Today’s post is about something a little taboo: self-diagnosed mental illness. I distinctly remember my Abnormal Psychology professor prefacing the course with the warning we’d see aspects of each diagnosis in ourselves, but they are not classified as disorders until they interfere with our daily lives. Let’s be clear that my goal here is not to make claims about having any particular condition(s). Instead, what I’d like to argue instead is that self-diagnosis is a financial necessity in a for-profit healthcare system. I won’t argue that self-diagnosing oneself for mental illness presents problems, but it seems the only logical long-term solution is a combination of universal healthcare and universal basic income.

Several years ago, I came across this TED Talk from Ethan Lisi about “What it’s really like to have autism”. This got me thinking a lot about the role of trauma in mathematics education. During my time teaching, I worked with a number of autistic students and noticed aspects of myself reflected in their behavior. I’ve started wondering if the reason I was “good at math” was likely a side-effect of having an undiagnosed social communication disorder as a child. I might have been physically present in a social situation, but quite often I was mentally off somewhere else – completely enthralled by the math problems in my head. The reason this wasn’t caught was that the diagnostic criteria for the “Autism Spectrum Disorder” simply didn’t exist at the time. Such labels were only recently introduced in an effort to disentangle “Asperger’s Syndrome” from “Autism” in the DSM-V-TR. Cases of late diagnosis for autism are difficult, but can you honestly look at this blog and not describe me as being pedantic, having a narrow range of interests, and oblivious to social cues?

The reason my symptoms went untreated likely came from an interaction of power and privilege dynamics. As a white male showing promise in mathematics, I was placed in “gifted classes” rather than “special education classes”. No one cared about the negative symptoms correlated with my social isolation because I always came in the 99th percentile for math on all their standardized tests. My condition was treated as something to cultivate rather than fix. This attitude of exploiting children on the autism spectrum for social progress reflects the fact that “Asperger’s Syndrome” was literally named after a Nazi researcher engaged in applied eugenics. Identifying individuals with this condition was never about helping them, but rather part of a deliberate effort to exploit them in the advancement of white supremacist ideology.

The irony in all this is that Asberger’s ideas about appropriate treatments for autism were actually highly progressive for the time. He didn’t treat his patients’ as having an illness to be cured, but as people who could flourish in the right environment. Well, I suppose it is more accurate to say he treated young Aryan autistic males as people who could flourish in the right environment. See if you can spot the moment in this TED Talk from Steve Silberman where he deliberately avoids using the word “Nazi”. The level of care with which he treated autistic children reflects the type of humanizing support that those children need, but we also need to acknowledge the fact that this care was not distributed equally to all.

It’s very unfortunate, but the unequal distribution of resources still haunts the education system to this day. Providing accommodations costs money, so schools put the accommodations behind a “paywall” through the form of a formal diagnosis. Families that can afford to dedicate the necessary time and money to receive a diagnosis can use that to obtain special treatment. Families for whom regular behavior therapy sessions would present a financial burden are not so lucky. The result is a special education system that benefits the rich and stifles the poor.

The case of autism is a unique problem because it doesn’t necessarily imply an impairment in itself. Many autistic people are highly functional, and it’s only when there is a mismatch between their needs and the environment that it becomes a problem. When one has money, they can afford to control their environment to ensure those needs are met. It’s only when those environmental factors are out of the person’s control that they become obstacles. Having defined mental illness by an interference with daily life, autism might be a boon or a bane depending on one’s socioeconomic status.

If it sounds like I’m engaging in some verbal gymnastics to avoid referring to myself as autistic, that’s because a real diagnosis is complicated. In order to narrow down the root cause, it’s necessary to rule out the many possible alternatives. Maybe I have some kind of attention disorder that’s interfering with my ability to follow conversations. Maybe I’m depressed and don’t have enough cognitive resources to keep up with the energy levels other people seem to have. Maybe I enjoy those craft beers a little too much. Any combination of those factors could explain my behavioral patterns, but the fact remains that I’m not an objective observer in this situation. There’s a distinct difference between self-diagnosing mental illnesses and physical ones.

