Has our increasingly therapeutic culture impacted upon our understanding of suffering, and our ability to withstand it?
At the Battle of Ideas Festival in Dublin at the weekend, that question was explored at a session called, ‘Over-Diagnosis? Mental Health’s Expanding Empire.’
On the panel was Professor Patricia Casey, a consultant psychiatrist in liaison psychiatry in the Hermitage Clinic in Dublin. Prof Casey previously worked in the Mater Hospital for several decades in her role as professor of psychiatry at University College Dublin. Also speaking at that session was Stella O’Malley, a psychotherapist and author of several books, including What Your Teen is Trying to Tell You. O’Malley is also the author of the book Cotton Wool Kids, and her private practice focuses on parenting, family dynamics and mental health in adolescents.
The session was designed to outline and debate a number of ideas. Firstly, that the language of illness is steadily replacing the language of ordinary hardship. Has sadness, a normal human emotion, now become “depression?” It’s a good question, isn’t it?
Is pressure being replaced with “trauma,” and is normal emotional struggle now treated as pathology? The audience of around 400 people heard from both O’Malley and Casey that diagnoses are rising sharply among children and young adults, while services remain under strain from demand that simply cannot be met amid an explosion in people seeking treatment for mental health struggles.
The audience were asked to consider: Is this a crisis of mental illness, or a crisis of interpretation? Are we now living in a culture which has taught people to see adversity as a medical category? The argument can reasonably be made that if we begin medicalising ordinary distress, something which is simply part and parcel of the human experience, then those in genuine crisis end up paying the price, as does society’s capacity to endure hardship at all in the first place.
I found the arguments fascinating. As a woman in my late twenties, we are engulfed in a culture where just about every woman my age and younger, as well as older, seems to be seeing a therapist. You’re almost an outlier if you don’t go to therapy or counselling, or if you’re not actively dealing with “your trauma.”
It was so refreshing to hear that maybe, there’s nothing wrong with you – suffering is normal, and you’re normal. You’re simply subject to the human condition and the ups and downs of life. Our therapeutic culture has made that seem alien. There’s a liberation in that which we’re rarely able to enjoy in a cultural climate where we are trained to embrace self-pity rather than resilience.
Stella O’Malley herself recalled how she is told rather frequently that she may have ADHD. This is a suggestion, she said, which has cropped up in the last three or four years, but which she had never heard before. She thinks its due to a diagnosis of such a condition now being more desirable.
“You should see someone,” she is often told.
THE STEPHEN FRY EFFECT
Prof Patricia Casey spoke of the phenomenon seen sometime around 2010, of bipolar self-diagnosis increasing due to what was known in the media as the “Stephen Fry effect.”
She explained that Fry, as a genius and a high-profile bipolar disorder sufferer, showed a willingness to talk about his condition publicly. When he came out as bipolar – (previously known as manic depression, is a condition affecting people’s mood) in her own experience, the diagnosis became more desirable to people. Indeed, researchers around that time claimed that Fry’s advocacy led to more people diagnosing themselves with the illness.
Writing in The Psychiatrist in 2010, Dr Diana Chan and Dr Lester Sireling said: ”The increasing popularity of bipolar disorder may be attributed to increased media coverage, coupled with the high social status associated with celebrities such as Stephen Fry talking about their own personal experiences of mental illness.
”This appears to have promoted the disorder as less stigmatising and acceptable to the public, a phenomenon that may have an evolutionary basis.”
According to Casey, it is now the case that more people wish to get a diagnosis of ADHD – a condition which, she acknowledges, exists. However, she feels it is grossly overdiagnosed. Casey said there are a number of reasons people want such a diagnosis. In the case of ADHD, it relates to the term neurodiversity – a term which she says has crept into our lexicon as “something that makes us different from everybody else.”
In the case of Bipolar disorder, the medic says, an increase in diagnoses around the time of Fry’s advocacy, stemmed in some cases from a desire to be perceived as genius or different from others.
The psychiatrists said that pharmaceuticals play a factor in relation to ADHD, but not to the same extent as things like parental expectations and the individual’s desire to be different in a world that is very challenging for young people.
Referring to a study which took place in 2024, Casey said: “49 per cent of people in Ireland, in the past year, have seen either a GP or a psychiatrist or a therapist, and half of those have seen therapists. So we are living in a therapy culture.”
