You can't have appropriate skepticism without gatekeeping, and you can't have gatekeeping without gatekeepers. In the case of health, it is natural to think the gatekeepers would be health experts. It would then follow that the health experts are likely to be doctors, people with a medical background, and people with a background in public health. In other words, the medical establishment.
Personally speaking, I have *negative* trust in the medical establishment of this country to gatekeep effectively; that is, I trust them less than I would a random, reasonable observer off the street. That is, I regard the medical establishment as actively detrimental to solving the issue of appropriate skepticism. There are lots of motives for this, and people on my side (the Right) often alight on the profit motive. That's part of it. But I think by far the greatest motive is simply that of not wanting to offer undue skepticism, of not wanting to question people, of trusting lived experience, of simply not rocking the boat. Basically, of being nice and compassionate. (Laudable things! In their place.)
Admittedly this manifests itself more in simple non-diagnosis and non-confrontation than it does fraudulent diagnosis. But in my view this is still a massive problem. Gatekeeping only works if it's proactive. We discourage drunk-driving before the crash, not after. But our medical establishment doesn't do this. It should be shouting from the rooftops that the glamourized self-diagnoses people give themselves are probably wrong and really damaging and you don't want them anyway. But they don't. The biggest indicator of this, for me, was so-called "long COVID", which they continue to treat with kid gloves long past the point that it should have been written off as a useful concept.
A common sense approach, rather than the expert-led approach that we live under, would surmise that people who have a hashtag "illness" with no ill effects but plenty of rewards within their subculture are probably just malingering attention-seekers, but the oversocialized can't and won't think that or say it, and are guided by their compassion to indulge it instead. So, here we are.
We can see exactly how society functions in this milieu by looking at long COVID and other examples that we needn't go into.
I really like that you are addressing this issue. What I think is not 100% complete in your analysis is that "the glamour shot treatment" where we e.g encourage those who've suffered to share their story and pat them on the back is not fully negative - it's a tradeoff. I think you've done a good job describing the downsides, especially given most are not willing or able to do so. But I still think there is an upside. Let's say someone suffers from autism and really has a tough time all through high school, but still manages to graduate. Is it bad if that person were to speak at commencement about their experience and the audience applauds? I think there are pros and cons. Stories of perseverance can be inspiring, and I don't believe the reaction of most people would be to say, "hey, I wish I could get that applause too, maybe I'll lean into talking more about my bouts of mild depression" - but some might. I think the reaction of most would be to be happy for the individual who persevered, and count their blessings.
Thank you. In some online spaces there is definitely a "not like the other girls" vibe of fashionability for some kinds of mental illness, as with various food-aversions and weird allergy-adjacent claims (I'm not talking "need an epipen" allergies).
I see it as a broader sense of wanting to be different, yes, but also wanting to be seen as somehow too delicate, to cope with the world at full strength. And an implication that the hearty folks who can eat anything, and don't have anxiety, and aren't neurodiverse or whatever, are just unrefined oafs.
NORMAL is practically a pejorative.
And it's a tendency to pathologise normal human emotions. You get nervous before a test? That does not mean you "suffer from anxiety", that means you're a regular person.
> The Americans with Disabilities Act standard is one of the most elegant and useful in law - that we should extend every reasonable accommodation, but not every conceivable accommodation, to those with disabilities.
My late disabled uncle advocated for the ADA and I agree, it is an elegant standard. I'm a big proponent of Universal Design practices: it would be great if all new builds included wider door frames and flat thresholds, for instance, and adopting that standard hurts nobody while helping a great deal. Requiring all homes to have elevators, for example, would be ridiculous. Part of disability is the coping. Same with mental illness. The ADA demands dignity and respect for people's physical realities; it does not demand praise, or pity, or veneration of the disabled.
