Review
Books
Care
Comment
Psychology
7 min read

We don’t have an over-diagnosis problem, we have a society problem

Suzanne O’Sullivan's question is timely
A visualised glass head shows a swirl of pink across the face.
Maxim Berg on Unsplash.

Rates of diagnoses for autism and ADHD are at an all-time high, whilst NHS funding remains in a perpetual state of squeeze. In this context, consultant neurologist Suzanne O’Sullivan, in her recent book The Age of Diagnosis, asks a timely question: can getting a diagnosis sometimes do more harm than good? Her concern is that many of these apparent “diagnoses” are not so much wrong as superfluous; in her view, they risk harming a person’s sense of wellbeing by encouraging self-imposed limitations or prompting them to pursue treatments that may not be justified. 

There are elements of O-Sullivan’s argument that I am not qualified to assess. For example, I cannot look at the research into preventative treatments for localised and non-metastatic cancers and tell you what proportion of those treatments is unnecessary. However, even from my lay-person’s perspective, it does seem that if the removal of a tumour brings peace of mind to a patient, however benign that tumour might be, then O’Sullivan may be oversimplifying the situation when she proposes that such surgery is an unnecessary medical intervention.  

But O’Sullivan devotes a large proportion of the book to the topics of autism and ADHD – and on this I am less of a lay person. She is one of many people who are proposing that these are being over diagnosed due to parental pressure and social contagion. Her particular concern is that a diagnosis might become a self-fulfilling prophecy, limiting one’s opportunities in life: “Some will take the diagnosis to mean that they can’t do certain things, so they won’t even try.” Notably, O’Sullivan persists with this argument even though the one autistic person whom she interviewed for the book actually told her the opposite: getting a diagnosis had helped her interviewee, Poppy, to re-frame a number of the difficulties that she was facing in life and realise they were not her fault.  

Poppy’s narrative is one with which we are very familiar at the Centre for Autism and Theology, where our team of neurodiverse researchers have conducted many, many interviews with people of all neurotypes across multiple research projects. Time and time again we hear the same thing: getting a diagnosis is what helps many neurodivergent people make sense of their lives and to ask for the help that they need. As theologian Grant Macaskill said in a recent podcast:  

“A label, potentially, is something that can help you to thrive rather than simply label the fact that you're not thriving in some way.” 

Perhaps it is helpful to remember how these diagnoses come about, because neurodivergence cannot be identified by any objective means such as by a blood test or CT scan. At present the only way to get a diagnosis is to have one’s lifestyle, behaviours and preferences analysed by clinicians during an intrusive and often patronising process of self-disclosure. 

Despite the invidious nature of this diagnostic process, more and more people are willing to subject themselves to it. Philosopher Robert Chapman looks to late-stage capitalism for the explanation. Having a diagnosis means that one can take on what is known as the “sick role” in our societal structures. When one is in the “sick role” in any kind of culture, society, or organisation, one is given social permission to take less personal responsibility for one’s own well-being. For example, if I have the flu at home, then caring family members might bring me hot drinks, chicken soup or whatever else I might need, so that I don’t have to get out of bed. This makes sense when I am sick, but if I expected my family to do things like that for me all the time, then I would be called lazy and demanding! When a person is in the “sick role” to whatever degree (it doesn’t always entail being consigned to one’s bed) then the expectations on that person change accordingly.  

Chapman points out that the dynamics of late-stage capitalism have pushed more and more people into the “sick role” because our lifestyles are bad for our health in ways that are mostly out of our own control. In his 2023 book, Empire of Normality, he observes,  

“In the scientific literature more generally, for instance, modern artificial lighting has been associated with depression and other health conditions; excessive exposure to screen time has been associated with chronic overstimulation, mental health conditions, and cognitive disablement; and noise annoyance has been associated with a twofold increase in depression and anxiety, especially relating to noise pollution from aircraft, traffic, and industrial work.” 

Most of this we cannot escape, and on top of it all we live life at a frenetic pace where workers are expected to function like machines, often subordinating the needs and demands of the body. Thus, more and more people begin to experience disablement, where they simply cannot keep working, and they start to reach for medical diagnoses to explain why they cannot keep pace in an environment that is constantly thwarting their efforts to stay fit and well. From this arises the phenomenon of “shadow diagnoses” – this is where “milder” versions of existing conditions, including autism and ADHD, start to be diagnosed more commonly, because more and more people are feeling that they are unsuited to the cognitive, sensory and emotional demands of daily working life.  

