diagnosed like, you know yourself better than probably anybody, so sometimes they're correct. But sometimes they're just not. And those are the cases that they get really worried about because they're like, once you have that label, once you really do feel aligned with it, it can become very easy to start seeing everything through that lens. The risk is The risk is confirmation bias. We notice the evidence that supports the diagnosis and we overlook the evidence that complicates it. We start collecting examples that fit forgotten appointments, awkward interactions, bad days, and not examples of maybe a more accurate explanation. This is similar to the risk of over identification. Right your diagnosis, especially in this case where it's a self diagnosis made on simplified information right without clinical help, it can feel like, in that isolated way, it becomes your whole identity rather than just one part of the person that you are in one part of your experience. The problem with that is that it turns, as well language and terminalogy into something that can explain everything and is therefore overly loose and overly casual or even at times aesthetic, and that can really flatten important differences in severity and important differences and experience. If every mildly relatable struggle is described in the same language as profound, life altering incredibly difficult, then the people who do and who need the most help become a lot harder to see. If you know, I'm a bit distracted and I hate admin gets put into the same category as profound difficulties with executive function that can really make an individual's own experiences feel less seen and less visible. Something important gets lost, Like we cannot deny that there are variations and their definitions, and there are criteria and levels for this very reason. You know, if ordinary sadness is described in the same way or breath as incapacitating depression, or if discomfort is described in the same breath as trauma, there is meaning that is lost there that is important for literally everybody. That is when you start to see examples of people feeling invalidated, people feeling like they are missing out on understanding, they are missing out on help because the language that they would typically use to describe their experience has now and is now used in very general ways that maybe aren't accurate. Maybe aren't accurate, I will say, sometimes people Again, this is all this is all out for debate, and obviously everybody's situation is different. This is just a general trend of what we're seeing with the oversimplification. Listen, I think what I should say is like the role of social media is not simply good or bad. It has the potential to reduce shame, but it also has the potential to spread confusion. Both things are true, and both things are things we should pay attention to. It really does help previously miss people find themselves, especially people for whom these conversations are not something that has had in their environment or in their families, but it can mean that that has done in an unsupported way. We have to recognize the paradoxical effect and the flow on impact that this has on accessibility of services, on pigeonholing, and on the dilution of other people's experiences. The other thing that general, highly stereotyped content made for broad audiences and mass engagement doesn't do is it doesn't understand your context the way that a professional can. Everybody is coming into this space onto social media with so many different things going on, and some of those things would actually explain their behavior and what they're going through better than a diagnosis. But if the only video or content they see is like the only way you can be experiencing this is if you have this, that can become really confusing. I read this piece the other day that talks about how a desire to label everything, every single human behavior is meaning that some parts of the human experience that probably need working on are not being changed because it's all coming down to a problem with the individual. So basically like, everybody is depressed, and nobody is investigating the fact that the systems around us are becoming more depressing. Right, everybody is anxious. Everybody could have the label of having an anxiety disorder, but nobody is then focusing on why that is because the world is becoming more uncertain because of financial presses, because of pressures, because of unstable housing, emotional unpredictability. You know, everybody has ADHD and everybody could have the label, but then we're not investigating the fact that Wait a second, maybe the real question is why does modern life ask people to stare at screens for twelve hours a day. Why does modern life ask people to switch tasks constantly? Why does it ask us to process endless notifications and manage impossible admin and maintain sustained focus under artificial conditions? I could go on. Of course that is going to have an impact on human attention. I think that everybody would be slightly mentally fragmented under those conditions, but people with ADHD so much more so. And what's interesting is that they are asking to be given a label, take medication, change all these things, and nobody's thinking like, wait, why do our systems not support these people? Why does it all come back to here's a diagnosis, Here is the thing that is wrong with you, and not the things that are wrong with how our society has been set up to support you. I listened to this amazing podcast the other day that essentially talked about how modern society is pushing more people into a space where their behavior and their mood is of concern because of how little our current systems act match what we need as humans or how our brains are designed. And so again, no wonder more people see themselves in the symptoms of ADHD, or in the symptoms of mood disorders or anxiety or depression when our physical, social, financial, emotional environment is so disrupted. I think the real issue I have with this discussion of like why does everybody have a diagnosis these days, is like, because why wouldn't