Have We Turned Personality Into Diagnosis?

0:00I'm Wesley Morris. I'm a critic for the New York Times. And I'm the host of a podcast called Cannonball. We're going to talk about that song you can't get out of your head, that TV show you watched and can't stop thinking about, and the movie that you saw when you were a kid that made you who you are, whether you like it or not. I was so embarrassed the whole time because it's a bad film. Yeah. And I still love it. You can find Cannonball on YouTube and wherever you get your podcasts.

0:31Tressie McMillan Cottom:There's an aspect to this where I think the list of things like, oh, you have a, do you not like loud sounds? Do you have a favorite spoon? That one got me recently. I do have a favorite spoon, as it turned out. And I do only eat out of one bowl. I also have a favorite spoon. Thank you. Me too, me too. If this is the diagnostic criteria. Right.

0:52A quarter of American adults suspect that they have undiagnosed ADHD. But only 6 % have a formal diagnosis. So what's going on? Tell me you have ADHD without telling me you have ADHD. I'll go first. Put a finger down if you leave things half open like cabinets, drawers or doors. I will procrastinate an assignment for like two weeks and somehow get it done in two hours. And if any of these sound like you, you probably have ADHD too. With self-diagnosis on the rise, I started to wonder, when is a diagnosis liberating and when is it limiting? and what compels us to label ourselves at all. I spoke with opinion columnist and sociologist Tressie McMillan-Kottam and author Mary H.

1:35K. Choi, who has written about being diagnosed with autism and ADHD. Tressie, Mary, thank you so much for being here with me today. Thank you for having me.

1:44Tressie McMillan Cottom:It's a real pleasure, Nadia. We're going to be talking about neurodivergence and diagnostic labels like ADHD and autism. And what interests me in that conversation is these systems that we use to understand ourselves. and how they change our self-perception and sometimes our lives. So, Mary, you were diagnosed with ADHD and then with autism, both as an adult. And I was wondering if you could start our conversation by telling us a little bit about your journey to those diagnoses and what they allowed you to understand about yourself that you maybe didn't have words for before. Yeah, totally. I mean, this happened in my early 40s, which is to say that, like, you know, I do think that there was this suspicion my whole life that something was, I mean, not like a miss, but like in my 30s at some point, I was like, I don't get invited to weddings.

2:34And I was like, what is that? And I was just like, and then it was like the dual thing of like, and I don't want to go to any weddings. And so I was just like, okay, that's a thing. And I sort of like set that aside. But there were these like kind of schisms or these things that I really believe that like held me apart from other people. And I didn't really know what that was, but boy, was I working really, really hard to make sure to mask those qualities. And so some of that is just kind of like people pleasing or just like this almost like preternatural sort of receptivity to what I think you will do.

3:09And so, you know, that made for a lot of like really ill-advised, long monogamous relationships. It made for like, because there's a lot of safety in that just being like, we're together. I'm using this other person as a human shield. It's going to be fine. So that sort of thing. But at a certain point, like more specifically, when my dad got sick and he passed away, there was just such a torrential sort of like seismic reorganization of my thinking. And so I was like, not only is it weird that I can't seem to reconcile how death works, and I'm sure this is not like a unique proposition, but, you know, because no one significant in my life previously had died before, which is also incredibly rare to, you know, what a gift, like to be in your 40s before you suffer that kind of like grievous loss.

4:02But when he died, I was so caught up in masking. And what that looked like was, okay, well, my mother is closer to my dad. She's known him longer. So she gets to be this degree of sadness. And then my brother, because he's the masculine child, like, and he has sons, like he gets to grieve for his father this amount. And I just kept crunching on this in this like really like recursive way. Like, how do I figure out with these two data sets how I'm supposed to feel? And then I was like, oh. Were you figuring out how you were supposed to feel or were you figuring out how much you were allowed to express?

4:43Was it internal or was it about external expectations? expectations I mean I wish it was just external expectations the fact that it was entirely internal is the is the thing that I found so disquieting where I was just like fam like you just want to know for yourself how much you are allowed to miss this person and then I was just like okay something's weird and I at that point you know I started looking into as one does social media. So I immediately went to an authority, aka TikTok. And then from there, I sought like actual diagnostic assessment. Yeah. What came first for you, your diagnosis for autism or for ADHD?

