#Pathological Diagnosis

[hyperlexichypatia]

Follow up to this post where I was asked about the "Autism presents differently in girls" myth, which is one of my many berserk buttons.

Here is a non-exhaustive list of reasons this concept makes no sense and you should stop saying it:

A. Autistic people are more likely than non-autistic people to be trans, nonbinary, or otherwise gender-non-conforming, so any attempt to group autistic people by binary, birth-assigned gender is even less likely to be accurate than the gender binary already is in the general population.

2. There is absolutely no evidence supporting the "presents differently" theory that could not be better explained by clinician bias.

iii. The alleged "presentation differences" between autistic "girls" and "boys" are just bog-standard gender stereotypes with "autism" plugged in somewhere. "Boys are better at math and science and logic and not having feelings and their dominant emotion is Anger, but girls are better at socializing and caretaking and brushing hair and their dominant emotion is Approval-Seeking." "Huh, that sounds like reactionary sexist hogwash." "No, I mean, autistic boys are better at math and science and logic and not having feelings and their dominant emotion is Anger, but but autistic girls are better at socializing and caretaking and brushing hair and their dominant emotion is Approval-Seeking." "Oh, okay, now it's Objective Science."

four. Sexist bias, including among clinicians, tends to frame "male" neurodivergence as essentially cognitive and "female" neurodivergence as essentially emotional, because, as we all know, Men Think, Women Feel. Psychology is obsessed with the idea that "girls" are universally and inherently self-loathing and self-destructive -- anything a "girl" has trouble with cannot possible be a skill she hasn't learned or an ability she doesn't have, let alone merely a different way of being; she must simply be self-abnegatingly denying herself the thing she cannot do. So a "girl" with the same traits as an "autistic boy" will have those traits attributed to something emotional, like depression, anxiety, bipolar disorder, borderline personality disorder, or eating disorders. "Autistic girls" aren't being "missed" (read as neurotypical); they're having their exact same autistic traits as "autistic boys" being framed as mood disorders instead of neurodevelopmental disabilities.

cinco. Fundamentally, this premise gets completely backward what diagnosis means and why pathologization happens. People are pathologized and diagnosed, with any kind of disability, when they have traits that fall outside the range of traits considered "acceptable" for their position. "It's more acceptable for boys to have meltdowns, so autistic boys have more meltdowns than autistic girls, so the boys get diagnosed with autism" -- No, this doesn't make sense. That's not how diagnosis works. If it were more acceptable for boys to have meltdowns, then boys who have meltdowns would not be getting diagnosed with anything. Their behavior would not be seen as pathological. If "It's more acceptable for boys to have meltdowns" were to explain any kind of diagnosis differential, it would be "Therefore girls who have meltdowns are diagnosed, while boys who have meltdowns are just considered normal boys." And, to be clear, that kind of thing is absolutely a factor in gender differences in diagnosis, but in the opposite direction from how people mean it. Like, as a "girl," I wasn't really expected or pressured to be athletic, so my absolutely abysmal gross motor skills were just shrugged at and not seen as a sign of disability. Can't run or throw? Well, I was a girl, and a nerd to boot. What do you expect? A "boy" with my level of gross motor skills would draw a lot more Concern.

ζ. "Girls are pressured to mimic/mask more than boys are," even if true (debatable), elides over the fact that many autistic "girls" can't "mimic/mask," because they are disabled. They have a disability. Because some of the things their society expects them to be able to do are things that they cannot, in fact, do. "Girls don't have meltdowns because they're not allowed to. Girls don't forget to do essential tasks because they're not allowed to. Girls don't --" Okay but they do. Girls do in fact very much do those things. Because they are disabled. Because they have disabilities. Because there are things they are expected to be able to do, which they cannot, in fact, do. And it's weirdly disability-erasing (ableist) to claim that people simply develop the ability to do things they can't do just because they're expected to.

heptad. Circling back to point A., while I can't prove it, I really think a lot of this "gendered autism" stuff is a way to pathologize and also explain away queerness/transness/gender-non-conformity in diagnosed-autistic kids. "Oh, no, don't worry, the reason your son consistently Fails At Masculinity isn't because he's some kind of sissy; it's actually because he has this Masculine Male Boy Disorder where he just doesn't understand how boys are supposed to behave. Lots of boys have it. No, no, the reason your 12 year old son is kissing his male friend on the mouth isn't because he's gay; he just has a social skills disorder and doesn't know that boys don't kiss their platonic guy mate dude friends. It's a very masculine disability. Elon Musk has it." I know somebody who was told by an Autism Mom that all autistic people are bisexual because "They don't know the difference." Sure, keep telling yourself that.

