Is there a difference between seeking out a diagnosis and "diagnosis shopping"? It seems to me that the former is just the desire to explain the pain you're feeling, while the latter is seeking out a *specific* explanation for that pain and (importantly) choosing between various explanations (thus, "shopping"). My back hurts, I seek out a diagnosis for that pain as the first step in treating it. Diagnosis shopping would entail rejecting one diagnosis in favor of another, for instance because I prefer to believe I slipped a disc rather than admit my hip flexors are tight and prone to injury from sitting down for too many hours a day.
Perhaps Eloise did engage in diagnosis shopping, but admitting she "sought a diagnosis" doesn't seem to constitute a "direct admission" of diagnosis shopping.
Don't disagree with the overall thrust of the review, though.
The relevant issue is that she sought the diagnosis, explicitly - she looked for a doctor who would give her a diagnosis that she had already decided she had. This is a deeply unhealthy practice.
I think there is nothing wrong with believing you have a condition, and seeking the help of a medical professional to see if they agree with you.
I would define diagnosis shopping, as going to doctor after doctor until you get the diagnosis you want, and the process is less about treatment, but getting the "label." (Just as doctor shopping is going from doctor to doctor until one will give the narcotic prescription you want).
(That said, haven't read the book (and not going to), I'm not saying that FdB's label was inappropriate.)
This is a deranged way to look at any other ailment. If I suspect I may have sinusitis and I go to the doctor and he says "yep, it's sinusitis", I have not "gone shopping for a diagnosis" and it is deranged to portray it this way. What I have done is perfectly healthy behavior. If somebody had incessant thoughts of murdering their wife and sought help from a psychiatrist for it, there is absolutely nothing unhealthy about it. It's at least as misleading to describe this as "shopping for a diagnosis" as the "loads of drugs" comment.
I see what you mean, but I went to a psych after I suspected I had ADHD. I had suspected it for a number of years after talking to friends who had had diagnoses since childhood, but I didn’t want to be “that person”. But I had a lot of struggles all my life that my friends said they experienced too, bad grades even though I was capable, just felt impossible to get started unless someone sat with me. 8 years to finish university (funny enough my dad had the same issue!) and in the last 4 semesters I crushed it because my husband (then boyfriend) sat with me every study night. Maybe I did it right because I tried to not google or assume, I didn’t look at tests online because I wanted to know for sure. But I did “seek an evaluation” and I hit almost every requirement and medication has made my life A LOT better (not perfect but better). I certainly see it as debilitating and I’d absolutely trade it away tomorrow if I could, but I had to take charge, everyone else missed it. I don’t think that invalidates the diagnosis I received.
Ain't nobody going to a psych for years and not getting "a" diagnosis. They toss those out for everything. Hell, a huge problem is them rolling people on meds after just two sessions. It's clearly implied that she finally got "the" diagnosis, that is, the one she knew she must have.
I'm a little confused by your comments. Psychiatrists are medical doctors; their job is to treat psychiatric illness, and the mainstay of psychiatric treatment is medication. Putting a client on medication after one or two sessions is the norm for a reason, and it's neither negligence nor "a huge problem". You would not expect to meet with your GP several times before they prescribed something to treat an identified medical condition. For a new client, a diagnostic interview can be time-consuming, but that's generally done once a year or so, is sometimes outsourced to another species of professional who completes it first, and sometimes doesn't take long at all because clients come with a well-documented illness history. The kind of information psychs need to obtain to make good prescribing decisions does not take long to convey (what symptoms are you struggling with the most, what have you tried in the past, how did it work, what medical conditions do you have, what meds are you on now, that kind of thing). They don't need to know about your relationship with your mother to decide whether to start you on Celexa or Wellbutrin. I'm not sure what you think they should be taking additional sessions to do before they start prescribing medications.
Psychologists and other therapy practitioners don't have the ability to prescribe medication. They can also treat people without having to care too much about what their diagnosis technically is, and some do assessments mainly for the purposes of completing insurance paperwork. Others are more diagnosis and assessment focused. They aren't "rolling people on meds" after two sessions because they aren't involved in that process at all.
A long time ago, psychiatrists would also provide therapy, and there are some in private practice who still do. But the model is out of favor, and overwhelmingly now, psychiatrists do the medicine and therapists do the talking to you.
“Is there a difference between seeking out a diagnosis and ‘diagnosis shopping’?”
Yes, but I think the usage difference means “diagnosis shopping” is more pejorative than you suggest.
What’s pejoratively meant by “diagnosis/doctor shopping” (and its usage is often pejorative) is being willing to go to as many specialists as it takes to find the one who’ll diagnose you with something the majority of experts in the field would probably disagree that you have.
“Diagnosis/doctor shopping” could have the less pejorative sense of simply being an informed medical consumer capable of self-advocacy and with the resources and support to seek warranted medical care, but unless the less-pejorative sense is specified, people seem to default to the pejorative interpretation.