you relate to these symptoms and why wouldn't you relate to these depictions of these of these conditions and sometimes these disorders when yes, a social media is depicting them as so simplified, but also when life is so awful at times people that it is actually pushing people into a state that does mimic symptoms of very real conditions and disorders. Obviously, like this isn't all about environment at all, but I think it really does go to show that, like the individual blame that we place on people, or that this discussion would like to place on people, is not fair, Like it is not fair to be like to assume that everybody is trying to get attention or putting it on or whatever, like the ideas or that there's some huge biological epidemic when we can very clearly see all these factors that are really increasing our conversation around mental health and increasing diagnosis rates at times as well. I think at the end of the day, what we're really circling is like who deserves a diagnosis, deserves being in quotation marks, and who doesn't? And what does a label actually mean? Obviously it means something. That's why people are so protective over it. That's why it's so closely guarded by clinical guidelines. What does a label mean to people? Why is it important? Why is it discussed? Why why is it controversial? We're going to talk more about that after this short break, So what we're really getting it was like, why is a label important a formal diagnosis? And a label is important because of the doors that it opens. Firstly, it opens the door of self understanding, and whether that's self diagnosis or a formal diagnosis, I think the understanding is the most crucial part. Research continuously shows that although a diagnosis is a complicated feeling for some, for most it is a relief and it's self affirming, and it provides much deeper understanding. A label then also provides access to treatment, relevant accommodations, educational support, workplace adjustments, legal protections, medication. You know. The list goes on. And the reason it provides that is because we live in a society that runs off of systems, and those systems need a clear, reductionist way of categorizing people so they know who gets let in the door, so they know who gets access to what in society. On a structural and service level, governments and healthcare boards need categories, need evidence around prevalence to be able to the services to support those people. A lot of countries, granted, are now in a position where they simply cannot keep up with the demand, and there are a lot of complicated factors where governments aren't prioritizing the funding for mental health and for neurodivergent support services and support systems. The problem I have is that then people turn around and blame others who are getting a diagnosis for that problem, and not the fact that this is not a prioritized thing in our society. If we are truly worried about more people claiming a diagnosis, you should actually care more about expanding mental health services nonetheless, whether you think people are serious or not, whether you think people are just getting that from Instagram, TikTok or not, because having access to a professional will clear up any confusion in any direction. I know that sounds kind of contradictory to like that whole rant I went on about social media before for but like to do a mini summary of what I'm really saying here is that people are very confused and skeptical of increasing rates of certain conditions, and they want to put those rates and that rise down to theories about vaccines or changes in the environment, or they want to put that down to people making it up or people suddenly overpathologizing. I get the fear. It's very scary for people to see this and think that something's going wrong, and so they're looking for an explanation. It's just that the explanation is a lot bigger and is a lot more complicated. The real explanation is that the reason we are seeing diagnosis rates increases that criteria are broadening. More people are finding the language to describe themselves. More people are being identified by mental health systems and being able to self identify and then get help, which is a good thing. A small portion of those people are being misidentified and misidentifying themselves because of concept creep, because of social media. Often those people like it's very rare those people ever get a formal diagnosis anyways, because it's not like they're just handing them out like candy. The problem with that small amount of people who are getting the wrong diagnosis is firstly that they actually don't get to understand themselves in the correct way, but also that, you know, the pressure that people are claiming that puts on services. What I'm really saying is like, if we actually had more funding for services, it wouldn't be a problem, right because people would get the help they needed. Whether that was a diagnosis or not. Gatekeeping actually helps no one, Like we would have a more accurate idea of how many people are dealing with mental health concerns and disorders and conditions, whether that is more or less. We would be able to help more people, regardless of whether they had a diagnosis or not, regardless of what was going on if we concentrated on expanding mental health funding rather than focusing all of vali attention on this larger debate about who counts and who doesn't. Does that make sense, because I don't want this to come across as like a this isn't a problem, or be that self diagnosis is a problem. We're just seeing such an uptick in demand because of all these factors in our governments being able to cope with that, not because of the people, not because it's people seeking help. It's not their fault. It's because they just don't see it as a priority. And I think that's where the big problem, just where this all comes down to, and why so many people are forced to go looking for the language and forced to go looking for the explanations by themselves that perhaps gives them a less accurate picture or less access to the help they really need and makes them deal with this