Girls Self-Diagnosing on TikTok Aren't Why Ableism Happens

A response to Freddie deBoer's “Of Course People Make Up Disabilities”

A reading list for a Marxist who cares a great deal about neurodivergence and disability but apparently has not read any relevant theory on it?

I gotta admit I read Freddie deBoer’s newest Substack entry Of Course People Make Up Disabilities the moment I saw it in my inbox. Before diving into my critique, you can read it in full here:

Of Course People Make Up Disabilities

I find deBoer to be an incredibly effective writer whose ideas sometimes challenge me in a beneficial way, and I enjoyed much of his latest book (which I asked him for an early copy of, and he was kind enough to give me) — but I’m consistently frustrated by his takes on disability.

For a Marxist, deBoer steadfastly refuses to engage with numerous Marxist writers’ critiques of psychiatry and the pathology paradigm of mental illness; when he does set his sights on criticizing contemporary thinking about disability, it’s people being annoying on Twitter and TikTok that draw much of his focus. In this most recent piece, girls on TikTok who say they have dissociative identity disorder, or DID, are deBoer’s main concern.

To an extent, I do understand deBoer’s disdain toward online disability discourse. DeBoer is very candid that bipolar disorder has shaped his own life for the worse, so it rankles him to see people claiming that mental disabilities aren’t debilitating, or that bipolar never influences a person to act in a manner counter to their professed values. Of course these conditions can be painful and unpleasant to have and many of us wish (at least at some moments) that we did not have them. Of course a disorder that touches a person’s thoughts and feelings will sometimes touch their behavior in ways they regret.

It shouldn’t be controversial to acknowledge such things (and when it comes to bipolar, it isn’t — all the major bipolar advocacy and support-group spaces I have visited as the partner of a bipolar person, both in person and online, welcome discussion of how much the disorder can bring suffering. It is noticeably more common to disparage one’s condition or one’s partner’s condition in these spaces than in, say, Autistic self-advocacy spaces.)

Admitting that disability is often an unpleasant and unwanted state does not, in any way, threaten the larger cause of disability justice. In much the same way that feelings of personal “body positivity” can never fix the systemic exclusion of fat people that’s caused by discriminatory laws and medical policies, bipolar pride can’t fix the pain of being bipolar, and believing that Autism is a superpower doesn’t fix the fact that Autistics are systematically excluded from nearly every aspect of public life. Individual feelings can’t mend systemic injustice. And regardless of whether you love your disability or hate it, the project of disability justice should have a place for you.

Because my disability politics is rooted in a leftism that prioritizes collective autonomy and power, I often find online disability discourse annoying and counter-productive, myself. I’ve witnessed a fourteen-year-old nonverbal Autistic boy receive death threats and ultimately be driven off Tumblr — all because he had the audacity to say he wished he wasn’t disabled, and dozens of proud Autistic adults who were verbal and more privileged than him couldn’t tolerate it. I’ve seen thousands of disabled Twitter users agree that speaking to a neighbor or offering them food is ableist. And I’ve heard online Mad Pride advocates claim that any act of socializing during COVID lockdowns is eugenicist and inexcusable, as if taking risky, impulsive action isn’t sometimes a consequence of being mad (it certainly is for me).

Over time, I’ve come to fear that the version of disability politics that plays out exclusively on social media directs people toward a more atomized, individualistic existence, rather than building powerful movements to fight for greater accessibility and more resources. And so, while I find many of his essays about the subject of disability to be missing the mark and entirely too focused on the claims of random online teenagers rather than a seriously grappling with the work of disabled scholars, I’ve mostly grasped why deBoer says what he does. Lord knows, I’m not above writing about bad posts. This stuff does affect and reflect the world.

But I found his newest piece on DID particularly frustrating, because it’s a topic most people already have such a half-informed knee-jerk attitude of dismissal toward, and one that deBoer (who is entirely capable of quality scholarship) could do a lot more to inform himself about. He doesn’t have to shoot off a needlessly sexist rant about how girls on social media are making themselves weak by self-diagnosing with DID for attention and carrying canes they don’t need (yes really). He could dive a lot deeper than that — and I don’t understand why he doesn’t, if disability is such an important topic to him.