Freddie, I think, objects to the whole idea of being a “medical consumer”, for understandable reasons. But patients have to navigate the system before them, which is one that works better for patients who can accurately self-screen and then choose the provider they see accordingly.
Screening, of course, is not diagnosis. If you screen positive for something, you should be open to the best diagnosis being something else (including the null diagnosis, “We don’t always get medical explanations for why life sucks”).
But our medical system relies on self-screening to direct patient care, even as it often belittles it — at least, belittles it for some, typically contested, diagnoses (or some typically contested patients like teen girls). If your big toe only torments you after drinking or cold weather, asking the relevant professionals whether a gout diagnosis is right for you isn’t typically belittled as “diagnosis shopping” since gout isn’t contested or politically polarized. It’s just gout.
You hit the nail on the head. As long as our healthcare system forces patients to act as consumers, we have to expect patients to make consumer choices. There are better and worse ways to do that!
Frankly, the only way to safely and successfully navigate the whole health care system in the US is to be exceptionally well-informed and willing to challenge professionals from time to time. That can look like rejecting a given doctor's opinion and seeking another. It probably shouldn't look like rejecting seventeen doctor's opinions, though. If you think you're right and a bunch of medical professionals are wrong, the same evidence that convinced you should be able to convince some of them. A lot of doctors are willing to say "oh shucks, I guess I wasn't up to date on the latest research" (or whatever the deal is) in the face of evidence. If you can't, your evidence might be....bad, and your alternative interpretation not so correct. (Knowledge and advocacy themselves might arouse suspicion that you have a weird or malign motive, but the best way to dispel that impression is not to have a weird or malign motive.)
>"Knowledge and advocacy themselves might arouse suspicion that you have a weird or malign motive, but the best way to dispel that impression is not to have a weird or malign motive."
I think there might be a degree of ambiguity here. But I find Freddie's interpretation of her words reasonable, and thus to the extent that it's an interpretation she didn't intend, that's ultimately on her as the writer.
Perhaps one tension is that autism/ ASD and ADHD are now often championed on Tiktok and Instagram as ennobling and even desirable, whereas OCD had its cultural moment in the '90s and has somewhat returned to being mockable and largely a condition that sufferers are expected to get over/ transcend, rather than a form of neurodiversity to which society should adapt. [The degree to which OCD should be included within the label of neurodiversity is highly contested].
Personally, being diagnosed young like Eloise with OCD (at 10ish) and struggling with it pretty badly due to stress over the last month, I can't see many benefits of the condition. However, I'm not sure it's straightforwardly curable so much as because the symptoms no longer cause you distress because you've become so adept as using techniques to deal with them you ipso facto are no longer diagnosable as having the condition.
Off the back of your review, I actually chose the book for my Unitarian book group. It didn't go down well, but I found it relatable enough that I got a bit of solace from it - plus there were some striking images and lines that made me laugh. It needed an edit though.
Maria Bamford is still by far and away the best person at communicating what OCD is like. NSFW:
I was diagnosed with OCD as a kid, too. It's mostly morphed into a manageable generalized anxiety in adulthood, and I don't have the compulsions much anymore unless I'm very stressed, but even then I can usually talk myself down from them now. The doc did put me on meds for it back then, but nothing like that ever worked on the OCD, specifically, so I stopped. Klonopin helps me occasionally with anxiety attacks, but therapy works best for me overall.
I credit my "recovery" from OCD to reading an OCD workbook in my early twenties and keeping a specific passage in my head that basically said "magical thinking isn't real, and you are not important enough to affect the events of the universe in the way you think you are." Honestly, keeping that in my mind made a world of difference. It was over 20 years ago since I read the book, so my memory of the "recovery period" is probably a bit truncated, but yeah, OCD is more torturous than anything else. I cannot think of a single "superpower" it gave me as a kid who spent entire summers voluntarily shut up in the musty basement because of my overwhelming fear of tornadoes, or stuck in a bathroom counting letters on books (based on my own nonsensical alphabet numbering system, of course) before I would let myself leave, as just two examples. My own brain held me hostage for much of my childhood. How on earth could someone twist that into some kind of benefit? Either they really just went overboard trying to not hate themselves (understandable), or they don't really have very severe OCD if any of that really makes them feel good. I don't wanna be a gatekeeper, but come on now. Maybe I'm better at pattern recognition than I would have been without it? Maybe that's a benefit? I'd happily have traded it for a normal childhood, though.
Absolutely same here. I think some workbooks are brilliant; some best approached with the guidance of a therapist. Using a workbook a year-and-a-half back prompted my first (and hopefully only) hospital stay because as per exposure-response therapy it instructed you to deliberately think about the things that were upsetting you and stay with the anxiety. The problem is, intentionally thinking about wildly taboo things made me feel incredibly guilty and confessional - plus, I was so desperate to get rid of the OCD thoughts I was forcing myself to do the exercises lots of times during the working day, which was distressing.
Once I swallowed my pride and got through some of the cheese rhetoric, David Burns's 'Feeling Great' actually helped me quite a bit :)
When I write, I go back to check what I already wrote to make sure it's consistent. I even re-read my own book when writing a sequel. I forget that what I wrote.
