In today’s rapidly evolving society, it often feels like many individuals are dealing with various health conditions, some of which are relatively recent and on the rise. Leading diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) encompass ADHD, autism, depression, and anxiety. Additionally, conditions such as asthma, pre-diabetes/diabetes, hypertension, hypercholesterolemia, cancer, and POTS (Postural Orthostatic Tachycardia Syndrome) have become more prevalent, despite not having a primary classification in the DSM-5. It is increasingly common for individuals to present with a combination of these seemingly unrelated conditions.
This trend could indicate that (1) we are less mentally and physically healthy than previous generations, (2) modern physicians are better equipped to recognize and diagnose medical issues, or (3) personality traits and normal physiological differences are increasingly being pathologized. My initial thoughts on the latter notion crystallized as I transitioned from basic research to tutoring medical students and participating in the Admissions Committee. One key consideration for applicants was whether they were introverted or extroverted. As a newcomer to the committee, I questioned the relevance of this attribute, pointing out that both introverted and extroverted medical students could learn to connect effectively with patients as they develop into competent physicians. Consequently, the terms “extrovert” and “introvert” were removed from the evaluation criteria in the following cycle. This experience led me directly to Shyness: How Normal Behavior Became a Sickness by Christopher Lane, wherein he argues that shyness is a normal aspect of human behavior.
Dr. Suzanne O’Sullivan offers a broader perspective on this topic in her thought-provoking book, The Age of Diagnosis: How Our Obsession with Medical Labels is Making Us Sicker, published in March 2025. She starts with a bold assertion:
Importantly, overmedicalization and overdiagnosis are not merely conducted by the medical community on an unsuspecting public. The tendency to pathologize life’s inherent complexities has roots in both scientific and social trends. If we indeed face an overdiagnosis crisis, we must consider how societal expectations of success and perfection contribute to it. We are led to believe that anything we desire should be achievable, but this is not always the case. I observe that medical diagnoses are increasingly utilized to reframe perceived shortcomings. An unrealistic expectation of unattainable physical and psychological perfection could be transforming many individuals into patients and stripping them of autonomy over their own lives. (italics in original)
Dr. O’Sullivan elaborates further, expressing concern about how modern medicine is reshaping the boundaries between health and illness, which profoundly affects our lives. She notes a troubling trend of healthy individuals being reclassified as patients without sufficient benefits and unaddressed harms. Diagnosis is often perceived as a key that unlocks desires—offering explanations, support, and community among fellow patients—but this key also opens the door to more daunting realities that are often overlooked.
The term “patient” is derived from the Latin “pati,” meaning “to suffer.” Unfortunately, the growing capacity of modern medicine to diagnose conditions has not always been matched by effective cures, leading to individuals living longer with diagnoses but not necessarily enjoying longer, healthier lives, as seen with conditions like early-onset dementia that remain unchangeable.
Exploring these issues in greater detail, Dr. O’Sullivan begins with Huntingtin’s Disease (HD), an autosomal dominant condition where the presence of one copy of the mutated huntingtin protein guarantees the onset of the disease, although the timing remains uncertain. The dilemma is whether knowing about an inevitable diagnosis is always beneficial. For those carrying the risk of passing the disease to their children, knowledge is crucial. However, for individuals with a parent suffering from HD who do not plan on having children, the desire to undergo testing is less clear. Research indicates that around 90% of at-risk individuals who consult with genetic counselors ultimately choose not to take the test, often because they realize that knowledge cannot be unlearned. As investigations into HD continue, a solution remains elusive.
The conditions of Lyme Disease (LD) and Long Covid follow as notable examples. Both are very real diseases, and Dr. O’Sullivan provides a comprehensive history of Lyme disease, caused by the bacterium Borrelia burgdorferi, which is spread by deer ticks. Recognized only in the mid-1970s through the experiences of Polly Murray and her community, the broader issue at hand is whether chronic Lyme disease (CLD) is a legitimate medical condition. Given that Polly Murray battled the ailment for nearly two decades before it received formal acknowledgment, there is a strong argument in favor of its reality.
Both Borrelia burgdorferi and the bacterium causing syphilis (Treponema pallidum) are spirochetes—insidious pathogens that can elude treatment and precipitate multi-system diseases. Is there a community of patients and practitioners fixated on CLD, making the condition psychosomatic? Dr. O’Sullivan presents a compelling argument but emphasizes that this does not invalidate Lyme disease as a recognized medical issue. The concept of Long Covid emerged on Twitter in May 2020 during the early days of the pandemic, with claims that it too may be psychosomatic. While this claim is persuasive, it’s worth noting that SARS-CoV-2 is a serious pathogen that can induce prolonged, multifactorial health issues, despite having parallel groups advocating for its psychosomatic nature.
