Fiction writers are constantly exhorted: Write what you know! To explore something all too real — the distorted way mental illness is regarded today — author Freddie DeBoer picks up that venerable admonition and runs with it.
In his new book “All in Your Head: Illness as Identity, Trauma as Fashion, and the Desire to Be Disordered,” DeBoer argues that mental illness must be seen for what it is: an impairment, rather than an identity, too readily adopted by Americans today.
On Substack and in two previous books, DeBoer has attracted notice for being a leftist who criticizes the left. Progressive education policy, he has argued, ignores the reality that students differ in terms of cognitive ability. Leaders of the social justice movement, he contends, are generally affluent and have lost touch with the working class they claim to speak for.
He’s mostly avoided the topic of mental health, although he was diagnosed with bipolar disorder at age 20. “I didn’t want to get pigeon-holed,” DeBoer, 45, explained to The Post. “Now there’s an uncomfortable conversation that needs to be had, and I thought if I have credibility to write about anything, it’s this.”
Online self-diagnosis troubles DeBoer. (A recent study reveals nearly a third of Americans looking for health advice on the internet have self-diagnosed a mental-health condition based on what they read.) He’s also concerned about the marginalization of serious conditions, and the tendency of some patients to center their whole lives around their illness.
The author concedes that psychiatry has had a troubled history. It remained a rudimentary medical science well into the 20th century, and until the introduction of Thorazine and other anti-psychotic drugs in the 1950s doctors had few effective treatments to offer. The barbarous practice of lobotomy, primitive electroconvulsive therapy and the warehousing of the severely mentally ill in grim institutions fueled public suspicion that vulnerable patients were regularly mistreated. The 1963 passage of the Community Mental Health Act, closing down many state asylums and releasing patients into local communities, represented an important turning point.
As DeBoer describes, the 1960s hippie movement and the advent of countercultural attitudes only amplified anxieties about the power doctors possessed to suppress individuals. He notes that the 1975 movie “One Flew Over the Cuckoo’s Nest” still stokes distrust of psychiatrists. And he reviews the well-known and disastrous consequence of emptying the state-run hospitals. Community care never materialized, and today too many of those with severe mental illness live on the streets of American cities, or end up in jail.
While this history makes for interesting reading, the best and most revelatory chapters of DeBoer’s book describe the current day, when psychiatric, cognitive and developmental disorders have lost much of the stigma they once possessed. In theory, this should be a very good thing. But removing the shame previously attached to such diagnoses has had — with the rise of social media — an unforeseen, and deleterious, rebound effect.
It’s become cool to claim certain mental impairments. Have no friends at school? Look for them online. The internet makes it easy to locate and join communities of like-minded, sympathetic individuals. People with profound autism, who can neither speak nor care for themselves, aren’t surfing the web. But in chatrooms dedicated to autism, lonely young people find recognition they don’t get in the real world by proudly announcing (often without a formal diagnosis) they too are “neuro-spicy” — slang for experiencing the world in a way that is not neurotypical.
DeBoer calls this phenomenon the “gentrification” of mental health and disability culture. The metaphor is powerful. Just as a dodgy neighborhood will change character after more affluent residents “discover” it and move in, more privileged patients — “those whose disorders range from mild to dubious” in the author’s words — have come to dominate intellectual and discursive spaces once dedicated to the needs of the most afflicted. As a result, the problems of people in serious mental trouble are sidelined, while those who are happy to call themselves sick get busy demanding attention and sympathy.
“We’ve created ‘disorder communities’ of recent converts as though having a debilitating illness is similar to rooting for a particular sports team,” DeBoer writes.
He cites the example of a large group of young women on TikTok treating dissociative identity disorder as “a quirky lifestyle choice.” Also known as multiple personality disorder, DID is a contested psychiatric diagnosis which doctors apply rarely, and mostly to people who have endured lives of extreme trauma, addiction and instability.
But on DID TikTok, women — and occasionally men — who look to be leading otherwise successful lives will switch personalities on command, something at odds with accepted DID symptomatology. (A change in posture, facial expression or tone of voice might indicate an “alter” has taken over. Alters can be fairies, or wizards or based on popular anime characters.) “It seemed fair to me to conclude there was a lot of acting going on,” DeBoer writes.
“It seemed fair to me to conclude there was a lot of acting going on,” DeBoer writes.
Fake disorders soak up scarce psychiatric resources. And, worse, when diagnoses become fads, the long-reviled figure of the psychiatrist once again lands in the public’s cross hairs. Patients resent doctors who won’t automatically endorse what they are convinced is true about themselves.
In 2023 a doctor at the renowned McLean Hospital in Massachusetts suggested to his peers that the sudden rise in self-diagnosed DID was being driven by TikTok and the cases were likely “not genuine.” Such was the harsh and threatening on-line backlash once this lecture was discovered by those in the DID community that it had to be removed from the hospital’s website.
In a sound medical system, psychiatrists would be effective and respected gatekeepers, but as DeBoer points out, some doctors are willing to accede to patients’ wishes, especially when it comes to college students desiring, on grounds of disability, extra time on tests. At Stanford nearly 40% of undergraduates are registered as disabled.
Of course, actual, severe mental illness afflicts many people, DeBoer among them. He writes eloquently about how bipolar disorder has “dominated and distorted” his life, and how assiduous he must be in managing his condition. “If I let go, if I ease up, if I surrender once again to the never-ending seduction of going off my meds and missing my psychiatrist appointments, I will stay alive for a while, slowly destroying my life, and then eventually I’ll die. I will throw myself off a bridge, or hang myself, or I’ll eat a gun,” he writes.
The author’s candor gives “All in Your Head” both authority and urgency. And while DeBoer acknowledges the crippling burden a condition like bipolar disorder can be, he also believes that over-identifying with one’s diagnosis will be an impediment to healing. One expert whom DeBoer spoke to works with PTSD patients, and she told him something he’s carried with him: “The point of treating trauma is to get past it.”
Yet today’s disability culture pushes people to constantly associate themselves with their weakness. This, DeBoer told The Post, represents a change from when he was first diagnosed in 2003, when “the central claim of disability politics was a defiant one — that the disabled were strong, even if they might need accommodations from society in order to flourish.”
On-line communities have pushed people in a different direction. “To raise the bar, to act as the most disabled person there, gets you a certain kind of cultural capital in these spaces,” DeBoer explained. But more significant in encouraging a different attitude has been modern progressivism. “In liberal politics today, the victim has been elevated to the moral pinnacle of society.”
Does DeBoer consider himself a victim? “No,” he says simply. “Psychiatry saved my life.”
