While I agree with viewing health holistically and treating the person, not the disease, I felt uncomfortable with some of the conclusions that Suzanne O’Sullivan draws from the cases presented (Are we less healthy than we used to be – or overdiagnosing illness?, 1 March). Implying that we are overdiagnosing certain conditions only reinforces the stigma associated with them, and will prevent people in need from being taken seriously and receiving appropriate support and treatment. The scepticism, however well-meaning, can be damaging for patient outcomes and public health in general. Treatments and support available for conditions such as ADHD and autism are already lacking and underresearched.
The rise of diagnostic levels of most of these conditions comes from increased awareness, and also from the environmental changes in our society that place ever-increasing pressure on individuals to perform at a certain standard. Neurodiversity conditions have become a lot more debilitating for those experiencing them. Increased population density exposes individuals to more stimuli than their nervous system can handle. Technological progress, particularly the advent of smartphones, has led to an expectation of being always available and a pressure to react and respond in real time that did not exist 20 years ago.
The solutions to the problematic rise of diagnoses, then, must also be societal. Individual adjustments, as seen in the case of Anna in the article, can only help to a degree, and for some it may not be enough to allow them to be fully functioning in society. There needs to be a recognition that some of the narratives shaping our society today are actively preventing a significant part of the population from being able to fully contribute. Placing the onus on the struggling individual is unhelpful.
Diana Anisimova
London
• Suzanne O’Sullivan’s 2015 book, It’s All in Your Head, made a huge impact. We psychotherapists felt this doctor was singing our song – the power of the mind over the body. Her powerful case studies demonstrated the psychological underpinnings of medically unexplained diagnoses. Nine years later, O’Sullivan writes of the startling rise in the diagnosis of mental health disorders: “We are not getting sicker – we are attributing more to sickness.”
I wonder if we need to think in broader terms about what is needed now for our sickness. If our bodies are screaming in distress, what is not being heard? Psychotherapy offers an environment in which people can and do heal and change. Through understanding and care, our most basic human needs are met. This transformational process is very different from diagnosis. It offers an exploration that tries to understand why we are the way we are, and not rush to conclusions.
I can understand why taking the diagnostic route is tempting. But I have always believed that psychotherapy is, in the words of Stephen M Johnson, “the hard work miracle”. Hard work in the sense that facing pain is not for the faint-hearted: opening up our vulnerability, being honest about our inner conflicts and entrusting ourselves to someone else are acts of bravery. And a miracle in that, with patience and time, the good stuff starts to make an impact.
When we feel understood and accepted, and start to apply this to ourselves with compassion, the painful parts of the self settle down in peace and coherence. We can relax and feel safe in the world. These are the qualities, so much in short supply, that could be a salve for our current sickness.
Philippa Smethurst
Duns Tew, Oxfordshire
• The extract from Suzanne O’Sullivan’s new book, The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far, that you published lays bare a patronising attitude that many healthcare professionals take towards neurodivergent people. She has spoken to scores of people diagnosed with autism or ADHD – all of whom have said their lives were better for it. Yet she wants to discourage diagnosis.
Why? Because she worries about their future, noting that many left jobs, dropped out of education, or lost friends. It seemingly never occurs to her that these changes might be deliberate, even positive. As an autistic person, my diagnosis empowered me to leave a high‑stress career in London and start a fulfilling online business, where I can work alone, from home. It also helped me cut out unhealthy friendships and build a life that genuinely suits me. Others have done the same, not out of helplessness but choice. O’Sullivan and her colleagues should try listening to their patients. And when neurodivergent people say they’re happier, they should believe them.
Name and address supplied
• I feel Suzanne O’Sullivan overlooks the anxiety and distress people who are neurodivergent have in trying to function in a world that often makes little sense to them. This can lead to profound feelings of isolation, which in turn can lead to problematic behaviours for society. And for an individual struggling like this, even suicide. I feel this is being largely sidelined here.
If there is no diagnosis, there is a missed opportunity for helpful therapy and a better understanding of their struggle, both for themselves and those around them. People need to feel seen and heard, and when this is absent there can be profound implications for us all. So “pathologising”, with its implication of overdiagnosing symptoms, would not be the goal but perhaps the way the health and education systems work – without a diagnosis, no help is available.
From a neurodivergent person’s point of view, a great deal of relief may come from a recognition that they are facing real difficulties. I agree that to see mental health problems as a person’s response to a threat to themselves can be a useful and compassionate approach. But if their struggles are profound and enduring over a lifetime, it still needs to be recognised, and we have a duty to offer treatment where possible.
Anne Sanachan
Edzell, Angus
• I was disappointed by this edited extract from Suzanne O’Sullivan’s book. As a disabled specialist psychotherapist working with neurodivergent and chronically ill clients, I feel that her representations need challenging. While I agree with the importance of hope and dangers of pathologising common experiences, she ignores the role inequality and social context play in health. She minimises the disabling impact that chronic conditions can have in the absence of mainstream understanding of their complexity; the medical gaslighting she scorns is all too common, and her simplification of the potential for improvement shows a striking ignorance of average experiences.
These misrepresentations can, ironically, contribute to the lack of hope and disabling impacts she mentions. With a failing NHS and lack of specialist support, the validation of a diagnosis can be all a person has, if they can get one at all.
Elizabeth Turp
Liverpool
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