like in solitude and without actually somebody there to give them a clearer understanding of themselves. Unfortunately, as well, with this huge increase in demand for diagnosis and government systems that can't or won't step up, what we're also seeing is that private industries are looking to make a buck in this gap in the market, and the role of these industries cannot be overstated. Pharmaceutical companies are obviously the example a lot of us think of, because you know, they do want more people diagnosed by any means possible so that these people become consumers of their medications. Right. There is this documentary I think it's called The Age of Anxiety, and it was made in twenty twelve, and it does an amazing job at investigating how big Farmer has exploited the increasing demand for mental health support regardless of what's best for the individual, like they've seen this increasing demand as a money making thing. Prior to the nineteen seventies, I don't know if you guys know this, there was a greater distinction between medical depression that required medication and depression caused by circumstances, which required more talk therapy or more you know, life intervention, or a mixture of both. But as pharmaceutical companies began to market antidepressant drugs, which by the way, I'm a big fan of this is not some conspiracy. But as they began to market these drugs, the focus of treatment for many people became more homogeneous and it became more medical for everyone, and that obviously helped these companies make a lot of money because they were able to erase some of the distinctions that are required when it comes to mental health. Private assessments, private assessment clinics, therapy platforms, self help brands, wellness apps, supplement companies, productivity tools, coaching industries all benefit from a culture where more and more people are encouraged to see themselves as needing an explanation, a label, treatment, optimization management, and less people have access to actual clinical services with people who are trained, with people who could seriously help them. I've seen articles about people being conduct of hundreds, if not thousands of pounds and dollars trying to seek ADHD diagnosis, only for it to not be formally recognized by a regulated healthcare professional, so they actually couldn't even get access to the support and medication that they need. Anyways, there's all these as well, examples of courses for people with anxiety with ADHD with OCD that aren't even made by licensed professionals because people are like getting into this gap in the market and these courses. I actually was looking at one the other day. I just so inaccurate and simplified, and it's just dumb. And this is so incredibly sad because it's like everybody wants to focus on how everybody has a problem these days, and diagnoses are fake. But people are really desperate for help and are really desperate to be heard and supported. And when we do not find a good way to meet that demand and to help these people, whether they have a diagnosis or not, there are money making machines that will capitalize on that lack of support. There is money in framing it this way, and there is money in being able to sell people a solution to their problems through a label. I just think that when there is money involved, we need to be really, really cautious. Again, that does not mean everyone seeking help is being manipulated, is self diagnosing inaccurately, absolutely not. This doesn't mean that medication is bad or that clinicians are acting in bad faith. No, it just means that diagnostic systems don't exist in a vacuum. They exist as part of all these wider factors to do with politics, to do with economics, to do with clinical understanding, and some of those factors come with incentives, and we need to be aware of that so that we're not acting blindly. Some skepticism is healthy, not towards the individuals who are trying to find an explanation and trying to better themselves, but towards any system that might profit from telling more and more people that their distress is best understood as an internal problem that has it a label that can be serviced through a product, a service, or a subscription that only they can sell you. So this brings me to my final point of the day. With all of this in mind, is it better to overdiagnose or underdiagnose? There's a huge question to end on, but I want to break it down. Underdiagnosing is what we had in the past, and honestly, I think there are large parts of it that are quite tragic. It leaves people unseen, unsupported, and blamed for struggles others do not understand it means people can spend years of their life thinking that they are lazy, thinking that they are difficult, dramatic, weak, broken, when in reality they're just dealing with something that has simply never been recognized and that they were never able to have the language to understand, and that really has That has consequences. Of course, I don't need to say that, but it impacts our self esteem. Our relationships are fine, fine answers the quality of life that we have. We do not want to go back that way. We do not want to go back to the underdiagnosis path and make it even harder for people to get help. Overdiagnosis, though, has its own risks too. It can pathologize ordinary human variation without meaning to. It can pull attention away from the context that we're in that may be describing why more people are having severe symptoms, and it can sometimes lead people towards explanations or treatments that don't actually fit the full picture of them as a person, and that can really blur the line between mild difficulty and profound impact. And when that happens, diagnostic language can start to lose some of its meaning. So I don't think it's necessarily better to do either. I think that the real goal here is to diagnose well and diagnose carefully, contextually and with room for an evolving understanding of a person, not just a lay people like who is this person? Rather than seeing them as having this or that? Who are they? What are they going through? What language do they need? Label? Or