8️⃣. In the past, when I was less Galaxy Brain Mad Radicalized, I conceptualized the phenomenon of "'Boys' are diagnosed with autism while 'girls' with the exact same traits are diagnosed with depression/anxiety/OCD/BPD/ED" as a phenomenon of "Autistic girls, who objectively are autistic, whose objectively, scientifically correct diagnosis is autism, are misdiagnosed with psych disorders instead." But what neither autistic nor Mad people really want to admit is that "autism" is as arbitrary a diagnostic category as any other. No two human brains are exactly alike. All systems of classification are made up. I happen to think that the proposed explanatory mechanism of "autism" (brain processes sensory input/information differently than average, results in wildly uneven skill development) is generally more accurate than the proposed explanatory mechanism of most psych diagnoses (people are weird somehow and that's bad somehow), but it's still fairly arbitrary. People with autism diagnoses get ABA and people with psych diagnoses get CBT/DBT, and you can argue about which is worse, but ultimately anything with a B in it is fundamentally abusive. Abolish psychiatry.

[chronicsymptomsyndrome]

I’ll never forget my counselor’s face when I said I used to secretly be really into aliens because I was worried that I was one. I thought I must not be from earth. But I must have known how weird that was because I never wanted anyone to find out. I would pull up the wikipedia page for dogs or trees or something, just to have a decoy tab to click to really fast so I wouldn’t risk anyone noticing what I was actually reading about or asking me why.

Anyway I’ve never attempted clinical diagnosis but if a professional ever tries to tell me I’m allistic I will laugh at them so hard and mock their career choice.

Go ahead tell me I don’t seem autistic I dare you

[niranutcake]

The... The compelling urge to write that x y/n fic with Mr Puzzles... To insert the two of them in every meme, pose reference, dialogue prompt and tiktok you saved in your gallery...

But the lack of time (and experience), dammit

Curse you, winter exams! Curse youuuuuuuuu!

[schizoid-hikikomori]

There is an issue with people obsessively pathologizing people and characters in various media.

With the spread of more language that's commonly used in psychology, so much of it is diluted and becomes a trend, to where the original meaning is lost.

Pathologizing can happen in a perceivably positive or negative way depending on the person's intentions: they suggest a diagnosis because it makes them feel more represented or makes a character more relatable to them or adds sympathy. Negatively, it's to enhance villainous traits, to make someone seem like an irredeemable monster, etc.

I don't engage with fandom culture because it is full of menial petty drama that I don't see the point in caring about. Not to mention the constant diagnosing of characters that show anything slightly different from "normal". And it is so often something like autism or ADHD, either as a self projection or a manifestation of stereotypes.

This spreads to real people. This behavior becomes so acceptable with characters that people begin to think they understand how to recognize diagnosable traits in people and armchair diagnosis friends or strangers. Not to mention characters often don't have the same complexity or depth as real people, so pathologizing their behavior is pointless.

People will misinterpret behavior and storytelling choices to better fit their perception. To preach about empathy but never approach this from a different perspective—almost always choosing autism—it's antithetical.

This is based on a discussion I had with a friend of mine. It's such a pattern in fandom spaces which just reinforces my decision to not engage with them.

[psychabolition]

saw ur post about wanting asks

what is ur thoughts on the aspd or maybe cluster b community in general on social media/tumblr? what about cluster b influencers?

honestly I feel like aspd is a diagnosis that most people reject since the reason people get diagnosed with it is that you dont feel bad about an extreme deviancy from societal norms. why would you accept a diagnosis that pathologizes that?Wheres the benefit in that? Especially bc its often in a setting that also criminalizes you and is very obviously forced onto you and thus unwanted (court mandated therapy).

Thats why its always fascinating to me who the demographic of people actually are that accept that diagnosis for themselves and actually view themselves and their experiences the same way their therapists/psychology tells them to. Who finds comfort in this extremely stigmatizing label and the inhumane treatment it accompanies and why ?

I think its mostly people who first found comfort in other labels that are less stigmatizing via the usual "relief of shame that comes with saying that its a disease causing us to not be able to do something that is expected societally instead of feeling like we ARE a bad person for thinking/feeling/doing 'bad/immoral things' and then also accepting an aspd diagnosis as fitting afterwards. Also fitting into several pathologizing labels (=diagnoses) in the first place also means that youve probably experienced more violence (psychiatric abuse/child abuse/social ostracization/patriarchal violence/racism/...) and had/have less community to help you through it and thus also were then less able to find identity and language for the way that youre different from others through a community and a non-conformist way of living together, than others did who might only get labelled w aspd. the social ostracization/lack of community an thus lack of language for our experiences then also makes you more susceptible to accepting an aspd diagnosis since after (self) diagnosis you finally have words for the ways that you deviate from neuronormativity.

