Thanks for this review; having followed Robin on the socials for years I've been contemplating buying his book, so it was great to read your thoughts (and thanks to Helen Lewis for the link).
I particularly liked your argument that there's an impactful permission structure associated with a diagnosis. I don't know that I'm comfortable with the identitarian angle on that (finding your tribe, etc), and it should go without saying that it's *not* permission run amok without regard for those you're sharing space with;
but the knowledge that your internal processes are divergent and NOT in fact deviant (despite a lifetime of social and disciplinary signals otherwise) is a powerful and positive thing.
I agree too that fuzzy biology makes a huge challenge for a resource-strapped health system that is (necessarily) geared toward 'one-size-needs-to-fit-as-many-as-we-can-make-it'. And weirdly, ALSO with Robin's heated defence against claims of over-diagnosis by the neurotypical!
Reflecting on that dissonance in myself, it occurred to me that - as someone reluctantly diagnosed with ADHD when > 50, and only after a pyrrhic battle with other mental health issues - the contention of over-diagnosis simply doesn't match my lived experience. When one has spent 2/3 of one's life having to re-invent ways to stay afloat in the normative world *without* any of the framing, tools or therapies that go with diagnosis, perhaps my sense is that the pendulum has much further to swing yet, before that contention is truly proved?
Going further: I would not wish great swathes of my lived experience on ANYONE - I want everyone who needs that extra therapeutic support to get it as early as they can (be it CBT, talking therapies, medication, or even just having that pre-formed 'label' to defend oneself against the punishments society deals to the non-conforming).
Lastly, discussions of over-diagnosis are also routinely used as a reason to delegitimise a condition or to avoid engaging in the tricky business of getting those support levels right. Perhaps that's another reason I can live with the implied contradictions.
Anyway, that's all just navel-gazing about that tension threading through Robin's memoir, and in part Helen's writing on the topic. Thanks for the opportunity to ruminate!
I do think an underrated part of mental health management is learning to distrust your own first instincts or impressions. In many cases, the way you understand people, pick up their social cues, react to their actions, can be misunderstood through the warping lens of mental illness. The modern solution of the world being more accommodating is important. But in the process the equal responsibility of the sufferer to acknowledge his impaired judgment, to second-guess himself, to apologize when misjudging, seems to have been absolved. It’s now referred to as “masking”, and the expectation is regarded as almost an abuse of the sufferer. But if you refuse to acknowledge where your behaviour has crossed a reasonable social norm, all you are doing is declaring a Victim Olympics, where the rules of engagement are always set by whoever is suffering the most.
Taking a real-life example, I burst out crying a couple of days ago when the cafeteria guy accidentally put sauce on my meat. I’m pregnant, overwhelmed, anxious and depressed, suffering from heat. I have every diagnostic reason in the world to explain my reaction. But that doesn’t change the fact that it was an overreaction and a shitty way to treat someone in service. So I apologized, without excuse. And I don’t feel like that is the kind of response that is encouraged in a mental-illness-identitarian approach.
Excellent thought. Thank you. We can have empathy and self awareness regardless of how much our mind is challenging reality and context. A continuous get out of jail card for all forms of neuro divergent overreaction creates even further division and isolation.
Great review which highlights the tension between a neurodiverse individual and the others around them, and the impact of a diagnosis on that. The language around 'permission' is very telling - having a diagnosis does not give you a get-out-of-jail free card to behave exactly as you wish and blame the world around you for not accommodating it. Social contract and all that. I personally found the chapter in Robin's book headed "Am I an arsehole?" personally quite triggering. My ex partner had mental health issues that got significantly worse during our relationship. He treated me horribly, and wouldn't meaningfully engage in treatment or therapy that might have helped him. For several years I tried to be understanding of this, and excused his behaviour (and my misery and depression resulting from his abuse) to family and friends on the grounds of his mental health problems, and that we all just needed to work harder to understand and accommodate him. Only one friend sat me down and said, "Yes, he might have these issues, but he is also being a **** and you need to leave."
