As per part 1, 2, 3 & 4 of this series. I'm not qualified, but qualified professionals are almost certainly available to you. Everything I present here is opinion, the product of my experience and susceptable to every cognitive bias and distortion available.
The 2010's for me was very much the decade of meeting people and having them tell me that they "have anxiety" it's a decade where the meme 'trigger warning' went viral, and it hasn't gone away, but if you see it at all it will probably be abbreviated to 'TW' or 'CW' (Content Warning).
These were clues, breadcrumbs, that there was something going on of a different kind, but it took me 5 or so years to follow those breadcrumbs out of the forest.
By happenstance 6 years ago I had a panic-attack, or at least I think I did, I got it diagnosed by a social worker friend who put me onto the book 'i-brainmap' by Rita McInnes that explained what was going on physiologically, the neuro-anatomy and implicit memory and how to use mindfulness techniques to work out my hippocampus and how to consciously react to physical emotional states.
But it explicitly stated that identifying triggers and avoiding them was counterproductive. Which gave me an uncanny advantage in having a bullshit detector for the many suedo-scientific memes spreading via social media about approaching mental health.
That was trigger warnings what about the explosion in people 'having anxiety'. This seriously would come up in the first conversations I was having with strangers, they were readily disclosing it. In the early days, this made an impression on me, my naive assumption was that an awful lot of kids these days were undergoing psychotherapy, and something must be going on in the environment, likely the education sector but maybe also increased working hours and less parenting hours, to induce clinical levels of anxiety.
I reflect now that this was all likely horseshit. Though I know of only one concrete case of a person reporting they 'have anxiety' and then learning they had never seen a clinical psychologist or other professional qualified to diagnose, the big give away is that 'anxiety' is not a diagnosis.
Anxious Personality Disorder is a diagnosis, Generalized Anxiety Disorder is a diagnosis, Obsessive Cumpulsive Disorder is a diagnosis. I will even grant to my limited understanding that under an OCEAN personality test, properly administered one could be assessed as being high in trait neuroticism. 'Anxiety' however is a normal human emotion, all the people reporting that they 'have anxiety' impressed upon me so greatly that it was an actual thing diagnosed by actual professionals that I was convinced I couldn't be anxious because I definitely didn't have this disorder.
I had to learn, that of course I would feel anxious, it is a normal and appropriate response to states of uncertainty. It is probably unavoidable. What most likely was happening in the early 2010s, was a meme was spreading, people were diagnosing themselves and then sharing their diagnosis leading to more self-diagnoses. I suspect, but have not proved and won't that what was at work was much the same as this memorable Chris Rock bit:
People were identifying absolutely ordinary mental-emotional behavior as symptoms of some condition - yeah awaiting consequential test results makes me feel nervous, I also don't like turning up to a party alone in case I don't know anybody or nobody else is there, when my workplace sets unachievable minimum expected performance rates I find myself worrying about my job security too, the news makes me really worried about the future when I hear it - congratulations, your diagnosis is* that you are completely ordinary as regards these responses to stimuli.
*I'm not qualified to diagnose you, I'm not qualified to diagnose me. That's kind of the point I'm trying to make.
There's a beguiling question of why would anyone self-diagnose, so I feel through a lack of imagination I'll go through the 'pros' and cons.
Scare Quote "Pros"
The first is having the autonomy to pick the diagnosis you would prefer. By medical analogy you could diagnose yourself as having a rhinovirus (common cold) instead of Covid-19 (you may have heard about it). In a mental health scenario, you could diagnose yourself as having 'Dragon Energy' rather than a diagnosis of Grandiose Narcissism.
Following from that, generally a diagnosis implies treatment. Qualified professionals are often obliged ethically if not legally to prescribe a treatment plan that has been shown most effective. Individuals can devise their own treatment plans. In the case of a non-diagnosis of 'having anxiety' can result in treatment plans that include drinking alone, regular consultation with reddit sub-threads, and avoiding social events. Self diagnosis of having too much negative energy can result in treatment plans involving quartz crystals and rebirthing ceremonies.