And so I’ve decided to tackle some of my issues with deBoer’s piece. If it somehow encourages Freddie to at least read and grapple with the scholarship on disability and neurodiversity from a Marxist angle instead of just taking pot-shots at teenaged girls who are annoying and self-victimizing, I’ll be happy, even if ultimately his stance still winds up being one that irritates me. So let’s go:

One of deBoer’s big issues whenever he discusses disability, mental health, or the neurodiversity movement is that he still operates as if the pathology model is always verifiably correct and appropriate, rather than just one model for understanding where human psychological suffering comes from (the Social Model, Neurodiversity Model, and the Money Model being the other major ones in the literature. It’s especially curious for a Marxist like deBoer to ignore that last one).

He applies the pathology lens even to understanding the perspectives of people who do not use that model to explain their experience, which leads sometimes leads him to nonsensical conclusions, such as assuming that the number of people who self-realize as having DID should somehow be on-trend with the officially observed diagnostic rate for the disorder. But obviously, people who reject the pathology paradigm and do not seek out psychiatric diagnosis (or cannot seek it out) are very different from people who can & do receive diagnosis via formal channels.

Throughout his piece, deBoer is dubious of the fact that suddenly tens of thousands of people have all realized they have a psychiatric disorder that was, until recently, exceedingly rare — but that’s not what’s actually happening when tons of people take to TikTok to speak of their alters or self-describe as a system. Some people who identify as systems think they have DID specifically; others do not, and reject such psychiatric framing out of hand. Some experience being a system as a debilitating disability; others do not. deBoer’s conflating a variety of different perspectives into one here, in order to argue for the existence of a frightening trend.

Within the (messy, nonrepresentative) world of systems TikTok, there are people who were diagnosed as DID, in what was typically a traumatic institutional experience, who have since located a community online for other DID sufferers and benefitted from getting to finally share about what they’ve gone through. There are patients who were initially misdiagnosed with schizophrenia or psychosis (both common mistakes), and only later arrived at the truth of who they are thanks to online self-advocacy. There are people who do not meet the conventional diagnostic guidelines for DID and do not pretend to, but who resonate with many of the experiences common to the wider DID community. Some of these people wouldn’t qualify for a diagnosis because of lifelong masking of their symptoms, or because they aren’t wealthy white women who match the psychiatric stereotype for the condition.

On systems TikTok there are also “median systems,” people who experience themselves as a sometimes-conflicted whole of multiple disparate parts, but who function more or less like a unified individual. And there are people who began thinking of themselves through a systems lens because of Internal Family Systems Therapy. There are people who benefit from or enjoy experiencing themselves as a system, and might even regard that way of thinking about themselves to be a choice. Some people (like me!) have a ton in common with systems and know a few systems in real life, and could perhaps find a place for ourselves within the broader systems community, but are a bit afraid to pull at that psychological thread and see what comes apart.

And yes, there are also fakers who are churning out cringey bullshit “personality switching” videos for clout. Sometimes people do make up things on the internet. Sometimes young people are annoying online. We can consider whether that’s a pressing social problem that merits any concern, or whether increased scrutiny toward disabled individuals does anything meaningful to address it, and we will later on, but for now, let me just allow that yeah, people lie online all the time! And lie to themselves. I will not deny this.

deBoer assumes that most of the people self-describing as systems on the internet must be lying about it, because historically, very few people have ever been diagnosed with DID. I won’t lie and say that when a disorder becomes more widely spoken about there isn’t a rush of people trying the label on, sometimes with less depth of reflection than I’d ideally like them to have.

I see that happening with Autism, sometimes. Since I’m the guy who wrote the book popular among self-diagnosers, I hear from people contemplating an Autistic identity a lot— though more often, I encounter people hesitating to claim any community for themselves until they get official psychiatric sign off, no matter how well the label seems to fit or how much support and acceptance neurodivergent people offer them.

Lots of people are really afraid of being accused of faking a disability, it turns out. (And many genuinely disabled people are terrified to confront their body or mind’s limitations, because to lose one’s independence or productive capacity under capitalism is akin to losing one’s humanity. Any discussion of rooting out malicious disability fakers would do well to keep this in mind.)

In his discussion of diagnosis rates, deBoer fails to explore why the DID rate has always been so exceptionally low, even relative to other mental disorders, and the slipperiness with which it and all other mental health diagnoses are handed out.

