Who's read 'Age of Diagnosis' (overdiagnosis in Long Covid, ADHD, Lymes, autism, cancer screening)

[FrodoBiggins]

Inspired by another thread, has anyone read/ listened to Suzanne O’Sullivan's new book Age of Diagnosis? I just finished it and found it so interesting. She's a high profile consultant neurologist.

Touches on Long Covid, Autism, ADHD, Lymes disease (all in terms of diagnostic debates) and also Huntingdons genetic testing and Cancer/ Alzheimers screening (along what benefits there are of knowing of a risk/ certainty of future illness, especially if there is no cure).

I'll quote from a review:

"in her outstanding new book O’Sullivan offers a third possibility; that variance in bodily and mental health is being unnecessarily medicalised and pathologised: “We are not getting sicker – we are attributing more to sickness.”
She describes a trinity of “overs”. Overdiagnosis, where a medical problem is treated when treatment might not be needed; overmedicalisation, where non-medical behaviours are turned into the business of doctors; and underlying both, overdetection: we are ever better at identifying signals of disease, sometimes earlier than necessary, when those indicators may not end up presaging the disease itself. Alongside balanced analysis of the epidemiological data on prostate and breast cancer, O’Sullivan examines the growth in behavioural conditions such as autism and ADHD. The tone is not sneering or dismissive, as debunkings of bad science so often can be. O’Sullivan is instead full of compassion, care and grace."

I believe it was also the Radio 4 Book of the Week. The full review quoted from above is here: https://www.theguardian.com/books/2025/mar/12/the-age-of-diagnosis-by-suzanne-osullivan-review-do-no-harm?CMP=Share_AndroidApp_Other

Has anyone else read it? Thoughts?

You are completely missing my point.
Tell me that not ONE person will interpret that sweeping statement as “I don’t find all complex social situations easy therefore I must be ND”

These threads always go the same way. Nuance is always lost. Some People are extremely defensive of and attached to their diagnoses. And that’s fine. They can feel like that, nobody is going to take their diagnoses away from them.

But what about people who may think “ah, I could have been seriously let down by the medical establishment here. Maybe I don’t have {insert condition} after all”

It’s like Dr Chatterjee said on his podcast when he interviewed the author - he spent 6 weeks with a woman who had been diagnosed with 20 different conditions including Fibromyalgia, IBS to name a few. He spent 6 weeks with her and by the end of it, she was pain free and was completely off all medication within a year.
He got absolutely lambasted by people on social media who also suffered from fibromyalgia. As if him curing this woman was somehow a threat to them.

No NT person will be reading that and thinking I must be ND.

You're right about only a psychiatrist can diagnose adhd, however (and I do have adhd so not being snarky!), stimulants used to treat adhd can be used by people without it and they will 'work', as in it will increase a person's focus, concentration, enable them to get shit done, have energy etc, it's why they are used recreationally, including studying for exams or working long hours. They are stimulants and will affect a person's brain in similar ways regardless of having adhd or not. I do think that private diagnosis of adhd is a bit risky as medication is handed out quite freely, and they are controlled stimulant drugs.

Don’t be ludicrous. You seriously think that not ONE NT person will be worried by that statement?
Someone linked info upthread about the rise in people seeking diagnoses based on TikTok videos.

You talk over people sometimes? You have a junk drawer? You don’t navigate every single complex social situation with ease? You must have ADHD.

Or maybe, you’re a perfectly normal but occasionally flawed human being.

No I don’t think they will. And the fact that you keep shifting the original quote says it all.

I also think this.

If a child is struggling do you do this.

1. find fault with the support in place
2. find fault with the environment
3. find fault with the child and diagnose them

I think it’s extremely, extremely important that 1 and 2 are seriously considered first before you do 3.

The issue is that people are not addressing 1 and 2 and jump to 3.

I haven’t shifted the original quote. The original quote is an absolute statement. It doesn’t say “usually, NT people can navigate complex situations with ease” or sometimes they can, or that it’s most situations.
You yourself have made a blanket statement of “absolutely NO NT person will be worried by that statement”
How can you be so sure of that?
Do you really think it is IMPOSSIBLE that ANY NT person has self diagnosed when they don’t actually have any condition at all?