But to me the aspd label is the worst possible lens through which we can of interpret our own norm deviancy, honestly. you really notice that with cluster b influencers in general where its really obvious that they think theyre evil irredemable people. Like when they say extremely dehumanizing things about themselves like: "I need supply from people to function otherwise I crash!". they would benefit greatly from trying to humanize their experiences and getting rid off this pathologization that they internalized. I cant even imagine what it means for their personal life to actually say all these things about themselves and others that all literally convey that they are people that are not to be trusted . like they legit say things like "all my relationships are transactional, I use people for my own benefit and I cant feel love for anyone" and expect their friends to still like them? LOL. Like I mean I ALSO fit the aspd criteria haha dont get me wrong but its the worst most dehumanizing way to interpret your own experiences.

though generally I think ppl who are labelled w cluster B PDs are all awesome and I can only hope for all of us that we find new non-stigmatizing depathologized language for ourselves and community through which we can find a real meaningful identity , acceptance and support in our norm-deviancy outside of pathologization via psychology and also healing through a community that holds emotional space and understanding for the abuse and ostracization that we have faced in the past and shows solidarity in our present struggles. I think especially people labelled w aspd are cool as fuck since ,to me, we are literally born anarchists. I often think about what difference it would make if we all got radicalized politically - all psych wards would burn immediatly . Pathologizing us is always a means of trying to neutralize dissent and resistance to the social order. This is why we're perceived as a threat in the first place, because we are one.

Thanks for the ask. I'd love to hear other anti psych opinions on the aspd /cluster b community !

[henrysglock]

no one:

people talking about TFS: we HAVE to make sure everyone knows Henry is extremely empathetic we HAVE to. also we have to make sure everyone knows he’s good at math. that’s important write that down.

[mactiir]

I am tired of being in the DSM-V, please put me in another book. am i irritable, hyperactive and and forgetful because i have adhd or because i am a werewolf on my lunar week. is it the depression or my ancestral curse coming to bear. Is it anxiety or am I haunted by the ghosts of the city around me. let's keep some whimsy in the world plz and not make literally everything about how we're incorrect in some way.

[videoworm]

Hot tip:

If mental illness doesn't get treated properly / don't improve and festers for years it can turn into a personality disorder. Or any kind of trauma disorder. Or whatever. Point is it festers.

[idontmindifuforgetme]

Every time I have a day at the neuro clinic I have sooo many stories for u guys like I really had to go out of my way today not to spam the dash w how this one visit went. So much tea

[owlbelly]

oh i love that in response to me sort of coming out as face blind on a FB post (because it's gotten so much worse that i feel like i do actually need to tell people now), all of my most autistic/ADHD (but mostly autistic) friends are showing up in the comments in support :') <3

we're all talking about not getting diagnosed or even suspecting certain kinds of neurodivergence until adulthood & it's fucking hilarious because i could have told you years ago about these friends being autistic & i bet they also pinged me as ND but not themselves

i still don't think i'm autistic but i really am out here queering the autistic/allistic binary sometimes lmao (obligatory disclaimer it's not a fucking binary. diesemfive categories do not dictate reality)

i'm about to write something for a zine someone's making about sensory issues with food & i'm like. the only non-autistic ARFID person i know. i wish more people were aware of The Cluster, which is my fun term for the autism, ADHD & anxiety Venn diagram that's mostly circle

[shrinkrants]

The rise in psychiatric self-labeling among young people has raised concerns among researchers for its negative impacts on self-esteem, stigma, and distress.

Some have linked this self-diagnosis trend to social media, particularly TikTok, where teen girls are persuaded to identify with and glamorize rare disorders and develop eating disorders to fit in with popular content creators. This is encouraged by for-profit companies too, like Cerebral, who use TikTok to prey on teenage concerns around weight and appearance to promote their diagnosis and medication services.

In the current study, Tse and Haslam linked “concept creep” to that increase in self-diagnosis. Concept creep is when a definition balloons outward over time to encompass more and more. In the psychiatric context specifically, it includes a wider range of behaviors or feelings being considered “disorders” (horizontal creep) as well as milder forms of emotional distress becoming considered a “disorder” (vertical creep).

As an example of concept creep, the new diagnosis of “prolonged grief disorder” (PGD) has been controversial because it now defines people who still mourn their loved ones intensely after just six months to one year as “mentally ill.” Beyond framing a normal part of human experience as a “mental illness,” the diagnosis has also opened to door to the pharmaceutical industry, who claim that grief is an “addiction” that can be treated with addiction drugs.

[badolmen]

My psychiatrist: sorry I need to write this down - I love how you describe your experiences; you’re not a box checker type and the language you use is really insightful

Me: this is good I’m getting a good grade in mental illness. normal to want possible to achieve etc etc.

[chronicsymptomsyndrome]

Someday I’ll get over my weird panic thing about doctors and needles and get blood work done and a doctor will get my results back and be like “holy fuck you’ve been living with untreated _____ and ______ this whole time how are you just now getting diagnosed are you okay??” and I’ll be like noo lol and then everyone that’s ever called me lazy will be suddenly struck by an all-consuming wave of guilt and shame <3 yay

[brinnanza]

I think it's important to resist the urge to pathologize ultimately harmless behavior like maybe you can trace it back to its parent disorder but if it's not harmful to you in any way that isn't a symptom it's just a trait

[wetslug]

something kind of cool about my job is im the first person to know about Good News i.e. when a organ is removed for query cancer but based on appearance i can see itll likely turn out to the benign. its Epic to think about the relief the patient will feel in a couple weeks