Psychological diagnoses offer an easy way in to understanding character - but our habit of using them comes at a cost, says Dr Lucy Foulkes (UCL Psychology & Language Sciences).
It takes around 30 seconds to diagnose Holden Caulfield. Sixty, maybe, if you look at more than one website. The unhappy protagonist of The Catcher in the Rye has post-traumatic stress disorder (PTSD), brought on by the death of his 13-year-old brother several years before the novel begins. The diagnosis explains a lot: the distressing thoughts, the trouble sleeping, his habit of drinking to numb the pain. Other critics say he might have depression instead, or an anxiety disorder, or maybe all three. The details don’t actually matter. One thing is clear: Caulfield is a teenager in need of a diagnosis.
He’s in good company. Search the internet and you’ll discover that Dorian Gray, it seems, has body dysmorphia. Lady Macbeth, with her incessant handwashing, has obsessive compulsive disorder (OCD) . King Lear? Bipolar disorder. Even in the Hundred Acre Wood, home of Winnie-the-Pooh and friends, neurodevelopmental and psychiatric disorders are rife. Pooh himself has attention deficit hyperactivity disorder (ADHD); Eeyore has depression; and Piglet, with his relentless, uncontrollable worry, is a textbook case of generalised anxiety disorder.
Today, this is what we do. We look at the people around us, real or fictional, and we try to figure out what it is they have. In the past, this kind of exercise was reserved for those in extreme distress. Now it is applied more widely. We try to diagnose people in the public eye (hello, Donald Trump ), but also our friends, family and colleagues. Most importantly, perhaps, we diagnose ourselves.
The terms don’t even need to be established or legitimate concepts. Sexually attracted to intelligent people? You’re sapiosexual. Tendency to stay up late at night? That could be a case of revenge bedtime procrastination. And if you’re struggling in the aftermath of an affair, there’s a name for that too: post-infidelity stress disorder. It doesn’t matter whether these terms originated from a psychiatrist’s handbook or a tweet, all of us now have and are things, psychological conditions and disorders, things that have names.
There are some good reasons for this. It’s less mental effort, for starters - it’s easier to rely on pre-existing categories than to try and understand someone’s individual circumstances. It’s comforting, too, knowing that we’re not alone, that there has been some historical precedent to an experience. And labels have power. They can represent a recognition of the pain we have been suffering and a signal to others that we need more help. When it comes to psychiatric or neurodevelopmental diagnoses in particular, a label can be - if you’re lucky - a ticket to accessing treatment and support.
Yet this classification habit comes at a cost. This isn’t just about the possibility of diagnoses exacerbating rather than reducing stigma by enhancing a sense of otherness. Or the fact that having a supposed disorder can make a problem feel more permanent and harder to fix. This is about what we lose when we reduce ourselves to something too simple - often, to a single word. When you use a label to describe someone, and that includes yourself, you can turn a multi-faceted, endlessly complicated character into a flat stereotype.
These labels were supposed to help us understand each other better. Many mental health campaigns are specifically designed to raise awareness about what different disorders really are, with the goal of better understanding the people who have them. This is important: we do need to improve awareness of all kinds of difficulties, and terminology gives us a broad-brush framework for understanding a person’s challenges. But if you only use labels, if you privilege that level of character explanation above describing the individual, then you can end up understanding someone less.
"If you’ve met one person with autism, you’ve met one person with autism," academic and autism advocate Dr Stephen Shore has said , and this is true of all diagnostic terms. Even when a condition or disorder significantly shapes a person’s behaviour, it can still only be one part of the story. When attempting to understand and describe someone’s character, we need to resist linguistic laziness, and use full sentences and paragraphs to convey who they really are. There is not a person on earth that can be adequately captured with a single word.
Of course I’m in favour of raising awareness of specific disorders, but I want to raise awareness of another idea, too: that there’s a broad range of psychological colour within all of us that cannot be named, that doesn’t need to be diagnosed at all.
This will require a shift in thinking. In 2021, diagnostic language rules - even the entirely unverified variety found on social media (for example, TikTok videos on "high functioning anxiety" are extremely popular). There is an unspoken sense that unless a problem has an official name it’s not real, or not bad enough to warrant attention or help. So a recalibration is needed, in all of us. Something can be difficult without being diagnosed; pain is no less valid if it doesn’t have a medical-sounding name; and people going through an undefinable difficult time still deserve your help. Arguably, if we resist the terminology and opt for the long-form description of the problem instead, we might actually be able to understand each other better.
And so in fiction as it is in real life. Children don’t love Winnie-the-Pooh because it’s an age-appropriate introduction to psychiatry. In Shakespeare’s day, audiences didn’t need a diagnostic manual to be moved by his characters, and we still don’t today. And The Catcher in the Rye isn’t one of the bestselling novels of all time because it teaches readers about the symptom checklist for PTSD. Maybe Holden Caulfield does have a mental disorder: he is certainly troubled, and needs support. But it takes a whole book - as it should - for us to even begin to understand him.
This article first appeared in The Guardian on 18 October 2021.