Undiagnosing, The Algorithmic Self, Psychiatry Drama
[Friday link party!]
Hello and welcome to the Friday link party, a collection of interesting stuff I found this week and think you should check out, too. I have included the highlights because I know you’re busy!
Because Your Algorithm Says So, The Cut
You know that feeling that the algorithm knows you better than you know yourself? It doesn’t, but it’s becoming a feedback loop for self-awareness in the modern age nonetheless.
If you’ve ever read a horoscope that made you feel a wave of dread (or made you annoyed at the idea of having your fate handed to you), then you can see how our relationship to these algorithms and astrology are similar. In a blog post, astrologer Alice Sparkly Kat offers some useful insights on how algorithms see us: “The predictable person that the algorithm imagines you to be is a corporate fiction.” Sparkly Kat writes that, somewhat similarly, astrology is a language that can help people describe themselves, “but it is also a technology that can try to tell you who you are.” Once upon a time, astrology was invoked to reduce the whole of a person to what the stars said they were. We are not our sun signs, nor are we who our algorithms say we are.
I wrote a very long (more philosophical) analysis of this kind of marketing back in September, and I would just like to say, for the record! that I called it!!
TikTok users are beginning to notice the influx of advertisements attempting to convince users that they have and should be medicated for ADHD. One user wrote in overlaid text “pharmaceutical companies after running tiktok ads to convince children they need to start ADHD meds” with the song Major Bag Alert playing in the background (implying that the companies see this as an opportunity to make a profit).
Another user screen-recorded their feed to show that right after the video calling out the predatory advertisements appeared on their For You Page, they immediately received an advertisement from Cerebral with the text “I think I have ADHD but I’m too nervous to talk to a doctor.”
[Here’s the tiktok they’re talking about]
A great essay in my favorite newsletter that echoes a piece of advice I give people on the regular — that it can be far more helpful to focus on understanding your feelings and experiences rather than a DSM label:
Once a seventh diagnosis was suggested—ADHD—I hit diagnosis burnout. I wasn't doing any better. No new diagnosis or medication moved me towards healing. Frequently the medication shifts only made me more unstable, and masked life problems like abusive relationships that worsened the instability.
My new therapist was on board. They put down whatever diagnosis I needed as a tool on paper, which lived separately from my treatment plan. We ditched symptom language. I wanted to see what it would take to make my life better without the framework of symptoms and categories. What could we learn by just looking at me holistically, as a person and within the world?
Neurobiological Explanations Can Foreclose Self-Understanding, Mad In America
Some academic talk to complement that personal essay:
…the appeal to neurobiological mechanisms forecloses other possible understandings of causes of our suffering, which in turn can promote conformity to dominant cultural values and definitions of the “good life,” as well as close off other imaginaries of recovery, therapy, and change. It can also narrow our horizons for imagining agency, acceptable human variability, and difference.
Critical psych twitter is my favorite hole to wriggle down on the bird app, and I’ve been following their debates in real time over the past few weeks. (Nothing gives me more pleasure than watching my favorite scholars dunk on their rivals.) This article is a pretty balanced summary of the history, main points and important players in the current psychiatry drama, sandwiched by a couple good human interest stories.
When the most recent edition of the DSM was published in 2013 (the next is due in March 2022), it was met with a strong backlash – especially in the UK. The British Psychological Society (BPS), which has 50,000 members, condemned diagnosis altogether. Lucy Johnstone co-wrote a BPS “position statement” with ten others, demanding a “paradigm shift… towards a conceptual system that is no longer based on a disease model”.
One of the most high-profile critics of the DSM-5 was Allen Frances, the American psychiatrist who oversaw the development of the DSM-4. In 2013, Frances published a book called Saving Normal, which argued that for decades the DSM (and Big Pharma) had driven rampant diagnostic inflation. (He wrote that he had tried to be conservative when working on the DSM-4, but that it nonetheless triggered “epidemics” of certain illnesses: ADHD diagnoses tripled in its wake; autism diagnoses increased 20-fold; and, among children, bipolar disorder diagnoses increased 40-fold.)
Nonetheless, Frances has little time for critical psychologists, dismissing their statements as “pie-in-the-sky stuff with no real-world foundation”. When we spoke on the phone, he said that the DSM’s flaws are not reason enough to abandon diagnosis. Psychiatrists need these criteria to help determine if a patient’s problems are the result of a physical illness, he said, or a reaction to illegal or prescription drugs, and to guide treatment.
But he will admit that the manual is a crude tool: “I don’t trust people who worship the DSM as a bible. That’s a reductionistic way of looking at things. As Hippocrates said 2,500 years ago, it’s more important to know the patient who has the disease than the disease the person has,” he said. In Frances’s view, critical psychiatry would be better thought of as a complementary rather than a contradictory position: “Conceptually, it doesn’t take a genius to say we should have a model that stands on four legs: biological, psychological, social and spiritual.”
What would it look like if we abandoned the idea of mental illness? In 2018, Lucy Johnstone and the psychologist Mary Boyle published a model they said could provide an alternative to diagnosis: the “Power Threat Meaning Framework” (PTMF). Developed with former patients, it is based on inter-related questions, such as: how is power operating in your life? What kind of threats does this pose? Instead of symptoms, the framework invites people to think of “threat responses”; instead of disorders, there are “general patterns” of behaviour.
[Bonus: here’s a podcast where Lucy Johnstone explains the PTMF]
Surprisingly not a terrible article on autism in a mainstream news outlet!
Oxana is an assistant psychologist. “Being autistic for me means that I am on high alert most of the time,” she says. “I tend to overthink social interactions, notice patterns of behaviour, have an excessive urge to understand systems and organisations. This makes me a good therapist because I ask a lot of questions and facilitate patients to find their own truth. I do not have any preconceived notions of one ‘right’ way to solve their problems.”
But she wouldn’t dream of disclosing her autism. “I have witnessed how professionals would discuss someone autistic and doubt their abilities,” she says. “I feel that instead of gaining credibility for going through any mental health or neurodiverse difference, I might actually lose some.”