(Mis)Diagnosed Quotes

“Whether my client has schizoaffective disorder or bipolar disorder or depression, my job is pretty much the same. I am there to listen and to try to help. Together we play, and "the play's the thing," to quote Shakespeare. The work continues, always.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“This is my hope for you as well. We all deserve to have someone listen to our concerns and take them seriously, to really try to understand the shifting dynamics that make up our personalities and do their best to help. At times, diagnoses can help with that, but as I've demonstrated throughout these chapters, far too often that is not the case. The same sort of dynamics can crop up in therapy too; we are not immune from the racism, sexism, transphobia, and so forth of our day. We must try to be better, though, and that starts with a real encounter with the person sitting in front of us.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“All told, I saw Ken over a period of about four years, usually every week with larger gaps when things were going well. I realize that is often a luxury in our country where insurance company bureaucrats dictate the circumstances of our treatment. I had good enough coverage to allow me to see him at a minimal cost and for a length of time that worked for me. That should be a basic human right when it comes to mental health care, but of course it often does not work out that way.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“If I were more honest, I would have told them that in the nine months at our clinic, they would almost certainly hear stories of loved ones lost to gun violence. They would work with people who witnessed murders, some who had survived being shot and still carried the scars. They would hear of intimate partner violence, of patients who desperately wanted to escape but felt like they had nowhere to go. They would work with others whose roommates were active drug users and invited other drugs users into the home, but their patients would not be able to afford to move. Many of their patients would not feel comfortable leaving their homes, making many of the coping skills the applicants learned in school for depression and anxiety obsolete. They would be more than the sum total of their trauma, of course, but hearing the magnitude of pain they had experienced could easily become overwhelming.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Humans struggle with difference. We shape stereotypes and patterns of behavior that help us navigate an often perplexing and confusing world, but they often fail us by reducing the full humanity of others to a dull set of characteristics. When faced with difference, whether in regard to who someone finds sexually attractive or how someone conceives of their gender, we have often fallen back onto the well-worn belief that the problem is them. Psychology does not exist above and beyond our prejudices, no matter how much it aspires to scientific objectivity. It has too often started not with a concern for the mental health of others but rather our own discomfort, and mental illness becomes the label we use to classify that discomfort by reassuring ourselves that "they" are the problem.
But "they" are also "us," of course. There are trans mental health professionals just like there were gay mental health professionals back when homosexuality was pathologized. Our understanding of gender and sexuality has grown significantly in just the past few decades, but our diagnoses and our nomenclature have proven slow to catch up. This is a matter not just of proper labeling but of justice; as long as gender dysphoria remains, trans people can still be diagnosed with a mental illness if some facet of them is uncomfortable with being trans, not a difficult task to accomplish in a still-transphobic world. This can impact their ability to be parents, to work the jobs they want, to work at all, to be housed, to be protected from discrimination. Gender dysphoria as a diagnosis is an improvement over gender identity disorder, but it is far from perfect, and it continues to give ammunition to the Rowlings and Singals of the world. Hopefully, in due time their arguments will appear as irrational and off-base as the belief that men became gay because their mothers loved them too much.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Attempting to shape a child's gender expression toward a more normative form stifles the growing voices of children and communicates to them that they are able to explore only so far, that only certain ways of being in the world are okay. That strikes me as an exceedingly dangerous message to communicate to a developing mind, far more insidious than letting them play with nail polish or dolls in the process of becoming who they are.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Singal also cited an anonymous clinician from the GIC who expressed concern that trans children who want to desist might be pressured into remaining trans if their parents get involved in advocacy work, if they come out to their school and classmates, and so forth. As a parent, this strikes me as deeply confusing. Our basement is littered with the toys and hobbies of ages past, and while that can indeed be annoying, at no point did I consider forcing my daughter to play more with her expensive handmade doll or ride her scooter. To be a child or adolescent is to be in perpetual flux, picking up hobbies, interests, and identities to find out what feels right, what feels like home. This can happen with sports, with music, and yes, with gender and sexuality, but at no point does any good parent insist that their child keep their hair blue or stay on the soccer team long after their interest has withered.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“You are the pigs who make it possible for the cops to beat homosexuals," Alinder told Bieber. "They call us queer, you—so politely—call us sick."
Alinder says that Bieber responded, "I never said homosexuals were sick, what I said was that they have displaced sexual adjustment."
"That's the same thing, motherfucker," one of Alinder's fellow activists countered.
Bieber replied, "I don't want to oppress homosexuals, I want to liberate them, to liberate them from that which is paining them—their homosexuality."