French neurologist and anthropologist Paul Broca meticulously documented cases of breast cancer through his wife’s family across four generations, being one of the first to demonstrate that breast cancer can have hereditary factors. This occurred long before the rediscovery of Mendelian genetics in 1900, when the mechanisms were not yet understood. Today, we recognize the molecular basis behind familial breast cancer through identified mutations in BRCA1 and BRCA2, which increase susceptibility to breast and ovarian cancer, often leading to preemptive surgeries for valid reasons. While this has undoubtedly saved lives, predictive diagnoses remain statistical in nature, not definitive for individuals. Genetic counselors now provide improved insights into these risks, yet a recent meta-analysis raised questions about whether early screening genuinely improves overall survival rates, revealing:
The study encompassed over 2 million individuals screened for various cancers, including prostate, breast, and colorectal cancers. In the case of colorectal cancer, screening extended lifespans by an average of one hundred and ten days, but for other cancers, no evidence indicated that early detection from screening conclusively led to longer lives.
Statistics apply to populations, not individuals, so each person must navigate their own path based on the current understanding of their health. In cases of known biological diseases, it seems prudent to err on the side of caution. However, the right choice is not always clear-cut; sometimes a strategy of “watchful waiting” is appropriate (as with prostate cancer), while other scenarios may call for immediate intervention. Dr. O’Sullivan noted that many women who opted for risk-reduction surgeries felt that their surgeons didn’t fully appreciate the gravity of their decisions, a sentiment that reflects the pressing demand for decisive actions in the medical field.
Autism presents a long-standing history in the DSM, with the significant rise in diagnoses over the past few decades often attributed to broader definitions and enhanced recognition of this diverse spectrum of disorders. Contrary to contemporary American policy-driven interpretations, there is no singular “cause” of autism, and vaccines are not implicated. The narratives shared in The Age of Diagnosis are compelling and deserve attention, featuring individuals like twenty-four-year-old Poppy and nonverbal Elijah, who, at twenty, has the cognitive abilities of a four-year-old. Poppy has expressed dissatisfaction with the support offered by the National Health Service in the UK, stating:
‘You’re not happy with the NHS message on autism?’
‘Too much misinformation.’
‘For example?’
‘The term “high functioning” implies that I’m not disabled enough. And calling me a “person with autism” suggests I carry it around as if it’s an object. I’m autistic; that’s part of my identity.’
The debate over the authenticity of the increase in autism diagnoses is still ongoing. However, it is undeniable that individuals “on the spectrum” are just that—individuals, each coping with varying levels of challenges. Elijah’s mother poignantly reminded those around her, “This is what autism looks like, not the version you saw on television last night,” highlighting the necessity of acknowledging each person’s unique experience and meeting them wherever they may be on their journey toward understanding.
ADHD presents its own narrative. It is a genuine condition with roots dating back to DSM-2 in 1968, where it was referred to as “hyperkinetic reaction in children (usually boys),” briefly described as distractibility and restlessness that would resolve in adolescence. In my own elementary school during the 1960s, this was often dismissed as “boys being boys,” which led to increased recess time when weather permitted. By DSM-3 (1980), the term “attention deficit disorder” (ADD) was introduced, incorporating hyperactivity in DSM-4 (1994) and ultimately becoming ADHD as defined in DSM-5. The latest definition stipulates that ADHD manifests as patterns of inattention or hyperactivity impacting social functioning or development, necessitating the presence of symptoms before age twelve and across multiple settings that adversely affect educational, social, or occupational performance. The nuances of ADHD severity—mild, moderate, and severe—are often subjective, varying from patient to patient and clinician to clinician.
Dr. O’Sullivan makes several critical observations regarding ADHD:
It has been repeatedly demonstrated that younger children in a classroom setting are more prone to receive an ADHD diagnosis than older counterparts, suggesting that immaturity may be mistakenly interpreted as a neurodevelopmental disorder. Significant diagnostic rate discrepancies exist even within a single country, not easily explained by cultural influences or healthcare access disparities. For instance, in Norway, diagnostic rates fluctuate between 1% and over 8% across different regions, contrasting sharply with ADHD rates of 14% in Mississippi versus just 5% in California. This disparity indicates that some healthcare professionals are more inclined to make diagnoses than others.
A stark reality is that, despite decades of research, no biomedical study has conclusively identified a common brain abnormality among individuals with ADHD. There are no biomarkers that adequately differentiate behaviors associated with ADHD from other disorders or even from typical human behavior.
Stimulant medications like Adderall and Ritalin are typically prescribed as the first-line treatments for adults, who have only recently been recognized as diagnosable with ADHD. For children, these medications are generally reserved until educational and behavioral interventions have proven ineffective, a practice that remains debatable. Alarmingly, among the Advisory Committee responsible for developing ADHD criteria for DSM-5, 78% disclosed ties to pharmaceutical companies, raising concerns about potential conflicts of interest. Industry funding for ADHD-related educational resources and advocacy groups is widespread, suggesting significant biases in information dissemination.