The vast majority of DID diagnoses have been given out by just a handful of psychiatrists, many of whom specialize in the disorder and have made a career of uncovering record-breaking numbers of alters in patients and baiting them to perform headline-grabbing acts of switching between various accents and mannerisms. Many of these high-profile DID patients were financially exploited and abused by their psychiatrists, and implanted with false memories, contributing to the “Satanic Panic” of the 1980s. The field of DID became so filled with bad actors that few others in psychiatry or psychology wanted to touch the subject, and to this day, it’s hard to find a practitioner who will diagnose it.

Looked at from one angle, the fraught nature of DID within the field makes it nearly impossible for anyone genuinely suffering from DID symptoms to receive clinical support. In this way, the number of people diagnosed with DID lags behind the number of people who identify as having it, for the same reason the diagnosis rate lags behind the self-diagnosis rate in Autism: it’s a condition with very narrowly defined diagnostic criteria, which were based on how the condition looked in a homogenous, privileged sample from the mid-century, and you can’t even get assessed for it unless you seek out a specialist who can be quite hard to find and afford.

From this perspective, it makes sense that DID self-realization would rapidly become more popular, once people had greater access to information and community via social media. We would also expect that the people least likely to be diagnosed as having DID would be the people who pass the most easily as neurotypical — because their symptoms are less visible, less severe, or simply less likely to be taken seriously because they’re poor or marginalized. Indeed, this is what we see among Autistic self-diagnosers: it’s not that they’re less Autistic than their diagnosed peers, they’re just less visibly so, and more likely to be Black, poor, queer, elderly, or otherwise neglected by society.

Another way of regarding the flawed diagnostic data on DID is to conclude that psychiatry just isn’t all that great an authority on it, actually — that either DID is a fake condition made up by celebrity psychiatrists trying to sell books, or that however psychiatrists view it, the descriptions just don’t really nail down what it’s like to have it all that well.

This would not be a particularly unique take to have on a psychiatric disorder. If you read Psychiatric Hegemony (and I hope deBoer and everyone else reading this will), you’ll learn that almost every mental health diagnosis was made up by a handful of psychiatrists who were launching a career for themselves by naming a new disorder. A lot of the combinations of symptoms these professionals made a name for themselves on were just previously observed effects of trauma, which tend to cluster in all kinds of ways.

Is Borderline Personality Disorder “real,” or are women simply being branded as sick for having insecure relationships within a sexist society where they hold little power? Is schizophrenia “real,” or are Black revolutionaries being called paranoid for observing a real pattern of police violence in their communities? Do I sometimes forget things I’ve done and said because I have DID, or am I “just” traumatized, highly reactive, and prone to becoming whatever the people around me want me to be as a survival tactic, and have formed a shaky sense of self around that?

The answers to these questions are never simple, and what insight psychiatry can provide is far from categorical. The suffering of a Borderline person is real, I can attest to that — and factors like culture, class, and gender have a strong influence over how the diagnosis is defined and who is on the receiving end of it. Psychosis exists, and paranoia too, but the shape that person’s delusions take are influenced by their position in society, and who they have reason to believe might be chasing them. I can twist my memories this way and that, seeing evidence of alternate personalities vying for dominance from one angle, but from another, I see some confused whole who just happens to be highly mutable and prone to zoning out.

There is no objective measure that proves whether a patient has a single identity or multiple dissociative ones. Many cognitive scientists have already argued that there is no singular self for anyone, that we are all a mix of disparate parts. That’s why Internal Family Systems therapy exists and connects with so many people. So, is a DID patient sick in an easily verifiable way, or is the boundary between a dissociated and an integrated self quite blurry and up to someone’s own personal myth-making, to a certain extent?

I know that deBoer and people who share his perspective think that mental illness can be understood in carefully delineated clinical terms. But the data (which again I really wish he would just read!) does not support this notion, and never has. Psychiatrists have a laughably terrible inter-rate reliability rate. That means you can’t use one psychiatrist’s diagnostic decisions to predict the decisions that another would make. For the past 60 years, professionals have widely diverged on the diagnoses they assign to identical patients, the standards for differentiating between post-traumatic stress disorder and dissociative identity disorder (just to name one example) being largely subjective and lacking statistical rigor.