Any time you play the fact card, you better check the facts to make sure you are right. I can't tell you how many times that I've sat down at the keyboard to refute someone and when I checked, it turned out they were right. I try not to waste anyone's time.
Of course, in the post Twitter age, people simply say things are true and no one checks.
"I do not quite know what to do with a woman who directly acknowledges pursuing a diagnosis for five years but also denies ever engaging in diagnosis shopping."
You're wrong here, Freddie. She's saying she didn't "shop around" for a diagnosis, meaning she didn't see multiple doctors seeking a diagnosis. If she sought the diagnosis but only saw one doctor, it's not "shopping around." You're also confusing drinking with alcohol abuse.
The author apparently thought she drank, but didn't abuse alcohol. I don't see how you can call that "demonstrably false." I think you're twisting her words here...
One person in this extended conversation wrote the book, but we're discounting her assessment also, so I don't see why we would credit your assessment any more than hers in the absence of textual evidence to base this claim on.
Respectfully, a lot of people with alcohol problems don't personally believe they have one. The quoted passages suggest alcohol abuse, not normal drinking. The way many people drink is not, in fact, normal or healthy.
The distinction is whether she pursued a specific diagnosis *only* or whether she additionally sought out multiple doctors until she heard what she wanted to hear.
All of these comments basically amount to an argument over what "diagnosis shopping" is. But since the phrase is not in common use, there's no right answer to that question. For FdB gets to tell use what he intended by the phrase.
The more interesting question is whether, or under what circumstances, we can indict someone for seeing multiple doctors until they get a treatment that "works" for them, considering that in the United States we have a healthcare system that treats patients as consumers and thus forces consumer choices on them.
Must be nice to grow up rich. Most of the rich kids I knew in school were awful people when I knew them, but it still must be nice. And I'm sure they all grow out of that, right?
Thin-skinned writers are the funniest kind. Someone should tell them not everyone is going to love their work as much as they do. Deal with it.
And a memoir age 28? Ffs. Unless you’re Michael Jackson, Britney Spears, or a Holocaust survivor back in the day, there will not have been enough notable stuff in that period of time for anybody to GAF about. She had a mental illness? That’s unfortunate, and intensely unoriginal.
I'm also ASD and have a lot of the same problems Marianne Eloise has, and my current role is working with ASD adults. I'm not a therapist or psychiatrist, so don't assume I am one. I've written and published three novels, too. You probably haven't read them.
FDB is paying the author a compliment here by taking her work as seriously as he takes everything else. If she's overcoming adversity to be taken seriously, she succeeded. My books don't get reviews out of the blue, so good for her. The bad reviews I have gotten haven't been this well-written or comprehensive. They are one-line one-star reviews on Amazon.
I'm completely in agreement with FDB that a disability is only a disability if it negatively impacts the person afflicted by it. Otherwise, it's not a problem. Additionally, there are much, much worse disabilities to have than high-functioning ASD. Try low-functioning ASD, or any number of other problems whose sufferers can't write about, because they can't write at all! Or being ASD and low status.
A big problem in publishing, and this is going to sound like I'm bitching (because I am), is that the author's identity is far more important than their work. Marianne Eloise was published because she's a young, elite, educated woman. I could write a memoir about my life dealing with the same problems (even down to the EDS) and no one, no one at all, would care. I'm too old, too male, and too low status. I'm not unhappy about any of that, because I've long since given up on a literary career (lol), nor do I consider my particular struggles of any interest to people I don't know, but it's true and FDB doesn't quite say it. Status matters in memoirs.
It's especially matters if you don't accomplish anything on your own! Even low status people get interest if they do something extraordinary. I'm not sure what Eloise has done other than write about having a disability while being young and high status.
Temple Grandin, for instance, has written a lot of memoirs, but she's only interesting because she's accomplished a lot, too. She takes a dim view of autistic people obsessing about how disabled they are. The goal is how to be a useful person, overcome challenges, and use your gifts. In other words, the same as everyone else.
Everyone has problems. Everyone. Some are much worse than others, and it's all unfair. Treating a relatively mild problem like high-functioning ASD (and I have it, and I know exactly what I mean) as an epic challenge to a high-status person who would otherwise end up much the same without it, is worth questioning. How, exactly, would her life be different without ASD?
I work with people at a community college who have ASD. Last week, the most challenging thing one student had to do was open a combination lock. The fine motor skills and the need for detail were overwhelming. They were so upset by it that they had to ask for help. Another student felt sorry for them and did it. How must that feel?
Doesn't sound very warm or fuzzy, does it? Something someone would brag about in a memoir?
I know FDB has worked with the most difficult students in the public school system, and I appreciate that he doesn't dance around someone who doesn't deserve special consideration for a very mild disability. It's an elite person exploiting her status to tell us about her problems, which no one would care about otherwise. If Eloise was doing something for the people who aren't being helped, that would be great. But it's all about her.
