You Are What You Read (and Scroll) Like social media today, some mental health memoirs, while groundbreaking for their time, didn’t empower readers with information about the shaky science behind DSM diagnoses and the dangers of identifying too closely with a label.
I was just writing a post on the lack of depth and breadth that we seem to tolerate in this digital age. I suspect we are experiencing a growth spurt in how we view mental health as we come to grips with how much we don’t know. The complexity of the human mind means that our current diagnostic tools are only a starting point. While it's true that mental illness diagnoses often lack the rigorous scientific evidence we see in other medical fields, it's also true that these diagnoses are evolving. Mental health professionals strive to understand and categorize mental health issues better, and this process includes acknowledging the limitations and working towards more comprehensive, evidence-based approaches. The ongoing research and development in neuroscience and psychology aim to bridge these gaps and provide deeper insights into mental health, ultimately leading to more effective treatments and understanding.
Hi Sarah. I couldn't agree more. The only time a diagnosis helped me was when I was suffering excruciating panic attacks in the 1970s and until I understood the panic disorder diagnosis I thought something had attacked me from the outside (like outer space) and that I was just going completely crazy. I was lucky though...the masters level student counseling me actually explained to me why not having an official diagnosis was a good thing (I was paying via sliding scale vs. insurance). I once read that if you put very few people in a room who had all been diagnosed with borderline personality disorder there could be as many as 250 different symptoms. I hope this all changes one day.
Very eye opening read - I honestly don't trust Tiktok/social media influencers pushing mental health advice, unless they are a true professional/expert. I have trouble focusing sometimes - and wonder if I have a ADD or something like that, but I also put too much on my plate, so then I think my lack of focus is self-imposed, for which I am working on DOING LESS. I started having dissociative episodes last year. I told the doc at a physical and she immediately offered me a prescription... sighhhh... I think they are part of my grief process and potentially part of per-menopause. I work through them - they don't hurt me. The point is that I could so easily self-diagnose multiple different with allllll of the info out there, and with mis-information mixed in - that is a little scary.
You’re so self-aware. I feel like that’s the most important thing.
I saw a different kind of medical professional, and she said something that blew my mind: perimenopause is the other side of puberty. It made me realize that perimenopause is really a big thing that we have to honor and give ourselves time to go through.
I hope you find a publisher with the wisdom to take this on and help get the word out. Too many suffer trauma on top of trauma because of minsinformation on mental health. I'd recommend the publisher I've worked with---they are excellent and brave about taking on what others might consider to be risky projects. Writing Brave is a hybrid publisher. https://www.wearewritingbrave.com/
My problem with the term "diagnosis," is that it assumes a pathology, a problem that must be cured or fixed. This has the effect of shaming the person, which adds more trauma to the suffering they are already experiencing. Not healthy at all, but it is profitable.
He put it so well. You’ve actually articulated some thing I haven’t been able to articulate for myself. Diagnoses trapped me into thinking something was always wrong. You’re absolutely right.
Difficulty with publishers for authors comes with the territory. Sarah, your profound mental health successes want/need/must be shared. Keep fighting and the right publisher will appear. Yes the books listed are filled with the errors you've listed and Tik Tok influencers due have an audience and misinformation causes real harm. More and better education is needed and your Substack publishing is part of the education solution. We are in this together. Thank you for sharing your truth with your readers.
I’m so glad you’re writing about this, Sarah. While I recognize and honour that people find support and healing in different places (and that, for many, this support includes the DSM, their diagnoses, etc.), I don’t personally subscribe to the biomedical-psychological model (except, perhaps, as a tool or way of explaining something in select situations). It’s a human construct and is in many ways arbitrary - just like other models and frameworks for understanding the human experience. I also realize that, to many, even just saying that is considered "misinformation" and even ableist.
But I’ve seen that model and its misapplication cause tremendous, life-altering harm - including to two family members whom I love dearly.
Also, this really struck a chord: "It allows her to avoid looking at other possible causes for her suffering, e.g., drinking, drug use, and her profound immaturity." Drinking in itself has a massive impact on mental health. Also: not sleeping enough, not getting proper nutrition, not moving our bodies regularly, spending loads of time on screens, and the very culture and context we’re immersed in.
Idk why, but of all your posts about mental health that I've loved (which is nearly all of them), this one is really igniting in me the desire to tell my own mental health story.
