Why I now distance myself from my mental illness diagnoses

Or: TikTok's "aestheticisation of anxiety" and the rise of trauma-as-identity

In the listicle that I did a few weeks back, of all the smart things I’ve learned in 50 years treading this mortal coil, sitting at #23 is:

“Don’t collapse into your diagnosis”

50 lessons I learned the hard way from half a century spinning in Earth's embrace

A few of you told me this wisdom resonated and so today I want to expand on it.

A lot has changed since I first launched what was - back in early 2017 - a controversial conversation around anxiety, framing it beyond the medical model and surfacing this idea that anxiety can actually be a superpower, when modulated right¹.

Anxiety and other mental ills have gone from being things to be “medicated into submission” and privately “dealt with”, to an almost enviable label, “its own genre of popular (social media) content”, as The Atlantic has put it. In the process, anxiety, neurodiversity, PTSD and the like have become “identities”, not just to be celebrated, but to be clung to.

Glorious image by Nick Andréka

Witnessing this sudden twist in the plot has got me doing something very particular - feeling self-conscious for the first time in decades about being a person with several diagnosed mental disorders. It’s an oddly ambivalent feeling - a bit cringe, a bit protective, a bit needing to put an arm’s length between me and the hoo-ha (a bit like how Swifties might have felt yesterday watching Australia’s former Prime Minister Scott Morrison do his farewell speech to Parliament as a series of Taylor Swift lyrics, which you watch on my IG feed here).

Shall we talk all this?²

As a recap, I was diagnosed with Generalised Anxiety when I was 13, with OCD shortly after, and then bipolar (or manic depression as it was called back then) when I was 21. I’m not going to detail all this here; you can catch up on my post This is What Bipolar Looks Like or read my book First, We Make the Beast Beautiful.

Recently I was also diagnosed with Autism Spectrum Disorder and it was suggested that the other conditions potentially fit under this umbrella diagnosis. I have not “spoken out” on this and barely mention it to close ones. In big part because of this ambivalence I mention.

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Some background

Around the western world mental disorder diagnoses are up. Specifically among young people and women. In Australia they’ve soared by nearly 50 per cent in 15 years. The spike is particularly prevalent in the UK. A survey in 2023 found that one in five 8-16-year-old Brits had a probable mental disorder, up from one in eight in 2017. In 17-19-year-olds the figure had increased from one in ten to one in four. As a result, 4.5 million Brits consulted mental-health services in 2021-22, a rise of almost 1 million in five years, while no other European country has seen a greater increase in the use of antidepressants.

Meanwhile, social media is awash with people earnestly sharing about their various angsts and traumas. Once one is in this particularly hysterical algorithmic loop, it can seem like no one is immune from a mental illness in one form or another. Instagram now converses in therapy-speak; the TikTok hashtag #Trauma has more than 6 billion views.

The Atlantic observes:

According to Listen Notes, a podcast search engine, more than 5,500 podcasts have the word trauma in their title. Celebrity media are awash with mental-health testimonials, and summaries of those testimonials, including “39 Celebrities Who Have Opened Up About Mental Health,” “What 22 Celebrities Have Said About Having Depression,” and “12 Times Famous Men Got Real About Mental Health.”

As you can probably guess, the uptick in diagnoses and the dialled up social media hype are related. But let’s piece it out, bit by bit. I’ve been collating information on the topic for a while, trying to get a read on the issue. What follows is a patchwork picture that can hopefully open up a discussion in the comments!

Sigh, “prevalence inflation”

In 2022, two researchers coined this helpful term to describe how when you consume an entire feed of information about anxiety disorders (on TikTok etc) you begin to process normal woes and emotions - call it everyday life - as mental illness. The researchers wrote:

“If people are repeatedly told that mental health problems are common and that they might experience them … they might start to interpret any negative thoughts and feelings through this lens.”

Which can trigger a self-fulfilling spiral: You get hyperaware of the prevalence of anxiety disorders, which sees you process low levels of sadness or angst as signs of a medical disorder, which leads you to engage in behavioural avoidance habits (like #stayinghome), which… dials up anxiety for reals.

(The growth in mental health awareness programs also seem to be “inflating” the prevalence of disorders, for similar reasons. One study of a U.K. mindfulness program found it increased anxiety in the cohort of 8000 teens that were followed.)

Over-self-diagnosis

Let’s return to the UK situation where the uptick in mental disorders is particularly stark.

I think the phenomenon is partly explained by the fact the UK was so far behind in the mental health conversations for decades and is now catching up. Additionally, commentators are describing the vibe in the UK at the moment as, indeed, sad. When I went to revise This One Wild and Precious Life for the publication of the UK edition in September, I stumbled upon some statistics that speak to this: I originally reported on how life expectancy in the US had declined for several years in a row due to “diseases of despair” (suicide and opioid and alcohol abuse). In the UK, the Institute for Fiscal Studies has now reported the same pattern in the UK. The Brits are also getting shorter (height is a marker of a nation’s wellness). British five-year-olds are up to 7cm shorter than kids of the same age in Europe.

Which is a slight digression…

But there’s also this:

Brits are choosing to declare themselves sicker than doctors do.

While medical diagnoses are up somewhat, self-diagnoses have spiked. Almost 60 per cent of university students claim to suffer from a mental-health issue (as opposed to having been diagnosed with one), while over three-quarters of parents with school-age kids sought help or advice online over their child’s mental health in 2021-22. Other studies show Britons increasingly describe grief and stress as mental illnesses.

Why has this suddenly happened? The health care system in the UK has certainly not gone through a dramatic change that has seen more people having access to medical care.

Nope, the answer is social media, particularly TikTok.