I suffer from a chronic case of allergies. Everytime the pollen level rises, so do my respiratory symptoms. Over the course of my life, I’ve learned how to adapt. I pop my generic-brand Zyrtec in the morning if I expect it to be an issue, or a generic-brand Benadryl in the evening if symptoms catch me by surprise. I’m able to self-medicate for my allergies because I’ve learned how my body reacts through years of experience with expensive medical bills. There’s nothing like spending $600 at a doctor’s office only to learn that your congestion and nasty cough is really just an adverse reaction to the change of seasons and solved by common over-the-counter medicine.

In America, there’s this philosophy that one should take personal responsibility for one’s healthcare. If I know I need regular medication on hand to keep my healthcare costs low, it’s up to me to shop around for the best bargain. This is suboptimal as far as I’m concerned, but it’s something I’ve learned to manage. It’s possible because I can act as an objective observer of my own physical symptoms. If it feels like allergies are acting up, it’s probably because they are and I should take some meds. If I cut myself while cooking, I can still make a rational judgement about whether the wound requires a trip to the emergency room or a Bandaid and some Neosporin will suffice. One of those courses of action is substantially more expensive than the other, even with insurance, so self-diagnosis can be a very practical skill to have.

In contrast, I’m not an objective observer with regards to my own social behavior. I have no way of knowing if I’m weird or if everyone else is. What I observe is a pattern in which the topics which seem to excite me make other people roll their eyes, and what passes for polite conversation to others bores the hell out of me. It’s not my fault that other people don’t want to talk about math; nor is it my fault for not caring about who won the sportsball game. I can clearly see the difference in norms, but at what point is this difference sufficient to call it a disorder? How socially awkward do I need to be to have a social communication disorder? It’s impossible for me to self-diagnose myself relative to social norms that I don’t understand to begin with.

Let’s consider a hypothetical situation where two people are suffering from depression, but one of them has a high-paying job and the other does not. The person with the job can afford to spend time in counseling and pay for prescription antidepressants as necessary. For the other, this becomes a very difficult financial decision. Is it worth it to spend $45 and an afternoon each week covering a “copay” for therapy when you’re not sure about paying your bills? If you get prescribed medication, how will you pay for it? At the same time, how do you expect to find a job when the mere act of getting out of bed presents a struggle? This person is trapped in a situation where they have to make an impossible decision about whether or not to seek help. They are forced into a position of self-diagnosis through material necessity.

I don’t know about you, but the mere thought of that situation makes me anxious. What’s even stranger to me is the way I label this feeling “anxiety” rather than attaching an emotion like “fear”. In place of “feeling sad”, I notice myself experiencing “symptoms of depression”. I think this emotional detachment is closely related to the social construction of gender. The prevailing system of patriarchy discourages boys from discussing their feelings, so boys fall into patterns of behavior where they detach themselves from those feelings – sometimes maladaptively. In my case, I don’t think I had a working vocabulary for my feelings until I started studying Psychology so the line between the subjective experience of “feelings” and the objective experience of “symptoms” is inherently blurred once I start talking about myself. An external evaluator is necessary for accuracy and that inherently costs money.

By attaching a cost to mental healthcare, you place a financial burden of diagnosis on the people that need the assistance the most. Even most state agencies require you to submit documentation of a disability before they will provide accommodations during the hiring process, but having a job is a prerequisite to getting mental healthcare in a capitalist society. Once mental illness interferes with your employment, it can initiate a vicious cycle which the lack of employment makes the symptoms even worse and compounds the problem further. Let’s acknowledge the reality:most hiring managers will “weed out” applicants that sound even remotely depressed.

I think this is where many “Diversity, Equity and Inclusion” efforts are falling short. The prevailing attitude that the burden of proving a disability should be placed on the person with the disability is inherently unequitable – especially when it comes to mental illness. In order for an organization to truly be inclusive, they need to take a proactive role in making sure that their hiring process is accessible to a diverse audience. People shouldn’t need to ask for accessibility; it should just be there. It’s not.

