January 24, 2025

"Stop self-diagnosing with depression"

What it really means to stop self-diagnosing with mental illness and why it's actually quite sinister

Tony Blair was back in the headlines last week when he talked to a podcast about mental health and especially self-diagnosis1. His actual statement was the sort of noncommittal waffle we've come to expect of him, saying that "you've got to be careful" not to medicalise ordinary emotional responses and that "we need a proper public conversation" about the amount of money we spend on mental health, but headlines claimed he said we should stop self-diagnosing with mental illness because of the rising benefits bill.

Plenty of people stepped up to point out that nobody gets to claim benefits on the basis of a self-diagnosed mental illness alone. But I feel like that misses the point slightly. What makes the headline interpretation sinister rather than just clueless is that anyone who claims benefits for mental illness must have self-diagnosed at some point.

The NHS doesn't routinely screen for mental illness the way they do for things like high blood pressure or various cancers. At best, a doctor or other health professional would be alert to symptoms of mental illness that a patient mentions in an unrelated appointment, but in practice they're often under pressure to get through everything quickly, so that there's not even an opportunity to bring it up. Unless we make an appointment for the explicit purpose of discussing a symptom, chances are it will go unnoticed.

Even when we do bring symptoms to a doctor's attention, we might be brushed off. Told that what we're experiencing is perfectly normal, or we just need to make sure we're eating and exercising right or think of how fortunate we are compared to victims of a natural disaster. Someone who doesn't have a clear idea of why they're feeling bad may well give up at this point and simply resign themselves to being miserable. If your mental illness tends towards quiet despair rather than aggressive acting out, you can slip under the radar like that for a long time.

This is what it means to "stop self-diagnosing". Stop seeking help. Stop believing that you have a problem that needs addressing. Learn to live with the quiet misery, day after day, until you've forgotten how to do anything other than go through the motions. Be quiet. Be unobtrusive. Have no needs.

And the problem is that we can't live like that long term. It erodes our health in other ways that will eventually become impossible to ignore, assuming we don't do something overtly self-destructive first. Addressing mental health problems when they're relatively minor can save a lot of heartache, not to mention a lot of resources, further down the line.

Blair's actual words, although more carefully measured, essentially give the same prescription. Consider that actually there might be nothing wrong with you, that the way you're feeling is completely normal and that you need to get better at dealing with it rather than try to seek treatment for it.

I don't know who it's addressed to, whether there are people somewhere who mistakenly believe they're mentally ill when they're just going through "the challenges of life". Perhaps those people exist and I've just never met them. But I have met a lot of the opposite type: people like me who tell ourselves again and again that there's fundamentally nothing wrong with us, we just need to try harder. Just need to cope better. Just need to be less of an abject failure, and since this is so hard perhaps it would be better if we just didn't exist.

Mental health services, inconsistent and underfunded as they are in this country, can't always lift the misery. But even if the best they can offer is a voice on the phone who tells you to fight your self-destructive urges through the power of a cup of tea and a bubble bath, they're better than trying to power through unaided.

At least the voice on the phone acknowledges that you're struggling. At least they don't urge you not to think there's anything wrong because we "cannot afford to be spending the amount of money we’re spending on mental health". It's a pitifully low bar, but one that apparently the media and Blair are struggling to clear.