Partly it's because this dovetails powerfully with my thoughts on sexual orientation — we're facing the same constricting identity labels in both realms — but mostly because I've read Cured and loved it, and I'm incensed that publishers aren't jumping at the bit to bring this to the public.
I honestly think eventually we will look back at these times as so backward in our thinking about issues around mental health, and general health services too for that matter. The separation between body and mind is also bonkers. It seems ridiculous not to publish a work from someone with experience as it is so impossible for professionals to understand what it feels like to go through such things. Sorry about your book
The age of the 'Tik-Tok' diagnosis has interrupted the mental health community in both positive and negative ways. I say 'positive' because we are in an era of destigmatizing mental health and understanding it more deeply, which (I believe) is a healthy move forward. And 'negative' because of all the reasons you've listed here. A psychologist once told me she can't really use the standard diagnostic tools for diagnosis and pre-screening because they're all over the internet, and the kids have taken them and self-diagnosed. Then, when they come to the office, they answer the questions to support their bias. It makes the job challenging. Still, these specialists will need to come up with newer, fresher ideas about how to diagnose and treat mental illness accurately, as the cat is out of the bag, as they say. What to do - what to do... it isn't very easy. I believe we learn and grow so much from each other's stories. I'd hate to see that 'taken away.' or diluted. When reading memoirs, don't you think some of the responsibility lies with the reader to understand this is simply a person's experience and not a medical book?
Really appreciated reading this, and I strongly agree that there’s too much pathologizing of human existence. It is tricky that publishers only want books written by medical professionals—you make a strong case for why books/content shared by just anyone can do damage — it totally does! But yours is the opposite and our society needs it. I’ve seen way more people debilitated than helped by a label.
Side-note: one of the subjects I write about is happy money management, making it desirable for other budget-resisters as THE PATH to pursuing your dreams. As I’ve sought out speaking opportunities etc, I’ve been told by some that they’re looking for “evidence-based” speakers and I’m like, “when do any of us make our spending decisions based on evidence???” We need more relatable, non-stuffy/non-expert stories to counter all the expert advice from people in fancy clothes/suits that just made people like me try to hide my money problems in shame, feeling irresponsible and “bad with money” etc. My example might seem tangentially related but it’s where my mind went when I read this. I got so much freedom when I realized I wasn’t this permanent thing (“bad with money”), was wonderfully ok as me, and just hadn’t discovered tools and approaches that made a huge difference
You’re so right. I will check out your Substack. This is one of my favorite topics, and I have no interest in hearing from people who have been saying the same things that everyone else is saying. I’d much rather hear from one person‘s experience. Money is one of those things that’s so individual.
I care a ton about money stuff, but am still figuring out what money stuff I want to bring into my Substack, but really appreciate your response of agreement about prefering a PERSON'S experience versus an expert's. Especially with AI added to the mix, I care more than ever about HUMAN experience in all writing I consume
I know that your principal interest in these comments is the issues surrounding mental health, but I want to pick up on your inability to get a traditional publisher.
I am a strong advocate of self (or 'independent') publishing and have given some time to two other writers here on Substack who were contemplating this route. I would be more than happy to discuss this with you by email or any other route. I published a number of books traditionally (including with HarperCollins and other prestigious publishers) and eventually took my rights back for two of these and sold many more copies of my books (with a much higher royalty rate (70% on Amazon). Readers don't care who publishes your book - they just care if it is good. And unless you are a celebrity or someone the publisher decides to push, they don't do much in the way of marketing.
Self-publishing is easy, quick and you can hold your head up high. You can buy all the editing, proof-reading, cover design etc you want via very good self-employed people. AND you maintain control over every aspect of your book. For instance, I never liked the covers of my books chosen by publishers; I love them now.
I would advise, as an important first step, joining the Alliance of Independent Authors (known as ALLi). This is a link (with an affiliate link, which means I get a small bonus for recommending it, but you pay the same. if you decide to join): https://allianceindependentauthors.org/?affid=3803
There is a whole wonderful community (a bit like the Substack community) of self-published authors out there. Don't be overwhelmed. Embrace it. Here to help.
Thank you! That’s so kind of you. I will look into all of this. I am somewhat beholden to traditional publishing. But maybe I should broaden my perspective.
There's a whole new world out there. Never too late to learn – I learned all this stuff in my 70s and am now in my 80s – older than Biden, but I believe I seem younger and in any case have no ambition to be President of anything. My offer is genuine.
