Living in the age of diagnoses

Indian Express

28-07-2025

I am writing about something that has been on my mind for a long time. There are questions that have churned me, kept me awake at night and knocked around in my head. What is wrong with our culture that there is so much yearning for psychiatric diagnoses? How did we reach this stage? Who does it harm and how? Can we be innocent bystanders in this, or do we need to question this idea or trend, a potentially dangerous one, that has become the zeitgeist of how we live, relate and understand ourselves and each other?
Let me step back a little and give a little context. Mental health has a dark history, and I will cite a few examples. Many celebrated psychiatrists played a significant role in carrying out the atrocities of eugenics in Nazi Germany. The pioneer of frontal lobotomy (a discredited and damaging neurosurgical treatment that spanned over 40 years) was awarded the Nobel Prize. More than 30 years ago, when I began my journey as a clinical psychologist, homosexuality was considered a sexual deviance and conversion therapy was standard practice. I am sure variations of these dark practices still persist. I got into trouble for questioning then, and despite the ripples it has created, I persist in questioning to date. Because, as the French philosopher, Michel Foucault commented, 'People know what they do; frequently, they know why they do what they do. But what they don't know is what what they do does.' I am sure, unwittingly, I have participated and gained in building of this 'mental health industrial complex' (an idea I borrow from child & adolescent psychiatrist, Sami Timimi).
I heard an astute young man recently comment, 'Nowadays everyone has some 'thing'. … It is as if we are seeking labels as a way to fit in a world that is so broken.' What happens when we or our children do not fit into the normative measures of worthiness, success or productivity? We find solace in diagnoses, as then we can explain why we are not measuring up to some unreasonable standards. We cannot even point a finger as we are all part of the policing system – mental health professionals, social media, academia and so on. We are surveilling each other and ourselves. The high yearning for self-diagnosis is a clear sign that the 'industry' is thriving.
'I am Borderline Personality Disorder. I also have Bipolar, PTSD, Generalised Anxiety disorder, and maybe Autism,' Shania counts them on her fingers while sharing this with me. Something in the way she shares it with me makes me wonder if this is something she has had to do multiple times. After all she has been to so many psychiatrists and therapists. Each one adding a new diagnosis to the list. 'They have all given up on me. There is no hope for me.' After understanding some of her struggles, I was curious to know, 'What would it be like if there were no diagnosis?' Head bent down, deep in thought, she sighed and said, 'Without them, I would have no excuse for being such a failure in life.'
Shania had been sexually abused as a child. She lived in silence about it for years, and finally, when she did share with her parents, they tried their best to get her help. She was in Grade 12 and struggling to manage her academics and navigate the complexities of high school life. Her teachers had declared that she would not pass her boards, and no college would accept her. Recently, she had taken to cutting herself and raging against her parents. Shania's distress is real. She is not failing the system; the system is failing Shania.
Every time I ask a young person, 'How does getting a diagnosis help?', their answer ranges from 'It is such a relief that it is not my fault,' or 'I finally have a label for what I am going through,' or 'I feel seen and understood.' Imagine if we lived in a culture where children and young people did not need diagnoses to be seen, understood or believed in. Where they could access help or get accommodations without first getting a diagnosis. Where they could opt out of the rat race without internalising it as their failure. As Suzanne Sullivan puts it in her book, Age of Diagnoses, 'Wellness culture has made us expect a lot from our bodies and our minds…Perhaps what they need from a diagnosis is a permission to do less in a world that only values a particular type of success.'
How can Shania believe that she has the ability to influence her own life, make decisions with confidence when she sees herself as an assortment of all these diagnoses? In therapy, we gently unpacked Shania's belief that 'something is inherently wrong with me.' And how diagnoses rarely change, but humans do. We could zoom out and look at the gender politics behind the diagnosis of Borderline Personality Disorder, and that maybe the rages and self-harm were responses to the abuse and adversity she had experienced and not due to 'mental illness.' We worked together as a team, along with her family, to support her through her board exams. As she claimed agency of her own life, she decided to take a gap year and work in an animal rescue centre. I marvel at the robustness of the human spirit that shines through every time she talks about her work with sparkling passion.
I would also like to clarify that it is fine if you are living with a diagnosis that works for you. My only hope is that you will not take it as the ultimate truth about yourself. Maybe you could poke holes in it, let it sit beside you as you carry on with your life and not let it define you or make predictions about your future. Keeping history in mind, today's so-called science can be dismissed as quackery tomorrow.
Resistance is building, change is happening, and there is a movement that is growing across the world against pathologising, dehumanising 'doings'. Narrative practice, Power Threat Meaning Framework, Soteria Model, Open Dialogue, and in India – Mariwala Health Initiative and other organisations are questioning the dominant and expert-led 'mental health industry'*. We have to question the system that makes us believe we are sick. I often think of Jiddu Krishnamurti's quote, 'It is no measure of health to be well-adjusted to a profoundly sick society.'
Composite stories and pseudonym are used to maintain confidentiality.