The idea that everything should be diagnosed and medicalised is rife. Remember that 2023 report from Scotland which found that, staggeringly, more than a million Scots were on antidepressants.The year prior, it was reported that GPs were breaching medical guidelines by prescribing antidepressants for children as young as 11 who could not get other help for mental health problems.
The number of antidepressants prescribed in Scotland soared by more than 200,000 in 2023/24, which is probably more proof that big pharma is playing a major role, and that we are getting it wrong when it comes to tackling mental distress.
Felice Basboll, a student originally from Denmark in her fourth year of studies at Trinity College Dublin, spoke about the many allowances made for students on campus, which she worries are not necessarily for their own good. She spoke not only of a diagnosis culture but a more generalised culture which she thinks starts at school. For example, she says, if you have anxiety, teachers may let you do your presentation in a separate room without it being in front of the class. Or exams might be changed slightly.
“If you say you feel uncomfortable in a certain situation, someone will come in and change the circumstances. It’s very subtle, and I don’t think it’s something any individual teachers think they are doing. But it is based on the idea that we should take kids seriously, and take seriously what they say their problems are, whether they have an official reason for that or not.”
“In University, when you come in, you have all these welfare teams run by the SU where you can go if you’re having a bad day to talk about your problems. You have all sorts of initiatives that are directed at the general welfare of the student body. The idea is that you come into little groups and you talk about your problems. So you come from a school system where everything you say is taken seriously by teachers, and then you come into university where everything is guided towards how you feel, and making you feel better,” says Basboll.
This, she points out, has actively changed the way assessments are done in some cases, meaning there can be fewer and fewer exams and more continuous forms of assessment. This includes things like multiple choice questions so that students are not faced with very difficult and high-intensity situations where they might fail.
Therapy now includes things like Better Help, a form of online therapy.
“I once had a friend who would have Better Help calls in public, in a group setting where other people were present. That seemed like a strange place to have a therapy call.”
The problem also expands to the way that many young people now understand themselves, she adds. Content produced by the algorithm on platforms like Instagram will keenly tell you that your boyfriend or girlfriend being selfish is toxic, or the way that you think about something which has happened to you is innately damaging.
“Ordinary experiences are understood in terms of trauma. But it has nothing to do with actual trauma reductors. You don’t get into contact with the therapist. It’s more that you can circumvent this system and find out on your own – and increasingly speak of your personal experience in terms of things like anxiety or depression, or even autism.”
“Even autism has become more of a shorthand for awkwardness, with or without a diagnosis,” Basboll adds. The existence of a diagnostic culture, she says, has actually taken away a lot from young people, particularly from the ages of 15 to 25, when you’re supposed to grow up and develop as a person and have uncomfortable experiences.
“This culture ends up rolling back personal development, and also creates a strange dynamic between teachers and students. Professors are no longer assumed to know better or whether a student who hasn’t handed in their assignment in time is actually maybe just being a bit lazy or drinking too much. Instead, there is an idea that we have to take it seriously, so things like extensions in universities have exploded because professors aren’t trusted to say no.”
There are very real problems facing young people, says Basboll, which are mainly economic. Graduates are now downwardly mobile, but rather than fixing those material problems for young people, students have been taught to think of every problem as something which is “going on inside.”
“If only we go to enough welfare teams, we’ll all be ok. And I think that’s the wrong approach.”
I couldn’t agree with her more. One man from Galway rightly said at that public session that we are failing to teach children to be resilient, to the point that we are coddling them without even realising it. We need to build more resilience, rather than problematising everything.
Someone else said that the coddle culture has created the opportunity for accountability avoidance. This, I suppose, boils down to always finding someone to blame rather than pointing the finger back on yourself when you’re in the wrong.
Stella O’Malley had some great closing thoughts on the problematising of education.
“All roads lead to children thinking, ‘Maybe there’s something wrong with you. Maybe you need to get fixed by other people because if you feel uncomfortable, there is a big problem,” she said.
“I’ve recently had some experience with third level education, because I am doing a PhD. I’ve experienced first-hand this wall of bureaucracy, and when I raise some of these issues, they keep telling me to go to Cheer Up Tuesdays. I keep getting asked, ‘How am I?’ and I reply ‘I’m actually fine. Your system is disastrous though,” laughed O’Malley.
“It is very difficult for your head, because we are swiping away the real problems, and then look at your mental health and ask if you’re having a bad day. Honest anger at a disaster of a system is not being categorised as such – it’s being categorised, very quickly, as mental health.”
“I think what we’ve done is we’ve taught people to weaponize vulnerability so that they can avoid accountability.”