I know it is infra dig to put links here to posts we have written, but there is one on my site called Writers and Serial Reciprocity which is very apposite.
You have built a strong platform so you could recoup costs and grow from there. I’ve had 7 traditional Big 5 and other big publishing deals and I hybrid published my last book. It was a good experience!
Hi Sarah, Have you read Rose Cartwright’s The Maps We Carry. She talks about the shift in her thinking away from a strict bio- medical model. She certainly challenged my perceptions of mental health. It was an excellent read.
Publishers only want mental health books by medical professionals? That's baloney, as you have touched on. Some of the best mental health books are not even in that category. If they want only credentialed writers in the field, put MHP or MHS after your name as if it were a degree. Mental Health Professional of Mental Health Specialist. I can get you a printed certificate and we will have an awards ceremony to make it official. I remember learning about the negative effects of labeling in a book I read in graduate school, "Trick or Treatment: How and When Psychotherapy Fails." by Richard Stuart. There is a chapter in there called "The Iatrogenic Effects of Dispositional Illness" all about the dangers and downsides of labeling. This was a small but significant part of my revelations about mental health on my way to a bona-fide Ph.D. The degree by itself is not important. What's important is what you do with what you know.
This is an area I’m very interested in and fascinated by given my experience as a “patient” or “client,” my life experience, my professional status and experience as a LCSW and the conclusions I’ve arrived at. My Substack tagline is: There’s nothing wrong with you and there never was.
At the same time, I’m not discounting that mental illness exists but I believe it’s rarely organic. We are snowflakes, all of us and by that I mean, there’s no “normal.” Theres only YOUR “normal.”
I could say more and need to write a long form essay on this or series of posts. I’m thrilled I met you, Sarah. You have so much to offer the mental health industry and “Cured” needs to be published. But gatekeepers will protect that territory. Persist.
I was just writing a post on the lack of depth and breadth that we seem to tolerate in this digital age. I suspect we are experiencing a growth spurt in how we view mental health as we come to grips with how much we don’t know. The complexity of the human mind means that our current diagnostic tools are only a starting point. While it's true that mental illness diagnoses often lack the rigorous scientific evidence we see in other medical fields, it's also true that these diagnoses are evolving. Mental health professionals strive to understand and categorize mental health issues better, and this process includes acknowledging the limitations and working towards more comprehensive, evidence-based approaches. The ongoing research and development in neuroscience and psychology aim to bridge these gaps and provide deeper insights into mental health, ultimately leading to more effective treatments and understanding.
Hi Sarah. I couldn't agree more. The only time a diagnosis helped me was when I was suffering excruciating panic attacks in the 1970s and until I understood the panic disorder diagnosis I thought something had attacked me from the outside (like outer space) and that I was just going completely crazy. I was lucky though...the masters level student counseling me actually explained to me why not having an official diagnosis was a good thing (I was paying via sliding scale vs. insurance). I once read that if you put very few people in a room who had all been diagnosed with borderline personality disorder there could be as many as 250 different symptoms. I hope this all changes one day.
Me too.
Very eye opening read - I honestly don't trust Tiktok/social media influencers pushing mental health advice, unless they are a true professional/expert. I have trouble focusing sometimes - and wonder if I have a ADD or something like that, but I also put too much on my plate, so then I think my lack of focus is self-imposed, for which I am working on DOING LESS. I started having dissociative episodes last year. I told the doc at a physical and she immediately offered me a prescription... sighhhh... I think they are part of my grief process and potentially part of per-menopause. I work through them - they don't hurt me. The point is that I could so easily self-diagnose multiple different with allllll of the info out there, and with mis-information mixed in - that is a little scary.
You’re so self-aware. I feel like that’s the most important thing.
I saw a different kind of medical professional, and she said something that blew my mind: perimenopause is the other side of puberty. It made me realize that perimenopause is really a big thing that we have to honor and give ourselves time to go through.
I’m with you.
That is so very true - it really is the other side of puberty isn't it!
I hope you find a publisher with the wisdom to take this on and help get the word out. Too many suffer trauma on top of trauma because of minsinformation on mental health. I'd recommend the publisher I've worked with---they are excellent and brave about taking on what others might consider to be risky projects. Writing Brave is a hybrid publisher. https://www.wearewritingbrave.com/
Thank you!