5:28I was assessed for ADHD first by a psychiatrist. And then afterwards, I was formally assessed for autism, but they were having a two for sale. So like, I got assessed for ADHD at the same time. And so ADHD first around five years ago, and autism was about like three and a half years ago. And how did that retroactively change your understanding of your life? I mean, it was a complete OS update. I mean, not even an OS update. It's not like, you know, going from one to another. It's like, you know, like Sequoia from Panther. It was just like, I was like, oh my God. Not only do I feel so profoundly affirmed in the fact that I knew it was weird that I had time blindness.

6:15I knew it was weird that I have absolutely no sense of direction to the point where I can get lost on my way home to a home I've lived in for 20 years. If there's any sort of aberration in, I could meet you once and if you got a haircut by the next time I saw you, I would know you got a haircut. Like I can tell from a person from behind, like my pattern recognition is like really, really potent. The way I store information is really specific. The way I even tell a story is very peripatetic. It's very nonlinear. And it also answered a lot for like why I didn't feel close to a lot of people and why when I was with a lot of people, even though I'd known them for such a long time where I felt completely closed off and exhausted.

7:04And so that was like really helpful. It explained so much for me and it, you know, affirmed so much for me, but then there was also so much grief. You know, I think there was like a childlike belief in my heart that like befriending people or keeping friendships would become easier or that like my sense of direction would improve when I'm like a grown up. Meanwhile, I'm in my 40s, you know, and so there is a lot of grieving those hopes in certain ways. And but that's also really beautiful because there is so much like surrender and there's so much sort of like peace in that kind of reconciliation, at least like, you know, at least those like CPU aren't being eaten up by all the tabs being open for all the things I'm waiting on to get better.

7:58That's really interesting. And I think touches on sort of one of the central questions I have as we think this through together, which is like, in what ways can a diagnosis be liberating and in what ways is it limiting? And Tressie, you're a sociologist. How do you think about labels and the ways in which they limit us, how they liberate us, how we use them to categorize ourselves and each other?

8:26Tressie McMillan Cottom:Well, the basic definition we give to people when they're like, sociology is like social work, is that sociology is quite literally the study of groups and societies. And so when it comes to labels, it's one of the ways that we sort ourselves into our groups and we determine what's normal, which all I hear in a lot of what Mary has said is a miscalibration between her internal state and what is considered normal or normative. But as a sociologist, for me, everything happens in a context. And I think labels maybe do their best work. They're most what we might call like functional work, positive work, pro-social work.

9:08Tressie McMillan Cottom:When they help us figure out ourselves in a way that gives us a better way, yes, to talk about ourselves, to talk to ourselves, to recalibrate our expectations for ourselves. You know, the flip side, however, of a label is that any kind of sorting lends itself to moral judgments, to hierarchy, can become just another boundary or binary that traps people in a group that does not feel normal to them. And those things can change over the time. And I think one of the things that we are experiencing is just like a moment of like rapid change in how people identify themselves and how many people feel empowered to identify and sort themselves.

9:58Tressie McMillan Cottom:These are things that are still actually pretty new in the long, you know, duray of history. And we're just in an era where I think we are renegotiating which labels are available to us and kind of expanding the repertoire. are. And the good side is for a lot of people that is going to be empowering. It is going to help them make sense of their world. If done uncritically, though, I do think it will do the opposite too. It is going to make more people feel left out or out of step with what is expected to them and can create more anxieties about what are the right ways to act and think and feel when really the answer is there isn't a right way to think or act or feel.

10:36Tressie McMillan Cottom:But everything to my mind always has a little bit of both. Yeah. I want to pivot and dig in specifically on the label neurodivergence because I have been hearing it so much more recently and was interested when I was looking up the origin of the term. It was introduced in the late 90s by an autism rights activist, but really gained steam during the pandemic. Like if you do a Google Trends search on the word neurodivergence, in 2020, it just takes off and we are right now in peak neurodivergence. As I understand it, and maybe Mary will ask you to give your definition too, but as I understand it, neurodivergence is not a medical term.

11:19It's an umbrella term that can hold lots of different diagnoses and ways of being that differ from the norm. That just says there's an umbrella term for this person's brain is a little bit different from the sort of normative brain as we think of it. Is that how you would define it? How would you define it? So neurodivergence, as I understand it, as I experience it, is also just basically like it introduces this notion of, you know, especially specifically with autism, that it's not like a gradient. You know, it's not like you go from low support needs to like high support needs. And that's that.

