The Incentive to Be Sick: Why many young people play along with diagnosis culture

 

In his book, Teen 2.0, psychologist Robert Epstein gives an account of the medical profession’s complicity in the movement to marginalize young people: “In short, my own colleagues have long played and continue to play a leading role in the maintenance of the artificial extension of childhood. They have pathologized socially induced behavior and have, in recent years, even medicalized its treatment, relying heavily on drugs to get young people under control.” (p. 363)

Of all ageism’s manifestations, I find this one especially disturbing. Although I’m lucky enough never to have been truly harmed by Epstein’s “colleagues” (though I’ve met a few young people who have), I’ve experienced the insidious way they can distort reality, and make their young patients powerless.

To give one small example: when I was 18, I went to speak to the dean of students at my university because I was incompatible with my professors and classmates, and was considering withdrawing. In the five minutes it took to tell her this, she concluded that I needed to see a “healthcare professional” because I might have a “medical condition.” Although I asked her with obvious skepticism whether wanting to leave school could really be considered a medical condition, I ultimately did as she said. And of course this “healthcare professional” diagnosed me with depression.

We have to acknowledge that there is (to put it mildly) a conflict of interest when the people in charge can simply call it a medical condition to be unhappy with their institution. Before any professional had so much as heard my name, I was already the one whose mental health was in question, putting me on the defensive when it should have been the other way around. Yet what are the odds that the dean of a university would be sent to see a “healthcare professional” for being unhappy about her students (or for making them unhappy)?

Epstein cites a study claiming that “49.6 percent of Americans ages thirteen to eighteen are diagnosable with at least one emotional, behavioral, or substance abuse disorder.” (p. 140) He seems to think that this trend is due partly to the desire (like that of my dean of students) “to get young people under control,” and partly to the fact that these pathologies are “socially induced.”

I like Dr. Epstein’s argument. But because the truth is never so simple, I want to take it a step further. I’m now going to leave the beaten path of Epstein’s book, and social trends you can easily read about online, and enter the wilderness of my personal experience.

Now, when it comes to disorders and conditions, our tendency is to focus on the stigma that goes with them: the shame that causes secondary problems on top of the original illness. I’m not saying this stigma doesn’t exist (in fact, I know it does)—however, in the last few years I’ve actually noticed the opposite trend. Part of this may be due to the middle-class, politically liberal community I live in, but the tendency now seems to be for my classmates to wear their disorders and disabilities like badges of honor. Strangers will mention theirs to me out of the blue, and then this will end up being one of the two or three things I know about them. I might identify a one-time acquaintance as “the guy from Nevada who has dyslexia.” Sometimes, being around so many sufferers makes me feel ashamed just because I haven’t been diagnosed with anything lately.

For a long while, I couldn’t understand why I was observing this trend, even in this one community. Not that I think it’s shameful to suffer from a condition or disability, or to discuss it openly—just that it’s nothing to be so exuberantly proud of that it’s one of the main things you want people to know about you.

But after reading Epstein’s book, and thinking about youth rights in general, this behavior started to make sense to me. Let’s imagine for a moment that we’re young. Adults have a set of expectations for us, and we have no say in what those are, or how strictly we have to adhere to them. Consequently, if we don’t like them, there’s very little we can do. For example, let’s say we don’t want to go to school today. We say, “I’m mature and responsible, and will use the time productively.” Most adults will refuse us on principle, without a second thought. On the other hand, if we say, “A doctor diagnosed me with anxiety, I can’t go to school today,” then adults are usually obligated to listen to us. Suddenly, young people have a real weapon that can be used use on a day-to-day basis to fight for the accommodation that’s otherwise been completely denied. And the best part is, we can’t even be blamed for speaking above our station, or for asking for special treatment: we’re victims of our conditions. We didn’t ask for any of this. If anything, we deserve pity and sympathy, rather than scolding.

Now, I should make it clear: I’m not saying young people who’ve been diagnosed with conditions are faking, or that the doctors aren’t making legitimate diagnoses. I’m merely pointing out that we’ve created an incentive (and a rather powerful incentive) for young people to be seen as victims of a condition, and to advertise that victimhood at every opportunity. It’s simple economics: if there’s an incentive to exaggerate, people will (even if they’re not aware of doing it).

Even people with real disorders have an incentive to see how far these can get them. For example, let’s say we suffer from anxiety, and know from experience that we can take the day off from school if we think we need to. Today, we’re feeling a notch or two more anxious than we’d like to, but could most likely function if we tried. But we’re also tired and not in the mood for school. Should we stay home sick? Why not? Who’s to say that this tiredness and apathy isn’t just an extension of the anxiety?

There’s no real way to solve this accountability problem. But ageism has made it worse than it has to be. By refusing to accommodate young people for any reason other than sickness, we’ve left them few alternatives but to fall into the role of someone who is chronically sick. In effect, we validate and reward young people for being sick or neurotic, but we treat them just as inflexibly (which in their case amounts to a punishment) for being healthy and mature.

Epstein’s argument should be expanded: the incentive to diagnose isn’t just there for psychologists (money and credibility) and parents (passing the blame); it can also be there for children themselves. And this is a deeper problem than even Epstein acknowledges in his book. If all parties have a vested interest in young people being diagnosed, who on earth has enough at stake to oppose it?

There is no obvious answer. The best defense we seem to have is from 1) the handful of psychologists who have clear principles that haven’t been bent by the allure of money or fame, and 2) the scattered objections of a few concerned citizens.

Bizarrely, this latter group includes both youth rights advocates and the more old-fashioned breed of puritanical ageist bigots—though they make the same objection for different reasons. Youth rights advocates say, “Nearly all young people don’t need to be treated, except with respect,” while puritanical bigots say, “Anxiety and depression are just fancy words for laziness. Kids are lazy, and it’s because we let them be. Get a job or get out, that’s the way it should be. That’ll put an end to all this ‘anxiety’ baloney.” Whenever these two seemingly opposite viewpoints happen to agree on an issue like this, it’s easy to see that puritanical ageism (i.e. the “grab a shovel and get to work” variety) almost looks like youth rights compared to neo-ageism (i.e. the “sit still and take your Ritalin” variety), which is arguably worse. Neo-ageism wears a mask of compassion, despite actually having more contempt for young people than puritanical ageism, and disempowering them to an even greater degree.

At its essence, being accommodated because of a condition is a crutch. That’s not so say it isn’t necessary—sometimes we need crutches. But we need to be skeptical if we don’t want to all end up dependent on crutches we wouldn’t have needed if we’d been allowed to walk properly from the beginning. We need more people pressing basic questions like, “Is it really a medical condition to want to leave school?” And more importantly, we need to accommodate young people when they’re mature and responsible—just as much as we do when they’re sick. Otherwise, where is the incentive to ever be completely healthy?