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Have We Turned Personality Into Diagnosis?

38m 9s

Have We Turned Personality Into Diagnosis?

This conversation between an interviewer, sociologist Tressie McMillan Cottom, and author Mary H.K. Choi examines the growing trend of adult self-diagnosis of ADHD and autism, especially post-2020. Choi describes her late-life diagnoses as transformative—affirming lifelong quirks like time blindness and intense pattern recognition—but also admits grief over lost expectations and a need to step back from over-analyzing symptoms. Cottom frames labels sociologically: they help people sort themselves and find community, but can also enforce norms and hierarchies, especially when applied rigidly. They attribute the pandemic spike in diagnoses to social rupture, isolation, and algorithm-driven content that made medical terms feel personalized and accessible, even if much of it is inaccurate (e.g., 52% of top ADHD videos contain misinformation). They differentiate between internet shorthand—like identifying with a favorite spoon—and genuine self-understanding, noting that many young people treat these labels casually. Choi emphasizes that for her, the real benefit was granting herself more patience and compassion, not seeking medication. Cottom adds that labels can offer a "permission structure" for kindness, but critiques a culture where such permission requires a diagnosis. Ultimately, they agree that while labels can be liberating and clarifying, they risk becoming thought-terminating clichés that avoid the hard work of feeling emotions, and that the human condition—suffering, ambiguity, and anxiety—is not always a disorder to be named.