11:55It's like, you know, there is this saying in the autism circles where it's like if you've met one autistic person, you've met one autistic person. And so the profile is very much this three-dimensional sort of constellation where it's not this like left to right with like, you know, like extremity or anything like that. And so neurodivergence, I think is, it is this like beautiful sort of like queering term where it's just basically like, it's not a binary. And so that to me is really, really helpful. So it's just like kind of, for me a launching pad and being like, okay, well, this is the baseline information I have.

12:33And then from there, I can add the colors to the tapestry of my own mental stuff. Like, you know, it's just, it's a beginning place. Yeah, you might call it yes and in improv. Looking at the data, something happened around the time of the pandemic, but it's not clear why or what exactly. There's a Canadian study out of British Columbia that found that the rate at which adults were diagnosed with ADHD more than doubled during the pandemic, and then starting in the summer of 2021, nearly quadrupled from the pre-pandemic rates. And I'm just curious, Tressie, what was happening around the time of the pandemic that we both started talking about neurodivergence online and started seeing this increase in adults being diagnosed with ADHD?

13:23Tressie McMillan Cottom:Yeah, the spike in adults, the start of that trend of adults being diagnosed with ADHD lags and mirrors the same sort of pattern that we saw happen with children. And I think actually those two things are related. So these type of like cultural transformations always happen within a context. And so it is not a surprise to me that during COVID, what we really mean is during COVID shutdowns, right? The social isolation, the social distancing, everything that came with that, you know, horribly fraught period between COVID becoming a global phenomenon and the first vaccine. Everything about that moment isolated us in the real world, cut us off from our social systems, broke us from our routines, and then funneled almost all of our energies, our performance of ourselves, our connection with other people through the internet, right?

14:15Tressie McMillan Cottom:We're working on Zoom. We're doing Zoom school. At the time, there were lots of studies about Instagram face and Zoom face during this moment because we were watching ourselves, some of us for the first time with that kind of concentrated focus in it, and it skewed our perception of how we looked. And so you see an uptick in interest in things like cosmetic surgery and face filters. I think the same thing is happening with the idea of our mental health, which is that a social rupture produces a lot of anxiety. The way we manage that is by going online. And one of the things that had happened by the time we were all going online in 2020 that had not been true even four or five years earlier is that the algorithm made the internet feel personalized and delivered then these ideas to you, not because you've been up thinking last night, like, hey, is my hyper focus maybe an indication that I could use some medical intervention.

15:16Tressie McMillan Cottom:No, you were sitting there shopping or watching the CDC announcement on TikTok and Instagram and the algorithm decided to expose you to the idea that, hey, if you do these five things, you may have ADHD or ADHDers be like and normies be like this, right? That whole framing, the algorithm was pushing the idea that it was normal, changing people's expectation at a time when people were extremely anxious about everything and did not have a lot of ways to figure out what was normal, what the options were. And we just had so much more time to do the self-assessment, to obsess with ourselves in a way that usually work and commuting and school and everything would have distracted us from.

16:02Tressie McMillan Cottom:So I think COVID is a very, very big part of the story about adults seeking, if not a formal diagnosis, a medicalized label that would have some sort of coherence in a time of great upheaval. I mean, I want to make clear that like a medical diagnosis of any kind, especially a mental health diagnosis, is important. It can be lifesaving. It can allow access to treatment, to medication, to accommodations that people need. And I want to make a separation between talking about that and sort of talking about a phenomenon that we're observing online, because I think that what you're talking about is very true, Tressie, that there's these social media videos that throw around medical terms without necessarily being medically sound.

16:45There's a study that showed that 52 % of the top-performing ADHD videos and 41 % of the autism videos contain inaccurate medical information. I collected a few just because I was curious. According to social media, these are symptoms of autism. liking the sound of a hairdryer feeling tired after socializing having very strong opinions looking up the menu at a restaurant before going to it um heavily researching a product before buying it um having a high pain tolerance having a huge compassion for suffering having only one or two close friends instead of many close friends um i just i feel like this it's it's But it's within the capacity of the algorithm to want to tell us about ourselves.

