Article
America
Conspiracy theory
Culture
Politics
6 min read

When America presses in on you

A returning American feels the heat generated by contesting ‘realities'.

Jared holds a Theological Ethics PhD from the University of Aberdeen. His research focuses conspiracy theory, politics, and evangelicalism.

A runner passes a church and a flag in an America suburb, under billowing clouds.
Nick Jones/Midjourney.ai.

There’s a man. Running. My eyes snap into focus. Time slows - I catch his pace. Then, my eyes start widening. An odd feeling. Being forced into it. Seconds stretched out into minutes. Taking in more, looking for more, looking down that sidewalk, on a street corner in New Jersey. 

Before? I was sitting there. In the backseat of my Uber. Winding our way through New Jersey. And I’m sitting there, tired, mindlessly scrolling my phone until that moment. He’s there running.  

And I see him. T-shirt. Running shorts. And I’m sitting. And—a nervous flash—he’s running. Why?  

And my eyes adjust, widening, scanning, checking detail, and I’m almost seized. My mind shaking itself, coming online, no more automation. My consciousness catches up: “you’re in America,” I tell myself. 

Right. I’m not in Scotland. And that man is running. Here in New Jersey. In America. And I’m talking back to myself in this silent car. I’m watching him run. I’m asking why am I slowing this down? And—it flashes—“running from what?” 

And I catch up to myself. To what I was trying to say, that people in America run from shooters, too. A wave crashing, sitting in the back of the Uber, and look. Now I’m really looking. Not forced. But naming. There’s other pedestrians passing him, walking. Slowing. On the other side of the street— no fast movement. No screaming. No pops. 

I start breathing. I didn’t know I stopped. He’s out jogging. The automated safety check ends. The tranquility of tyranny resumes. I’m sitting in the back of an Uber. I make a note. Be more alert at the train station.  

— 

People ask me how the relocation back to America has been. And I don’t know what to tell them. There’s a wide gap between the visceral sense of it all pressing in on you, and more common—but also abstract—analysis.  

The experience of coming back has been oddly particular. I lived in Scotland for three years, and most of it was spent studying America. From that distance, the broad strokes of American life, the larger trajectories and dangers of our shared political decisions and religious extremism, well, they’re a bit clearer. 

But coming back, America presses in on you. And the only way of talking about that, maybe, is specificity. Kerouac was always good at articulating this. His America wasn’t the rise of the military industrial complex in the 50s. It was the road, the gas station on the way from Denver, it was jazz, the dim doorways of San Francisco bars. I’m thinking of Kerouac, but also Langston Hughes. Poets and artists who in their own time, held a mirror up to America, helped us move from the “I” to the “we” as Steinbeck said. 

We’re all asking a version of “what’s wrong in America?” (And, do keep asking.) But to ask that question often assumes the broadest strokes, the ones that are most clear from a distance. Which means they are, in one at the same time, the most abstract.  

These realities are everywhere, and no where. They are the air we breathe. They appear to the privileged as “logical” and to the powerless as “inevitable.” 

Asking after democracy, after the election, and the increasingly nebulous “the church” — I’m convinced that answering “what’s wrong in America?” in the biggest of terms is leading me to (wrongly) believe that responsibility lies among the gargantuan free-floating concepts which we use to narrate our world. As if solving the “crisis of democracy” is a conceptual problem. When in reality, it is concrete, and involves more than coalition building or political activism.  

Why more? Because the choices Americans have made over the last 10 years originate from imaginations which limits the scope and scale of what is possible. This is what I mean by “America presses in on you.” 

Coming back to America has made this clear. I’m more aware than ever that we can produce good answers and generate compelling analysis about America without ever asking in what way these answers or analysis are sharp enough, concrete enough to puncture the bubbles of social reality in which people choose to live and in some cases are forced to live. 

These realities are everywhere, and no where. They are the air we breathe. They appear to the privileged as “logical” and to the powerless as “inevitable.” They press in on us all in their own way. 

In some cases, they dull our senses. We say, “as long as our Amazon deliveries continue, as long as the streaming services work.” In some cases, they don’t just press in on us, but press down and perpetuate injustice. As Dietrich Bonhoeffer asked, “where are the responsible ones?” 

The visceral shock of return is ongoing. And it hits me in strange ways, on Uber rides and in worship. American life is everywhere and I’m seeing it with different eyes.

Do I care about democratic machinery? Yes. Am I concerned about whether or not the church is, in fact, the church, and not a gear in a partisan machine? Yes. But I’m increasingly convinced that responsible living in the American situation becomes most clear, most evident as we consider the large in terms of the small. 

Responsibility emerges with attention paid to the concrete and intimate. January 6 is the subject of my dissertation. But before that, in the months leading up to January 6, I was a pastor just 40 miles from DC. For me, January 6 was a local event. That particularity, that specificity, is a window into a concrete responsibility.  

And now, back in this same community, I found myself distracted in a church this weekend. The man in front of me raised his hands in worship, revealing a revolver hanging on his belt. What America is this? But also, what Christianity is this? 

The visceral shock of return is ongoing. And it hits me in strange ways, on Uber rides and in worship. American life is everywhere and I’m seeing it with different eyes. And I wonder what it will take to break the spell of our most cherished illusions, of a certain type of freedom — one that tells us it is Christian to raise our hand in surrender to a god who we say is loving enough to save the world, but seemingly not strong enough to deliver us from our evil. 

In the end, perhaps it’s best to say that it’s been proof of a good ruining. After all, we’ve experienced nothing short of a conversion, a move closer towards peace, towards hope, that unsettles all our strategies of security and comfort underwritten by violence and oppression. This is the kingdom of Heaven. Something Jesus announced that continues to unsettle and disrupt the likes of T.S. Eliot who put it well in Journey of the Magi

We returned to our places, these 

Kingdoms, 

But no longer at ease here, in the old 

        dispensation, 

With an alien people clutching their gods 

I should be glad of another death. 

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.

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