How the failures of psychiatrists contribute to people self-diagnosing with adhd

[ Based on a post in a different space, 2023-05-04. ]

Over the years i've heard and read many negative experiences of psychiatrists. Most of the people relating these experiences are women and/or afab; most of the psychiatrists involved are cis men. Common themes are arrogance, condescension and dismissiveness - not particularly surprising, given the presence of not only gender dynamics, but also things like class privilege on the part of the psychiatrists involved. The stories range from “That wasn't so great” through to “I was actively psychologically damaged or traumatised”.

Although, in theory, one can lodge complaints about these things with various professional and government bodies, it's unlikely to be a trivial process in practice. In fact, it's likely to require a substantial amount of resources, both psychological and financial - and many clients of psychiatrists simply don't have these resources. Worse, there can even be limitations on sharing information via informal channels: here in Australia, private Facebook groups can be held liable for defamation if people in that private group say “I had this negative experience with this particular psychiatrist”.

All this suggests to me that the psychiatric profession has a systemic lack of adequate self-reflection, despite the supposed processes in place. And this is a huge issue, given that psychiatrists are often in the position of being gatekeepers with huge power over the course of people's lives - such as whether they can access adhd meds.

It's in this context that psychiatrists complain about “people self-diagnosing adhd via a TikTok video”[a]. Yet part of the reason for this phenomenon is that the profession has systemically failed to diagnose adhd in women and afab people, instead often diagnosing us with things like ‘treatment-resistant’ depression / anxiety / borderline personality disorder (bpd). And as these (mis)diagnoses have continued to be applied over time, they've had significant negative mental health impacts, as i described in a previous post about failures to recognise and diagnose autism:

It can be implied (or stated explicitly!) that if the tools aren't working, it must be because we're just “resistant”, or “not really trying” or that we're “not putting in the effort”. So not only is our mental health not helped, and the original issues not addressed; it can actually have been made _worse_, as we end up feeling that we're at fault, that we're not good enough, that we're failures, that we're shit. This is another way in which we get gaslit, and again traumatised.

-- Autism, the mental health professions, gaslighting, and trauma

So it's hardly surprising that, when some women and afab people finally get diagnosed adhd, and start using meds or psychological tools that make a noticeable difference to their daily lives after many years of other meds or tools failing to do so, they want to let others know. And in doing so, they cause others to start wondering whether, given their own experiences, they might actually have adhd, and then _they too_ end up getting a diagnosis of adhd. And so on. There's a chain reaction. This is basically what's been happening in my own circles (and not only regarding adhd, but autism as well).

Along the way, a number of people regularly encounter psychiatrists whose understandings of adhd continue to basically be “it's physical hyperactivity in boys”. Sometimes this is ‘merely’ a failure to keep up with the state-of-the-art around adhd diagnoses; but there often seems to be an _active resistance_ to developing new understandings, regardless of the mounting ‘lived experiences’ evidence informing them.

There might be valid critiques to be made of the “self-diagnosis via a Tik-Tok video” phenomenon, but given how many psychiatrists are themselves contributing to this dynamic, the profession needs to get its own house in order if its own critiques in this regard are to have any real credibility.

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[a] For a more general discussion about the ‘reality’ of adhd:

Leftist history repeating itself: on the notion that adhd is caused by capitalism