Is “overdiagnosis” the new culture-war buzzword of choice? I had been wondering this for a while, and then Wes Streeting claimed on Sunday that there is an “overdiagnosis” of some mental health conditions. Now I am certain it is.
I first noticed the term being used in relation to anxiety and depression, then attention deficit hyperactivity disorder (ADHD) and most recently autism. Two books on overdiagnosis, Suzanne O’Sullivan’s The Age of Diagnosis and Searching for Normal by Sami Timimi, have garnered attention across the media, adding fuel to a new fire that we might characterise as “Bloody everyone has a label these days, don’t they?”.
This is not to say that these authors and medical professionals don’t have valid points, or that the medicalisation of societal issues isn’t of concern. We all know how “therapy speak” has leached into public discourse, how teens are now throwing around terms such as “trauma response” and “stimming” – lifted from earnest TikToks – with a confidence that must seem startling to some of their elders, who grew up with the idea that you only went to a shrink or a counsellor if there was something “wrong” with you, or you were about to get divorced.
There is a generational aspect here, though really the divide is determined by our openness to examining our mental health. In some households, a faultline can develop between those who have had a diagnosis and therapy (often younger), and those who won’t countenance it (often older). Just look at Prince Harry, whose determination, after extensive therapy, to talk about the trauma of his mother’s death was considered ghastly and exhibitionist by those used to the stiff-upper-lip attitude of previous generations of royals. Post-traumatic stress disorder – a diagnosis I have had in the past – is another one of those conditions people like to claim isn’t real.
We have all noticed that the autism spectrum has widened massively in the past three decades, partly owing to the removal of the Asperger’s diagnosis. When my brother was formally diagnosed at four years old, in 1997, you usually had to be what they then called “severe”. Nowadays, there are children who are verbal and able to be in mainstream school who have diagnoses. This surge deserves examination, too. However, I am not one of the people saying this must mean that those people aren’t autistic, or that they don’t face enormous challenges. Heterogenous and multifactoral disorders tend to be that way.
It isn’t the existence of books on overdiagnosis that perturbs me. I have a lot of respect for the opinions of doctors, especially those who ask vital questions about how we treat patients with chronic illness, mental distress and neurodivergence. What is alarming is how the concept of overdiagnosis is being deployed by culture warriors as a battering ram to beat ill and disabled people with, to cast doubt on their diagnoses, to mock them and, in the case of politicians, to justify further punitive cuts to their support systems.
Take this paragraph from a Sunday Times review of Timimi’s book: “Instead of operating on the Socratic principles of doctors talking with patients to find the emotional and historical source of their unhappiness, too many have pivoted to treating mental health like physical health. They diagnose their patients with a ‘disorder’, slap them with a pathologising label (ADHD, autism etc) and medicate them.”
Where to start? The fact that autism and ADHD aren’t mental illnesses? Autism and ADHD are neurodevelopmental disorders (they can both co-occur with mental-health issues). But what I find most troubling is the suggestion that doctors are slapping diagnoses of neurodevelopmental disorders on to patients willy nilly.
Presumably we must now mistrust the neurologists, the developmental paediatricians, the psychiatrists, the geneticists and the speech and occupational therapists involved in a diagnosis? The parents who have noticed that their child is struggling to meet their milestones, the school special educational needs coordinators, and the GPs and health visitors who refer?
The wait for an NHS autism assessment – and the meagre support that may result from it – is more than four years in some trusts. No one is simply “slapping” an autism diagnosis on anybody, at least not in the NHS. I do worry about the private market for diagnosis, though it is worth noting that in order for these diagnoses to be of any use, many boroughs require that they be reviewed by a panel of NHS experts.
Amid all this ill-informed noise about overdiagnosis, there has been little discussion about what it is about Britain that makes so many people struggle to function within it, no real admission of the fact that this country has become quite a depressing place to live, or what has been done to an education system within which anxious and neurodivergent children are simply the canaries in the coalmine.
This culture war places the onus on the individual to function within a brutal society that makes little effort to include or support them. It demonises patients as a starting point, and has real-world effects on people’s lives. It means people having to repeatedly justify their diagnoses or those of their children, even to others in their families. It means people having to fight harder for support for themselves or their children. It means being confronted with people parroting lines like: “ADHD? What he needs is a good smack.” It means a general atmosphere of ignorance and contempt.
Sick people, disabled people and the parents who advocate for their children, as well as the professionals who support them, deserve far better than this unkindness. The measure of our society lies in how we treat our vulnerable. As it stands, it is downright nasty.
Rhiannon Lucy Cosslett is a Guardian columnist
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