Another way this learned helplessness manifests is the "affirm everything" / "that is SO valid" therapy- speak culture that is getting stronger and stronger in certain yuppie spaces. What's so sad about it to me is that, under the guise of allowing for greater emotional support and connection, it actually does the opposite and creates layers of vapid bullshit between people and destroys any ability to form ACTUAL connections which are not in fact rooted in running your brain like a computer constantly scanning for the politically correct thing to say and indulging each other non stop on a hippie fest of "feelings" all over the place. There IS a crisis of ennui in society and young people in a society that had any kind of community left could nurture and support each other on the road to building a life and finding some meaning but people are taught to make themselves marketable forever. It's like some of these people are living their lives as if it's one long bullshit college admissions essay.
Of course, the solution is to advocate for the complete and total destruction of the physical infrastructure that enables the internet to exist as I've long been advocating.
One large factor with this sort of thing is people confuse identifying their own suffering with identifying the cause of their suffering.
Suffering is subjective, and the best person to determine if you are suffering is you. However, that doesn't mean that the cause of your suffering, or how best to treat it, is subjective, or that the sufferer necessarily has any particular insight into these questions.
Along these same lines, a lot of people confuse questioning someone's diagnosis with questioning their subjective experience. If someone tells you that your pain/fatigue/brain fog/etc. aren't caused by chronic Lyme because chronic Lyme isn't a thing, they aren't denying that you have these symptoms, only that you have misidentified the cause of them. And just like one of the major problems with imprisoning an innocent man for a crime he didn't commit is that it leaves the real perpetrator on the street to commit more crimes, settling on the wrong diagnosis for your real symptoms makes it harder, not easier, to address those symptoms.
You may be experiencing psychic discomfort but it's because you're bored, lonely, dissatisfied, and/or too-online.
The best means of ameliorating the unpleasant symptoms is addressing the situational issues, not medicalization or accommodation.
A major problem is no one wants to tell anyone to face the truth. Who wants to tell someone who is emotionally and socially invested in this type of performance to cut it out? You will only bring grief on yourself by telling people things they don't want to hear.
There’s a real Twilight Zone quality to the current situation where everyone (?) is basically aware that social media is making us sick. It’s in the New York Times, it’s in the congressional testimony, it’s in the leaked documents from the tech companies. People know it! And they’re just kinda scrolling right past it. Are we just going to do this forever?
I remember my brain feeling a lot better, like ten years ago, in the six months between getting rid of Facebook and getting Twitter. It definitely was not as good of a feeling after getting rid of Twitter earlier this year, because social media sickness has eaten so much of the actual world. That, and you somehow still manage to be aware of many of the worst tweets...
WaPo is somehow more pathetic than the NYT, which is a real fucking accomplishment. They should do an article on the many ways Taylor Lorenz is messed up - there's probably at least one diagnosis to be made there.
Just want to say I’ve been thinking about this a lot, as I’ve been feeling incredibly anxious (like heart racing, gut churning, brought-to-tears moments) and distracted/mentally frantic in recent months. How much of this is a product of external factors, of the way many of us live now, of me being just kind of a moody and sensitive person, and how much of this could be a deep brain-misfiring breed of anxiety that medication could address so that I can simply cope better? How much of this could be ADHD? (Which my father does have and apparently that makes me more likely to have it.) I find myself very much not wanting to define myself with these terms because they make me feel stuck; the more I describe myself as anxious the more anxious I feel.
It feels strange that so many people I know are suddenly talking about being neurodivergent, though I don’t discount the “realness” of it. I wonder if many (not all) of us are actually just really emotionally sensitive and in jobs that aren’t the best fit for how we think, or need better practical and interpersonal skills re: modern relationships and communication, need to set up our lives differently. I hate the “just exercise and meditate” brand of “advice” in this regard so that’s not what I mean. But I do wonder whether the fact that life just feels so fucking difficult for many of us isn’t a medical issue, it’s an emotional and personality-driven one. But then, what to do? I still have to work a job and deal with modern life. I get why a diagnosis can be comforting—like, “Here’s your problem, now you get medicine.”