There’s rampant disagreement even about how to apply diagnostic criteria for widespread and common conditions — what counts as depression, anxiety, or even bipolar largely depends on whom you ask, and how a patient is viewed at the time of intake. Clinical psychologists are still taught that a single period of 'risk-taking’ behavior ever in patient’s life can be ground for a bipolar diagnosis, for instance, leading to lots of Autistics, PTSD sufferers, OCD patients, and even just highly sexually active people initially getting misdiagnosed with the condition.

In the case of a ‘misdiagnosis,’ you can argue that both diagnoses are equally true, or equally not: it all depends on which behaviors get examined first, and how both patient and professional choose to interpret them. I could be a teenaged bulimic (for attention) who later also became Autistic (for attention). Or I could be an Autistic person who didn’t realize it when I was young, and over-exercised to the point of amenorrhea in order to deal with sensory overload. Which is true? Well both. And neither. Each story only touches the truth.

It’s not just Marxist critics of psychiatry who point to the low correlations between one professional’s diagnosis and the next. Many psychiatrists publish on the moral and epistemological crisis of having diagnostic categories that cannot be statistically backed up. It leads many professionals to argue, each time the DSM is revised, about which disorders should even continue to exist at all. Which disorders get included and how those disorders get described is largely shaped by political pressure, the sway of a handful of especially lauded and influential professionals, and the work of lobbying groups.

Seriously read this book!!

I don’t think any person could know the history of psychiatry or the shaky scientific grounding it continues to rest upon and still believe that diagnostic labels like DID are sacrosanct, so I’ll have to assume that deBoer simply is not aware of all this. I do find that a bit difficult to believe, because he’s a widely read guy and appears to be passionate enough about the topic of mental health to publish about it regularly, but I’ll allow that we all have blind spots about the things that make us incensed.

I’ll move on from all the problems with deBoer’s idea that a person’s DID status is easily determined by a professional and a professional only, and that it’s not a label that people should play around with lightly — I think I’ve sufficiently made the case that it’s one of the psychiatric labels that’s been thrown around the most senselessly in the history of the DSM, which is saying a lot. I don’t see the harm in members of affected communities reclaiming the term for themselves, reevaluating what it means to them, and yes, even reinterpreting it. That’s what has happened with Autism — the existing clinical literature on the subject neglected masking, and sensory issues, and pretended for decades that all Autistic people were white males. But the community developed its own, better sense of itself and shared its growing self-understanding with other Autistic (and questioning) individuals, and then later, the broader world.

At this point most neurotypicals professionals who study the disability agree with me and my community that masking is a genuine phenomenon that they missed, that sensory issues are real and debilitating if often invisible, and that the current diagnostic guidelines for Autism are flawed and fail to capture the disability in women, trans people, people of color, and oh yeah, all adults more generally. Much of the valuable knowledge that we do have on neurodivergency in these groups is community-created — which flies in the face of any claim that those of us who are disabled fundamentally lack any insight into ourselves, and require institutional authorities to define who we are.

Let’s talk about the harm that comes when people do make their identities up. In his piece, deBoer takes it as a given that some kind of apparatus for investigating disability claims and rooting out fakers is necessary, because hey, people lie. He provides no support for this assertion. I'm happy to allow that of course, sometimes human beings lie about having conditions they do not have, and as deBoer discusses, sometimes people convince themselves they have a condition when they do not have it. Both things are true. But we don’t have any evidence that people doing this places some massive strain on the social welfare system.

Disability benefits are incredibly difficult to secure. The rejection rate for initial disability benefits applications is around 75%. The average applicant must wait between six months to two years to get their application reviewed, and an additional five months after that for payments to begin coming in. If they are rejected and forced to apply for an approval hearing, their average wait to get one is a whopping twenty-seven months.

And these are the outcome rates for all disability applicants, not persons with mental health diagnoses, whose applications tend to be rejected at a far higher rate since their conditions are rarely terminal and they theoretically could become “productive” again, as the Social Security Administration sees it. Does deBoer sincerely believe that the DID TikTok girlies are filling out disability applications for one of the most highly scrutinized and widely disbelieved diagnoses around, when they likely don’t even have a formal diagnosis, and gleaning any benefits from that?