@WhereIsMyJumper judging by the responses I had from the poster you are addressing earlier, I don’t think this is worth your energy!

You did. You added ALL several times 😂

And, no, I absolutely do not think any NT person is actively self diagnosing ADHD or anything else. Do they have ADHD? Who knows. But there’s something going on.

Sorry but you do realise the NHS assessments aren’t really any different?

My DD was privately diagnosed due us being at breaking point. School agreed. She had her appt, she had her QbTest, filled out screening questionnaires both from us as parents and school being the second setting.

I sent all the diagnostic information over to our local NHS ND pathways and it was accepted due to it meeting NICE and departmental guidelines.

Private assessments are not invalid. My DD is on medication now and is doing so much better.

Actually I read that that is not always the case and stimulant may actually have the opposite effect on someone who takes them who does not have ADHD.

Also not true it’s not just a psychiatrist that can diagnose ADHD.

from nice: ADHD should only be diagnosed by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in diagnosing ADHD,

the NHS itself uses ADHD specialist nurses as well as the above psychiatrist/paeds

Ok, thank you for the warning 😂

Knowledge is power. Why does she want to take that power away from people?

If you know you have BRCA mutations, you have the power to decide what to do next, if you know you have ADHD, you have the power of knowing you're not 'just' unlikeable, too lazy, too unfocused, that there is a reason why you struggle with things that others expect of you - that you can't 'just try to be normal for a change' and that 'What the hell is wrong with you?' has a clear answer (beyond 'Fuck off' or being unable to speak at all when feeling attacked or on the spot, at any rate).

If you know you have an autoimmune disease, you can access DMARDs and biologics to reduce pain, inflammation and premature death. You can have adaptations put into place at work, rather than them terminating your employment because they don't accept that standing up for four hours after a full workday in the heeled shoes they determine constitute Professional Attire is unnecessary or unreasonable.

If people aren't diagnosed, there's no evidence that there is a need for research that could lead to cures and ongoing treatments that can turn a life destroying condition into something that happens to be there.

Even a throwaway comment earlier about there always being people who weren't as smart as others - why is the assumption that neurodiversity only means lower intelligence? The more people with average or above average intelligence diagnosed, the fewer assumptions that anybody ND is less intelligent and the greater the scope for those people to attain qualifications more in keeping with their ability through access arrangements and suitable adaptations.

Diagnosing conditions evidences needs that can be met and also be an advantage to others - the number of people requiring a wheelchair space on a bus has advantaged many parents with buggies, the numbers needing level access has resulted in adaptations to access that are at worst a neutral act for those who don't and could easily be argued to still be a net benefit, as it's safer for everybody to not have to go up and down uneven, poorly lit or overcrowded stairs with a slippery surface.

Who does she think she is that she gets to decide people don't have a right to know about themselves? It's a throwback to the no labels/I'm not having anybody know there's something wrong with them/they can be made to act normal/oh, the silly girl thinks she wants to know when we know better bollocks.

While you make a lot of good points, I think you’re misrepresenting the author. She isn’t trying to take away anybody’s ’right’ to a diagnosis. Merely discussing some of the downsides in getting one so that people can be empowered to make the right choice for them

@NeverDropYourMooncup

I think that’s an extremely good post.

I think the issue I had with my son was the assumptions that went with the diagnosis and those assumptions not being an accurate reflection of his needs.

A more specific speech diagnosis seems to be targeting his needs better.

I also think it’s shocking that one NHS doctor felt she had sufficient evidence to diagnose and another didn’t. This is wrong.

This book came up at my supervision meeting yesterday (PhD/creative writing/motherhood and autism). I am mum of 2 teens with ASD, one with ADHD. Both late diagnosed. Will definitely download and read this book (alongside Timimi’s Searching for Normal, mentioned above).