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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 be out of a favorite spoon. Thank you, and I'm like, "What do we do?" If this is the diagnostic criteria, right? A quarter of American adults suspect that they have undiagnosed ADHD, but only six percent have a formal diagnosis. So, what's going on? Tell me you're of ADHD without telling me you're of ADHD. I'll go first. Put a finger down if you leave things half open like cabinets drawers or doors. I will procrastinate in assignment for like two weeks and somehow get it done in two hours. And if any of these sound like you, you'll 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 Tressy McMillan-Cotton, an author Mary H. K. Choi who has written about being diagnosed with autism and ADHD. Tressy, Mary, thank you so much for being here with me today. Thank you for having me. It's a real pleasure, not you. We're going to be talking about neurodivergence and diagnostic labels like ADHD and autism, and what interests me in that conversation is the 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." And 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 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. And 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. But 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, this, this degree of satis. And then my brother, because he's the masculine child, like, and he has sons, like he, he gets degree for his father, this amount. And I just kept crunching on this like, 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, you're supposed to feel or are you figuring out how much you are allowed to express? Was it internal or was it about external 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 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 saw like actual diagnostic assessment. Yeah. What came first for you, your diagnosis for autism or for ADHD? I 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 like, I knew it was weird that I had time blindness. I knew it was weird that I have absolutely no sense of direction, like to the point where I can get lost on my way home to a home I've lived in for 20 years. Like, if there's any sort of aberration in like, 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 even tip, tip, tell a story is very parapetetic. It's very non-linear. 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. And 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 child like 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 that's also really beautiful because there is so much like surrender and there's so much sort of like peace and 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. That'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 Jesse, 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 in each other? Well, the, you know, the basic definition that we give to people when they're like sociologies, I like social work is that, you know, 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 of what we might call like functional work, positive work, pro social work. When they help us figure out our selves 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. These are things that are still actually pretty new in the long, you know, deraille 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. 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 of right ways to act and think and feel when really the answer is there isn't a right way to think or act to feel. 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've 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 trend 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 Maryl asked you to give your definition to but as I understand it neurodivergence is not a medical term it's an umbrella term that cat that can hold lots of different diagnoses and ways of being that differ from the norm that just says that it'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 is 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 it'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 and 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 it's a it's a beginning place it in yeah you might call it yes and in improv yeah well looking 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 Jesse what was happening around the time of the pandemic that we both started talking about neurodivergence online and so I started seeing this increase in adults being diagnosed with ADHD 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 in 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 we're working on zoom we're doing zoom school right at the time there were lots of studies about like Instagram face and zoom face during this moment because we were watching ourselves some of us for the first time at that with that kind of concentrated focus in it and it skewed our perception of how we looked and so you see an uptick and 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 had been up thinking last night like hey it's my you know it's my hyper focus maybe a indication that I could use some you know medical intervention 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 and we just had so much more time to do the self-assessment to obsess with ourselves in a way that usually work in commuting in school and everything would have distracted us from 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 and a time of great people I mean I want to make clear that like a medical diagnosis of any kind needs especially mental health diagnosis is important it can be life-saving 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 what you're talking about is very true Tressy that there's these social media videos that throw around medical terms without necessarily being medically sound there'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 heavily researching a product before buying it having a high-paying tolerance having a huge compassion for suffering having only one or two close friends instead of many close friends I just I feel like this it's it's within the capacity of the algorithm to want to tell us about ourselves and 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 in the manosphere and this not any other and like you know how gen alpha doesn't know juice world is dead you know like all of these different things wait I don't know about this what is juice world oh I don't know what it is and I don't know 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 they they still have access to like his avatar or his you know skin or whatever that I know anything about this by the way not just oh it's okay I know 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 to take this they don't they know they don't they're so savvy yeah and so I do think there's however yes the parents are little too incredulous but yeah the kids actually are pretty much aware of the the question so I question like for anyone who's even written like autistic or like oh my god that's me like I I do wonder sometimes if we assign too much credulity to them to them and 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 much larger conversation rather than lol I love blow dryers so I think that's so important and I 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 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 inputted I've 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 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 like so I 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 jonka likes to say shout out to jonka who does have an unofficial diagnosis which is very hard for women which is you know shout out to Mary almost impossible for black women, which my friend Johnneka is. And so we've talked very openly about this and her journey of getting a medical diagnosis 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 Johnneka, Johnneka girl, I 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 write 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, 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 and a quick joke to my friends and 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 short hand driven by internet speak and the real changes for people who find either self diagnosis or community or self identifying as neurodivergent, really impact it their everyday life. Yeah. I was reading one of your sub stacks, Mary, the one called why I quit therapy. And 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 needed to take a step back from it. And I'm curious if you can talk a bit about that. Yeah. I mean, there is an aspect to it that is incredibly stultifying and there is a aspect to it to your point, trust you, what you're 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, like 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 that 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 said. 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 and add a girl, your friend said, "Oh girl, what did you figure out today?" You get to unpack it with them of a little martini or, you know, whatever your thing is, right? Like this new and exciting story to put on, you know, the grammar and TikTok and it's really hard to come up with new content ideas, 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 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. And I do think that matters because they're, we're not exactly sure how much of things like this, you know, the list you just gave me reminds me of, you know, you go to the, you know, the state fair and there's somebody there will 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 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? So, there's an aspect of 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 have a favorite spoon. Thank you. I'm like, oh, we do. 