Why Can't We Be Honest About the Rise of Mental Disorders as Consumer Products?

this is an undeniable and widespread phenomenon with obvious negative consequences for society that mainstream media simply will not cover

I just found a cost-free way to farm sympathy and attention 😊

I will never not be fascinated by those issues or arguments or perspectives that are studiously ignored by the media generally and the New York Times in particular. I’ve whinged about this many times when it comes to education, as the NYT is simply not going to consider the notion that different individual people have fundamentally different levels of academic potential in its pages, not even in an attempt to rebut the idea. I suppose that notion is just too challenging to the elite meritocratic liberalism that the Times epitomizes; the idea that we are all ultimately capable of achieving academic and professional greatness flatters the high-achievers who read and write the paper, and the “anyone can be anything” ethos is pleasant and unchallenging. It’s also destructive, which is the point. Bad ideas grow like weeds in the shade, or whatever the saying is. Disability issues are another place where the Grey Lady is very picky about what ideas to consider, and as usual they set the rhythm for many other publications.

This weekend the Times released a long piece looking at the ever-escalating rates of ADHD diagnoses and what exactly they tell us. What’s in the piece is fine - of course, the ADHD activist class doesn’t like it - but what’s remarkable is what isn’t in it. Once again, there’s just about zero consideration of ADHD as a social contagion, any recognition that there is now a vast and deeply annoying ADHD culture online that acts as a kind of evangelical movement for a neurodevelopment disorder. There are millions of people on ADHD TikTok and ADHD Tumblr and ADHD Twitter. There’s a vast universe of facile memes, dubious statistics, and self-flattering nostrums about ADHD floating around out there, and increasingly they’re penetrating into broader internet culture. (I am genuinely unaware of a subculture that is more directly and shamelessly self-celebrating than the online ADHD community, and I’ve read the comments at LessWrong.) Unsurprisingly, a big subsidiary industry has sprung up, with all kinds of products and services for sale, books and apparel and tchotchkes and conferences and boutique forms of therapy and exclusive members-only Discords…. Whether neurodevelopmental disorders should have merch is an open question. What’s not subject to questioning is that this is happening. Five minutes of cursory searching would reveal the remarkable scope of online ADHD culture.

And yet the piece’s author, Paul Tough, is just about totally silent on this glaring reality. I find it genuinely bizarre. In a long and rambling (in a good way) piece where he kicks the various rocks of ADHD and asks good-faith questions about how diagnostic rules and social perception of the disorder influence medical practice, he still somehow fails to ever refer to the large, influential, and growing online movement that has raised the profile of the disorder even beyond its prior notoriety and in doing so injected a ton of money into the equation. You can dismiss that community as an online sideshow if you choose, but of course the online world has become profoundly influential on real life, and in other contexts neither the New York Times specifically nor the elite media generally has any problem acknowledging that fact. Why not here?

This tendency extends beyond ADHD. Recently Holden Thorp, editor in chief of the prestigious journal Science, wrote an essay for the NYT that explores the rise of autism diagnoses, which have expanded at truly ludicrous rates. To the extent that it’s referenced at all, the idea of social contagion is dismissed without argument. A couple years ago the Times published a piece by Azeen Ghorayshi about the absurd case of Tourette’s spreading (or “spreading”) among too-online adolescent girls via TikTok; though Ghorayshi is admirably clear that those young women did not in fact have Tourette’s, her piece is also slavishly, almost comically sympathetic to them, never bothering to suggest that maybe these were just bored teenagers who engaged in a frivolous and offensive bit of minstrelsy. (Imagine, judging teenagers for doing something stupid!) The idea that anyone could ever have unserious and wrongheaded motivations for adopting a disability seems to be one of those stories that the New York Times absolutely refuses to tell.

But why? People make up fake illnesses all the time, both consciously and unconsciously. Factitious disorders are real; we have references to what we might now call psychosomatic illnesses that stretch back to antiquity. Munchausen by internet is real. Hypochondria, factitious illness, Munchausen’s, the worried well… these have represented a major challenge for psychiatry for as long as the field has been formalized and integrated into the larger medical project. Why does no one ever talk about this stuff in our stuffy elite publications? Why do so many people in our media dance and shuffle rather than ask direct questions like “How many of these diagnoses are fundamentally faulty?” Why can’t anyone point out that saying you have a medical disorder is a shortcut to getting sympathy and attention, and that human beings crave sympathy and attention the way they crave water and air? We’ve lived through something like a “vibe shift,” and previously-unchallengeable social justice pieties are increasingly challenged, in good ways and bad. Yet under the broad umbrella of disability rhetoric, it’s always 2018, with both traditional and social media operating under a cloud of fear of giving offense. As I’ve said many times, the number of people who privately agree with me about all this is legion. The number who are willing to say so publicly are very few indeed. Nobody wants to paint that target on their back, I suppose. But why do these issues make people feel like targets at all?