17:31And it is changing how we think about ourselves. And to me, that's really interesting. I do wonder, though, you know, like, you know how like Gen Alpha and everyone's worried about their Internet consuming habits and the manosphere and this, that, and the other. And like, you know, how Gen Alpha doesn't know Juice WRLD is dead, you know, like all of these different things. Wait, I don't know about this. What is Juice WRLD? Oh, he's a rapper. I don't know what it is and I don't know that it's dead. He's a rapper, but he appears in different sort of like video game based places where it doesn't make a difference to them if he's alive or dead because they still have access to like his avatar or his, you know, skin or whatever.

18:07Tressie McMillan Cottom:I regret that I know anything about this, by the way, Nadja, so it's okay. I'm grateful to you for bringing me more online. Thank you, Mary. No, I just say this to say, but if you were to actually talk to these kids and be like, how much do you believe this or how seriously do you take this? They are so savvy. They don't, they know. They're so savvy. And so I do think there's probably – Yes. Their parents are a little too incredulous. But yeah, the kids actually are pretty much aware of the concept. So I question like for anyone who's even written like autistic or like, oh my God, that's me. Like I do wonder sometimes if we assign too much credulity to them.

18:49And if we were to ask them, do you actually seriously consider yourself to be autistic? I think that we might get a much more nuanced sort of take on it or a much larger conversation rather than, LOL, I love blow dryers.

19:05Tressie McMillan Cottom:I think that's so important. And that's my instinct too, Mary. Not just generationally, but I think there is a difference between the shorthand that develops in like internet speak. speak, you know, there's a language of the internet that lends itself to identifying, self-identifying, because that is the way you speak back to the algorithm, right? This is the communication method. By the way I identify the things that I allow to capture my attention is my interaction with the algorithm. And it gives me some sense of that, that the algorithm is accurate, right? Because it is responding to the things that I have input, even though that may not necessarily be true anymore, that lends itself to, yeah, maybe taking on labels that don't in any way shape how you actually see yourself or the decisions you make in your life.

19:58Tressie McMillan Cottom:But we aren't exactly clear on the line between, you know, fun shorthand and the way the concept creep of these terms can take up residence in your mind, even if you do not think that they have done so. So, you know, my friends have been joking with me for quite some time for the record that I am neurodivergent or neuro spicy, as my friend Johnica likes to say. Shout out to Johnica, who does have an official diagnosis, which is very hard for women, which is, you know, shout out to Mary, almost impossible for black women, which my friend Johnica is. And so we've talked very openly about this and her journey of getting a medical diagnosis.

20:37Tressie McMillan Cottom:And every step along the way, she has come back wanting to report to me that she is pretty sure that I, too, am on the spectrum. And I'll tell you what I told Johnica. Johnica, girl, I don't have time for a new way to understand myself. Right. Like I don't discount that it may be absolutely true. I'm saying I do not have the bandwidth at this time to figure it all out. I've gotten this far. I'm just going to ride it out. But I do think that there are a lot of people who are in that sort of mushy middle. Well, you know, it might be fun. It might even be a little clarifying. The way your horoscope might be some days, you don't believe in it.

21:10Tressie McMillan Cottom:But hey, that is really timely today. I do need to pay attention to my deadlines a day. If I want to attribute it to Mercury retrograde in a quick joke to my friends in group chat, fine. But that doesn't necessarily signify, you know, that I have changed how I think about myself. I would be really interested in like parsing out the difference between our shorthand driven by internet speak and the real changes for people who find either self-diagnosis or community or self-identifying as neurodivergent really impacted their everyday life. Yeah. I was reading one of your sub-stacks, Mary, the one called Why I Quit Therapy.

21:52And I know this is just your experience, but you were saying that to some degree, the diagnoses had also caused you to sort of hyper-focus on symptoms in a way that had felt like perhaps you needed to take a step back from it. And I'm curious if you can talk a bit about that. Yeah, I mean, there's an aspect to it that is incredibly stultifying. And there is an aspect to it, to your point, Tressie, what you were talking about, the pandemic and isolation, where, you know, people talk about dissociation all the time, right? And like, sometimes I really do be like jettisoning out of my body being like leaving that body for dead, where it's like, it's just me and my brain now.