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. It isn't 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 the human condition is really tough and it's hard. It's hard. The whole thing, the Buddha said, 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 too, 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 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 kind of a gable 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 ADHD, 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. I want to go back and catch something from earlier because we were talking about, oh, the young generation, they don't take these things so seriously, they can tell the difference between an autism video that is using, like that is not medically sound and they don't take it too seriously, but you know, there's a survey from last year that shows that nearly a third of American adults and half of Gen Z adults report having self-diagnosed themselves with a mental health condition because of stuff they saw in social media. I think it is really widespread. I mean, I am susceptible to these videos. I think I have ADHD for, I cannot focus on a task for very long. I want to be thinking about lots of different things at once. And then when I meet my friends, I have friends who like have many more symptoms than just the ones that I see on the internet and I'm like, you really need medication in order to function in a work office environment in a way that I do not. And I understand your diagnosis is something different than something that I'm diagnosing myself with based on a couple of traits on the internet. And to me, I see those two things as separate. But for me, this feels really personal, this question because it's the thing I've thought about my whole life, my family, my nuclear family, I would say absolutely none of us are neuro-typical, but my French mother has always been very, very against the idea of any kind of mental health diagnoses, and especially when my siblings and I were younger and I think exhibiting behavior that could have lent itself to a mental health diagnosis and intervention. She really didn't want us to feel limited in our capacity to become our full selves by giving a single word to what we were. I mean, you trust me when you're like, I resist this. I don't want to be labeled in this way by my friends, even though I see myself in so many of these descriptions. How do you think that through? That's a great question because I think some of what your mother, I really, my gut really leaned into your mother's perspective on this, which is that, you know, it could even be useful in some sense, but when a child is still developing, unless the behaviors are getting in the way of that development, development is not linear. I actually am not entirely sure it matters if a child, you know, can read aloud from the picture book at the end of kindergarten, and maybe it's okay if it doesn't happen to second grade, and that we used to have far more flex ability at the classroom level in schools for those determinations to be made, right? When there wasn't a whole bunch of standardized testing and teaching to a test, a teacher could go, "Okay, trust me, you read really well, but you cannot get the round item into the square hole, and yet you keep trying." That was a real thing that happened to me. I almost flunked kindergarten because I couldn't cut a piece of paper in a straight line. This was an assessment for whatever reason, but I could read at the sixth grade level, right? And a teacher could assess that and go, "Okay, you're probably fine. It's going to shake out by high school, right?" The idea that all of that flexibility has left our children's lives. Children's lives have become so structured that the stakes of the diagnosis seem really out of whack with the possible benefits for a lot of people and families. And so I think it is an adult what I was dealing with is that I had come from that time when there was so much more flexibility for me to develop in my own way, and the milestones weren't so rigid. And I think that having come up with that worldview, I'm not really willing to give it up just yet, something about it just didn't quite sit well with me. That is not to say that I rejected, however, again, from my friends, and that I won't necessarily reconsider, but that was my gut. I think my gut was much more like your mother's. And Mary, we're reaching the end of our time at Mary for, like a hypothetical, if we could imagine a world in which you never received a diagnosis, but somehow in your 40s, a friend or a therapist suggests these behavioral interventions of like, maybe you don't have to go to parties, you don't want to go to. And maybe you can wear earplugs and loud spits. That's so radical. Are you telling me not to? I don't have to go to parties. I don't want to go to. Only if you get diagnosed, Tressie, without a diagnosis, you have to go to the party. What has changed is everything. Thank you very much. That's the hidden accommodation. Yeah, totally. No, I mean, like, you know, it is true. Like to your point, it's like, I, I understand the thinking behind that too. And I agree. Like if you were to get a full behavioral, like diagnosis from a clinician and that affords you certain accommodations in school, like who is to say if those accommodations, again, that largely are one-size-fits-all, which is like, you get more test by time or you get more of this or you have this remedial class with other kids. Like, that is also not for you. You know, and it could, and it could affect you in adverse ways that we absolutely do not know. And in my particular circumstance, like because I wasn't diagnosed until later, like, it was edifying and clarifying to see all these, like, really sort of meticulous and hilarious, like, rude, gold, burguian ways that I had organized my life with, like, the routines or the systems and things like that. And a lot of those were ingenious. And a lot of those actually do sort of point to my, like, acuity and faculties and other places where those skills outpace, like, an holistic person, or like a non-autistic person. And that, I do derive a great deal of pleasure and esteem from. But really, the only perk for self-identifying or being formally assessed as an autistic person is because it is not a drug-seeking behavior, because unlike ADHD, there is no amphetamine that I'm trying to get with this behavioral diagnosis of self-evaluating. All I can actually do is give myself more time, more patience, exponential amount of compassion and kindness. You know, like, there was a moment in which I was just like, you know, I'm woo-woo, like, I do, like, inner family systems, I do inner child work, all this stuff. I'm just like, oh, my inner child has, like, very special needs. Like, and I never got that until my 40s. Like, I felt unloved, but even by my parents. And so that it's not my parents fault entirely. Like, that affords me more compassion for them. Like, it's just like, oh, like, I wasn't ruined by my parents' immigrant experience and workaholism. It was a factor in the way that I received love and was like, and, you know, again, it's hereditary symptoms. I'm just like, are you neurodivergent? Can I give you more compassion and understanding? And so, really, the only, the boon or the salve of it was the fact that I was just like, okay, I can be less unkind, and I can be less demanding of myself, and I can be less perfectionistic or hard on everyone. And so, for me, that's been like an incredible gift. That is so much fun. That makes me feel very, that really is. Yeah. Yeah, Tessa, I wanted to ask you, you as well, like, what is it about labels and the ways in which we label ourselves that can be liberating? Oh, for sure. I mean, a label is a possible shortcut, yes, to, you know, foreclose possibilities, thought-terminating cliches, but it can also be a way for you to give yourself a permission structure, which is what I kind of hear and marry that feel so profound, that for some of us, how we are socialized, the repertoire of identities that we inherit from our families, from our communities, may not have a costume in it for us, right? And so, maybe it takes something as medical sounding as a diagnosis to give ourselves the permission structure to be kind to ourselves. Maybe that's what it takes for some of us, which I think is not an indictment of the people who do it. It is an indictment of our culture that gives people so few options to find themselves in a healthy way with reasonable risks that we would go through instead this whole process. It is not easy to get a diagnosis. I'd even argue, they're down sides to self-identifying as such, right? It can kind of come with a lot of judgment and it can come with jokes and things that can diminish your experience. I think it is an indictment of a world that for some people that feels more reasonable than just saying, maybe I'm going to be kind to myself today. Maybe I'm going to give myself more time to get where I need to be. Maybe I won't rush, right? Like, maybe I'm worth the extra steps in my process that it takes for me to get out of the door in the morning. And I just find that really profound and not a process that necessarily needs the label, but that we have produced labels that engender that kind of permission structure, says something about where we are, what we need, and the people who need it and who benefit from it. That's beautiful. Thank you both so much for talking about this with me today. I really appreciate how much you've shared both of your intellect and of your personal experiences. It's been really wonderful to talk about it with both of you. Thank you for having us. This was a lot of fun. Thanks for having me.