Literature is a way to meet people who are different than you. That's fine, but the writer needs to make it worth your time to meet them.
I don't get the impulse toward this kind of writing. If I write anything remotely "memoirish" I feel like those scenes in Mad Men when Roger Sterling is dictating his memoir and it's like, "I was born. I was a cheerful child. My mother ..." The point is, who gives a fuck about this wildly narcissistic product?
That link on Hume was a great diversion. I like his approach of flat out not responding to critics and always maintaining a sunny disposition. Wise words for anyone. And his vow to himself that he would live as frugally as possible so he could pursue his writing dream.
I only like memoirs if something extraordinary happened to the author. And I skip all the chapters that take place before the interesting event.
“I know you all bought my book because of the dramatic, high-profile thing that happened last year. But first here’s 100 pages about my childhood, my time in college, my early career….” Zzzzzzzz. It’s the worst.
Yeah. I'm pitching a memoir about Soviet era escapees in my family, and linking it to the current refugee crises... and like, I have to talk about my childhood, etc., just to link up events chronologically, but I'm just like ... allergic to it! Like wow, "Let's discuss how I grew up in SoCal. Oh no! I got sunburned at the beach and all the boys liked blondes!" I know Suffering Olympics are overrated, but eventually you gotta be like, "I have a very safe and comfortable life, due to the immense amount of work put in by people who had much bigger problems" At which point, I think it's kinda a moral responsibility to pivot to telling other people's stories who are less lucky.
Every angry woman is diagnosed with BPD over the internet. I don't see anything from her interaction with Freddie, excerpts provided, or the free available portion of her NYT article that would indicate she satisfies any more than three (self-harm, impulsivity, anger) of the 9 DSM-5 diagnostic criteria for BPD of which 5 are required to satisfy a diagnosis. Sure, three might seem like a lot, but many of the criteria are comorbid with other disorders. Freddie has in the past experienced at least three (emotional instability, anger, and paranoid ideation) not because he is borderline but because many of the diagnostic criteria are comorbid with other disorders.
Diagnosing people over the internet is fucking stupid to begin with anyway.
Our understanding of borderline personality organization substantially predates the current DSM, which is at least half insurance billing manual.
Somatic symptoms (headaches, migraines) and eating disorders are often indicators as well, even though they aren't required by the DSM. Her seeming lack of identification with her past self could indicate dissociation. Autism is a common misdiagnosis, and OCD symptoms are a feature of many personality disorders.
The DSM is just one lens through which to view psychiatric disorders. I think she may have complex PTSD from her chaotic childhood, and the adaptations she made to handle the consequences put her in the borderline range. Other people make narcissistic or schizoid adaptations in response to their trauma. Complex PTSD isn't even in the DSM 5, which I think is a big mistake.
I use BPD as shorthand because it is a lot simpler than what I wrote above.
Do you hear the sounds of screamed diagnoses? Sounds serious, could be psychosis. That would explain assuming the expertise of a mental health professional when you aren't one.
I will use this opportunity to push the novel "The Speed of Dark," by Elizabeth Moon, if you want to meet an engaging character with ASD. It's one of my favorite works. It gets across both why ASD is a challenge and why it should be overcome as much as possible.
Curious to hear from anyone who's read the book (including Freddie potentially) if the samples provided here are representative of her writing. I for one would be very embarrassed to accidentally publish my livejournal archive.
I would say they are. She occasionally has a vibrant turn of phrase and there were some amusing parts, but it is quite livejournal like. It reminded me most of some ofthe autobio comics writers that were popular in the early 00s, like Ariel Schrag.
When someone is "self diagnosing" via TikTok, Instagram and Tumblr to determine they have multiple and overlapping mental health issues which are then manifesting into other physical ailments and then having diagnosed yourself, you then shop therapists for 5 years who will confirm your self diagnosis, you've effectively "shopped" for a diagnosis regardless of the spin you put on it.
Is there a difference between seeking out a diagnosis and "diagnosis shopping"? It seems to me that the former is just the desire to explain the pain you're feeling, while the latter is seeking out a *specific* explanation for that pain and (importantly) choosing between various explanations (thus, "shopping"). My back hurts, I seek out a diagnosis for that pain as the first step in treating it. Diagnosis shopping would entail rejecting one diagnosis in favor of another, for instance because I prefer to believe I slipped a disc rather than admit my hip flexors are tight and prone to injury from sitting down for too many hours a day.
Perhaps Eloise did engage in diagnosis shopping, but admitting she "sought a diagnosis" doesn't seem to constitute a "direct admission" of diagnosis shopping.
Don't disagree with the overall thrust of the review, though.
I also think, in fairness, diagnosis shopping reflect the desire for certainty and labels that lots of folks with OCD and autism crave.
Yeah, she's saying she didn't "shop around", meaning she didn't see multiple doctors.
The relevant issue is that she sought the diagnosis, explicitly - she looked for a doctor who would give her a diagnosis that she had already decided she had. This is a deeply unhealthy practice.
