“I understand that you believe” …that questioning diagnostic clarity is associated with some nebulous conversational or clinical scenarios that make you uncomfortable. But sticking your head in the epistemological sand and chastising people for being “extremely insulting” (based on your own extrapolated associations with their position) is extremely …condescending argument-by-assertion.

I have skin in the game on this one and in my own experience sloppy diagnostics have caused way more suffering than stigma. I was nodding along with gp’s entire point. Your confidently dismissive chastisement is what feels out of line.

I don’t really disagree with you other than to say that if your issue is with my tone and not my point, I don’t really have anything to say. Nothing I’ve said has been far off and I am speaking from a lot of experience here as a former admin of multiple large private mental health support groups. These arguments are all very much the same, and serving a very specific subtle purpose that does not actually advance discussion on this topic, and that is to cast doubt onto people suffering whethering they are “actually” suffering from whatever and therefore, in this hypercapitalist healthcare system (speaking of the USA specifically here), whether or not it is “worthy” of care, especially in the eyes of doctors that should know, who frequently have a high amount of control in these situations wrt to what care you are deemed “worthy” to receive.

Thus the result of these situations is many people cannot afford (or even if they can, sometimes no) proper care necessary to them. Gatekeeping types of arguments like these do not make that better.

What Ive seen from these support communities like /r/Adhd is admins gatekeeping their interpretations with this guise of knowing whats best for everyone.

The admins there for example have decided that 1. The word "neurotypical" is banned, 2. One cannot say adhd isnt a disorder / adhd might have benefits. 3. Discussing negatives of medication seems to be removed

ADHD forums are notorious for this. I do not personally moderate this way. Everyone’s opinions should be valid if they respect others. No one’s problems are any more special than anyone else’s, and if someone is displaying that type of behavior, they probably don’t belong in a support group.

ADHD in particular is further complicated by the fact that there are many, many drug seekers that game the system and even fool themselves. Even worse these drug seekers have collectively done alot to create scarcity in a limited supply of a class of drugs that many people think they need to survive - (i am making no comment about the efficacy of adhd meds) - so strong violent opinions are evoked (understandably). That is why these rules are in place. People simply cannot discuss the subject rationally. I do not try to involve myself in those communities, but many of the Autism spectrum disorder communities and depression support groups don’t suffer similar issues and people that try to gatekeep are promptly scolded. I do acknowledge adhd forums are a unique place for the reasons I mentioned above.

This gets to the quick of one half of the matter, and in another post you acknowledge the other half too -- the incentive that exists for healthy people to "game the system" (whether it be to get access to stimulants, or "just" sympathy).

I agree with almost everything you've written here, and have the same sympathies, except that I don't think it's legitimate to criticise the style of argument you criticise just because it's often used to subtly question whether people are "actually" suffering (and I agree that it is often used that way).

Why blame people skeptical of psychiatry for affordability issues when you could just blame big pharma? Wouldn't that actually make sense? The fact that you mention the former but not the latter makes you lose a lot of credibility

Or I guess, if you have skin in the game, it does make sense to criticize the people criticizing the game instead of the people perpetuating it

> in this hypercapitalist healthcare system (speaking of the USA specifically here), whether or not it is “worthy” of care

What's more hypercapitalist than this "ask your doctor" shit?

If I was a pharmaceutical company, it would be in my financial best interest to deem as many people eligible as possible. If I was an admin at some mental health thing somewhere, it would be in my financial best interest to make sure as many people buy into it as possible

I never advocated “ask your doctor shit”, whatever that means, and I think you have severely misunderstood the post you are responding to.

Regarding big pharma, they are certainly to blame, but you don’t really see similar types of discussions regarding purely physical ailments like cancer.

As I said in my comments I am approaching this as a moderator for mental health groups where this type of discussion frequently arises and to point out a line of reasoning I frequently have to deal with.

There's plenty of skepticism of corporate influence in health care. I am skeptical of anything where money is involved.

Cancer is an extreme example here because being 1. Based on hard physical evidence and 2. having a huge liability for misdiagnosis, doctors/hospitals would be in huge trouble if they diagnosed you with cancer and gave you chemo when you did not have it. This serves as a check against pharmaceutical interests.

Mental diagnoses/treatment on the other hand is mostly done in independent offices, private practices, and in prisons/institutions on committed people, and it carries very little risk if misdiagnosed. With adhd its even worse, because its often a diagnosis a patient seeks.

I really don't understand where you're coming from. It seems you don't want people to criticize psychiatry because it makes some people feel bad not having the validation of these disorders being a totally legit, agreed upon science?

I think that's taking the completely wrong angle, like I said I am diagnosed and I don't feel bad about it one bit despite all my opinions here.

> I am merely pointing out that the type of reasoning you’re using is typically seen in the type of psychiatric gatekeeping

You called this reasoning "completely faulty" in your previous comment, which clearly goes well beyond that.

What you are actually trying to do is stigmatise a valid form of reasoning, by association.

I understand the first sentence I've said "seems like" a statement made by with someone with prejudice saying something like "people with adhd are lazy". But as I clarified, my actual criticism is entirely different and I for one have never even seen it be mentioned.

We will never advance our understanding of psychiatry if we can't criticize it, and I for one definitely don't think we already perfected it.