It's been fascinating and horrifying to watch something that was once practically a Tumblr in-joke spiral out into something with real-world relevance. You can basically draw a direct line from those years where Tumblr users were super into tulpas to the extent it looked like people were trying to induce schizophrenia in themselves, and whether it was sincere or ironic or both was rather unclear, to people pretending to have DID on Tiktok.
As Monia Ali put it: "Much of what we did online was like roleplay, I didn’t think of it like that, and I still don’t like thinking of it as such, but it’s the only way I can think of how to describe it. It’s not that we were putting on an act, but rather that we observed self-imposed rules. This was fine as long as all everyone was on the same page, that the lines in the sand would be respected."
That's what happens with a lot of online communities, whether Tumblr or 4chan. A lot of what goes on is performative -- not quite roleplaying, not quite real. But eventually it gets discovered by people who don't really get its a semi-ironic set of cultural mores and memes, and that's when you start running into problems as those ideas begin to get picked up by people closer to the mainstream. It astounds me to see people just plainly and obviously pretending to have mental disorders and I don't really know where it leads or how to stop it beyond just hoping that people on social media find some new fad.
"Young people understand the allure of being seen; they don’t yet understand the horror of being frozen in other people’s gazes." I really think that's true.
I'm 38 and I really think that up through my mid-thirties, I assumed that new identities would always be available off the shelf. I can't put my finger on why and how that changes - I'm tempted to call it age but I often wonder if it's really life milestone things like getting married - but it definitely changed. And I legitimately do think that part of it is "pure age," in a sense.
I think this excellent piece ties in with another small but burgeoning subset—the ‘Long COVID’ crew. **NOTE: No doubt this can be a thing, and exists**However, it simply can’t apply to everyone whose vision has gotten a little worse—welcome to aging!—or who has more headaches now, etc. There are a *lot* of claims floating around out there.
You can't have appropriate skepticism without gatekeeping, and you can't have gatekeeping without gatekeepers. In the case of health, it is natural to think the gatekeepers would be health experts. It would then follow that the health experts are likely to be doctors, people with a medical background, and people with a background in public health. In other words, the medical establishment.
Personally speaking, I have *negative* trust in the medical establishment of this country to gatekeep effectively; that is, I trust them less than I would a random, reasonable observer off the street. That is, I regard the medical establishment as actively detrimental to solving the issue of appropriate skepticism. There are lots of motives for this, and people on my side (the Right) often alight on the profit motive. That's part of it. But I think by far the greatest motive is simply that of not wanting to offer undue skepticism, of not wanting to question people, of trusting lived experience, of simply not rocking the boat. Basically, of being nice and compassionate. (Laudable things! In their place.)
Admittedly this manifests itself more in simple non-diagnosis and non-confrontation than it does fraudulent diagnosis. But in my view this is still a massive problem. Gatekeeping only works if it's proactive. We discourage drunk-driving before the crash, not after. But our medical establishment doesn't do this. It should be shouting from the rooftops that the glamourized self-diagnoses people give themselves are probably wrong and really damaging and you don't want them anyway. But they don't. The biggest indicator of this, for me, was so-called "long COVID", which they continue to treat with kid gloves long past the point that it should have been written off as a useful concept.
A common sense approach, rather than the expert-led approach that we live under, would surmise that people who have a hashtag "illness" with no ill effects but plenty of rewards within their subculture are probably just malingering attention-seekers, but the oversocialized can't and won't think that or say it, and are guided by their compassion to indulge it instead. So, here we are.
We can see exactly how society functions in this milieu by looking at long COVID and other examples that we needn't go into.
I really like that you are addressing this issue. What I think is not 100% complete in your analysis is that "the glamour shot treatment" where we e.g encourage those who've suffered to share their story and pat them on the back is not fully negative - it's a tradeoff. I think you've done a good job describing the downsides, especially given most are not willing or able to do so. But I still think there is an upside. Let's say someone suffers from autism and really has a tough time all through high school, but still manages to graduate. Is it bad if that person were to speak at commencement about their experience and the audience applauds? I think there are pros and cons. Stories of perseverance can be inspiring, and I don't believe the reaction of most people would be to say, "hey, I wish I could get that applause too, maybe I'll lean into talking more about my bouts of mild depression" - but some might. I think the reaction of most would be to be happy for the individual who persevered, and count their blessings.