The question isn't whether she made healthy choices, but whether she "shopped around" for a diagnosis, and it seems she correctly stated she didn't.
are you going to keep repeating the same over and over again or are you going to actually address the complaint here
What's the complaint?
Going to a doctor seeking a particular diagnosis IS diagnosis shopping. It's viewing a diagnoses as a consumer choice. That's the whole point.
I think there is nothing wrong with believing you have a condition, and seeking the help of a medical professional to see if they agree with you.
I would define diagnosis shopping, as going to doctor after doctor until you get the diagnosis you want, and the process is less about treatment, but getting the "label." (Just as doctor shopping is going from doctor to doctor until one will give the narcotic prescription you want).
(That said, haven't read the book (and not going to), I'm not saying that FdB's label was inappropriate.)
This is a deranged way to look at any other ailment. If I suspect I may have sinusitis and I go to the doctor and he says "yep, it's sinusitis", I have not "gone shopping for a diagnosis" and it is deranged to portray it this way. What I have done is perfectly healthy behavior. If somebody had incessant thoughts of murdering their wife and sought help from a psychiatrist for it, there is absolutely nothing unhealthy about it. It's at least as misleading to describe this as "shopping for a diagnosis" as the "loads of drugs" comment.
Some things are self-diagnosable, which is why we have over the counter drugs. IMO many more drugs should be OTC.
I mean, I've done that, but I pretty obviously wanted drugs
I see what you mean, but I went to a psych after I suspected I had ADHD. I had suspected it for a number of years after talking to friends who had had diagnoses since childhood, but I didn’t want to be “that person”. But I had a lot of struggles all my life that my friends said they experienced too, bad grades even though I was capable, just felt impossible to get started unless someone sat with me. 8 years to finish university (funny enough my dad had the same issue!) and in the last 4 semesters I crushed it because my husband (then boyfriend) sat with me every study night. Maybe I did it right because I tried to not google or assume, I didn’t look at tests online because I wanted to know for sure. But I did “seek an evaluation” and I hit almost every requirement and medication has made my life A LOT better (not perfect but better). I certainly see it as debilitating and I’d absolutely trade it away tomorrow if I could, but I had to take charge, everyone else missed it. I don’t think that invalidates the diagnosis I received.
Ain't nobody going to a psych for years and not getting "a" diagnosis. They toss those out for everything. Hell, a huge problem is them rolling people on meds after just two sessions. It's clearly implied that she finally got "the" diagnosis, that is, the one she knew she must have.
This is exactly how diagnosis shopping works.
I'm a little confused by your comments. Psychiatrists are medical doctors; their job is to treat psychiatric illness, and the mainstay of psychiatric treatment is medication. Putting a client on medication after one or two sessions is the norm for a reason, and it's neither negligence nor "a huge problem". You would not expect to meet with your GP several times before they prescribed something to treat an identified medical condition. For a new client, a diagnostic interview can be time-consuming, but that's generally done once a year or so, is sometimes outsourced to another species of professional who completes it first, and sometimes doesn't take long at all because clients come with a well-documented illness history. The kind of information psychs need to obtain to make good prescribing decisions does not take long to convey (what symptoms are you struggling with the most, what have you tried in the past, how did it work, what medical conditions do you have, what meds are you on now, that kind of thing). They don't need to know about your relationship with your mother to decide whether to start you on Celexa or Wellbutrin. I'm not sure what you think they should be taking additional sessions to do before they start prescribing medications.
Psychologists and other therapy practitioners don't have the ability to prescribe medication. They can also treat people without having to care too much about what their diagnosis technically is, and some do assessments mainly for the purposes of completing insurance paperwork. Others are more diagnosis and assessment focused. They aren't "rolling people on meds" after two sessions because they aren't involved in that process at all.
A long time ago, psychiatrists would also provide therapy, and there are some in private practice who still do. But the model is out of favor, and overwhelmingly now, psychiatrists do the medicine and therapists do the talking to you.
“Is there a difference between seeking out a diagnosis and ‘diagnosis shopping’?”
Yes, but I think the usage difference means “diagnosis shopping” is more pejorative than you suggest.
What’s pejoratively meant by “diagnosis/doctor shopping” (and its usage is often pejorative) is being willing to go to as many specialists as it takes to find the one who’ll diagnose you with something the majority of experts in the field would probably disagree that you have.
“Diagnosis/doctor shopping” could have the less pejorative sense of simply being an informed medical consumer capable of self-advocacy and with the resources and support to seek warranted medical care, but unless the less-pejorative sense is specified, people seem to default to the pejorative interpretation.
Freddie, I think, objects to the whole idea of being a “medical consumer”, for understandable reasons. But patients have to navigate the system before them, which is one that works better for patients who can accurately self-screen and then choose the provider they see accordingly.
Screening, of course, is not diagnosis. If you screen positive for something, you should be open to the best diagnosis being something else (including the null diagnosis, “We don’t always get medical explanations for why life sucks”).
