Of Course People Make Up Disabilities

kayfabe, again

Friends, I will be speaking at the GENUX Symposium in Boston on Friday, October 11th. The topic is AI and media. What are the incentives at play in media when it comes to covering AI, and how do they distort our cultural understanding of these technologies? I’ll be speaking with my lifelong friend Chris Bransfield in a semi-structured discussion. Should be a fun conversation. You can get tickets here.

Since my scandal in 2017, when I made terrible false accusations against Malcolm Harris and then faced justified personal and professional consequences for doing so, there has been a small but vocal group of people who suggest that I made up my bipolar disorder to get out of that trouble, that I never mentioned it before that happened. This is unpleasant but low stakes. Most everyone appears to have moved on, which is good, and anyway the claim is not very threatening; I had in fact been public about my disorder since early 2016, online and off, and mentioned it both on my old blog and on social media. It’s also the case that many people had talked about my instability for years and years, talk which always annoyed me but which I really had no right to dismiss. I learned, after the fact, that early that summer some people in the business had privately discussed whether and how to reach out to someone to check on me and provide help if I needed it, but it never came to anything. In any event, some people in my personal life knew long before that happened, and if I needed to I could pull together documentary evidence of 22 years living with bipolar disorder.

There’s also the fact that, had I been scheming, I would have had no reason to think that discussing my disorder would save me from personal and professional censure, which indeed it did not. None of my behavior makes any sense at all if you assume that I was operating rationally. Which does not absolve me from responsibility for what happened; I did it, and I am responsible for it.

While I think the accusation that I’m making it all up is stupid and motivated by bad faith, I’m not offended by the fact that the accusation has been made. Or, rather, when I am I’m offended by the stupidity and the bad faith, not based on the principle that a diagnosis is sacrosanct and that no one can ever question the legitimacy of a claimed disability. That has, I’m afraid, become one of those destructive identity-derived beliefs that have burrowed into liberalism like barnacles in the 21st century. Personally, I understand that we live in a world in which people come to sincerely believe that they’re suffering from afflictions they’re not, a world in which people knowingly pretend to have disabilities that they don’t, and a world in which some occupy the fuzzy space in between, wavering from sincerely believing in a factitious disorder to knowing they aren’t really sick. (The latter is how a lot of these complicated psychological constructs operate.) And I understand that society simply can’t function without the right to question whether a person who says they’re sick isn’t really sick. This is true in more obvious practical scenarios, such as when assessing whether someone is an appropriate recipient for disability benefits. It’s also true in the more abstract sense of recognizing that society cannot provide accommodations for everyone, whether formal legal ADA accommodations or in the broader sense of extending more patience and understanding to people with disabilities.

So, you know. I don’t think questioning my disorder is out of bounds. Just wrong.

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Let me turn back to the TikTok “systems,” the strange, maybe-shrinking world of adolescent women on social media who pretend to have an incredibly rare and debilitating mental illness and treat it as a fun and quirky alternative lifestyle.

This piece from The Verge, though a little misguided, is a good jumping off point for this topic. The basic story is pretty simple. Dissociative identity disorder (DID), long referred to as multiple personality disorder, is a remarkably controversial diagnosis that has long captured the public imagination. It’s not hard to see why; the idea of someone who switches from one personality to the other is lurid and dramatic, making it easy fodder for television. (The number of episodes of legal dramas about DID is immense.) The condition also invites a particularly stark consideration of the question of individual agency and culpability for bad deeds. As you can imagine, pretending to have “alters” can be very convenient; a notorious case involved an embezzler whose only defense for his crimes was that he had multiple personalities and one of them stole the money. There have long been researchers and clinicians in psychiatry who doubt the very existence of DID, and even among those who are friendlier to the concept, the disorder is known to be incredibly rare. Many prominent cases of DID have proven in time to be fraudulent. The most famous American case, that of “Sybil,” was particularly tragic. The woman who supposedly suffered from the disorder, who faced a childhood of abuse and neglect, would go on to admit to her psychiatrist that she had made the alternate personalities up. (We know because we have the letters.) But the doctor, who had been made wealthy and famous thanks to her work with Sybil, threatened to withdrawn her financial support if Sybil did not recant that confession. Having no other choice, she did.

