As 2025 comes to a close and we careen towards Christmas and giving season, I wanted to put in a plug for my favorite book of the year. The book is The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker, and I enjoyed it immensely. I found it originally when Jesse Singal did a Substack post called “Long Covid can be both Psychosomatic and Real”, and immediately forwarded it to my sister (an NP), who promptly got the book and then immediately called me to talk about it. She was annoyed I hadn’t actually read it yet, so I got the book and could see why she was calling. This is a book you want to talk about with people.

The author is a UK neurologist and a skilled writer, and she dares to ask the question “what is the point of diagnosing people with things”. She points out that diagnosis is supposed to be used strictly to inform treatment options, but we’ve completely overlooked the psychological impact a diagnosis can have. She starts with the example of Huntington’s disease, a fatal genetic disease that you can test for and diagnose, but for which there is currently no cure. Prior to the advent of testing, 90% of patients and their families said they would love to have a test. Once one was developed however, the decision to test or not proved a lot harder for people than they had expected.

She goes on to cover many other areas of medicine: COVID, chronic Lyme, autism, ADHD, cancer screenings, and points out repeatedly that there are two ways to be wrong. Missing a diagnosis you could have treated is obviously bad, but giving someone a diagnosis they may not have also carries a risk. It’s that second risk she explores for both physical and psychological illnesses. What does happen if you think you have a disorder that you don’t? Does disorder creep carry a cost? If your diagnosis makes you feel better about yourself but actually doesn’t improve your objective functioning or even worsens it, should it really have been given? Shouldn’t we be, you know, studying some of these questions?

I liked this book because I’ve spent a lot of time in the last 7 years or so thinking about the purpose of diagnoses and what they’re good for. Back in 2019 I wrote about my lengthy journey to getting diagnosed with chronic migraines (they had an atypical presentation at first), and it was a great relief to finally getting a name to my issue. However, it still took years to get a treatment regimen that worked, and I still have problems. I also have a new appreciation for psychosomatic illness because the migraines have messed up my sense of pain quite a bit. I now have to let every health care provider I have know that my sense of pain is not a great guiding light, in either direction. I have felt pain in places that appeared to have nothing actually wrong with them, and failed to recognize pain in other places because I thought it was part of the regular pain I have. Not having your senses work predictably is a huge disadvantage in diagnosis, but there are more people this happens to than you think. One highlight of the book was when she notes many people experience psychological pain as physical pain, and get slapped with every escalating numbers of diagnoses while trying to treat it. This isn’t good for anyone.

A related read this week was Accommodation Nation in the Atlantic, which points out that now over 20% of students at elite universities have a disability on file. This is a rate far higher than less elite universities, and the disabilities are primarily autism, ADHD and anxiety, and again makes us wonder what a diagnosis is really for. If the best and brightest are claiming to be disproportionately impaired, what are we really looking at here?

What The Age of Diagnosis highlights, sometimes uncomfortably, is that our institutions haven’t caught up to the psychological and social power of a label. In an era where traditional communities seem to be shrinking, we run the risk of allowing diagnoses to take a disproportionate role in the way we define ourselves. Books like this don’t offer easy answers, but they do give us the vocabulary to ask better questions about how we allocate care, how we define impairment, and what we actually want our diagnostic categories to accomplish in a world where they shape so much of public and private life.