Why I Refuse to Armchair Diagnose

We’ve all been there. Just another seemingly innocuous chat about a friend, relative, or coworker. Or maybe it’s a completely innocent exchange, perhaps with fellow parents on the playground after school discussing that new kid in the class who keeps getting in trouble. There’s the usual conspiratorial tone of a conversation not intended to be overheard, in part because you’re ignoring that gut feeling that the tone is on the verge of shifting. And then it happens.

“It’s so obvious that he has _______. All the symptoms are there.”

Fill in the blank as you’d like. In my recent conversations, I’ve heard autism, anxiety disorder, and various mental health diagnoses tossed around without a second thought. And I remain shocked by how many seemingly educated adults I know — and who usually work in fields that have absolutely nothing to do with mental health or disability — feel perfectly comfortable issuing armchair diagnoses in casual conversation.

This happened recently to me in a discussion, in which my co-gossiper issued an armchair diagnosis of autism. “I saw it from Day 1,” the told me knowingly. “Is this an actual diagnosis or just speculation?” I replied, caught completely off guard. It’s obvious, was the response.

In another recent talk with a friend, the term “spectrum-y” was dropped no less than five times. In other talks, I’ve heard casual speculation about bipolar disorder, narcissistic personality disorder, and even PTDS in the case of children thought to (perhaps, for some unstated reason) have spent time in the foster system. On the other end of things, I’ve heard countless people make these claims and immediately pivot to highlight the “good” sides of these labels, as gleaned from popular culture. That new boy might have autism and have issues self-regulating, but he’s a genius as soon as he gets in front of a computer.

(That one deserves its own essay.)

But here’s the problem: armchair diagnoses aren’t real. They are clinical terms-turned-catchphrases. They are tools of gossip and informal social organization. When borrowed by non-specialists, they can be incredibly dangerous. Yes, I have a “Dr.” in front of my name, but it’s not that type that gives authority to apply clinical labels to individuals — not ever, but certainly not on the fly. I’m an anthropologist, so any claims I have over expertise and diagnosis have more to do with social and cultural questions than anything physiological or clinical. n Like the rest of us with vaguely pleasant memories of our undergraduate introduction to psychology classes, I’m grossly unqualified to ruminate on the underlying cause — or etiology — of a person’s seemingly atypical habits. And, many times, they aren’t even atypical.

But this is a fixture of our time. It connects closely to the ways that we access information — including medical information. We are bombarded with news stories about health, mental health, and disability, and we encounter these stories in ways that are partly structured by our particular social, political, and cultural communities. We also have at our fingertips an array of medical information and misinformation so fast — and so instantly accessible — that it was hard to fathom even a decade ago. We assume Google is our friend and its endless supply of health and medical websites are helping us, but are we so sure?

Like any other technology, the unprecedented access that we enjoy to health information in digital spaces both helps and hinders. Sometimes this is harmless. Who hasn’t fallen down the rabbit hole of WebMD or internet message boards, self-diagnosing any number of improbably ailments or conditions based on mundane symptoms? (I’m as guilty as anyone. I once pulled a muscle swinging my young child around, only to feel a vague pain and become absolutley convinced I was on the verge of a pulmonary embolism.) What parent hasn’t pored over websites of “typical” child development? Googled any number of psychological conditions that might explain their partner’s/friend’s/colleague’s/parent’s odd or inconsistent behavior? It’s worth noting, too, that as a nation at least half of us have wondered what was up with our current president, with a perhaps curious public willingness to err on the side of a quasi-diagnosis. What happened to the idea that someone could simply be a jerk?

As someone who studies cultural beliefs about health and illness, I’m both intrigued and unnerved by this trend to medicalize people’s personalities. The gossip in me empathizes with the urge, but that doesn’t make it okay. First, most of us are woefully unqualified to even dabble with the DSM. We simply do not have the skills, knowledge, or expertise. Secondly, you cannot diagnose someone from afar, from second-hand retellings of events, or from brief snippets of observation. Third, for the love of god, online tests and quizzes to find out if you have _______ are not reliable. And, yes, that includes standardized tools; those are designed to be used by professionals in specific settings, not random thirty-something parents scrolling on their laptops at night.

Ultimately, my opposition to armchair diagnoses is simple: they harm everyone involved. Not only is the person subjected to it (often unknowingly) being labeled with something they may or may not have, but the people doing it actively perpetuate stereotypes of disability and mental illness that are both ableist and inaccurate. This has crept into the fabric of our daily lives, imbuing a social reality in which vast numbers of children receive questionable diagnoses from a variety of actors — including parents and professionals — who simply are not trained for that job. Gossip and speculation blur with reality, and the stakes can be higher than we realized.

I’m sure we have all seen this in action. Next time, consider speaking up.