What DID TikTok asks us to believe is that, in the span of maybe half a decade, tens of thousands of adolescent women developed DID, an exceedingly rare disorder marked by symptoms entirely unlike those on your For You page. The Verge article, written by Jessica Lucas, is typical of the media’s take on this issue, to the degree that they’ve written about it at all: relentlessly sympathetic to the DID TikTok adolescents even when grudgingly admitting that there’s a lot of fakery. And admit that she does, as it would be essentially impossible to pretend otherwise. Even the wokest wokie couldn’t help but look at this shit and conclude that a lot of it is bullshit.

The cases of DID that are considered to be particularly valid or believable are very few, and the people who have suffered in them have been people living absolutely wasted lives, lives filled with abuse and instability and addiction and misery; the overwhelming majority of DID TikTokers appear to be living perfectly stable and successful adolescent lives. Those with DID have almost never professed to be able to switch from one alter to another on command; many DID TikTokers playact that exact behavior for their viewers. Alters are notoriously uncooperative towards each other; TikTok DID videos routinely feature alters happily participating in “roll calls” in which they switch from one identity to the next, conveniently timed for the creation of #content. (The DID people claim that really they’re just opportunistically capturing organic switches, but a) it’s very clear that many of these videos are filmed in one day and b) that would still require alters to willingly turn the camera on and get into the costume etc, which is not at all how alters have traditionally acted.) In the DID literature alters are almost never aware of what’s happening when another alter is “fronting”; on DID TikTok they almost universally are, justified with the convenient idea of “co-consciousness,” which is one of many evolutions of DID these people have implemented to allow their little pageant to continue. Most people with DID diagnosis, historically, have not been photogenic women with an interest in getting more followers. I could go on.

Lucas’s piece is particularly useful for the remarkable, remarkably depressing story of Dr. Matthew Robinson, a clinician and researcher from Harvard Medical School’s McLean Hospital. (The site of Girl, Interrupted, among other things.) Like a lot of people in psychiatry, Robinson noted with alarm that his hospital had “been inundated with referrals and requests from schools, parents, and our own adolescent treatment and testing services to assess for symptoms of what [patients] call DID.” He proceeded to discuss the difficulties this sort of situation provokes in an already-overtaxed mental health system, and spoke frankly about the fact that a considerable number of the people presenting with this disorder obviously do not in fact have it. He stated plainly that which many are too circumspect to say, which is that [edit for accuracy] the claims of DID on TikTok are not credible. The consequence, of saying this in a lecture with his professional peers, was review-bombing of the hospital online, threats, a call to have Robinson’s medical license revoked, and sufficient harassment that McLean pulled online videos of the lecture. The online mob engaged in the typical social justice-vocabulary freakout campaign, McLean folded, and as stated in the piece, most researchers are now too scared to publicly comment on this absurd situation. If someone tells you that there is no such thing as a social justice-inflected cancellation campaign, you can point to this exact scenario and to the vicious and vengeful disability rights movement in general.

To be clear, I think that probably literally zero of the people who perform DID on TikTok have the disorder. Zero. I imagine that a significant portion of them have deluded themselves into thinking they do. But I’m quite confident that most of them are very well aware that they’re faking.

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Someone I know who’s a lecturer at a big state U told me that, in a large section with thirty-eight women students, nine of them carry canes. That seemed to him, and seems to me, to be unusual; the odds that nine otherwise healthy young women in their 20s who used (carefully decorated) canes would all be taking the same undergraduate seminar seems unlikely, given underlying base rates. This seemed particularly fishy to him because he knew several of these women in past semesters and none of them had walked with canes. As someone who’s among the very few who will ever go after the disability activist crowd over anything, I receive a lot of sighs and grumbles from people who are frustrated by the endless mushrooming of diagnoses and disorders but feel they can’t say anything about it. And apparently the sudden explosion of young people carrying canes is a thing, a broader thing. I mean, hey, self-expression! Instant attention. It’s insulting to people who really do have limited mobility thanks to their disabilities, obviously. But who would ever call it out? My friend the lecturer would face immense personal and professional harm if he questioned anyone’s (usually self-) diagnosis, in academia. So he won’t. And, you know, maybe those nine women all spontaneously developed some sort of motor disorder at the same time, maybe. But of course the existence of people who really have a disorder isn’t and can’t be evidence that no one is faking.