22:26Like, it's all pure cognition. And like for me, talk therapy, even something like cognitive behavioral therapy, like it got to a point and I also did like 12 step. I've taken my own inventory, like all of these things where I'm just like, by God, like how much more do I need to parse the like sort of like effluvia of my own personhood? I don't think I need to be in therapy to identify how I'm feeling. You know, elixithymia, which is an inability to really recognize emotions within yourself or feelings within yourself is an aspect of autism that I do also have. And so I was just like, you know, I think that time is better spent for me really sitting down and like sitting with a thing that I suspect to be sadness without curing it, labeling it, understanding it, you know, routing it back to some sort of childhood phenomenon or something that happened to me and just being like, apparently you're sad.

23:24Tressie McMillan Cottom:Yeah, I think that is so important. I do think this, I've been thinking about this a lot. I've been working on this memoir that in part deals with why the psychologicalization of the culture did not in any way empower me to better understand or to make better decisions in my family unit. that there is a difference between understanding your feelings and feeling your feelings. And understanding can have so much positive feedback attached to it, right? Your therapist gives you an attagirl. Your friends tell them, oh, girl, what did you figure out today? And you get to unpack it with them over a little martini or, you know, whatever your thing is, right?

24:06Tressie McMillan Cottom:You've got this new and exciting story to put on, you know, the gram or on TikTok. And it's really hard to come up with new content. idea, so that's great, right? There's just a lot of positive feedback loops to understanding your feelings. I think a lot about the trend, especially among adults, especially during this time of COVID, which I just think is a social rupture. And anything that accelerated during that time deserves like our critical eye, not because it's necessarily bad, but let's just think it through. And it happening during that moment gives me some pause to think about how much of this is about people avoiding the feelings, right, and getting into the hamster wheel of the positive feedback of performing how well they understand their feelings.

24:55Tressie McMillan Cottom:And I do think that matters because we're not exactly sure how much of things like this, you know, the list you just gave me, it reminds me of, you know, you go to the, you know, the state fair and there's somebody there who'll read your palm, you know, there's a palm reader or something. And, you know, they look you up and down and they're like, hmm, you have major decisions in your life and you need to resolve things with your mother. And you're like, oh, then you go home and you think about it. You're like, well, I'm a 40-year-old woman. What 40-year-old woman doesn't have major things in her life and needs to have a serious talk with her mother, right?

25:27Tressie McMillan Cottom:So there's an aspect to this where I think the list of things like, oh, you have a, do you not like loud sounds? Do you have a favorite spoon? That one got me recently. I do have a favorite spoon, as it turned out. And I do only eat out of one bowl. Thank you. Me too. Me too. If this is the diagnostic criteria, right, it can be both really rewarding because it labels a feeling that you haven't yet finished feeling, but so broad that there's no risk in it asking you to do anything, right? Because what am I supposed to do about my favorite spoon? I'm just going to keep using my favorite spoon. And I think that trap keeps us from dealing with how much some of our anxiety is just earned.

26:10Tressie McMillan Cottom:It is an earned real response to anxious times, right? COVID was anxiety producing. It was hard and it was challenging. And maybe, just maybe that's okay. Totally. But also like the human condition is really tough. It sucks and it's hard. Or the Buddha came up with the whole thing. The Buddha said to us, right, suffering, attachment is suffering, right? Yeah, this is the human condition. And I'm not sure that sometimes the way we treat the self-labeling and the labeling of others helps us in that condition. I will say, though, that the other thing to kind of like not to put a button on it, but it is there is as a dopamine seeking brain and as all of us dopamine seeking people, whether like that sort of thing is regulated or not, there is a tremendous incentive and satisfaction in naming a thing.

27:07Yeah. Because it feels solved. That's right. The taxonomy is great. Like not only giving yourself agency to call yourself something, but to be like, and now I'm done. There's a kind of a gavel thwack in being like, oh, that's an ADHD behavior. That's an autistic behavior. Rather than I am actively being challenged in this moment, I do not know if I have the resources to figure this out. I am so deeply, deeply isolated and uncomfortable rather than I'm out EHD. Slap it on the bio. Other people are like, yay, us too. It's like, you know, a chorus of minions. And then that is just like a different serotonin dopamine moment than just sitting with that horrible feeling of like absolute ambiguity.