otherwise? But then what help do they need as well? Remember, like label's diagnoses are just clusters of symptoms or patterns of functioning. They do not describe a person entirely. If you have met one person who has ADHD, one person who has autism, OCD, BPD, anxiety depression, whatever it may be, you have met one person who is experiencing that, just one, because it's always going to be different. A label is an oversimplification for a reason, because it needs to oversimplify things so we can categorize people. We need to instead be focusing on the person. And I know that might seem like a faraway dream because of the strain that resources and services are currently under, but I think that is like, really, the problem that we are getting to the system is faulty. The system is underserving everybody. I think what that means is that the problem with undoor versus overdiagnosis is being turned into an individual issue to deal with. It's turned onto the individual to try and make sense of themselves using whatever resources they have, social media being one of them. And we are being increasingly forced to take care of ourselves without the help of somebody who is trained to do so. And again, regardless of whether you have a diagnosis or not, the pressure should be on the system. It should be on underfunded healthcare systems. It should be on the fact that, you know, Russia, assessments take place all the time. It takes years to get an assessment for something. Schools support systems are not good at putting in place healthcare plans or identifying children who could need help. Like I can just go on and on on and like, the private companies come in and are like, we can make a buck off of making everybody believe that they are not well without actually caring about anybody who is not well. So I just think that's like something to really be conscious of. I'm going to finish up this episode with a quick summary of which I've done several but a proper summary for this topic. Why does everybody have a diagnosis these days? Point one? Not everybody has a diagnosis these days. Yes, rates are increasing, but they are just catching up to an underlying prevalence rate that has always been there. For conditions like depression and anxiety, those rates are incredibly high, and that is a real concern, and that is showing that there is something changing in our society and happening in our society, and there have been things happening in our society that are deeply, deeply impacting everybody really when it comes to other conditions, though, rates do seem to be increasing, but a large majority of this rate increase is coming down to people who previously, historically should have been diagnosed, but they were not included by diagnostic criteria. They didn't have the language, they weren't seen, or their case or the way that they represent it didn't match stereotypes. Some people are mislabeling normal human idiosyncrasies with catch or inaccurate terms. There's coming from social media and other sources, but it is not our job to be concerned with how an individual chooses to see themselves, and we should be more focused on ensuring that that person can get in and see a clinician, that person can get help than we should be trying to correct whether whatever they are experiencing is true or false in our eyes. We also need to be skeptical of a lot of systems around us right now that are trying to make more people feel like something is wrong with them, especially when they can make money from it, especially when they seek to gain from the oversimplification of mental health language. So make sure that you're looking out for that, make sure that you are aware of the systems in place that may be manipulating certain parts of distress or impairment happening in your life. But again, it is a really complicated, complicated thing. And until we have more money, and until we have more research, and until we have the care towards this and just towards humanity that we actually need, like, we're going to continue to see this debate like be very intense and continue to see people perhaps suffering and struggling in ways that they don't really need to. I'm going to finish it. There, we did it. This is the biggest episode of the year so far. I think it's the longest episode of this year. If you've made it to the end, thank you. I hope it stirred up some thinking for you. I hope that it taught you something new or just gave you a better bird's eye view of the situation. I know some of you won't agree with everything that I said. Totally welcome feedback. We'd love to hear it. If this is also something that you and your friends have been discussing, like me and my friends, send it to them. Is still an evolving conversation, and I feel like it's like it's one of those things like we just don't have answers to it, Like the only answer is like more money and more help, but that's kind of unrealistic. Besides that, though, if you and your friends again have been talking about it, send this episode to them. Maybe you guys can keep chatting about it. Me and my friends have actually been doing this thing where we've been doing like a podcast book club. So basically it's like a book club, but for podcasts, where we listen to like five podcast episodes a month and then get together and discuss them. This can be one of your podcast episodes. I want to hear your thoughts. I want to thank our wonderful researcher Libby for her wonderful research contributions to this episode. She is truly magnificent, and she's been doing some work on this very topic, which is just like so exciting. Make sure that you are following us on Instagram on substack. If you want to read the full version of this, you can also DM me, you can eat me, you can leave a comment down below. You can watch full episodes on Netflix. There's so much that you can do with this episode. But yeah, I hope you enjoyed it, and I just genuinely hope that it stirred up feelings and thoughts for you. And yeah, it's going to start some more conversations with that in mind. As always, be safe, to be kind, be gentle to yourself. We will talk very very soon.