As you point out in your review, we contain multitudes and different aspects of our personality and behaviour - especially those perceived as negative and with impacts on those around us in our personal and professional lives - can be hard to parse out and are not easily boxed and explained (or worse, excused) by a simple diagnosis.
I enjoyed this greatly- it's really pulled together some thorny paradoxes about diagnosis that I recognise from nearly 20 years diagnosing ADHD/Autism. Diagnosis is fuzzy, and has multiple meanings and forms depending on context, as you say. I think where I would defend Robin is when he says that on the one hand if you're happy with self diagnosis, don't bother with professional, while at the same time criticises professionals for being dismissive. For me the key is that diagnosis is a tool- if you are struggling, you might need it to help you, but if self-exploration has been enough, I'm happy to leave you be. I think that's how you explain his apparent contradictions- when he talks about wanting diagnosis to fade away I read it as him wishing for a more inclusive world.
It's true, also, that in some ways we are in the golden age of weirdo. But levels of bullying in neurodivergent youth are shocking and debilitating, so the inclusive future can feel quite far off at times. We still need tools to help.
Yeah I think that’s fair, my criticism is more that I think there’s an unresolved tension between the idea that a diagnosis is a tool in a toolkit, and the way that the journey in the book is presented as a single moment of epiphany in a way that seems to sort of glide over a bunch of other aspects. Diagnosis is sort of the end of the story rather than a stage or a beginning and I was missing really the exploration of ‘okay, but how do you critically examine that diagnosis, how do you evaluate it, how do you use that tool.’
That's true, and I guess I do worry that the impression is given that everyone would have the kind of revelatory experience that Robin had as soon as they realise their neurodivergence. And I would have loved more on the nature of diagnosis, it's just not what I was reading it for!
Martin, is there a reason why you don’t put your name at the top of the page, like almost everyone else on Substack does? Every time a new edition arrives, I find myself having to check who the author is.
Thanks for this review; having followed Robin on the socials for years I've been contemplating buying his book, so it was great to read your thoughts (and thanks to Helen Lewis for the link).
I particularly liked your argument that there's an impactful permission structure associated with a diagnosis. I don't know that I'm comfortable with the identitarian angle on that (finding your tribe, etc), and it should go without saying that it's *not* permission run amok without regard for those you're sharing space with;
but the knowledge that your internal processes are divergent and NOT in fact deviant (despite a lifetime of social and disciplinary signals otherwise) is a powerful and positive thing.
I agree too that fuzzy biology makes a huge challenge for a resource-strapped health system that is (necessarily) geared toward 'one-size-needs-to-fit-as-many-as-we-can-make-it'. And weirdly, ALSO with Robin's heated defence against claims of over-diagnosis by the neurotypical!
Reflecting on that dissonance in myself, it occurred to me that - as someone reluctantly diagnosed with ADHD when > 50, and only after a pyrrhic battle with other mental health issues - the contention of over-diagnosis simply doesn't match my lived experience. When one has spent 2/3 of one's life having to re-invent ways to stay afloat in the normative world *without* any of the framing, tools or therapies that go with diagnosis, perhaps my sense is that the pendulum has much further to swing yet, before that contention is truly proved?
Going further: I would not wish great swathes of my lived experience on ANYONE - I want everyone who needs that extra therapeutic support to get it as early as they can (be it CBT, talking therapies, medication, or even just having that pre-formed 'label' to defend oneself against the punishments society deals to the non-conforming).
Lastly, discussions of over-diagnosis are also routinely used as a reason to delegitimise a condition or to avoid engaging in the tricky business of getting those support levels right. Perhaps that's another reason I can live with the implied contradictions.
Anyway, that's all just navel-gazing about that tension threading through Robin's memoir, and in part Helen's writing on the topic. Thanks for the opportunity to ruminate!