But our medical system relies on self-screening to direct patient care, even as it often belittles it — at least, belittles it for some, typically contested, diagnoses (or some typically contested patients like teen girls). If your big toe only torments you after drinking or cold weather, asking the relevant professionals whether a gout diagnosis is right for you isn’t typically belittled as “diagnosis shopping” since gout isn’t contested or politically polarized. It’s just gout.
You hit the nail on the head. As long as our healthcare system forces patients to act as consumers, we have to expect patients to make consumer choices. There are better and worse ways to do that!
Frankly, the only way to safely and successfully navigate the whole health care system in the US is to be exceptionally well-informed and willing to challenge professionals from time to time. That can look like rejecting a given doctor's opinion and seeking another. It probably shouldn't look like rejecting seventeen doctor's opinions, though. If you think you're right and a bunch of medical professionals are wrong, the same evidence that convinced you should be able to convince some of them. A lot of doctors are willing to say "oh shucks, I guess I wasn't up to date on the latest research" (or whatever the deal is) in the face of evidence. If you can't, your evidence might be....bad, and your alternative interpretation not so correct. (Knowledge and advocacy themselves might arouse suspicion that you have a weird or malign motive, but the best way to dispel that impression is not to have a weird or malign motive.)
>"Knowledge and advocacy themselves might arouse suspicion that you have a weird or malign motive, but the best way to dispel that impression is not to have a weird or malign motive."
A-fucking-men
I think there might be a degree of ambiguity here. But I find Freddie's interpretation of her words reasonable, and thus to the extent that it's an interpretation she didn't intend, that's ultimately on her as the writer.
Perhaps one tension is that autism/ ASD and ADHD are now often championed on Tiktok and Instagram as ennobling and even desirable, whereas OCD had its cultural moment in the '90s and has somewhat returned to being mockable and largely a condition that sufferers are expected to get over/ transcend, rather than a form of neurodiversity to which society should adapt. [The degree to which OCD should be included within the label of neurodiversity is highly contested].
Personally, being diagnosed young like Eloise with OCD (at 10ish) and struggling with it pretty badly due to stress over the last month, I can't see many benefits of the condition. However, I'm not sure it's straightforwardly curable so much as because the symptoms no longer cause you distress because you've become so adept as using techniques to deal with them you ipso facto are no longer diagnosable as having the condition.
Off the back of your review, I actually chose the book for my Unitarian book group. It didn't go down well, but I found it relatable enough that I got a bit of solace from it - plus there were some striking images and lines that made me laugh. It needed an edit though.
Maria Bamford is still by far and away the best person at communicating what OCD is like. NSFW:
https://www.mariabamford.com/nocd
I was diagnosed with OCD as a kid, too. It's mostly morphed into a manageable generalized anxiety in adulthood, and I don't have the compulsions much anymore unless I'm very stressed, but even then I can usually talk myself down from them now. The doc did put me on meds for it back then, but nothing like that ever worked on the OCD, specifically, so I stopped. Klonopin helps me occasionally with anxiety attacks, but therapy works best for me overall.
I credit my "recovery" from OCD to reading an OCD workbook in my early twenties and keeping a specific passage in my head that basically said "magical thinking isn't real, and you are not important enough to affect the events of the universe in the way you think you are." Honestly, keeping that in my mind made a world of difference. It was over 20 years ago since I read the book, so my memory of the "recovery period" is probably a bit truncated, but yeah, OCD is more torturous than anything else. I cannot think of a single "superpower" it gave me as a kid who spent entire summers voluntarily shut up in the musty basement because of my overwhelming fear of tornadoes, or stuck in a bathroom counting letters on books (based on my own nonsensical alphabet numbering system, of course) before I would let myself leave, as just two examples. My own brain held me hostage for much of my childhood. How on earth could someone twist that into some kind of benefit? Either they really just went overboard trying to not hate themselves (understandable), or they don't really have very severe OCD if any of that really makes them feel good. I don't wanna be a gatekeeper, but come on now. Maybe I'm better at pattern recognition than I would have been without it? Maybe that's a benefit? I'd happily have traded it for a normal childhood, though.
Absolutely same here. I think some workbooks are brilliant; some best approached with the guidance of a therapist. Using a workbook a year-and-a-half back prompted my first (and hopefully only) hospital stay because as per exposure-response therapy it instructed you to deliberately think about the things that were upsetting you and stay with the anxiety. The problem is, intentionally thinking about wildly taboo things made me feel incredibly guilty and confessional - plus, I was so desperate to get rid of the OCD thoughts I was forcing myself to do the exercises lots of times during the working day, which was distressing.
Once I swallowed my pride and got through some of the cheese rhetoric, David Burns's 'Feeling Great' actually helped me quite a bit :)
Surprised she didn't call you sexist.
What a great response. I don't see how people can so easily lie to themselves and the world when the facts are right there to see.
Lying to yourself is the easiest way to lie, especially if you are going big.
It is much easier to gaslight others when you gaslight yourself first.