My problem with the term "diagnosis," is that it assumes a pathology, a problem that must be cured or fixed. This has the effect of shaming the person, which adds more trauma to the suffering they are already experiencing. Not healthy at all, but it is profitable.
He put it so well. You’ve actually articulated some thing I haven’t been able to articulate for myself. Diagnoses trapped me into thinking something was always wrong. You’re absolutely right.
Sarah,
Difficulty with publishers for authors comes with the territory. Sarah, your profound mental health successes want/need/must be shared. Keep fighting and the right publisher will appear. Yes the books listed are filled with the errors you've listed and Tik Tok influencers due have an audience and misinformation causes real harm. More and better education is needed and your Substack publishing is part of the education solution. We are in this together. Thank you for sharing your truth with your readers.
Thank you! You just made my whole world. I’m going to print out your comment and put it on my refrigerator.
I’m so glad you’re writing about this, Sarah. While I recognize and honour that people find support and healing in different places (and that, for many, this support includes the DSM, their diagnoses, etc.), I don’t personally subscribe to the biomedical-psychological model (except, perhaps, as a tool or way of explaining something in select situations). It’s a human construct and is in many ways arbitrary - just like other models and frameworks for understanding the human experience. I also realize that, to many, even just saying that is considered "misinformation" and even ableist.
But I’ve seen that model and its misapplication cause tremendous, life-altering harm - including to two family members whom I love dearly.
Also, this really struck a chord: "It allows her to avoid looking at other possible causes for her suffering, e.g., drinking, drug use, and her profound immaturity." Drinking in itself has a massive impact on mental health. Also: not sleeping enough, not getting proper nutrition, not moving our bodies regularly, spending loads of time on screens, and the very culture and context we’re immersed in.
Yes, you’re so right. It’s funny that the moment we question the mental health system, we risk being called ableist.
Idk why, but of all your posts about mental health that I've loved (which is nearly all of them), this one is really igniting in me the desire to tell my own mental health story.
Partly it's because this dovetails powerfully with my thoughts on sexual orientation — we're facing the same constricting identity labels in both realms — but mostly because I've read Cured and loved it, and I'm incensed that publishers aren't jumping at the bit to bring this to the public.
Thank you, Peter. You have to write about that. If you want to, of course.
Publishing’s pendulum swings back… it’s been such a hot topic
I honestly think eventually we will look back at these times as so backward in our thinking about issues around mental health, and general health services too for that matter. The separation between body and mind is also bonkers. It seems ridiculous not to publish a work from someone with experience as it is so impossible for professionals to understand what it feels like to go through such things. Sorry about your book
So true. The body mind distinction is bonkers.
The age of the 'Tik-Tok' diagnosis has interrupted the mental health community in both positive and negative ways. I say 'positive' because we are in an era of destigmatizing mental health and understanding it more deeply, which (I believe) is a healthy move forward. And 'negative' because of all the reasons you've listed here. A psychologist once told me she can't really use the standard diagnostic tools for diagnosis and pre-screening because they're all over the internet, and the kids have taken them and self-diagnosed. Then, when they come to the office, they answer the questions to support their bias. It makes the job challenging. Still, these specialists will need to come up with newer, fresher ideas about how to diagnose and treat mental illness accurately, as the cat is out of the bag, as they say. What to do - what to do... it isn't very easy. I believe we learn and grow so much from each other's stories. I'd hate to see that 'taken away.' or diluted. When reading memoirs, don't you think some of the responsibility lies with the reader to understand this is simply a person's experience and not a medical book?
Wow, I heard that mental health professionals have been experiencing that. It must be so hard for them.
And you’re right about readers. I also think we can put in new prefaces and forwards.
Really appreciated reading this, and I strongly agree that there’s too much pathologizing of human existence. It is tricky that publishers only want books written by medical professionals—you make a strong case for why books/content shared by just anyone can do damage — it totally does! But yours is the opposite and our society needs it. I’ve seen way more people debilitated than helped by a label.