When I read in O’Sullivan’s book that a lot more people are asking for diagnoses, what I hear is that a lot more people are asking for help.

O’Sullivan rightly observes that some real problems arise from this phenomenon of “shadow diagnoses”. It does create a scenario, for example, where autistic people who experience significant disability (e.g., those who have no perception of danger and therefore require 24-hour supervision to keep them safe) are in the same “queue” for support as those from whom being autistic doesn’t preclude living independently. 

But this is not a diagnosis problem so much as a society problem – health and social care resources are never limitless, and a process of prioritisation must always take place. If I cut my hand on a piece of broken glass and need to go to A&E for stiches, I might find myself in the same “queue” as a 7-year-old child who has done exactly the same thing. Like anyone, I would expect the staff to treat the child first, knowing that the same injury is likely to be causing a younger person much more distress. Autistic individuals are just as capable of recognising that others within the autism community may have needs that should take priority over their own.   

What O’Sullivan overlooks is that there are some equally big positives to “shadow diagnoses” – especially as our society runs on such strongly capitalist lines. When a large proportion of the population starts to experience the same disablement, it becomes economically worthwhile for employers or other authorities to address the problem. To put it another way: If we get a rise in “shadow diagnoses” then we also get a rise in “shadow treatments” – accommodations made in the workplace/society that mean everybody can thrive. As Macaskill puts it:  

“Accommodations then are not about accommodating something intrinsically negative; they're about accommodating something intrinsically different so that it doesn't have to be negative.” 

This can be seen already in many primary schools: where once it was the exception (and highly stigmatised) for a child to wear noise cancelling headphones, they are now routinely made available to all students, regardless of neurotype. This means not only that stigma is reduced for the one or two students who may be highly dependent on headphones, but it also means that many more children can benefit from a break from the deleterious effects of constant noise. 

When I read in O’Sullivan’s book that a lot more people are asking for diagnoses, what I hear is that a lot more people are asking for help. I suspect the rise in people identifying as neurodivergent reflects a latent cry of “Stop the world, I want to get off!” This is not to say that those coming forward are not autistic or do not have ADHD (or other neurodivergence) but simply that if our societies were gentler and more cohesive, fewer people with these conditions would need to reach for the “sick role” in order to get by.  

Perhaps counter-intuitively, if we want the number of people asking for the “sick role” to decrease, we actually need to be diagnosing more people! In this way, we push our capitalist society towards adopting “shadow-treatments” – adopting certain accommodations in our schools and workplaces as part of the norm. When this happens, there are benefits not only for neurodivergent people, but for everybody.

Support Seen & Unseen

Since Spring 2023, our readers have enjoyed over 1,500 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.

If you enjoy Seen & Unseen, would you consider making a gift towards our work?
 
Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.

Graham Tomlin
Editor-in-Chief

Article
Comment
Politics
Sport
5 min read

Bad blood is damaging both football and politics

Are we all in the stands baying for blood?
A view from a football stand over heads to the pitch.
Steven Collomb-Clerc on Unsplash.

Am I going mad? It definitely feels like I’m going mad. Let me tell you two tales, one about an ugly football match, the other about the early release of a ‘political’ prisoner’. It feels as if society, not just the fans in the stands, are baying for blood. I’m mad about it. Here's why. 

There’s been little love lost between my team Liverpool and their recent opponents Newcastle United. 

Liverpool’s crime? Wanting to buy Newcastle’s striker, Alexander Isak. How dare they! 

If reports are to be believed – and everything should be viewed with raised eyebrows when it comes to football transfers – Isak informed Newcastle of his desire leave at the end of last season and was given assurances he would be able to. Liverpool, with no recognised striker following Diogo Jota’s death placed a bid of around £110 million.  

A British transfer record fee. As an opening bid. A fee subsequently described as “disrespectful.” I feel like I’m going mad. If anyone would like to ‘disrespect’ me with £110,000,000, please let me know and I’ll send you my bank details.  

The game’s turning point is a tackle by Newcastle’s Anthony Gordon on Virgil Van Dijk, Liverpool’s captain, just before half-time. 