When I write, I go back to check what I already wrote to make sure it's consistent. I even re-read my own book when writing a sequel. I forget that what I wrote.
Any time you play the fact card, you better check the facts to make sure you are right. I can't tell you how many times that I've sat down at the keyboard to refute someone and when I checked, it turned out they were right. I try not to waste anyone's time.
Of course, in the post Twitter age, people simply say things are true and no one checks.
Better to be disgraced that to be a disgrace.
"I do not quite know what to do with a woman who directly acknowledges pursuing a diagnosis for five years but also denies ever engaging in diagnosis shopping."
You're wrong here, Freddie. She's saying she didn't "shop around" for a diagnosis, meaning she didn't see multiple doctors seeking a diagnosis. If she sought the diagnosis but only saw one doctor, it's not "shopping around." You're also confusing drinking with alcohol abuse.
1. Underage drinking is considered by many to be abuse in and of itself.
2. Going to the doctor with the express intent of being given a diagnosis you actively and consciously seek is diagnosis shopping.
The author apparently thought she drank, but didn't abuse alcohol. I don't see how you can call that "demonstrably false." I think you're twisting her words here...
one of the two of us has read the book
One person in this extended conversation wrote the book, but we're discounting her assessment also, so I don't see why we would credit your assessment any more than hers in the absence of textual evidence to base this claim on.
Respectfully, a lot of people with alcohol problems don't personally believe they have one. The quoted passages suggest alcohol abuse, not normal drinking. The way many people drink is not, in fact, normal or healthy.
I'm genuinely confused how someone could say this is NOT diagnosis shopping.
The distinction is whether she pursued a specific diagnosis *only* or whether she additionally sought out multiple doctors until she heard what she wanted to hear.
All of these comments basically amount to an argument over what "diagnosis shopping" is. But since the phrase is not in common use, there's no right answer to that question. For FdB gets to tell use what he intended by the phrase.
The more interesting question is whether, or under what circumstances, we can indict someone for seeing multiple doctors until they get a treatment that "works" for them, considering that in the United States we have a healthcare system that treats patients as consumers and thus forces consumer choices on them.
Must be nice to grow up rich. Most of the rich kids I knew in school were awful people when I knew them, but it still must be nice. And I'm sure they all grow out of that, right?
Salty Freddy is my favorite Freddy.
I see you are getting the Jesse Singal treatment: being accused of being obsessed with somebody simply because you did your job correctly.
Thin-skinned writers are the funniest kind. Someone should tell them not everyone is going to love their work as much as they do. Deal with it.
And a memoir age 28? Ffs. Unless you’re Michael Jackson, Britney Spears, or a Holocaust survivor back in the day, there will not have been enough notable stuff in that period of time for anybody to GAF about. She had a mental illness? That’s unfortunate, and intensely unoriginal.
I'm also ASD and have a lot of the same problems Marianne Eloise has, and my current role is working with ASD adults. I'm not a therapist or psychiatrist, so don't assume I am one. I've written and published three novels, too. You probably haven't read them.
FDB is paying the author a compliment here by taking her work as seriously as he takes everything else. If she's overcoming adversity to be taken seriously, she succeeded. My books don't get reviews out of the blue, so good for her. The bad reviews I have gotten haven't been this well-written or comprehensive. They are one-line one-star reviews on Amazon.
I'm completely in agreement with FDB that a disability is only a disability if it negatively impacts the person afflicted by it. Otherwise, it's not a problem. Additionally, there are much, much worse disabilities to have than high-functioning ASD. Try low-functioning ASD, or any number of other problems whose sufferers can't write about, because they can't write at all! Or being ASD and low status.
A big problem in publishing, and this is going to sound like I'm bitching (because I am), is that the author's identity is far more important than their work. Marianne Eloise was published because she's a young, elite, educated woman. I could write a memoir about my life dealing with the same problems (even down to the EDS) and no one, no one at all, would care. I'm too old, too male, and too low status. I'm not unhappy about any of that, because I've long since given up on a literary career (lol), nor do I consider my particular struggles of any interest to people I don't know, but it's true and FDB doesn't quite say it. Status matters in memoirs.
It's especially matters if you don't accomplish anything on your own! Even low status people get interest if they do something extraordinary. I'm not sure what Eloise has done other than write about having a disability while being young and high status.
Temple Grandin, for instance, has written a lot of memoirs, but she's only interesting because she's accomplished a lot, too. She takes a dim view of autistic people obsessing about how disabled they are. The goal is how to be a useful person, overcome challenges, and use your gifts. In other words, the same as everyone else.
Everyone has problems. Everyone. Some are much worse than others, and it's all unfair. Treating a relatively mild problem like high-functioning ASD (and I have it, and I know exactly what I mean) as an epic challenge to a high-status person who would otherwise end up much the same without it, is worth questioning. How, exactly, would her life be different without ASD?
I work with people at a community college who have ASD. Last week, the most challenging thing one student had to do was open a combination lock. The fine motor skills and the need for detail were overwhelming. They were so upset by it that they had to ask for help. Another student felt sorry for them and did it. How must that feel?