Thank you. In some online spaces there is definitely a "not like the other girls" vibe of fashionability for some kinds of mental illness, as with various food-aversions and weird allergy-adjacent claims (I'm not talking "need an epipen" allergies).
I see it as a broader sense of wanting to be different, yes, but also wanting to be seen as somehow too delicate, to cope with the world at full strength. And an implication that the hearty folks who can eat anything, and don't have anxiety, and aren't neurodiverse or whatever, are just unrefined oafs.
NORMAL is practically a pejorative.
And it's a tendency to pathologise normal human emotions. You get nervous before a test? That does not mean you "suffer from anxiety", that means you're a regular person.
> The Americans with Disabilities Act standard is one of the most elegant and useful in law - that we should extend every reasonable accommodation, but not every conceivable accommodation, to those with disabilities.
My late disabled uncle advocated for the ADA and I agree, it is an elegant standard. I'm a big proponent of Universal Design practices: it would be great if all new builds included wider door frames and flat thresholds, for instance, and adopting that standard hurts nobody while helping a great deal. Requiring all homes to have elevators, for example, would be ridiculous. Part of disability is the coping. Same with mental illness. The ADA demands dignity and respect for people's physical realities; it does not demand praise, or pity, or veneration of the disabled.
Another way this learned helplessness manifests is the "affirm everything" / "that is SO valid" therapy- speak culture that is getting stronger and stronger in certain yuppie spaces. What's so sad about it to me is that, under the guise of allowing for greater emotional support and connection, it actually does the opposite and creates layers of vapid bullshit between people and destroys any ability to form ACTUAL connections which are not in fact rooted in running your brain like a computer constantly scanning for the politically correct thing to say and indulging each other non stop on a hippie fest of "feelings" all over the place. There IS a crisis of ennui in society and young people in a society that had any kind of community left could nurture and support each other on the road to building a life and finding some meaning but people are taught to make themselves marketable forever. It's like some of these people are living their lives as if it's one long bullshit college admissions essay.
Of course, the solution is to advocate for the complete and total destruction of the physical infrastructure that enables the internet to exist as I've long been advocating.
One large factor with this sort of thing is people confuse identifying their own suffering with identifying the cause of their suffering.
Suffering is subjective, and the best person to determine if you are suffering is you. However, that doesn't mean that the cause of your suffering, or how best to treat it, is subjective, or that the sufferer necessarily has any particular insight into these questions.
Along these same lines, a lot of people confuse questioning someone's diagnosis with questioning their subjective experience. If someone tells you that your pain/fatigue/brain fog/etc. aren't caused by chronic Lyme because chronic Lyme isn't a thing, they aren't denying that you have these symptoms, only that you have misidentified the cause of them. And just like one of the major problems with imprisoning an innocent man for a crime he didn't commit is that it leaves the real perpetrator on the street to commit more crimes, settling on the wrong diagnosis for your real symptoms makes it harder, not easier, to address those symptoms.
We need to start using the appropriate language:
You may be experiencing psychic discomfort but it's because you're bored, lonely, dissatisfied, and/or too-online.
The best means of ameliorating the unpleasant symptoms is addressing the situational issues, not medicalization or accommodation.
A major problem is no one wants to tell anyone to face the truth. Who wants to tell someone who is emotionally and socially invested in this type of performance to cut it out? You will only bring grief on yourself by telling people things they don't want to hear.
There’s a real Twilight Zone quality to the current situation where everyone (?) is basically aware that social media is making us sick. It’s in the New York Times, it’s in the congressional testimony, it’s in the leaked documents from the tech companies. People know it! And they’re just kinda scrolling right past it. Are we just going to do this forever?