For me the issue is not that it’s being over diagnosed, but the fact that you NEED a diagnosis at all in order to obtain the support, empathy and understanding. We all know/have known individuals who we thought were ‘odd’, that people avoided or tolerated because they were different. Understanding of neurodivergence SHOULD have led to a society where schools and society generally could think, ah, that person is probably on the spectrum… I need to be more tolerant, perhaps ask them if they need anything (desk in a different location, directions to a ‘quiet space’), I should tell the arsy bullies in the class/workplace to back off and leave them alone.

Awareness should have lead to more understanding and compassion… for everyone. A new default in social situations where we consider ‘individual difference’ with anyone we meet, be it ASD/ADHD, dyslexia, social anxiety, old age!! But no. If we might be on the spectrum [or have any other need for a little bit of social support] then we need to prove it with a 27page/£1500 report and diagnosis in order for anyone to switch on the empathy switch, for teachers to offer extensions for homework or even just to take a fricking second to check a child has truly understood the brief, for pastoral support to kick in and arrange exam provisions.

I agree (not having read the book, just the Guardian article and a bit about it on other sites) that we are in danger of ‘over-medicalising’ what should simply be accepted as neurological and social differences - but the education system, the way our society seems to have evolved in the last decade especially, just won’t offer compassion or support freely and responsively with out a piece of bloody paper.

Well, no, she isn't - as long as it's her diagnosis of it all being in their head and they just need to think themselves better. Her 'case studies' are being used as a way of maintaining the Hysterical <whatever> position and denying people a diagnosis other than psychosomatic because she feels that encourages others to follow suit is something that harms many more people, particularly women.

@CautiousLurker01

Except I didn’t get the empathy switch, I got the exclusion switch.

And as exclusion rates are at an all time high, I think many schools are prioritising funding and pass rates over empathy.

So I’m curious, what are the downsides of pursuing a diagnostics then?

Because let’s be honest, I’ve never heard someone saying there downsides of pursuing a diagnosis if you have type1 diabetes or a heart attack. Or even pneumonia, tooth abscess, sepsis, meningitis etc etc…
Its always about illnesses that could be seen as ‘controversial’, ones where people have or still are told to just pull themselves up by the boot straps.

She is merely selling the idea that all of those diagnosis aren’t real and if people really wanted to, they could have a normal life.
Granted, it sounds quite close to what our current government thinks. It doesn’t make right or real though. Just a reflection of her own prejudices, with a so called ‘scientific’ gloss

How does she know? She has no ND, cancer etc expertise or lived experience.

Yes, and I think this is another negative result of the need for diagnosis. Sometimes a diagnosis means that schools/workplaces can say ‘ah, we don’t have the resources to help you with that’ and they manage you out.

Even in schools/setting where they are set up to provide support, if you don’t ‘fit’ with the majority of other autistics, for example, then you are still perceived as being odd/difficult. My eldest/DD was diagnosed with ‘Asperger's’ form of ASD, my younger DS has ASD with high anxiety. Their needs are very different. My DS was generally un-catered for because he ‘didn’t come across as autistic - are you sure they’ve not made a mistake?’ [Erm yeah, he’s just spent three days in a darkened room, in bed with a raging vomiting migraine after a 3 day school trip where he socially masked the shit out it], but my DD’s abrasive/rude/meltdown prone form of ASD/ADHD means they have always jumped to attention because they were terrified of an incident in the classroom and avoidant of having to manage the group to reduce anything triggering her [bullying]. She was encouraged to ‘study at home’, was given ‘authorised absence’ so that her attendance was not marked as low, but they don’t have to have her in class… a backdoor form of exclusion - dressed up as empathy and compassion - and only granted because she is genius bright and her exam results boost the schools…

The diagnosis has been both useful and weaponised. It’s a dual edged sword.

This. I’d rather take advice from someone with specialist knowledge in said area.

Several people here asking me what the Author means or, worse, completely making up what she has said.
If you want to retain your current belief that she is talking bullshit then knock yourselves out.
If you want to read or hear about something you might not agree with but keep an open mind, then either read her book or listen to her on the podcast that was linked. I thought she talked a lot of sense but I’m not going to convince some of you of that. And that’s fine.