E
Elizabeth M. Ellis, Ph.D.
Guest
When I began private practice full time in 1980, people were reluctant to seek treatment for mental disorders because of the “stigma.” Forty five years later, I still hear this trope about the stigma of seeking mental health treatment. It might still be true for a segment of Americans — the elderly, for example, or conservative leaning groups like blue-collar men and those in very “masculine” occupations such as law enforcement, firefighting, and the military. But for today’s youth, the GenXers and theMillennials, and even those under the age of 50, the opposite is true. They call mental health practices seeking a mental health diagnosis, when they do not have the requisite symptoms, nor the suffering, nor the disrupted lives of those who really do suffer from a mental disorder.
I get calls like this,
“I am 48. I get bored in meetings at work. I think I have ADHD.”
“I have terrible fights with my boyfriend. He’s says I’m bipolar. Can I be evaluated for that?”
“My parents fought a lot when I was a kid. I think I have PTSD.”
“I don’t like to socialize with my co-workers at the grocery store. My girlfriend says I’m neurodiverse, I’m on the spectrum. Can you test me for that?”
“I put off studying till the last minute and lose track of some test dates. I think I have ADHD. My roommate has medication for that. Can I get some?”
These calls are problematic for the clinician. The caller has an agenda — the confirmation of a diagnosis. Not just that, but they are expecting to reap certain benefits from the confirmation of their desired diagnosis. Yet, as clinicians we have an obligation to be ethical and not render a diagnosis where there is no basis for one. In fact, rendering a diagnosis when there isn’t a disorder constitutes insurance fraud. People get angry when you don’t confirm their desired diagnosis.
What are the benefits that are to be gained by getting confirmation of their desired diagnosis? This is something I often wonder about at the end of the day.
It could be a way of forming an identity, belonging to a group.
Fifty or sixty years ago, people identified with a group largely along political, racial or religious demarcations, e.g., “I’m a Methodist and a Young Republican.” “I attend the A.M.E. church and vote Democrat.” In American society today, church membership has fallen drastically. Racial groups are so diverse that membership in one conveys little sense of identity. Young adults are largely apolitical.
Yet young adults today still must find their tribe. Does one say, “I’m a runner” or “a Salsa dancer,” “a Bama football fan,”’ or “a dog lover”? Maybe. Much more trendy is, “I’m a vegan,” or “I’m non-binary,” or “I’m an animal rights activist.” There are hundreds of groups one can belong to today in American society which provide one a supportive community of friends with shared values and common interests.
Given those many options, why would choose to join the “ADHD” club? Or the “On the Spectrum” Club? Or the very popular “Neurodiverse Club”? Those are the ones that are popular right now. “The AuDHD club” (a combination of Autism and ADHD) is only about a year old and is trending red hot. OCD and PTSD are trending too but to a lesser extent. (If you don’t think diagnoses follow trends, I can take you back to the 90’s when people called me saying, “I’m an ACOA, an adult child of an alcoholic,” or “My girlfriend says I’m co-dependent,” or “I’m having recovered memories of sexual abuse.” These weren’t exactly diagnoses, they were mental/behavioral conditions largely fabricated by the media. They were debunked and faded away.)
So, why choose a diagnosis tribe to belong to? First of all, the widespread reference to these disorders on the internet, especially social media, has changed how we see them. We no longer see them as types of “mental illness.” In fact, that very term is forbidden. Now, journalists must use more neutral terms like “mental health issues” or “mental challenges.” So, many groups of people in our society now view these disorders as simply variations in human behavior like ice cream flavors or dog breeds. We have become a society that is more psychologically minded than we used to be. We have become more empathic, more understanding. We’re less judgmental. We don’t refer to obesity and alcohol addiction as lapses of character; we refer to them as diseases.
Adopting one of these diagnoses gains one a community of people on social platforms like TikTok, Reddit, and Instagram. Being part of a diagnosis community makes a person more “special” than say, being a bicyclist or an opera fan or sometimes who loves to garden. It implies that one is part of a group of people who have suffered and who deserve our empathy. It taps into our American preoccupation with victimhood. A diagnosis club membership carries with it a sense that someone has been born with a condition they couldn’t help, that they have been misunderstood, subjected to ill treatment. There is a certain nobility to it, a suggestion that they are valiantly striving to overcome their disability or disabling variation.
