What I Wish People Understood About Mental Health Problems
Essay in the New York Times
I have a new opinion piece in the New York Times, “We’re Thinking About Mental Health Diagnoses All Wrong” (gift link for access) (published with several other titles, including “Here’s What Psychiatrists Mean When They Say You Have A.D.H.D.”). It distills into a single public-facing essay several core aspects of what I have been thinking and writing about for years, especially when it comes to the gap between what psychiatric diagnoses are and what the public imagines them to be. The public conversation about mental health has become remarkably sophisticated in some ways and yet remains tethered to a picture of psychopathology that is far too simple: diagnoses as discrete things you either have or don’t have, rooted in identifiable biological malfunctions, waiting to be discovered by the right clinician. Once official psychiatric categories escape the clinic (as they have over the past decades), they have a habit of solidifying into folk psychology. The distance between the flattened story offered and what is actually happening leaves people alienated from their own experience and generates its own backlash in the form of skepticism toward the whole enterprise of diagnosing mental health problems.
The messy reality, as I try to lay out in the piece, is that mental health problems are dimensional, dynamic, shaped by personality and context, and often more meaningfully understood as patterns of distress and disability. None of this makes them less “real” or less deserving of care… if anything, it makes the clinical encounter richer and more honest. I hope the essay reaches people who have been puzzled or frustrated by their diagnostic experiences and offers them a more honest framework for making sense of what they are going through. (A special thanks to my editor, Alex Ellerback!)
The essay generated quite a bit of engagement on the NYT website. There were 586 comments before the discussion was closed. I also responded to a fair number of them. (You can see the comments here but a NYT subscription is needed.)
Hello and welcome to all the new readers who find their way to this substack through NYT! There were many more things I would have liked to include in the essay but wasn’t able to due to limited space. So, I’ll link here to a few other posts exploring various aspects of these issues in more detail that readers, especially new ones, will find relevant.
On how statistical clustering of psychiatric symptoms differs from clustering based on clinical observation
On issues of mental disorders and personal identity
On experience therapeutic relief from diagnosis
On systems thinking in clinical neuroscience
On evolutionary approach to psychiatry (Q&A with Randy Nesse)
On clinical staging (Q&A with Pat McGorry)
On demand-capacity mismatches
On diagnosis as explanation
On the social construction of disorder judgments
On alienation from reductive understandings of diagnosis and treatment (book review of Laura Delano’s Unshrunk)
This is absolutely right on. 👍