Even accurate representations of neurodiversity can be difficult to come by. I think the reason I’ve been drawn to playing Testament in Guilty Gear: Strive recently is that they share some of the same symptoms I do, but they seem to have adjusted in a way that seems healthier. It makes me wonder how my childhood would have been different if I had a role model that was more like me to observe. At least times are changing though. It’s definitely a little heartwarming to watch modern children’s shows and be easily able to identify the token autistic character that was absent from mine.

While each individual diagnosis only affects a small percentage of the population, the collective combination of all these diagnoses represent a significant proportion of the population. Estimates suggest that roughly one in five people could be classified as neurodivergent. These individuals are 3-4 times more likely to be unemployed as a result. It’s time that we level the playing field so that everyone can play on equal footing. The only way that happens is by removing the existing financial barriers to mental healthcare.

Moving to a system of universal healthcare might make it easier for neurodivergent people to access care, but that alone won’t address the problem. Like Asperger’s role in the Third Reich, companies seeking a quick buck will still look at neurodivergent people as a potential resource to be exploited. We don’t just need to make it easier for people to get help, but also need to simultaneously eliminate the class of predators that currently feed upon their vulnerability for personal gain. Those in power will not cede that power willingly. I think we need to accept the reality that mental illness and poverty are closely intertwined. Any attempt to address one without the other would likely be futile.

A publication from the American Psychological Association titled “Stress in America 2023” examined the impact of the COVID pandemic on mental health. For people in my age bracket, diagnoses for mental illnesses increased from 31% to 45% and approximately 3 out of 4 identify financial stress as one of the key factors. The survey also showed 39% of Americans identifying discrimination as a significant stressor, typically attributing it to their age (36%), their race (28%), or their gender (22%). The effects of stressors are compounded for people in historically underprivileged communities who are neurodivergent, with LBGTQIA+ individuals being nearly twice as likely to report stress due to discrimination.

Lately I’ve been working my way through an introductory mathematics text on category theory and have been struggling with a set of problems related to gender. Without digging too much into personal trauma, I self-identify as “male” but this particular problem has defined gender in a very specific way that I feel excludes me from the set of all “people”. For the first time in my life, I felt othered by mathematics and the experience is quite infuriating. This anger has interfered with my ability to think logically about this particular problem, thereby preventing me from solving it, which in turn made me even more frustrated with it. If a simple problem can have this large of an impact on a (mostly) cis-het white male such as myself, I can’t even begin to imagine how awful it might be for others.

Out of curiosity, I started to do some research on the relation between mental illnesses and gender nonconformity. I dug out that old Abnormal Psychology textbook to see what it had to say about “Gender Dysphoria”. What I found was outright appalling. This text had essentially classified gender nonconformity as a sexual fetish and was pretty much still treating homosexuality as a disease. I didn’t even think it was that old at the time. Did I really read this book ~25 years ago and not notice how biased it was? The reality of our present situation is that Psychology is a young science and many early studies have since been shown to have significant cultural biases behind them. Human behavior is complicated.

To make matters worse, the rise of generative AI chat bots as “online therapists” is only going to exacerbate these problems. Unlike deterministic systems like ELIZA, these Large Language Models are built upon a gigantic corpus of text and will inherit any biases contained within it. These models are more likely to induce psychosis than provide any real help for the people that turn to them out of desperation. As more and more AI slop invades our Google searches, getting reliable information about mental health is becoming increasingly difficult. The sad reality of our present moment in time is that self-diagnosis may in fact be the only viable option for many people right now.

If you are one of those people and are turning to this random person’s blog for help, I should advise you that I’m not a medical professional but perhaps I can point you towards people that are:

• If you or someone you know is suicidal or in emotional distress, please contact the 988 Suicide & Crisis Lifeline immediately. They’re trained to help in times of crisis.
• If you are looking for resources on self-diagnosis, I would consider starting with the American Psychiatric Association’s Assessment Measures. Select the appropriately age-targeted “Level 1 Cross Cutting Symptom Measure” and follow the evaluation instructions contained within. Depending on the results, consult the appropriate “Level 2” instrument and go from there.
• If you’ve already self-diagnosed and are looking for self-help resources, the American Psychological Association might be a good place to start. Research moves quickly in Psychology, so be mindful of publication dates as you review the literature.