Alinder ends his account by noting, "That used to be called genocide.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Being transgender is never easy, and as a cisgender man, I cannot fathom the myriad of ways in which our transphobic society makes life difficult for those who fail to conform to our rigid gender expectations.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“When it comes to such disclosures with friends or family members, many choose to come out directly through a conversation. In my own work, though, I've found statements like Harper's to be far more common; brief shots across the bow that test my reaction and see if I'm someone that's safe. It's vitally important to be aware of such moments, for while they may seem like passing comments to me, they are often the product of no small degree of internal wrangling, and the vulnerability inherent in such discussions means that my immediate reaction will crystallize for them whether or not I am someone they can talk to about such things. If they find that I am not, the therapeutic relationship will likely be irreparably shattered.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“The question is ultimately about whose suffering counts, who gets to have their difficulties adjusting to a new reality acknowledged and, hopefully, treated. For centuries, this has been almost the sole provenance of the mostly white upper and middle classes in America. Whether a behavior is regarded as a legitimate struggle or improper resistance often has far lass to do with the actual actions of a person than with how we describe those actions, both to ourselves and to others.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“The criminalization of marijuana devastated Black and Brown communities for generations, and prisons are still full of people convicted of marijuana-related crimes. Drug use occurs at the same rate across races and ethnicities, but what is considered a harmless bit of fun for white people becomes criminal when engaged in by minorities. Now that the tides have turned toward decriminalization, it is overwhelmingly white businesspeople who are reaping the benefits. Here in Chicago, almost all of the dispensaries that have opened are located on the (majority white) North Side. As of this writing, no people of color have received a license to open a dispensary, and the communities most ravaged by the War on Drugs are shut out of the newly legal marketplace.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“It can seem that there are two different Americas, one largely white and privileged that is granted access to the best our economy has to offer and the help they need when they need it, and another, mostly Black and Brown, left to get by on the margins. Such a construct is understandable but not all that helpful, for it can make it sound like we're dealing with two different realities. What we really have is two different ways of talking about the same phenomena.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Think about the radical difference between being told you are having trouble in school because of a problem with your attention versus attributing it to being defiant and disruptive. One diagnosis assures the student that it is not their fault; the other asserts that it most certainly is. A diagnosis of ODD colors not just how a student views themselves but how teachers and other administrators view them. The increasing presence of police and accompanying harsh disciplinary measures in our schools has created a school-to-prison pipeline, and giving a child a diagnosis of ODD allows them to pass to the front of that line.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Since we live in such saturated lives, it is no wonder that we find our attention often lacking these days. Instead of this being a side effect of our increasingly busy lives, though, what if that is the point? We work more than our peers in other countries, take fewer breaks, allow ourselves less time for rest, and try to do a multitude of things at once. When this process becomes overwhelming, we label it as a disease, both in us and in our children. The fact that these patterns are observable in such young lives should give us serious pause as we consider whether the way we live is working or not, but instead we medicate or treat our shattered attention instead of asking what precisely broke it in the first place.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“An analysis of total economic productivity data from the Bureau of Labor Statistics reveals that productivity has risen by almost 70 percent from 1979 to 2018, yet wages have only risen about 15 percent. Rather than our increased output leading to increased leisure, we have made those at the top far richer than most of us can imagine while the rest of us are scraping to get by despite being a part of one of the most advanced economies in the world. The COVID-19 pandemic only accelerated these changes, making the likes of Jeff Bezos far richer while around a third of Americans could not afford their rent or mortgage.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“I have found that one of the unavoidable aspects of being human is suffering...”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“The sort of mental institutions that used to house large numbers of patients for years at a time have all but disappeared. The institutionalized population of people with mental illness has shifted from asylums, which at least theoretically offered treatment to reduce suffering, to jails and prisons that house Black and Brown people in ever-increasing numbers. One estimate attributes 7 percent of the overall growth in the prison population form 1980 to 2000 to the deinstitutionalization of people with severe mental illness, landing an additional 40,000 to 72,000 people in jail or prison. Mental illness is far overrepresented in the inmates housed in such institutions; according to the American Psychological Association, 64 percent of those in jail, 54 percent of those in state prisons, and 45 percent of those in federal prisons have a mental illness, compared to a baseline rate of about 20 percent in the general population. Conditions associated with the modern prison industrial complex—including overcrowding, pervasive threats of violence, and the overuse of solitary confinement— are practically designed to further inflame the symptoms of mental illness. Any "treatment" incarcerated individuals receive is often aimed at blunting their symptoms to make them docile and compliant, not to restore them to health. Returning citizens often go back to chronically underdeveloped neighborhoods with few options available to receive mental health treatment, ensuring the cycle of mass incarceration and the criminalization of serious mental illness continues.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Label someone's thoughts as delusional and you ensure that neither you nor anyone else have to take them seriously.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“We know that people with schizophrenia have the best outcomes when they are able to maintain their lives in their community, receiving the help and support they need while not being removed from where they come from. Mass institutionalization and mass incarceration shatter these bonds, stealing Black lives from their communities and subjecting them to the ever-increasing carceral state.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Saying that someone is seeing things that aren't there or believes things that aren't true is an invitation to dive deeper in order to help them, not an excuse to write them off and bury them underneath powerful medications.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“It is possible for an illness to also be a means of social control (such as AIDS), and that is often the case with schizophrenia.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Black Americans—and Black males, in particular—are far more likely to be diagnosed with schizophrenia as compared with patients of other races, despite the fact that all ethnicities experience the disorder at the same rate. This doesn't just stop at diagnosis, though. Black people are also less likely to receive mental health services in the first place, and the care that they receive is often poorer. One study of a community mental health center's prescribing patterns found that whites were six times more likely to receive a second-generation antipsychotic medication—the contemporary treatment of choice for schizophrenia—while Black people were prescribed older drugs with riskier side effects. Black people are often subject to more coercive treatments, such as shots received on a regular basis instead of an oral medication. These depot medications can be great for people who struggle to remember to take their medicine, but they can also take away the element of choice from clients and become a tool of social coercion.