Doesn't sound very warm or fuzzy, does it? Something someone would brag about in a memoir?
I know FDB has worked with the most difficult students in the public school system, and I appreciate that he doesn't dance around someone who doesn't deserve special consideration for a very mild disability. It's an elite person exploiting her status to tell us about her problems, which no one would care about otherwise. If Eloise was doing something for the people who aren't being helped, that would be great. But it's all about her.
Literature is a way to meet people who are different than you. That's fine, but the writer needs to make it worth your time to meet them.
I don't get the impulse toward this kind of writing. If I write anything remotely "memoirish" I feel like those scenes in Mad Men when Roger Sterling is dictating his memoir and it's like, "I was born. I was a cheerful child. My mother ..." The point is, who gives a fuck about this wildly narcissistic product?
David Hume, the empiricist philosopher, who was also disgusted by self-indulgent memoirs, wrote his own.
https://www.econlib.org/book-chapters/chapter-my-own-life-by-david-hume/
It's about 4 pages long.
The man didn't like wasting our time.
Haha amazing.
That link on Hume was a great diversion. I like his approach of flat out not responding to critics and always maintaining a sunny disposition. Wise words for anyone. And his vow to himself that he would live as frugally as possible so he could pursue his writing dream.
I only like memoirs if something extraordinary happened to the author. And I skip all the chapters that take place before the interesting event.
“I know you all bought my book because of the dramatic, high-profile thing that happened last year. But first here’s 100 pages about my childhood, my time in college, my early career….” Zzzzzzzz. It’s the worst.
Yeah. I'm pitching a memoir about Soviet era escapees in my family, and linking it to the current refugee crises... and like, I have to talk about my childhood, etc., just to link up events chronologically, but I'm just like ... allergic to it! Like wow, "Let's discuss how I grew up in SoCal. Oh no! I got sunburned at the beach and all the boys liked blondes!" I know Suffering Olympics are overrated, but eventually you gotta be like, "I have a very safe and comfortable life, due to the immense amount of work put in by people who had much bigger problems" At which point, I think it's kinda a moral responsibility to pivot to telling other people's stories who are less lucky.
She claims autism, but her behavior and various ailments just scream BPD to me. That would explain her recent attack on you.
Every angry woman is diagnosed with BPD over the internet. I don't see anything from her interaction with Freddie, excerpts provided, or the free available portion of her NYT article that would indicate she satisfies any more than three (self-harm, impulsivity, anger) of the 9 DSM-5 diagnostic criteria for BPD of which 5 are required to satisfy a diagnosis. Sure, three might seem like a lot, but many of the criteria are comorbid with other disorders. Freddie has in the past experienced at least three (emotional instability, anger, and paranoid ideation) not because he is borderline but because many of the diagnostic criteria are comorbid with other disorders.
Diagnosing people over the internet is fucking stupid to begin with anyway.
Our understanding of borderline personality organization substantially predates the current DSM, which is at least half insurance billing manual.
Somatic symptoms (headaches, migraines) and eating disorders are often indicators as well, even though they aren't required by the DSM. Her seeming lack of identification with her past self could indicate dissociation. Autism is a common misdiagnosis, and OCD symptoms are a feature of many personality disorders.
I suppose if you want to simply ignore the DSM, you can diagnose anybody you like with whatever you want.
The DSM is just one lens through which to view psychiatric disorders. I think she may have complex PTSD from her chaotic childhood, and the adaptations she made to handle the consequences put her in the borderline range. Other people make narcissistic or schizoid adaptations in response to their trauma. Complex PTSD isn't even in the DSM 5, which I think is a big mistake.
I use BPD as shorthand because it is a lot simpler than what I wrote above.
which BPD?
Bipolar disorder?? Maybe?
My first thought was borderline personality disorder but could be either
Borderline is BPD. Bipolar is BP.
Do you hear the sounds of screamed diagnoses? Sounds serious, could be psychosis. That would explain assuming the expertise of a mental health professional when you aren't one.
I will use this opportunity to push the novel "The Speed of Dark," by Elizabeth Moon, if you want to meet an engaging character with ASD. It's one of my favorite works. It gets across both why ASD is a challenge and why it should be overcome as much as possible.
Curious to hear from anyone who's read the book (including Freddie potentially) if the samples provided here are representative of her writing. I for one would be very embarrassed to accidentally publish my livejournal archive.
I would say they are. She occasionally has a vibrant turn of phrase and there were some amusing parts, but it is quite livejournal like. It reminded me most of some ofthe autobio comics writers that were popular in the early 00s, like Ariel Schrag.
When someone is "self diagnosing" via TikTok, Instagram and Tumblr to determine they have multiple and overlapping mental health issues which are then manifesting into other physical ailments and then having diagnosed yourself, you then shop therapists for 5 years who will confirm your self diagnosis, you've effectively "shopped" for a diagnosis regardless of the spin you put on it.