I have learned that the quest for “specialness” is very much a part of the mindset of youth culture in American society today. I know because when I have used the term “ordinary” to describe a problem a young adult is having, they do not express relief, as they might have 30 years ago; they wince and frown. They are surrounded by young people who have achieved virtually instant success, fame, and fortune for just, well, being themselves, and voila, they became an “influencer,” a “YouTube-er,” or the new one, “Twitch streamer.” I have seen many adolescent boys whose life goal is to be a “professional gamer” — someone who plays video games while being filmed and who earns money when other gamers pay to watch him. They did not have to work hard for four years at a top tier university in order to gain entry into graduate school then spend five years mastering tough coursework and doing original research in order to get a Ph.D. in psychology (as I did), or go through four levels of rigorous training for 18 months to become a Navy Seal, or practice the violin for 2,000 hours to gain entry to an orchestra. All they had to do was take on a diagnosis, and they were instantly “special.”
A psychiatric diagnosis carries perks.
Thirty to forty years ago I met with parents who didn’t want their child to have a diagnosis because “We don’t want him to be labelled.” Now, I encounter parents who want a child to be labelled as “on the spectrum” so that they can be placed in a special education classroom with only 5–7 students per class so the child can get more individualized attention — when their child is not autistic.
Parents want their child who is performing poorly in school to be labelled as having ADHD “so he can take his tests in a quiet room and get longer test times.”
The young man who didn’t care to socialize with his co-workers or speak to customers wanted to be labelled as “on the spectrum” so his boss would let him work in the back of the store, listen to music on his headphones, and ignore everyone.
The student who put off studying to the last minute was hoping to get a diagnosis so he could get a prescription for a stimulant that would help him stay up all night studying before a test the next morning.
I’ve had several people in their 40’s and 50’s call me asking for a PTSD diagnosis so they could get on disability. They had trouble explaining how they have been working for 25 years without being disabled, but are only now experiencing PTSD symptoms that impair their ability to work.
The man who hated the boring sales meetings didn’t ask for it, but I suspect he wanted a letter that would get him excused from the meetings.
In today’s society, an ADHD diagnosis can get you workplace accommodations such as a private office (it’s quieter), more frequent breaks, or permission to work from home (the office setting is too distracting). An anxiety diagnosis for a college student means you get to bring your dog into your dorm room as a “support animal.” The student who didn’t show up for class for two weeks because he was playing World of Warfare continuously can get a diagnosis of depression and get a do-over for the exams he missed.
What is troubling to me as a clinician as the taking on the mantle of a diagnosis when it is not warranted, not only misses the mark but it becomes a way of, well, let’s go ahead and say it, making excuses for one’s not so desirable behavior. To say, “I have ADHD” or “I’m on the spectrum,” is to say, “This is just the way I am. I can’t help it. Don’t be mad at me. Show me concern, show me you understand, give me your validation. Tell me I’m fine just the way I am.”
If one is rude, or is a bore at parties, or is shy and awkward when meeting people for the first time, they don’t have to identify it and work on it in psychotherapy or simply join some social groups so they can practice conversation skills. They can simply say, “Well, I’m on the spectrum.” Case closed.
If one lashes out at others when frustrated, attacking them verbally, cursing them — problems that can be addressed in psychotherapy — they can say, “Well, I have PTSD.” Or “I have BPD (Borderline Personality Disorder.”
Instead of saying, “I’m disorganized, and I was smoking weed every day, so I slapped this presentation together at the last minute,” a student can say, “My talk is not well put together because I have ADHD.” Who can be mad at you if you have ADHD? After all, It’s not your fault if you have ADHD.
Younger people especially often have perfectly ordinary problems in growing up such as poor time management, lack of self-discipline or follow through, procrastination, pursuit of immediate gratification, impulsiveness, or poor judgment. These problems will get better with age and experience. A good psychotherapist or coach can help them get better a little faster. But many would rather say, “Well, I have ADHD, I need medication.” And, that’s that.
The ethical dilemma
So, how am I to say to a parent, “No, your daughter is not on the spectrum. She is a perfectly lovely, shy little girl with average abilities who will probably have to work hard to make B’s and C’s in school.”
The college student doesn’t want to hear me say, “No, you don’t have ADHD. College is harder than high school. You need to stop smoking weed, start using a calendar, and up your game — resolve to study three to four hours a day.”
The business man who hated sales meetings didn’t seem to mind too much that he didn’t have ADHD. He was willing to look at a few strategies to keep him alert and engaged during these meetings, but it was not the easy solution I think he was hoping for.
I gave the young man who worked at the grocery store and who didn’t want to have to talk to people a diagnosis of Social Communication Disorder, but it wasn’t the “neurodiverse” diagnosis he was looking for, and he dropped out of treatment.