Surely not. So what’s the issue? That some people online are getting attention they do not deserve?

Even if an application for disability benefits is successful, a recipient may lose access to monthly payments if they fail to sufficiently prove they are still disabled when re-investigated (which can happen as often as every six months). The idea that scores of fake-disabled people are subjecting themselves to a grueling, years-long application process and regular follow-up assessments and medical appointments in return for less money than anyone can live on independently anywhere in the United States is absurd.

Universal Basic Income advocates have argued that rather than investigating all these disability claims, it would be cheaper for the U.S. to just give out payments to anybody who asked. I assume that deBoer disagrees with that assessment on one level or another, and that’s fine. I can certainly see massive issues with UBI implementation. But the concern that somehow millions of people will end up languishing on disability (or any other kind of social welfare) because they’ve convinced themselves they’re sick on TikTok has no relationship to reality.

We have every reason to believe that like most other humans, disabled people are motivated to feel capable, challenged, and engaged, and find not being meaningfully in contact with the world to be depressing. The fact that so many disabled people are constantly on social media producing content is a testament to how isolating and boring it is to be stuck at home, honestly, and how desperate most people are to feel they’ve left an important mark on the world.

Again, I won’t deny that some of them are grifters. But does deBoer (or anyone else) think that spending one’s days online posting about a disability that one supposedly does not have is exactly the mark of the “well”? In his piece, deBoer considers that many of the supposedly fake DIDers on TikTok are deluding themselves and not simply lying for conscious personal gain — but what makes a person commit to such a bit? How isolated must you be, how confused about your own interiority? What would it take for a person to persist in that delusion if there were no evidence for it, and very little for them to gain? You can’t really believe that a person is completely out of touch with themselves and reality and also completely sane and undisabled with no problems that merit seeking social support for.

The majority of DID posters on TikTok are not making a living from generating content, even if a few can crowdfund and content-churn their way to comfort. Clearly most are persisting in their disabled identity for a reason beyond straightforward profit.

DeBoer, I think, would say that it’s because the disabled identity brings them comfort and gives them an explanation for all in life that they find to be difficult, as well as the warm feelings of acceptance and social approval. Maybe so, at least sometimes! But again, do these strike him as the actions of someone who has no mental difficulties?

If a person is depressed and confused about who they are because of the economy and a culture of profound isolation, are they not disabled by it? If a young woman starts doubting the solidity of her identity because she has no in-person community to hang it on, is she suffering any less than someone who got that way because of her genes?

The biological causes of mental illness cannot be separated from the social ones. There is no brain scan that can tell us a person verifiably has Autism, or bipolar, or PTSD, or DID. There is no genetic screening, blood test, fMRI, or EEG that tells us where a person’s suffering comes from. All we know is that they suffer. Because they have told us, or they’ve shown it. And a huge contingent of today’s youth tells us that they are suffering — feeling unmoored, confused about who they are, haunted by a sense of unbelonging, doomed about the future, ill in their bodies, mentally foggy, detached from reality, incapable of relating to everybody else.

I agree with most critics of psychiatry that these problems have non-biological and non-psychological causes. But they are psychologically experienced and expressed. And a diagnostic label is not an explanation for where a form of suffering comes from. It’s a summary of symptoms originally created for insurance billing purposes. It’s just a label, made up by other flawed humans, to describe a general experience of suffering that has been seen and spoken about many times before. And as the conversation around that form of suffering changes, so too does how the label gets used.

A person like me would not have been diagnosed as Autistic in the not-too-distant past. I know because I wasn’t. I had all the hallmarks that would get a kid flagged today, though: I spoke at a freakishly young age, I cried explosively for no reason, I communicated in TV show quotes and could not manage small talk, I had underdeveloped muscles, no fine motor skills, and a worryingly slow reaction time that landed me in special education. I had meltdowns and starved myself and had periods of self-harm. I still do most of these things.

I’m still not very well at all, actually, as I sit at my desk perseverating over this dumb essay for the seventh hour running, not getting up to eat or use the toilet because I’m so locked in, an intense relationship with a guy I have agreed to let consensually stalk me for kink reasons withering on the vine because I can’t decide whether to give up my regular life for him, like we’ve both fantasized about me doing, or attempt to return to some semblance of sanity.