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Consider the conditions here.

• We are told, with great aggression, that there’s nothing wrong with ADHD or autism, that having those conditions is not in any sense a negative but instead simply a different way of being; however,

• We are simultaneously told that people with autism and ADHD have an absolute right to demand formal legal accommodation and informal social deference from people around them, despite the fact that accommodation is only logically owed to people whose conditions are disabling

• That same class that demands these direct and material advantages for people who claim to have ADHD or autism also insist, with absolute fury, that self-diagnosis is 100% as legitimate and reliable and meaningful as diagnosis by a doctor, and any statement otherwise is an act of bigotry

• When it comes to formal diagnosis, doctors that are approached by diagnosis-seeking patients have every incentive to give them their preferred diagnosis and direct disincentives not to; a patient who is told no will simply secure that diagnosis from another doctor, while those doctors who resist will receive negative online reviews and potentially even more headaches

• Diagnostic criteria for these disorders, at least in the public imagination and in the discursive spaces where they spread most quickly, have become laughably loose, with vast lists of potential symptoms that are vaguely worded and broadly defined, leading to a scenario where no living human being would be incapable of asserting that they fit the criteria

• It’s now utterly common for people with and without these disorders to proclaim them to be superpowers, the “next phase of human evolution,” a generally superior way of experiencing life, or similar

• Contemporary social norms about disability leave most people, including most medical personnel, scared to push back about any of this; the effort simply isn’t worth the potential damage to reputation and career.

With ADHD you can add the fact that amphetamines and their analogs are fun to take (hence their status as drugs of abuse) and that making the consumer choice to have ADHD gives you access to amphetamines; with both you can add the fact that a growing number of employers seem to view them as professionally advantageous traits in job applicants and employees, at least among dubiously-afflicted applicants. (An inevitable and ugly part of the popularization and casualization of these disorders is that the people who are actually badly afflicted by them become marginal in their spaces, the gentrification of disability.) Under these conditions, how could we not expect to see spiraling diagnosis rates? How could anyone think that the relentless upward trend is mysterious? I understand the temptation to dismiss this all as internet nonsense. But there are literally millions of people in these communities, they are aggressive in their messaging, they are very sophisticated in using online networks, and they are shameless about attacking critics as “ableist.” It all adds up and it all matters.

As I’ve suggested, the ultimate reason that nobody challenges this is that we still live in the shadow of a social justice liberalism that cultivates fear over being perceived to violate its norms, and the unusual aggression of disability activists makes that fear feel particularly acute to others. This is a classic example of “I’m not getting involved in that mess” politics. It’s also been suggested to me that people don’t want to ask any hard questions about these dynamics because they want to defer to those who have disabilities when it comes to disability. This is dumb and unworkable; these conditions and their accommodations are policy-loaded and demand public review, and standpoint theory is still just wrong. What’s more, that attitude begs the question. Whether these people actually are afflicted with disabilities is precisely the issue of controversy.

I of course have my own set of idiosyncratic reasons for being so invested in all of this. I have personal exposure to disability, treatment, and the rhetoric that surrounds both that colors my interest. I will happily admit to being a bit of a crank when it comes to this issue, as I don’t mind being a crank when I’m right. You can insist as many do that this is not work fighting over, a common approach in the world of self-defensive liberalism, but I have spent thousands of words articulating why it all matters. But even were I not me, even if I did not have my own peculiar set of interests and connections, I would still find this whole situation curious. Surely the remarkable rise of disability-as-identity and the positively vast worlds of ADHD and autism as social communities are worth discussing in these contexts? Isn’t an army of highly-motivated online types spreading the Gospel of “neurodiversity” an inherently newsworthy part of the question of why, exactly, disorders that have no objective tests and endless-evolving diagnostic criteria have become vastly more prevalent?

I would suggest that the answer to those questions is yes. Maybe exploring them would only lead a New York Times writer to conclude that social contagion plays no role. I would disagree. But I would still be happy if they would bother to ask.