Podcast Summary

Key Points:

  1. The discussion explores the rise in adult ADHD and autism self-diagnosis, particularly during the COVID-19 pandemic, with only 6% of Americans formally diagnosed despite a quarter suspecting they have ADHD.
  2. Mary H.K. Choi shares her journey of being diagnosed with ADHD and autism in her 40s, describing it as an "OS update" that affirmed her experiences (e.g., time blindness, pattern recognition) but also brought grief over unmet hopes.
  3. Sociologist Tressie McMillan Cottom argues labels can be liberating by providing a "permission structure" for self-kindness, but can also limit by creating hierarchies, moral judgments, and binaries.
  4. Pandemic-era isolation and algorithm-driven social media (e.g., TikTok) fueled the trend, with studies showing over half of top ADHD videos contain inaccurate medical information, yet many users treat these as casual shorthand.
  5. Choi notes that diagnoses helped her extend compassion to herself and others, but she also cautions against over-relying on labels, as naming a thing can feel like solving it without addressing underlying feelings.
  6. The conversation critiques the "concept creep" of terms like neurodivergence, questioning whether broad symptom lists (e.g., liking a favorite spoon) dilute meaning and distract from real struggles.

Summary:

K. Choi examines the growing trend of adult self-diagnosis of ADHD and autism, especially post-2020. Choi describes her late-life diagnoses as transformative—affirming lifelong quirks like time blindness and intense pattern recognition—but also admits grief over lost expectations and a need to step back from over-analyzing symptoms.

Cottom frames labels sociologically: they help people sort themselves and find community, but can also enforce norms and hierarchies, especially when applied rigidly. , 52% of top ADHD videos contain misinformation). They differentiate between internet shorthand—like identifying with a favorite spoon—and genuine self-understanding, noting that many young people treat these labels casually.

Choi emphasizes that for her, the real benefit was granting herself more patience and compassion, not seeking medication. Cottom adds that labels can offer a "permission structure" for kindness, but critiques a culture where such permission requires a diagnosis. Ultimately, they agree that while labels can be liberating and clarifying, they risk becoming thought-terminating clichés that avoid the hard work of feeling emotions, and that the human condition—suffering, ambiguity, and anxiety—is not always a disorder to be named.

FAQs

Neurodivergence is an umbrella term, not a medical one, that describes brains that differ from what is considered normative. It emphasizes that conditions like autism are not a simple gradient but a three-dimensional constellation of traits.

The increase is linked to COVID-19 shutdowns, which caused social isolation and broke routines. This led people to spend more time online, where algorithms exposed them to personalized content about ADHD, prompting self-assessment and diagnoses.

Yes, studies show that over half of top-performing ADHD videos and 41% of autism videos contain inaccurate medical information. Many videos list broad, common traits as symptoms, which can lead to self-diagnosis without proper medical validation.

A diagnosis can provide affirmation, explain past experiences, and offer a 'permission structure' to be kinder and more compassionate to oneself. It can also grant access to treatments and accommodations, but it may also bring grief for lost hopes.

Labels can become limiting by trapping people in categories, leading to moral judgments or hierarchies. They may also encourage hyper-focusing on symptoms, sometimes avoiding the actual feelings, and can be used as a shortcut that forecloses other possibilities.

A diagnosis is liberating when it helps people understand themselves, talk about their experiences, and recalibrate expectations. It becomes limiting when it creates rigid boundaries, becomes a source of judgment, or prevents personal growth by reducing one's identity to a single label.

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