I have worked with many people who really do meet all the specific, rigorous criteria for a diagnosis of a mental disorder, and who in fact struggle to achieve a normal, stable life. They deserve our empathy. For them, just getting up and getting through the day takes courage. We do them a disservice when we anoint others who are having ordinary problems in living with the holy water of an undeserved diagnosis.
Elizabeth M. Ellis, Ph.D., clinical psychologist, Atlanta, GA
Continue reading...
I get calls like this,
“I am 48. I get bored in meetings at work. I think I have ADHD.”
“I have terrible fights with my boyfriend. He’s says I’m bipolar. Can I be evaluated for that?”
“My parents fought a lot when I was a kid. I think I have PTSD.”
“I don’t like to socialize with my co-workers at the grocery store. My girlfriend says I’m neurodiverse, I’m on the spectrum. Can you test me for that?”
“I put off studying till the last minute and lose track of some test dates. I think I have ADHD. My roommate has medication for that. Can I get some?”
These calls are problematic for the clinician. The caller has an agenda — the confirmation of a diagnosis. Not just that, but they are expecting to reap certain benefits from the confirmation of their desired diagnosis. Yet, as clinicians we have an obligation to be ethical and not render a diagnosis where there is no basis for one. In fact, rendering a diagnosis when there isn’t a disorder constitutes insurance fraud. People get angry when you don’t confirm their desired diagnosis.
What are the benefits that are to be gained by getting confirmation of their desired diagnosis? This is something I often wonder about at the end of the day.
It could be a way of forming an identity, belonging to a group.
Fifty or sixty years ago, people identified with a group largely along political, racial or religious demarcations, e.g., “I’m a Methodist and a Young Republican.” “I attend the A.M.E. church and vote Democrat.” In American society today, church membership has fallen drastically. Racial groups are so diverse that membership in one conveys little sense of identity. Young adults are largely apolitical.
Yet young adults today still must find their tribe. Does one say, “I’m a runner” or “a Salsa dancer,” “a Bama football fan,”’ or “a dog lover”? Maybe. Much more trendy is, “I’m a vegan,” or “I’m non-binary,” or “I’m an animal rights activist.” There are hundreds of groups one can belong to today in American society which provide one a supportive community of friends with shared values and common interests.
Given those many options, why would choose to join the “ADHD” club? Or the “On the Spectrum” Club? Or the very popular “Neurodiverse Club”? Those are the ones that are popular right now. “The AuDHD club” (a combination of Autism and ADHD) is only about a year old and is trending red hot. OCD and PTSD are trending too but to a lesser extent. (If you don’t think diagnoses follow trends, I can take you back to the 90’s when people called me saying, “I’m an ACOA, an adult child of an alcoholic,” or “My girlfriend says I’m co-dependent,” or “I’m having recovered memories of sexual abuse.” These weren’t exactly diagnoses, they were mental/behavioral conditions largely fabricated by the media. They were debunked and faded away.)
So, why choose a diagnosis tribe to belong to? First of all, the widespread reference to these disorders on the internet, especially social media, has changed how we see them. We no longer see them as types of “mental illness.” In fact, that very term is forbidden. Now, journalists must use more neutral terms like “mental health issues” or “mental challenges.” So, many groups of people in our society now view these disorders as simply variations in human behavior like ice cream flavors or dog breeds. We have become a society that is more psychologically minded than we used to be. We have become more empathic, more understanding. We’re less judgmental. We don’t refer to obesity and alcohol addiction as lapses of character; we refer to them as diseases.
Adopting one of these diagnoses gains one a community of people on social platforms like TikTok, Reddit, and Instagram. Being part of a diagnosis community makes a person more “special” than say, being a bicyclist or an opera fan or sometimes who loves to garden. It implies that one is part of a group of people who have suffered and who deserve our empathy. It taps into our American preoccupation with victimhood. A diagnosis club membership carries with it a sense that someone has been born with a condition they couldn’t help, that they have been misunderstood, subjected to ill treatment. There is a certain nobility to it, a suggestion that they are valiantly striving to overcome their disability or disabling variation.
I have learned that the quest for “specialness” is very much a part of the mindset of youth culture in American society today. I know because when I have used the term “ordinary” to describe a problem a young adult is having, they do not express relief, as they might have 30 years ago; they wince and frown. They are surrounded by young people who have achieved virtually instant success, fame, and fortune for just, well, being themselves, and voila, they became an “influencer,” a “YouTube-er,” or the new one, “Twitch streamer.” I have seen many adolescent boys whose life goal is to be a “professional gamer” — someone who plays video games while being filmed and who earns money when other gamers pay to watch him. They did not have to work hard for four years at a top tier university in order to gain entry into graduate school then spend five years mastering tough coursework and doing original research in order to get a Ph.D. in psychology (as I did), or go through four levels of rigorous training for 18 months to become a Navy Seal, or practice the violin for 2,000 hours to gain entry to an orchestra. All they had to do was take on a diagnosis, and they were instantly “special.”