As Gordon Livingston M.D. points out in 'Too Soon Old, Too Late Smart' a benefit of an ongoing sickness is that sickness is a responsibility relieving state. We have seen accomodation of mental health issues masquerading as treatment - Emotional Support Animals, Trigger Warnings, Ghosting. Suddenly it becomes incumbent upon the community to bare the cost of our Mental Health Issues in a manner that regards our Mental Health Issue as an immutable fact, denying the fact that treatments are available including CBT, Mindfulness, Exposure Response Prevention therapy, Group Therapy, Alcholics Anonymous, etc.
This is super wild speculation on my part, so put on your skepticles, but to a degree I suspect there's an element of a subclinical Munchausen syndrome where there's a slight thrill or buzz to letting someone know you are special via a self-diagnosed debilitating condition. Particularly as you outline all the things you require to accommodate your condition.
Cons
Firstly, I would feel bad if I didn't point out the above 'pros' are in fact all in the long-run cons. 2020 I invite you to consider is a year where almost every person on earth has been put out by self-diagnostics and particularly self-devised treatment plans.
I also invite you to reflect upon a mental exercise to help point to and hopefully mitigate our own exceptionalism, they both come from Sam Harris [paraphrasing] - "In the emergency room, it is appropriate for me to prioritize my daughter, but we do not want to live in a society where the triage nurse shares my priorities as a father." and "People need to understand that it cannot be up to you to decide whether you should be placed under arrest or not..."
The most basic failure of empathy is to assume other people can see the contents of our minds and accept it to be as reasonable and ordered as we do. There's obviously a threshold at which self-diagnosis is fine, that threshold is 'Something isn't right' and the prescribed treatment is 'I should talk to somebody qualified.'
A self-diagnosis simultaneously concedes that something is wrong while shrugging off any responsibility you have to yourself and others who care about you, or have to deal with you, to do something about it.
Inappropriate treatment plans can be lethal. Common high-risk prescriptions are - eating disorders, self harm, self-medication via illicit or controlled substances, a relationship, a baby, another baby, yet more babies, retail therapy, auto-erotic asphyxiation etc.
You set an example for other individuals, and influence them to not take their own mental health seriously. (remind you of any world leaders in 2020?)
It runs a high risk of imposing the costs of an issue you could potentially resolve on others.
The tricky thing to navigate in my experience, is that the natural and socially acceptable response to ailment, suffering and hardship is sympathy and compassion. (hence the sub-clinical Munchausen tendency) But that inclination to compassion has to be tamped down if we want to achieve better outcomes. Consider the following scenario:
Dave: 'Hi, how do you know Pete?'
Steve: 'Shit, I've known Pete for like ten years, we used to work at JB-Hifi together. What's your connection?'
Dave: 'Also I work colleague, I work with him now, across from his cubicle in the programmers section. You been to one of his parties before?'
Steve: 'A bunch, but not for a while. You?'
Dave: 'No it's my first, what are they usually like? What's the scene?'
Steve: 'Well, he used to real out a karaoke machine, I don't know if he plans to again tonight, it isn't out. I mean we did MDMA all the time back then too, but that was when we had casual shifts, know what I mean.'
Dave: 'Oh gosh, I hope my Dave's Syndrome doesn't flare up if there's karaoke later...'
Steve: 'Dave's Syndrome? What's that?'
Dave: 'I have it pretty bad, it basically means I can't handle fan recreations of IP...'
Steve: 'Is that a real thing?'
Dave: 'Yeah, but it's pretty rare. Like 1 in 7 billion or something.'
Steve: 'Well that sucks, what do you do? I mean like, how do you manage it.'
Dave: 'Well education mostly you know, I let people know about it, how to avoid setting it off.'
Where can the exchange go from here? It's an argumentum ad absurdum I grant you but for the purposes of illustration. It's more obvious in this example that Steve should further interrogate Dave's claims, but when someone is hitting you with the 'information' they have Anxiety, PTSD, OCD etc and it doesn't come with the prefix 'I've been formally diagnosed with...' then we should interrogate.