Side-note: one of the subjects I write about is happy money management, making it desirable for other budget-resisters as THE PATH to pursuing your dreams. As I’ve sought out speaking opportunities etc, I’ve been told by some that they’re looking for “evidence-based” speakers and I’m like, “when do any of us make our spending decisions based on evidence???” We need more relatable, non-stuffy/non-expert stories to counter all the expert advice from people in fancy clothes/suits that just made people like me try to hide my money problems in shame, feeling irresponsible and “bad with money” etc. My example might seem tangentially related but it’s where my mind went when I read this. I got so much freedom when I realized I wasn’t this permanent thing (“bad with money”), was wonderfully ok as me, and just hadn’t discovered tools and approaches that made a huge difference
You’re so right. I will check out your Substack. This is one of my favorite topics, and I have no interest in hearing from people who have been saying the same things that everyone else is saying. I’d much rather hear from one person‘s experience. Money is one of those things that’s so individual.
I care a ton about money stuff, but am still figuring out what money stuff I want to bring into my Substack, but really appreciate your response of agreement about prefering a PERSON'S experience versus an expert's. Especially with AI added to the mix, I care more than ever about HUMAN experience in all writing I consume
I know that your principal interest in these comments is the issues surrounding mental health, but I want to pick up on your inability to get a traditional publisher.
I am a strong advocate of self (or 'independent') publishing and have given some time to two other writers here on Substack who were contemplating this route. I would be more than happy to discuss this with you by email or any other route. I published a number of books traditionally (including with HarperCollins and other prestigious publishers) and eventually took my rights back for two of these and sold many more copies of my books (with a much higher royalty rate (70% on Amazon). Readers don't care who publishes your book - they just care if it is good. And unless you are a celebrity or someone the publisher decides to push, they don't do much in the way of marketing.
Self-publishing is easy, quick and you can hold your head up high. You can buy all the editing, proof-reading, cover design etc you want via very good self-employed people. AND you maintain control over every aspect of your book. For instance, I never liked the covers of my books chosen by publishers; I love them now.
I would advise, as an important first step, joining the Alliance of Independent Authors (known as ALLi). This is a link (with an affiliate link, which means I get a small bonus for recommending it, but you pay the same. if you decide to join): https://allianceindependentauthors.org/?affid=3803
There is a whole wonderful community (a bit like the Substack community) of self-published authors out there. Don't be overwhelmed. Embrace it. Here to help.
Thank you! That’s so kind of you. I will look into all of this. I am somewhat beholden to traditional publishing. But maybe I should broaden my perspective.
There's a whole new world out there. Never too late to learn – I learned all this stuff in my 70s and am now in my 80s – older than Biden, but I believe I seem younger and in any case have no ambition to be President of anything. My offer is genuine.
I know it is infra dig to put links here to posts we have written, but there is one on my site called Writers and Serial Reciprocity which is very apposite.
You have built a strong platform so you could recoup costs and grow from there. I’ve had 7 traditional Big 5 and other big publishing deals and I hybrid published my last book. It was a good experience!
Hi Sarah, Have you read Rose Cartwright’s The Maps We Carry. She talks about the shift in her thinking away from a strict bio- medical model. She certainly challenged my perceptions of mental health. It was an excellent read.
Thank you, Gary. I’ll check it out.
Publishers only want mental health books by medical professionals? That's baloney, as you have touched on. Some of the best mental health books are not even in that category. If they want only credentialed writers in the field, put MHP or MHS after your name as if it were a degree. Mental Health Professional of Mental Health Specialist. I can get you a printed certificate and we will have an awards ceremony to make it official. I remember learning about the negative effects of labeling in a book I read in graduate school, "Trick or Treatment: How and When Psychotherapy Fails." by Richard Stuart. There is a chapter in there called "The Iatrogenic Effects of Dispositional Illness" all about the dangers and downsides of labeling. This was a small but significant part of my revelations about mental health on my way to a bona-fide Ph.D. The degree by itself is not important. What's important is what you do with what you know.
Gary! I’d write a longer comment but I have to go figure out what I’m gonna wear for our award ceremony. Thanks so much for this.
This is an area I’m very interested in and fascinated by given my experience as a “patient” or “client,” my life experience, my professional status and experience as a LCSW and the conclusions I’ve arrived at. My Substack tagline is: There’s nothing wrong with you and there never was.
At the same time, I’m not discounting that mental illness exists but I believe it’s rarely organic. We are snowflakes, all of us and by that I mean, there’s no “normal.” Theres only YOUR “normal.”
I could say more and need to write a long form essay on this or series of posts. I’m thrilled I met you, Sarah. You have so much to offer the mental health industry and “Cured” needs to be published. But gatekeepers will protect that territory. Persist.
Kelly! Thank you so much for this. It means so much to me. You do have such a unique perspective.