Contrary to what you may think, this is, by and large, a Western problem. It is well-documented but underreported that outcomes are actually better for people with schizophrenia in less-developed countries.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Al did not have to "act crazy" to get approved for disability; he let his voluminous records do the talking. Our sessions consisted of reminiscing about his childhood, processing the racism both overt and covert that he had experienced throughout his lifetime, and discussing the news of the day. I believed that he did truly suffer mentally; he had very little contact with people other than me, didn't trust people, and seemed to hear and see things that weren't there. I used to see a lot of patients like Al. There was also Marvin, who believed he had inherited an ability to see and talk to spirits; Teddy, who claimed to be tormented by the sound of babies crying; Eric, whose outbursts of intense anger caused him shame and guilt in the aftermath. All had mental health symptoms that plagued them and shaped their interactions with others. All were also Black men. The strands of their stories were so infused with suffering that it was difficult to separate their symptoms from their history. Was Al depressed because he often self-isolated, or did he self-isolate because the only people he knew around him had chronic substance abuse issues? Was Marvin paranoid because some neurotransmitters in his brain were out of balance, or because he had been beaten by police upon multiple occasions in the past? How much of Eric's anger was due to the fact that he had very few friends left because so many of them had been murdered? All had ended up with diagnoses of severe mental illness along the schizophrenia spectrum, yet there was clearly more at work in each case.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“What if it was possible to both acknowledge their suffering while also condemning the injustices and inequalities that have helped lead them here?”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“My aim for this archaeological project is twofold. Contrary to what many think, diagnoses are helpful but by no means necessary for the work of psychotherapy. They are crucial if one is to prescribe medication or bill an insurance provider, of course, but they don't play nearly as large of a role in two people talking to one another. When a client comes to me and tells me that they have bipolar disorder, depression, or the like, I file it away as necessary data. However, that categorization is far less interesting or meaningful to me than exploring what gives their life purpose and how they could better live into their values. To paraphrase the British psychoanalyst Donald Winnicott, the business of therapy is really just two people playing together. I have found that the fear of diagnosis, what it might mean to be labeled as "depressed" or "anxious," much less "psychotic," prevents many people from consulting a therapist when they need help. A label that isn't all that useful to my work serves as an impediment to those in need.
Perhaps it's time to rethink the utility of those labels, or at least how we relate to them. Once I know the person sitting in front of me has schizophrenia, the focus becomes fixed on treating their hallucinations and delusions, on helping them best integrate into society. We thus exempt ourselves from considering everything that came before they entered our office. What if it was possible to both acknowledge their suffering while also condemning the injustices and inequalities that have helped lead them here? That is the task that I have set for myself in the following pages.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“We currently have no way to measure the presence of serotonin or any other neurotransmitter in a patient who presents with symptoms of depression. In addition to being incorrect, the chemical imbalance theory has never had a test to legitimate its claims. Yet it has had staying power because it neatly fits our current age's obsession with medicalizing all forms of human suffering.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“I just thought I was crazy this whole time. I honestly just feel relieved to know there's a name for all of that, you know?”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“Hopelessness is the water in which her family swims.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health

“A psychiatric diagnosis too often shapes how we listen to the person sitting in front of us. Once they are revealed to have hysteria or borderline personality disorder, everything that they might say only functions as confirmation of their diagnosis.”
― Jonathan Foiles, (Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health