Cray-Cray

Apologies for lack of blogging. Short version: I’ve been working too hard and I am changing careers, so things have been a little tough. Enough of that, on with today’s blahg.

Today’s verbose rant is vomited forth for a simple reason: Someone Annoyed Me On The Internet. The topic: Remote mental health “diagnoses”. So with a little expansion and adaptation, I’ll repeat what I said to this person.

Remote mental health “diagnoses”, or “prejudicial bullshit plucked from the backsides of clueless bigots” as I refer to them, with no trace of bias, annoyance or self interest, are surprisingly common. Such acts of lazy bigotry seem to crop up in every comment thread. Someone is always being exhorted to “get professional help”, being described as “off their meds”, or the pinnacle of the phenomenon, actually “diagnosed” with a specific condition be it bipolar disorder, schizophrenia, a personality axis disorder or what have you. There is the subset of this latter category that is the “concerned diagnosis”. You know the one, the “are you sure you’re okay?” or the “that person seems a bit hyper, I bet they’re bipolar, it’s not good for them to be on the internet.”. Basically these are the standard tropes about mental health that flow though various societies and rear their ugly heads, like so much else, very visibly on the world wide wankathon that is the intewebs.

The most common sightings of these things in my experience is when someone is doing something a bit bad or a bit odd in a video, comment section, or wherever. Where someone is violating some norm, even only slightly. There are always a few people willing to “diagnose” the object of their ire as being in some way mentally ill. For these people bad equals mad. So what prompted this? I was reading a thread on the Facebook wall of someone I know, the thread was about a rather spectacularly obnoxious comment on YouTube (the home of the “interesting” comment) made by someone with a bit of a grudge against the video maker. The comment was a bit sweary, factually incorrect and a bit daft, but as could have been predicted there were a couple of people perfectly willing, on the basis of ONE, SINGLE comment on the internet, to question the sanity of the commenter.

This, of course, drives me…ha ha…crazy. (See how easy it is to casually toss off an unthought piece of low grade, lazy bigotry regarding mental health?) And thus today’s message to the universe at large is a plea not to do this sort of thing and a little explanation about why. So to all those people who have encountered something on the internet that causes them some concern and they suddenly feel the urge to comment on the mental health of some other internet denizen, here is a series of points as why this is a bad idea:

1) Qualifications: lack of them. I seriously doubt you are a psychiatrist/psychologist or in any way qualified to diagnose mental illness in anyone. I am aware that mental health professionals are people, and thus fallible human beings and all that comes with that, but people without the training, qualifications and experience to make diagnoses are not really in the position to go around offering their uneducated opinion on complex topics with any likelihood of being correct. Where’s the humility? Responsible, relevantly qualified, experienced mental health professionals would not do this sort of thing. What makes you believe you have a sufficiently unique and special insight that you are capable of accurately assessing something so complex as another person’s mental health without such training and experience?

2) Qualifications: no lack of them. If you are a psychiatrist, making glib diagnoses over the internet based on one (or a few) comments is professional misconduct and you should be struck off. Let me know your employer’s details, I’ll let them know that your desire to commit career suicide has been successfully accomplished. You know what it takes to establish a diagnosis, and a single/few internet comment(s) are not it.

3) Experience: personal. People who retort “Ah! But I have a mental illness/know someone with a mental illness/took a psych course once/care for someone with a mental illness” get one thing through your skull: you are not alone in having experience of people with mental illness, having mental illness yourself, or what have you. It does not make you special or an expert, it does not qualify you for anything other than describing your own experience. Full stop. The end. It is certainly not a qualification for remote diagnoses.

4) Reading: The power of Google and Wikipedia etc. Perhaps most importantly, mental illnesses do not reduce in an uncomplicated manner to simple behaviours. Checklists like the DSM-V and the ICD-10 etc are descriptive not definitive. Their use is the start of longer diagnostic processes and augmented by reference to (hopefully) carefully observed clinical experience and research data. They are not tools to be bandied about by those unqualified and inexperienced in their use to score rhetorical points on the internet. Reducing complex issues to simple slogans is one hallmark of LAZY (note emphasis) bigotry.* A far greater understanding of the context is needed.

Allow me to expand a little. I work at the boundary of chemistry, biology and (mental health) medicine. In fact I am working on two mental health drugs at the moment. I am spectacularly familiar with these things from a professional and personal standpoint. I would not dare have the arrogance to make claims about someone’s mental health. Not just from a distance, but from right up close. Not only, despite being very familiar with the relevant medical literature, am I unqualified to do so, I haven’t sat down with a person and taken a sufficiently detailed medical history to make diagnosis possible. And to be blunt, even though I would be a competent amateur, I’d have no real idea how to interpret the information in context or even check I was administering the relevant tests in the right way. Add in my personal experience and I still would not dare do so. Such things are fraught with pitfalls. Making diagnoses is not just a complicated issue, it is also a complex issue. Remote internet “diagnoses” can only be done out of ignorance and prejudice, not knowledge or suitable professional humility.

Even in emergency mental health care, “rapid” diagnoses with patients in front of the relevant medics, professionals take longer than the equivalent of a few typed words on a screen. Attributing the actions of one person to some form of personality disorder (for example) takes vastly more than one liberally stupid comment on the internet and some vague understanding of mental health issues. Anyone can read the DSM or ICD or a few articles about mental health and note a couple of similarities with something “bad” on the internet and the behaviours of people with mental illnesses. This does not a diagnosis make, and pretending it does does a disservice to the complexity of the subject at hand, the professionals doing work in this area, and the people suffering from mental illnesses.

5) Opinions: Well that’s just, like, your opinion. Noting the flaws and stupidity of remote internet “diagnoses” does not mean I merely disagree with you. Internet “diagnoses” are simple recitations of common prejudices. As if behaviour someone deems aberrant or abhorrent is somehow indicative of medical (as opposed to merely behavioural) difference. There is a wide spectrum of human behaviour, much of which is horrid, not all of which is pathological. Attributing behaviour someone deems unpleasant/bad to mental illness is counterfactual. Do not for a second think this is merely a personal difference. You’re disagreeing with widely available evidence. Many perfectly sane people do far worse and far more self-involved things than make a stupid comment on the internet.

There are live, generation long arguments within the relevant medical fields about which, where and how behaviours are pathological. There are enormous areas of grey. An internet comment, however deranged, does not fit in any of them. It’s barely noticeable, let alone a hallmark of diagnosis.

6) Associations: Bad = Mad. Associating bad behaviour with mental illness is one of the major reasons stigma about mental illness persists in every society. The lazy examination of someone’s bad behaviour as being due to mental illness indelibly associates bad with mad. This is a perpetuation of the idea that “mad” people are “bad” people. This contributes to people not being “out” about their diagnoses, to people being refused jobs because of their diagnoses, to people losing relationships with friends and loved ones because of their diagnoses etc. There is real harm here.

An innocent little remote internet “diagnosis” made based on snottily stated “experience”, or what have you, is neither innocent nor harmless. It has splash damage. It is not a thing without consequence. Can I ask that people think about this? The association of mad with bad is not merely counterfactual, it’s harmful. Pause your fingers, think. Is that such a big request?

And here, for your convenience is a simple flow chart to illustrate how to cope with the urge to remotely diagnose someone with a mental health condition over the internet:

Flow Chart for Blog Post

* Not all bigots wear white hoods. Bigotry can be, and often is, a small, unnoticed thing. It’s not always some monstrous spewing of prejudice. Hence why I choose my words with care, lazy bigotry: the repetition of unthought, unexamined prejudicial social tropes.


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