I might write kinda well, but I’m not very, mentally. Arriving at an Autistic identity and forging community alongside other neurodivergent people has helped stabilize me a ton, but I remain the kind of person who does strange, self-destructive, and socially alienating things, and finds it difficult to remain alive — and then gets accused of having it too easy and faking it.

You can say that the Autism label has been watered down by the inclusion of people like me. I think that neglects how difficult it actually is to be even what gets called a high-functioning person. My ‘functioning’ hangs on a thread at all times — I can write well twice a month, and show up to an in-person work meeting in dress clothes once a month, and when I’m in public, I know how to tense up every muscle in my body so that I don’t ever forget myself for even one moment and do anything that draws stares. I can’t live alone, because I don’t remember to eat if I do, but I can go about my day mostly “independently” so long as I don’t have to speak to anyone or leave the house.

It’s true that Autistics like me who can speak well and are accomplished in their careers do get too much attention within the Autistic community. We are listened to at the expense of people like Angel, my nonverbal friend who was run off of Tumblr. It is a massive problem that people take respectable Autistic people more seriously and view us as more human, and it’s undeniable that those who cannot mask their symptoms suffer more and enjoy less autonomy and dignity.

But when deBoer and others argue that people like me and the TikTok DID girlies are devaluing psychiatric labels with our rampant self-diagnosing and complaining, it’s not the wellbeing of other disabled folks they’re arguing for, ultimately. They’re insisting, whether they know it or not, that all disability be highly visible and proven to be sufficiently “bad” before it merits any societal consideration. And that outlook harms all people whose bodies and brains sometimes refuse to comply with neurotypical standards.

In a prior essay on the “gentrification” of disability, deBoer argued against the growing popular conception of Autism as a quirky personality trait that brings no suffering to a person’s life — because in reality it is quite the debilitating disorder. He’s maddened by the fact that the more verbal, socially capable Autistics of the world have seemingly rebranded the disorder as not even being a disorder at all. Yet he also criticizes those level one Autistics for laying claim to a struggle that isn’t really theirs, for pretending to suffer when they don’t, and taking benefits they don’t need. So which is it? Are we understating how disabling our conditions can be, or are we claiming to be disabled when we really aren’t?

I do understand where some of deBoer’s complaints come from, even if the sense he makes of them does not hold up to scrutiny. There are people online who claim that Autism brings absolutely no difficulty into their life, and will attack anyone who suggests that some aspects of disability would remain, even in a world without capitalism. I have met individuals who believe that being Autistic is akin to being a highly sensitive, emotionally attuned psychic of some kind, and claim our disability makes us superior to others.

I do find it annoying, and I think it’s incorrect. But I generally view these kinds of statements as a fumbling attempt at overcorrection, in the face of a lifetime of disability stigma. Many people who are just beginning to come to grips with a disabled identity feel a need to assert that they are not broken, and that their disability makes them stronger, actually. I think that meets a perfectly reasonable ego-protection need. It can get overblown, just like when a newly-out queer kid believes that all gay relationships are inherently more ethical and safe than all straight ones, and most people outgrow that overly simplified notion with time.

But even among the ones who don’t, I think you generally do see some acknowledgement that all of Autism’s “gifts” come with real societal costs — I have never met an Autistic person who didn’t cop to the fact that they found daily life incredibly confusing, painful, and stressful. Even the most sunny, toxically positive types are very outspoken about the fact they need many more hours resting in the dark after utilizing their “superpowers” than neurotypical society will accept. Even the worst, most obnoxious, and yes, most privileged among us are genuinely disabled and know it — they’re unable to hold down jobs, can’t drive a car, can’t go to the grocery store, leave a trail of exploded relationships in their wake that they can’t explain.

And this is what I find so sadly self-defeating about deBoer’s suspicion of every seemingly high-functioning person who identifies as disabled: they really are struggling, just like he is, even if most outside observers fail to either see it or believe it. And the more we foster a culture of doubting disabled people’s claims, and gatekeeping access to support, the more difficult it becomes for any of us to receive help.