I do think an underrated part of mental health management is learning to distrust your own first instincts or impressions. In many cases, the way you understand people, pick up their social cues, react to their actions, can be misunderstood through the warping lens of mental illness. The modern solution of the world being more accommodating is important. But in the process the equal responsibility of the sufferer to acknowledge his impaired judgment, to second-guess himself, to apologize when misjudging, seems to have been absolved. It’s now referred to as “masking”, and the expectation is regarded as almost an abuse of the sufferer. But if you refuse to acknowledge where your behaviour has crossed a reasonable social norm, all you are doing is declaring a Victim Olympics, where the rules of engagement are always set by whoever is suffering the most.
Taking a real-life example, I burst out crying a couple of days ago when the cafeteria guy accidentally put sauce on my meat. I’m pregnant, overwhelmed, anxious and depressed, suffering from heat. I have every diagnostic reason in the world to explain my reaction. But that doesn’t change the fact that it was an overreaction and a shitty way to treat someone in service. So I apologized, without excuse. And I don’t feel like that is the kind of response that is encouraged in a mental-illness-identitarian approach.
Excellent thought. Thank you. We can have empathy and self awareness regardless of how much our mind is challenging reality and context. A continuous get out of jail card for all forms of neuro divergent overreaction creates even further division and isolation.
Great review which highlights the tension between a neurodiverse individual and the others around them, and the impact of a diagnosis on that. The language around 'permission' is very telling - having a diagnosis does not give you a get-out-of-jail free card to behave exactly as you wish and blame the world around you for not accommodating it. Social contract and all that. I personally found the chapter in Robin's book headed "Am I an arsehole?" personally quite triggering. My ex partner had mental health issues that got significantly worse during our relationship. He treated me horribly, and wouldn't meaningfully engage in treatment or therapy that might have helped him. For several years I tried to be understanding of this, and excused his behaviour (and my misery and depression resulting from his abuse) to family and friends on the grounds of his mental health problems, and that we all just needed to work harder to understand and accommodate him. Only one friend sat me down and said, "Yes, he might have these issues, but he is also being a **** and you need to leave."
As you point out in your review, we contain multitudes and different aspects of our personality and behaviour - especially those perceived as negative and with impacts on those around us in our personal and professional lives - can be hard to parse out and are not easily boxed and explained (or worse, excused) by a simple diagnosis.
I enjoyed this greatly- it's really pulled together some thorny paradoxes about diagnosis that I recognise from nearly 20 years diagnosing ADHD/Autism. Diagnosis is fuzzy, and has multiple meanings and forms depending on context, as you say. I think where I would defend Robin is when he says that on the one hand if you're happy with self diagnosis, don't bother with professional, while at the same time criticises professionals for being dismissive. For me the key is that diagnosis is a tool- if you are struggling, you might need it to help you, but if self-exploration has been enough, I'm happy to leave you be. I think that's how you explain his apparent contradictions- when he talks about wanting diagnosis to fade away I read it as him wishing for a more inclusive world.
It's true, also, that in some ways we are in the golden age of weirdo. But levels of bullying in neurodivergent youth are shocking and debilitating, so the inclusive future can feel quite far off at times. We still need tools to help.
Yeah I think that’s fair, my criticism is more that I think there’s an unresolved tension between the idea that a diagnosis is a tool in a toolkit, and the way that the journey in the book is presented as a single moment of epiphany in a way that seems to sort of glide over a bunch of other aspects. Diagnosis is sort of the end of the story rather than a stage or a beginning and I was missing really the exploration of ‘okay, but how do you critically examine that diagnosis, how do you evaluate it, how do you use that tool.’
That's true, and I guess I do worry that the impression is given that everyone would have the kind of revelatory experience that Robin had as soon as they realise their neurodivergence. And I would have loved more on the nature of diagnosis, it's just not what I was reading it for!
I really enjoyed reading that, what a nice review. Thank you.
Martin, is there a reason why you don’t put your name at the top of the page, like almost everyone else on Substack does? Every time a new edition arrives, I find myself having to check who the author is.
Aha! Fixed it. I was looking in the 'edit post' bit but it's actually a global setting.
Incompetence probably - I’ll see if I can fix it for next time!