Gordon comes flying in, studs up, raking the back of Van Dijk’s leg. It is a deeply unprofessional tackle from Gordon. A cynical attempt to hurt a colleague with no discernible attempt to win the ball. It’s a tackle that’s beneath him, frankly.  

By the time Anthony Gordon lunges in, the tone of the match is clear: we’re here to cause harm to anyone in a red shirt. (And the Newcastle fans are still in the stands cheering them on). 

At the end of the day, I’m just glad Liverpool won. But I am genuinely baffled and alarmed by the amount of normally level-headed people who became intent on causing harm because of a (potential) transfer. Bad blood is flowing, indeed rushing to the head of many of them. 

Most of all, I’m glad Liverpool won because, when I say what I’m about to say, you know it’s not coming from a place of bitterness that my football team lost a match. Because another story this week has left me feeling like I’m going mad: the release of Lucy Connolly from prison

In July 2024, three young girls were stabbed to death at a dance class in Southport. In the aftermath, amid (false) reports that the killer was an asylum seeker, riots broke out across the country as people targeted mosques, asylum seeker accommodation, and even libraries.  

In the midst of this, Lucy Connolly – whose husband was, at the time, a Conservative county councillor – tweeted: 

“Mass deportation now, set fire to all the [f***ing] hotels full of the [b***ards] for all I care, while you’re at it take the treacherous government & politicians with them. I feel physically sick knowing what these families will now have to endure. If that makes me racist, so be it.” 

Having left prison, Connolly told The Telegraph that she was a “political prisoner” and that Keir Starmer “needs to look at what people's human rights are, what freedom of speech means and what the laws are in this country.”  

The irony of her saying this in an interview with a national newspaper was apparently lost on her. 

Am I going mad? It definitely feels like I’m going mad.  

Lucy Connolly encouraged people to burn down hotels with people inside. To spill blood. She pleaded guilty to inciting racial hatred by publishing and distributing ‘threatening or abusive’ written material on X. She literally admitted to doing this in a court of law.  

But she is now being hailed in some quarters as a political martyr and champion of free speech. Let’s have it right: you are free to say what you want, but you are not free from the consequences of your speech. Whether you like it or not, migrants and asylum seekers are made in the image of God, as we all are, and are beloved by the creator of the universe. None of us has the right to end their lives. Incitement of violence towards them is rightly a crime.  

She deserves to be in prison.  

The people who rioted last year are ultimately responsible for their actions. But Lucy Connolly – and everyone else who incited violence in the aftermath of the Southport attacks – is also partly to blame for cultivating a society in which thugs feel as though that is an acceptable course of action. Now she is released from prison, every media outlet, every interviewer, every politician who repeats her reality-defying nonsense without challenge is as culpable as she is for fostering this climate of violence. This is before we even begin to talk about the record numbers of asylum seekers who have already died in our care.  

It was ultimately Anthony Gordon’s stupid decision to go in studs-up on Van Dijk. But referee Simon Hooper and the Newcastle fans should reflect on their part in fostering a climate of violence in which Gordon’s felt his decision was reasonable, too. 

We are all Simon Hooper. We are all the referee. When we allow rhetoric to become calls for violence, this has real-world consequences. People get hurt and killed. Blood is spilled. We are all responsible for the society in which we live, and the rhetoric of the debate that occurs therein.  

It’s not just febrile Newcastle fans that are losing their grip on reality: there seems to be a society-wide willingness simply to bypass the concrete facts of reality to further personal ideologies. The more people like Lucy Connolly are rehabilitated by media whitewashing, the more statements like “set fire to all the [f***ing] hotels full of the [b***ards] … if that makes me racist, so be it” become acceptable, the less safe the most vulnerable in society become and the more likely they are to be killed.  

That’s the nub of it. Lucy Connolly should be in prison because what she said leads to people being killed. No-one should have been surprised when Anthony Gordon went in on Van Dijk that night. No-one should feign surprise when migrants and asylum seekers are eventually killed on the basis of rumour and misinformation. Because they will be. And because we will all have been cheering on from the stands. 

Support Seen & Unseen

Since Spring 2023, our readers have enjoyed over 1,500 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.

If you enjoy Seen & Unseen, would you consider making a gift towards our work?
 
Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.

Graham Tomlin
Editor-in-Chief