Research indicates limited evidence supporting the effectiveness of these medications in adults. For children, ADHD can embody an understanding of neurodiversity, proposing that moods, focus levels, social skills, and creativity exist on a continuum, allowing for various strengths and weaknesses. Accepting this diversity is essential, even if society often struggles to do so. The concept of neurodivergent individuals stands in contrast to neurotypical ones, leading to stigma and misunderstanding, as seen in Poppy’s experience.
The “ADHD Industrial Complex” raises notable concerns regarding accommodations, like extended testing time and separate exam settings, although one could argue the environment is reasonably quiet for most exams. However, studies reveal no significant performance advantage for students with ADHD who receive special accommodations compared to those who do not. This phenomenon reflects a broader trend of the emergence of diagnoses for conditions such as ADHD and test anxiety, which can lead to an expectation of needing continued support that may not always be justified:
A significant issue with these accommodations is that they promise enhanced academic or work performance without delivering tangible results. This creates a mindset in which students believe they are dependent on additional support to succeed. As a result, they may incorrectly assume that they require such assistance in future situations when they could potentially excel independently. Eventually, they will encounter circumstances where no special considerations are granted, leading a history of dependency to set them up for failure.
This trend is alarmingly prevalent. Many students who have been diagnosed with ADHD or similar conditions continue to view their diagnosis as a convenient excuse for various responsibilities. However, the wider world does not accommodate such mindsets.
It is important to note that ADHD, along with many other neurodevelopmental disorders, once had a “recovery identity.” In the 1960s and 70s, DSM described it as a condition that would typically resolve in adolescence. Times have changed:
ADHD is increasingly being embraced as part of many young people’s identities, with some support groups encouraging individuals to embrace their ADHD traits rather than overcome them. While there is merit in understanding one’s identity, learning to manage our emotions, behaviors, and impulses is a natural aspect of maturation for everyone, regardless of ADHD status. As we grow, we become more socially adept, focused, and better equipped to cope through practice. Promoting an alternative mindset could unintentionally set young individuals up for perpetual challenges. The rise of adult ADHD presentations may further erode young people’s expectations that their difficulties will eventually abate. As a chronic medical condition becomes intertwined with personal identity, it can become inescapable.
Finally, Dr. O’Sullivan offers thought-provoking insights into our overly confident era, which seeks biological explanations for every disorder:
As the inclusion of milder cases in diagnostic criteria expands, the negative ramifications of medicalization are often disregarded. The reliance on biological theories and chemical treatments can inadvertently overshadow vital social changes. Numerous studies have identified adverse life circumstances—such as early-life trauma, family histories of mental health issues, negative family dynamics, bullying, racism, social isolation, and economic inequality—as key risk factors for mental health conditions. These factors are susceptible to intervention, suggesting they deserve our focus.
Additionally, the ease of a consultation that concludes with a prescription alleviates physician stress and gives the impression of efficacy. However, medications come with side effects, including drowsiness, agitation, insomnia, and sexual dysfunction. While biologically rooted explanations may provide some solace, they risk disempowering individuals and diverting attention from necessary social reforms.
The book concludes with a call to reevaluate our expectations for perpetual health, warning it is cultivating an ageist society. This recalibration is essential, especially in resisting the encroachment of genetic determinism and its associated eugenics tendencies. We also face peculiar notions from “longevity doctors” advocating for the abolishment of death; these perspectives, while not serious, can inflict substantial harm.
The Age of Diagnosis prompts deep contemplation by challenging our perceptions of health and our instinctual preference for medicalization in confronting life’s uncertainties. The book elicits discomfort and thoughtfulness, experiences that everyone should explore, especially in today’s intricate world.
Notes
[1] Recently, Jonathan Haidt published The Anxious Generation, which we previously discussed here in 2024. Both Lane and Haidt have faced criticism, yet they offer a broader perspective often overlooked. My interest in Shyness stems from personally experiencing extreme shyness as a child, a challenge I eventually overcame as I matured and recognized my nature as simply different—not abnormal. Each individual’s experience is unique, and blanket generalizations can be misleading. However, the “Yes, we have a pill for that” approach has proven inadequate in addressing these issues.
[2] Huntington’s Disease tends to appear earlier in subsequent generations due to genetic anticipation. The repeated replication of the mutant huntingtin gene results in longer and more severe symptoms.
[3] Psychosomatic illnesses are real for the patient and manifest in objective, measurable symptoms. The term does not imply that these conditions are imagined; rather, the psychosocial aspects are significant.
