- People often search for a diagnosis because they can’t make sense of their emotional distress.
- Feelings are hard to understand for any number of reasons. A common problem is a false notion of autonomy from our context of concern.
- Without recognizing how things matter to us, our distress can appear baseless and irrational, rather than a reasonable response.
In recent posts, I've considered the troubling trend of the “self-diagnosis” of mental disorders (here, here, and here). More and more people, especially young adults, are identifying with diagnostic categories and symptom presentations that they encounter on social media platforms.
Finding a diagnosis can be comforting. As we know from research, it can confer social recognition of personal struggles, ease a sense of isolation, and direct the way to treatment.
Diagnosis as Default Explanation
A diagnosis, people report, can also help them make sense of their distress. They are anxious, in conflict with people at home or work, lacking energy, feeling overwhelmed, or experiencing other difficulties. And they don’t know why. Their feelings and actions don’t seem to them like a rational or appropriate response to their situation. Baffled, they worry, as one young person put it, that “there’s something wrong with me.” In their search for answers, a diagnosis of disorder—i.e., having a medical condition—can offer a welcome explanation.
But why don’t their feelings make sense? I offered some possible reasons in a previous post, and many more could be added. I want to focus here on one that I have encountered in interviews. I have also been reading books written by psychologists and educators about youth struggles and I see the same problem there, too. Call it a false notion of autonomy.
Consider the case of a college student I’ll call Maya. By any reasonable standard, she is doing very well in school. She also frequently volunteers and has a stable and supportive family. Yet Maya is “sad” and “chronically not up to par.” She is “not excited about her life and where it’s going.” She doesn’t feel that she is standing out or demonstrating her potential, and it makes her feel “ashamed,” “bitter,” and “angry at the world and then myself.” If “I were an impartial observer of myself,” Maya says, “I’d be like, ‘You’re so pathetic.’”
Such critical self-evaluations are common. People often speak of their distress with reference to a sense of inadequacy—of falling short of the mark, of not being “somebody” or “good enough,” of feeling worthless or empty or overwhelmed or the odd person out, or, in a different key, judged deficient by others. The sufficiency of their very self is in question, giving rise to an anguish felt in the “self-conscious” emotions, including humiliation, regret, embarrassment, guilt, and shame.
At the same time, they fault themselves for these feelings. According to Maya, she should be distinguishing herself—by her high grades, her leadership, and by making the most of her opportunities—but that “is really not happening.” While she recognizes outside pressure, both from the intense college environment and her parents’ high expectations, nothing external is the problem. She is the problem. I’m “disappointing myself,” she says, I’m not “proving something about myself.” Somehow, she is the cause of her distress, and she has no idea why. Perhaps, she has come to suspect, she has depression.
We Care Where We Stand
We can’t understand this kind of suffering if we fail to see how things matter to us. Things like other people, our relationships, our social standing, how we are being treated, events and objects that we care about, how to be and act for the best. We are not spectators on social life or autonomous islands. We are dependent, vulnerable, exposed to others. Our relation to the world is not neutral and detached; it is one of concern.
Another example. In a book on the college mental health crisis, a psychologist describes students much like Maya. They were “tops in their high school,” but “now find themselves in the middle of the pack surrounded by other ‘perfect’ students.” They think, “I’m supposed to be smarter and stand out,” and when challenged by the question, “If I’m not the best, who am I?” some mistakenly “decide, I’m a failure and a disgrace.”
According to the psychologist, this is a purely subjective judgment, a sad “loss of perspective,” nothing more. Students could avoid this unfortunate pain and distress and get more out of their education if they would simply “allow themselves to be less focused and less perfect.”
But for many, like Maya, to be the best and live up to their lofty potential is not some mere calculation of abilities and opportunities. It is the ethical ideal they have been taught and the yardstick by which they should measure themselves. From parents, teachers, counselors, and others, they have been exhorted to: “live up to your full potential,” “follow your passion,” and “be the best version of yourself.” They are to build a distinctive life, conduct their affairs with energy and initiative, be socially outgoing, and much more. Obstacles, they are constantly—and annoyingly—reminded, will yield to their persistence if only they have sufficient grit and resilience. Never settle! No regrets!
These are the norms and values that many have learned and that, to varying degrees, shape their attachments and commitments. These norms and values, which inform most of our institutions, are not subjective judgments or some shadowy force to which people can simply force themselves to be immune. Students like Maya care about how they measure up because they want to be respected; they want to do the right thing and to be the right thing. Falling short necessarily reflects poorly on them. It jeopardizes relations with parents, teachers, coaches, and even peers who have encouraged and supported them. Confused and frustrated, they may feel like a failure for not being all they should be and ashamed of letting others down.
Painful feelings like these are reasonable, understandable responses. But they are incomprehensible if we imagine ourselves as somehow detachable from our social and normative environment and the claims it makes about us. Without that context of concern, we can’t see the reality to which feelings of inadequacy and shame are a response. Emotional distress appears like much ado about nothing. Or, to the youth involved, it appears to be, unaccountably, “just me.” Given such a conclusion, a diagnosis can be a relief.
In addition to clarity about how our situation bears on us, making the connection to what we care about has another benefit. It directs our attention to the very norms and values against which we evaluate ourselves. Are these the only or best possibilities? While we are not autonomous from the things we care about, neither are we trapped. There are other systems of values, other virtues to live by. Seeing what our situation is doing to us might be an occasion to explore alternatives.