DeBoer opens his essay about DID by speaking about the accusations he has faced of having faked bipolar disorder — some people believe he made up the diagnosis to justify a false sexual assault accusation he once lobbied at a colleague, and then retracted after getting treatment. But instead of growing angry at a public that instinctively doubts every disabled person’s claims of struggle, deBoer instead tries to distance himself (a legitimate, diagnosed, medicated disabled person) from the hordes of (self-realized, disreputable, unruly) disabled people whom he perceives himself as nothing like.

For some reason, deBoer holds us late-diagnosed and self-realized disabled people accountable for society’s pervasive and long-lasting ableism. He seems to believe that people doubt his disability because we now live “in a world in which people come to sincerely believe that they’re suffering from afflictions they’re not.”

But we have lived in a world where people have doubted the disabled for a very long time. Ask any wheelchair user who has been questioned in the grocery store for shifting a bit too much in their seat. Look to any owner of a handicapped parking tag who has been followed around the lot, harangued over the fact they can walk. The first women diagnosed with hysteria were accused of being overly dramatic fakers doing it for the attention too.

It is ableism that leads to the struggles of disabled people not being taken seriously. It is ableism that causes the less-disabled to be centered and listened to over the more disabled. Ableism (and racism) are why people refuse to believe that Kanye West’s bigoted rants are related to his fragile mental state and to revel in his downfall. And to the extent that people on TikTok are faking mental disorders, it is ableism that makes such a thrilling spectacle of it.

The root of our problem is not that desperate, disaffected people are reaching out into the digital abyss for an acronym that can explain why they feel crazy, lonely, and want to die. The problem comes from the social conditions that make so many people feel broken and like dying: the economic structures that have left them behind, the crumbling social welfare state that starves them out, the lack of public infrastructure that isolates them and makes them less physically capable, the replacement of community with corporate-owned advertising platforms that makes them so anxious around others.

You’d think a disabled Marxist would be able to see that. But internalized ableism can make it very hard to see oneself and one’s comrades clearly. Until deBoer and people like him recognize that they’re members of an oppressed class of disabled people — the largest minority in the world — and act accordingly, they will continue feeling like they must prove the legitimacy of their personal struggle by drawing a sharp line between themselves and the rest of the world. But the world of disability is vast. It contains virtually all of us, on a long enough timeline, and within it, there’s a diversity of experience and ability that cannot be easily contained by any institutional label.

Disability is a communal experience — not an unspeakable disease.

So many excellent books critiquing the pathology model from a Marxist or leftist lens have come out in recent years. Here are just a few of them. If you’re reading this, Freddie, I hope you will check them out, or weigh in on them if somehow you have already read them but find their analysis lacking:

• Micha Fraiser-Carroll's Mad World

• Robert Chapman's Empire of Normality

• Bruce Cohen’s Psychiatric Hegemony

• Roy Richard Grinker’s Nobody’s Normal

• Jonathan Metzl’s The Protest Psychosis

Finally, are a few parting thoughts on deBoer’s piece that merit mentioning, but which I couldn’t find a clean place for in the essay:

• I do see some merit to Freddy's observation that one's self-conception as disabled is often a shadowy, shape-shifting thing -- some days you convince yourself you really do have this disability, other days you are kind of rounding up the truth, other days you don't know at all -- but this is because of the subjective nature of how these conditions are defined and measured, including by professionals. I don't understand how he can openly explore just how difficult it can be to figure out whether you are a system (or Autistic, or bipolar) and then conclude that these categories can be assigned to others with full objectivity. He seems to think individuals cannot know our own mental health status categorically but that psychiatrists infallibly can?

• DeBoer’s anecdote at the end of the piece about lots of young women suddenly using canes is so needlessly obtuse. He's a better writer than this, he’s a better thinker than this, and I really wouldn’t say that if I didn’t respect him. Why might a lot more young people be physically disabled all of a sudden, hm? Something about a pandemic maybe? Does he not know POTS is a common side-effect of long COVID and often requires carrying a cane?

• And why does deBoer insist on describing the self-diagnosis of DID (or of needing a cane) as a phenomenon of young women? What is he trying to imply here? It doesn’t make his argument any more convincing; if anything it makes him seem more biased. More women use social media platforms, consistently. They’re also more likely to engage with other people socially online, and have always been more likely than men to access healthcare, especially psychiatric or psychological counseling. It is not unusual for seemingly more women to be open about a vulnerability they have than men.