The typical response to this sort of thing is always “No one would ever fake a disability!” But of course history is full of people who faked illness and injury, particularly psychiatric disorders. There’s a whole online subculture made up of those that hunt for “patients” faking cancer in an effort to secure money or social favor, and they feel that they have to because faking cancer is depressingly common. The Verge piece ends by referring to former members of DID TikTok who have admitted that they were faking, and if there are a lot of those, there are surely many more who pretended and then gave it up quietly, for fear of censure. Munchausen by internet is very real. Why is it so hard for people to speak plainly about this, when the asserted reality is so absurd?

The other version is “Why would anyone ever fake a disability?” Everyone already knows the answer: they want attention and sympathy. It really is that simple.

I’ve often discussed the tendency of those on the lefthand side of politics to express unhappiness about an observation or argument without really disputing it. This is the “Do we really have to talk about this?” tendency, that is, the common behavior to avoid a topic rather than to affirmatively argue one side because arguing would be psychically stressful. For example: in the early days of the “campus uprising” in the 2010s, liberal journalists and writers embraced this tactic, insisting that what happened on campus didn’t matter and you were weird if you paid attention. It was only in the late 2010s that most of them got religion and began actively defending the students. The DID TikTok phenomenon, while much more niche, is really a paradigmatic example of this. It’s very hard to believe that many people at all believe that what these kids are saying is true; to repeat myself, the implicit claim of that entire community is that the number of patients dealing with one of the rarest and most debilitating mental illnesses suddenly spiked by the tens of thousands, almost exclusively found in adolescent American women with smartphones and TikTok accounts. I have talked about this issue a lot in in-person conversations and no one, even in the lefty activist circles I spend some time in, is willing to affirmatively state that the DID epidemic is real. Instead, the attitude is this classic 21st century liberal discomfort with saying something that might sound like something a (gasp) conservative might say. This is textbook modern liberalism, being motivated more by the need to avoid associating oneself with “the other side” than by the desire to say things that are true and do things that are good.

In other words, it’s kayfabe. Kayfabe is the code of mutual deception in the world of professional wrestling. The outcomes of the matches are scripted, the winner predetermined, but the wrestlers maintain a strict code of never acting like that is true during their public appearances. And, these days at least, the audience is in on it too. In the modern era the fact that the wrestlers are performing according to a highly-improvised script is public knowledge to the fans. But they choose to participate in the sport by pretending as if that’s not true, for the sensible reason that it’s more fun to pretend that way. In other words, they keep kayfabe; they engage in mutual deception. They knowingly participate in pretending not to know. Which is cool. Wrestling is entertainment and the deception is all for fun. But I’m afraid that, as much as people would like to bury their heads in the sand so that they can avoid feeling like a Republican, issues of mental health have major real-world consequences. As I said, McLean and other hospitals really have dealt with an influx of patients with unconvincing symptoms who are unwilling to be told that the aren’t sick. Medical resources are scarce, and they’re particularly precious when it comes to mental health. People make extravagant demand for accommodations based on these flatly fake disorders. And, personally, I find it deeply vulgar and insulting to all the people who really suffer from ugly, painful, dispiriting mental illness to have all of these bright faces telling the world that it’s cool to be profoundly mentally ill. It’s not. I promise.

I do think that the online DID community is slowly contracting, a bit, for a damning but predictable reason: I suspect that fake DID is going out of fashion. It’s very 2022. But the underlying problems will remain even if that’s true. (Get onboard the cane train!) Factitious disorders exist. Contemporary social justice mores insist that we can’t give voice to this fact. But I’m asking you to have the courage to do so all the same.