It was my propensity to just accept at face value people's claims that took me 5 years to piece together that I had been hearing self-diagnoses.
Now I want to introduce a mitigating factor into this narrative. I was a teenager in the 90s when ADD was a big thing (later ADHD) and quite controversial. I simply lack the expertise to comment on this construct. I believe it is a real, but possibly overdiagnosed phenomena. I would actually like medicine to reach a space where a fMRI or something can detect a fairly objective level of activity or lack there of in the relevant activity center in the brain for attention, impulse control etc.
That taking amphetamines improves a patients ability to concentrate is not sufficiently convincing to me, because I imagine that anybody can focus better on amphetamines.
The point at which I get skeptical is when drugs are prescribed, but this for me is a personal prejudice.
What I'd be ready and willing to believe is that particularly in wealthier socio-economic groups a bunch of kids get sent to psychologists and psychiatrists and come away with convenient diagnostics that produce things like 'consideration of disadvantage' for their assessment and tertiary placement application, or drugs that conveniently mitigate symptoms and accomodate a parental work-life imbalance or marital dissatisfaction.
What needs must be pointed out is that every job that recruits humans to fulfill its function is going to be prone to incompetence. Surgeons are rigorously trained in high compliance industries, yet medical malpractice suits still exist. The Army has quite a rigorous selection process, and yet the army still produces spectacular cock-ups and scandals. Priests have studied the inspired word of God closer than anybody and are allegedly closest to the omniscient, omnipotent, omnipresent creator of the universe and speak with His authority, yet put their dicks in children.
So, chances are you will get unscrupulous Psychologists and Psychiatrists out there. I mean we know that the incidence with which counsellors enter sexual relationships with clients is not zero. They get stripped of licenses, involved in court cases and other dubious practices, because they are people.
But as will be the theme of the next post, the selection process is still a damn site better than how you came to be hired to fulfill the function of you, and how you picked your parents and friends. It's also a second opinion.
This shall be my final thought and is something I often think about as a strange cognitive disonance.
If we notice a lump on our skin, we want a doctor to tell us it's just acne, or a sun spot, liver spot, healthy mole etc. We don't want them to go... 'ooh that's weird. Never seen something like that before... we better run some tests, take a biopsy.'
Conversely, I suspect with mental health we are deathly afraid to hear from our counsellor 'yep, what your going through is a grieving process, your relationship breakdown is like a thousand others I've seen. They made a decision that effects you, that you weren't a part of, it blindsided you and it's going to take time to adjust to your new reality. Here's some reading material and a list of things you can do to calm your mind, help you relax and sleep better.'
Or 'Sounds like you have an anxious-preoccupied attachment style, some of your ex partners may have described you as "needy" generally this is how someone feels in a relationship when they like their partner but don't like themselves. We're going to work on your self image and how to build positive regard.'
I suspect people do want to hear from their psychologist 'Wow! What a unique and compelling case. I've never heard anything like it before, we need to run some tests.'
Perhaps the great fear is that we'll have to do work. Perhaps the great fear is discovering our lives could have been different and for the better.
I personally don't understand the allure of self-diagnosis. Certainly have your opinions, be on guard, but open to persuasion.
What I feel I come across again and again is people choosing a familiar pain over a painful healing process. A constant ache rather than a short sharp pain and then clarity.
Self-diagnosis has broader applications than mental health. I find in arguments with my friends I'm increasingly leaning on pointing out 'we have shared values and different diagnoses of the problem.' to keep conversations civil. But even when we are diagnosing the problem with the economy, the election, schools, child rearing, society etc. the propensity to self-diagnose based on limited perspective and intuition also impacts adversely on our mental health, and collective mental health.
I've spent much of lockdown trying to explain MMT and the difference between public and private sector debt to my parents, It inspires the following example of self-diagnostics and its adverse effect - for context it's a lay member of the public speaking to a panel that includes a professor of economics demonstrating how common intuitions lead to terrible policies like austerity, which prey on lay people's intuitive diagnostic skills:
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