A psychiatric diagnosis carries perks.
Thirty to forty years ago I met with parents who didn’t want their child to have a diagnosis because “We don’t want him to be labelled.” Now, I encounter parents who want a child to be labelled as “on the spectrum” so that they can be placed in a special education classroom with only 5–7 students per class so the child can get more individualized attention — when their child is not autistic.
Parents want their child who is performing poorly in school to be labelled as having ADHD “so he can take his tests in a quiet room and get longer test times.”
The young man who didn’t care to socialize with his co-workers or speak to customers wanted to be labelled as “on the spectrum” so his boss would let him work in the back of the store, listen to music on his headphones, and ignore everyone.
The student who put off studying to the last minute was hoping to get a diagnosis so he could get a prescription for a stimulant that would help him stay up all night studying before a test the next morning.
I’ve had several people in their 40’s and 50’s call me asking for a PTSD diagnosis so they could get on disability. They had trouble explaining how they have been working for 25 years without being disabled, but are only now experiencing PTSD symptoms that impair their ability to work.
The man who hated the boring sales meetings didn’t ask for it, but I suspect he wanted a letter that would get him excused from the meetings.
In today’s society, an ADHD diagnosis can get you workplace accommodations such as a private office (it’s quieter), more frequent breaks, or permission to work from home (the office setting is too distracting). An anxiety diagnosis for a college student means you get to bring your dog into your dorm room as a “support animal.” The student who didn’t show up for class for two weeks because he was playing World of Warfare continuously can get a diagnosis of depression and get a do-over for the exams he missed.
What is troubling to me as a clinician as the taking on the mantle of a diagnosis when it is not warranted, not only misses the mark but it becomes a way of, well, let’s go ahead and say it, making excuses for one’s not so desirable behavior. To say, “I have ADHD” or “I’m on the spectrum,” is to say, “This is just the way I am. I can’t help it. Don’t be mad at me. Show me concern, show me you understand, give me your validation. Tell me I’m fine just the way I am.”
If one is rude, or is a bore at parties, or is shy and awkward when meeting people for the first time, they don’t have to identify it and work on it in psychotherapy or simply join some social groups so they can practice conversation skills. They can simply say, “Well, I’m on the spectrum.” Case closed.
If one lashes out at others when frustrated, attacking them verbally, cursing them — problems that can be addressed in psychotherapy — they can say, “Well, I have PTSD.” Or “I have BPD (Borderline Personality Disorder.”
Instead of saying, “I’m disorganized, and I was smoking weed every day, so I slapped this presentation together at the last minute,” a student can say, “My talk is not well put together because I have ADHD.” Who can be mad at you if you have ADHD? After all, It’s not your fault if you have ADHD.
Younger people especially often have perfectly ordinary problems in growing up such as poor time management, lack of self-discipline or follow through, procrastination, pursuit of immediate gratification, impulsiveness, or poor judgment. These problems will get better with age and experience. A good psychotherapist or coach can help them get better a little faster. But many would rather say, “Well, I have ADHD, I need medication.” And, that’s that.
The ethical dilemma
So, how am I to say to a parent, “No, your daughter is not on the spectrum. She is a perfectly lovely, shy little girl with average abilities who will probably have to work hard to make B’s and C’s in school.”
The college student doesn’t want to hear me say, “No, you don’t have ADHD. College is harder than high school. You need to stop smoking weed, start using a calendar, and up your game — resolve to study three to four hours a day.”
The business man who hated sales meetings didn’t seem to mind too much that he didn’t have ADHD. He was willing to look at a few strategies to keep him alert and engaged during these meetings, but it was not the easy solution I think he was hoping for.
I gave the young man who worked at the grocery store and who didn’t want to have to talk to people a diagnosis of Social Communication Disorder, but it wasn’t the “neurodiverse” diagnosis he was looking for, and he dropped out of treatment.
I have worked with many people who really do meet all the specific, rigorous criteria for a diagnosis of a mental disorder, and who in fact struggle to achieve a normal, stable life. They deserve our empathy. For them, just getting up and getting through the day takes courage. We do them a disservice when we anoint others who are having ordinary problems in living with the holy water of an undeserved diagnosis.
Elizabeth M. Ellis, Ph.D., clinical psychologist, Atlanta, GA
Continue reading...