It costs to see a doctor to get a diagnosis (and there are horrific waiting lists , particularly in the UK, for doctors who can diagnose conditions like autism). Self diagnoses using via online tools and videos like “6 Signs You May Have A.D.H.D.” and “Signs That You Might Have O.C.D” are free.

As an assistant editor at Reason recently wrote,

“Certain (mental health) diagnoses are treated like zodiac signs or Myers-Briggs types”.

But I think we can go another few layers deeper…

This far in, I’ll add the caveat that of course I think destigmatising anxiety is a great thing. Then I’ll of course flag that using Dr Google or Dr TikTok for anything is dangerous.

And…

now…

let’s talk what I think are the more worrying implications and attendant issues.

First, crippled health care systems globally are a big problem. There need to be more doctors who can diagnose things responsibly.

Next, another structural issue:

A capitalist avoidance strategy

The Economist (ironically?) wrote a detailed sledge of the UK mental health situation, pointing out the vested interests at play in gleaning a diagnoses (self or otherwise). It reports that in 2022 more than a quarter of 16-18-year-olds in British schools were given extra time in official exams because of a mental health condition, while a mental-health problem can also make it easier to get welfare payments in the UK.

Then it gets interesting, per The Economist, my paraphrasing:

Corporates may prefer to label an employee’s “stress” a disorder rather than acknowledging that working conditions are shithouse. The number of people out of work with mental-health conditions has risen by a third between 2019 and 2023.

Similarly, directly quoting this time:

“The highest rates of diagnosed depression occur among England’s poorest people, but the government probably prefers prescribing antidepressants to trying to solve poverty.”

It’s almost a default question to ask with any issues we face today: Is this (insert concern) the real issue, or is it distracting us from the much larger issue at play?

It’s an identity!

There’s one final layer I want to add to this millefuille: Having a mental illness or being neurodivergent has become an identity, the kind that turns political and is weaponised way too readily.

The Reason journalist I refer to above wrote in The New York Times:

“This brand of identity politics creates a perverse incentive to collect as many “disadvantaged” boxes as possible. For those who might otherwise have little cachet under this politics, an identity-defining mental health label offers a claim to oppression. What was once a dry medical label is now what makes one worthy.”

This notion of “a claim to oppression” is something I’ve touched on before, again in relation to identity creation among young people:

The gender-y culture war is hard to wade into. Let's do it.

The Reason journalist adds that this comes with an aestheticising that is dangerous to those who are struggling with the less “Instagram-ready” aspects of having a disorder:

“These influencers show off the most attractive elements of their conditions, epitomizing an aesthetic view of everything from neurodiversity to mental illness. An aestheticized label comes with merch to match (flags, fidget toys, coloring books). There are “happy stimming” autism influencers and pages devoted to twee cartoons about O.C.D. Such aestheticization flattens the difficult reality of living with a psychological or neurological disorder to little more than cutesy products and personality traits.”

“We’re starting to wonder whether it’s time to scale down our mental-health awareness,” says Simon Wessely, a professor of psychiatry at King’s College London. Lucy Foulkes, a psychologist at the University of Oxford and one of the researchers who coined “prevalence inflation” (above), is blunter:

“The campaigns are alienating the very people they are meant to help.”

It’s making it all worse!

Leaving aside the prevalence inflation, which creates a self-fulfilling spiral, and the flattening of the “uglier” side of mental health, this mental-illness-as-identity phenomenon is also stopping people from…moving through their distress and troubles. You know, being able to grow, to mature, to turn their ailment into a superpower. And precisely because they’re choosing to identify as mentally ill, to be their anxiety.

Derek Thompson, writing in The Atlantic, quotes Darby Saxbe, a clinical psychologist at the University of Southern California:

“I worry that for some people, it’s become an identity marker that makes people feel special and unique. That’s a big problem because this modern idea that anxiety is an identity gives people a fixed mindset, telling them this is who they are and will be in the future.”

I discuss this with identity politics and identity fixation with moral philosopher and Director of the Einstein Forum Susan Neiman on Wild a while back:

She points out that “identifying” as something that is fixed (such as your race) limits growth and ability to focus on things that can be adjusted and used to your advantage. (She plants the wild idea that progressives need to abandon wokeism and identities and become truly awake to the real threat - that so much infighting is distracting us from the rise of fascism. “Much as Left infighting enabled Hitler to rise to power in the 1930s,” she says.)

Therapy only works when someone believes their anxiety is treatable, modifiable, and malleable, as opposed to fixed. Therapy is also a lot about avoiding outraged, catastrophic language (the opposite of what goes on online). And it’s about sharing with a third person (not ruminating solo with your iPhone). Oh, and it’s about not dwelling in the negative emotions and becoming overly vigilant (per what happens when the algorithms keep you stuck in one lane).

Studies for yonks have shown these wisdoms to be so. And, yet, here we are, dopamine-driven and doing exactly the opposite of what is best for us.

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There is a lot more to be said. As I flag way, way above, I mostly want to start an interesting conversation here.

I am seeing this through Moloch and collapse lenses, you might too?

The “claim to oppression” factor in the equation is also fascinating to me. You?

And I’m wondering if there are any therapists out there who might want to wade in and suggest some paths forward.

For me, the ambivalence that has crept in as a result of my concerns about this aestheticisation of, and over-identification with, mental illness has not been a bad thing. Per Lesson #23 in my listicle, I’ve been doing whatever is the opposite of collapsing into my diagnoses, which has produced some interesting results. This has included a lot more sitting through terrorising feelings and passing through into new, arguably better places. It feels like another stage of resilience, or adulting.

Rightio, see you in the comments,

Sarah x

1. I’m referring to my book, First, We Make the Beast Beautiful

2. Not the Scomo cringe. God no, no more Scomo cringe.