I remember my brain feeling a lot better, like ten years ago, in the six months between getting rid of Facebook and getting Twitter. It definitely was not as good of a feeling after getting rid of Twitter earlier this year, because social media sickness has eaten so much of the actual world. That, and you somehow still manage to be aware of many of the worst tweets...
WaPo is somehow more pathetic than the NYT, which is a real fucking accomplishment. They should do an article on the many ways Taylor Lorenz is messed up - there's probably at least one diagnosis to be made there.
Yup yup yup. I waited and waited for my bipolar frenemy to acknowledge on Twitter that their problem wasn't autism or depression or ADHD.
They still haven't done that but they've stopped claiming to have those other conditions, so that's a plus
Just want to say I’ve been thinking about this a lot, as I’ve been feeling incredibly anxious (like heart racing, gut churning, brought-to-tears moments) and distracted/mentally frantic in recent months. How much of this is a product of external factors, of the way many of us live now, of me being just kind of a moody and sensitive person, and how much of this could be a deep brain-misfiring breed of anxiety that medication could address so that I can simply cope better? How much of this could be ADHD? (Which my father does have and apparently that makes me more likely to have it.) I find myself very much not wanting to define myself with these terms because they make me feel stuck; the more I describe myself as anxious the more anxious I feel.
It feels strange that so many people I know are suddenly talking about being neurodivergent, though I don’t discount the “realness” of it. I wonder if many (not all) of us are actually just really emotionally sensitive and in jobs that aren’t the best fit for how we think, or need better practical and interpersonal skills re: modern relationships and communication, need to set up our lives differently. I hate the “just exercise and meditate” brand of “advice” in this regard so that’s not what I mean. But I do wonder whether the fact that life just feels so fucking difficult for many of us isn’t a medical issue, it’s an emotional and personality-driven one. But then, what to do? I still have to work a job and deal with modern life. I get why a diagnosis can be comforting—like, “Here’s your problem, now you get medicine.”
Great piece, thanks.
It's been fascinating and horrifying to watch something that was once practically a Tumblr in-joke spiral out into something with real-world relevance. You can basically draw a direct line from those years where Tumblr users were super into tulpas to the extent it looked like people were trying to induce schizophrenia in themselves, and whether it was sincere or ironic or both was rather unclear, to people pretending to have DID on Tiktok.
As Monia Ali put it: "Much of what we did online was like roleplay, I didn’t think of it like that, and I still don’t like thinking of it as such, but it’s the only way I can think of how to describe it. It’s not that we were putting on an act, but rather that we observed self-imposed rules. This was fine as long as all everyone was on the same page, that the lines in the sand would be respected."
That's what happens with a lot of online communities, whether Tumblr or 4chan. A lot of what goes on is performative -- not quite roleplaying, not quite real. But eventually it gets discovered by people who don't really get its a semi-ironic set of cultural mores and memes, and that's when you start running into problems as those ideas begin to get picked up by people closer to the mainstream. It astounds me to see people just plainly and obviously pretending to have mental disorders and I don't really know where it leads or how to stop it beyond just hoping that people on social media find some new fad.
"Young people understand the allure of being seen; they don’t yet understand the horror of being frozen in other people’s gazes." I really think that's true.
I'm 38 and I really think that up through my mid-thirties, I assumed that new identities would always be available off the shelf. I can't put my finger on why and how that changes - I'm tempted to call it age but I often wonder if it's really life milestone things like getting married - but it definitely changed. And I legitimately do think that part of it is "pure age," in a sense.
This is very, very good. It also studiously avoids the 4000%-increase-elephant-in-the-room implicated by the very, very good points being made here.
I think this excellent piece ties in with another small but burgeoning subset—the ‘Long COVID’ crew. **NOTE: No doubt this can be a thing, and exists**However, it simply can’t apply to everyone whose vision has gotten a little worse—welcome to aging!—or who has more headaches now, etc. There are a *lot* of claims floating around out there.