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Gerry Gajadharsingh writes:

“I recently read the article below by Professor Kathleen Stock and, although deliberately provocative in places, I think it raises an important and increasingly difficult question for healthcare.

Over nearly four decades of clinical practice, I have watched diagnostic fashions come and go. What seems different today is the extraordinary speed with which medical terminology, symptoms and diagnostic categories can spread through social media.

ADHD is perhaps one of the clearest examples. There are unquestionably adults — and particularly women — whose ADHD was not recognised earlier in life and for whom an appropriate diagnosis can be enormously helpful. However, I am also increasingly struck by how readily people describe themselves, or sometimes others, as having ADHD on the basis of relatively common experiences such as poor concentration, procrastination, forgetfulness, restlessness, difficulty sleeping or feeling overwhelmed.

The scale of the change in recorded ADHD diagnosis is striking. A large UK primary-care study involving more than 7.6 million people found that between 2000 and 2018 the incidence of recorded ADHD diagnoses increased by approximately 1,900% among adult men and 1,400% among adult women.

More recent Government analysis suggests that the upward trend has continued. Between 2021 and 2024, the overall recorded incidence of ADHD in primary care increased by approximately 146%, from 1.03 to 2.53 diagnoses per 1,000 person-years.

These figures do not mean that ADHD itself has suddenly become dramatically more common. Greater awareness and recognition that ADHD has historically been missed — particularly among women and adults — will undoubtedly account for some of the increase. Changing diagnostic practice and improved access to assessment are also likely to be important.

But changes of this magnitude should still make us curious.

How much represents the correction of previous underdiagnosis? How much reflects changing diagnostic practice and greater access to assessment? And might social media, changing cultural attitudes towards neurodiversity and the increasing tendency to interpret relatively common difficulties through diagnostic terminology also be contributing?

None of those questions diminishes ADHD as a genuine neurodevelopmental disorder. They simply reinforce the need for careful assessment and clinical reasoning before a diagnostic label is applied.

There is another part of this discussion that needs to be approached carefully: the relationship between diagnosis, disability and financial support.

Personal Independence Payment (PIP) is particularly relevant because it is sometimes misunderstood as a benefit for people who cannot work. It is not. PIP is a non-means-tested disability benefit intended to help with some of the additional costs associated with long-term ill health or disability. Importantly, someone can receive PIP while remaining in employment.

The scale of its use has nevertheless changed considerably. By April 2026, around 4 million people in England and Wales were entitled to PIP, of whom approximately 3.3 million — 83% — were of working age. The combined number of people entitled to PIP or Disability Living Allowance has also risen, from approximately 3.5 million in February 2020 to 5.3 million by November 2025.

These figures should not be interpreted as evidence that people are seeking ADHD or other diagnoses in order to obtain benefits. Nor does receiving a diagnosis itself confer entitlement to PIP. Eligibility depends upon the functional consequences of a health condition or disability, and many recipients have substantial and entirely legitimate additional needs.

Indeed, financial support and workplace adjustments may enable someone with a genuine disability to remain in employment and live more independently, rather than encouraging withdrawal from work.

But it would also be unrealistic to pretend that diagnosis exists entirely separately from the wider structures of society.

A diagnostic label may facilitate access not only to appropriate healthcare but also to educational support, workplace adjustments, disability benefits and other forms of practical assistance. It can simultaneously provide explanation, validation, identity, community and access to support.

None of these things makes a diagnosis invalid.

The more subtle question is whether, when diagnosis becomes an increasingly important gateway to recognition and support, this can unintentionally influence how individuals understand their symptoms and how healthcare systems respond to them.

This does not require conscious exaggeration, malingering or financial motivation. Human behaviour is considerably more complicated than that. Social systems, expectations, cultural narratives and individual psychology continually interact.

The appropriate response is therefore neither to assume that rising diagnosis simply reflects previously neglected illness, nor to assume that people are acquiring diagnoses for secondary gain. It is to remain curious about both possibilities — and everything in between — while continuing to ask whether the diagnosis accurately explains the individual patient’s difficulties and whether it ultimately improves their capacity to function.

The same phenomenon can occur with conditions such as POTS, hypermobility, fibromyalgia and chronic fatigue. These are real clinical conditions and should not be dismissed. Equally, many of the symptoms associated with them are non-specific and may have several possible physiological, psychological and environmental contributors.

This is where careful clinical reasoning becomes so important.

A symptom is real because the person experiences it. But the interpretation of that symptom — and therefore the diagnosis attached to it — is a separate question.

Palpitations, dizziness, fatigue, brain fog and pain can each arise through multiple mechanisms. Sleep deprivation, chronic stress, anxiety, physical deconditioning, medication, nutritional deficiencies, altered respiratory behaviour and disturbances of autonomic regulation can produce or amplify remarkably similar symptoms.

Social media adds another dimension. Once someone begins watching material relating to a particular diagnosis, algorithms can repeatedly expose them to people describing similar experiences. Recognition can be helpful, but it can also create confirmation bias: instead of asking ‘What might explain my symptoms?’, the question gradually becomes ‘Which of my symptoms confirm the diagnosis I already believe I have?’

Good clinical reasoning should work in the opposite direction:

Symptoms → history → examination → appropriate investigation → differential diagnosis → diagnosis

rather than:

Diagnosis → search for confirming symptoms.

There is another important issue. A diagnosis should ideally increase someone’s understanding and their opportunities for treatment and recovery. It should not inadvertently become an identity that defines what that person believes they can no longer do.

This is particularly relevant when symptoms lead to progressively less physical activity. Avoidance may initially be entirely understandable, but reduced activity can produce genuine physiological deconditioning. Cardiovascular fitness falls, muscle strength decreases and orthostatic tolerance may deteriorate. Standing and exercise then genuinely become more difficult.

A cycle can develop:

Symptoms → fear or avoidance → reduced activity → deconditioning → worsening symptoms → greater avoidance

None of this means the original symptoms were imagined.

Indeed, one of the difficulties with discussions such as the article below is that suggesting psychological, behavioural or socially influenced mechanisms is sometimes interpreted as saying that a person’s illness is not real. That is an unhelpful and outdated distinction.

The brain, autonomic nervous system, endocrine system, immune system, respiratory system and musculoskeletal system continually interact. Expectation, attention, previous experience and social environment can alter physiology just as physiology can alter mood, cognition and behaviour.

This is also one of the central themes of my forthcoming book, Clinical Reasoning for Complex Patients – The Integrated Regulatory Systems Framework (IRSF). Much of the book is concerned with what happens when patients present with real, often disabling symptoms that do not fit neatly into a single diagnostic category. Rather than beginning with a label and attempting to make the patient fit it, I argue for a return to careful clinical reasoning: identifying the interacting physiological systems involved, understanding the regulatory load being placed upon them, and distinguishing the factors that may have initiated symptoms from those now perpetuating them.

This does not make diagnosis less important. It makes the reasoning that precedes — and follows — a diagnosis more important.

We therefore need to be able to hold two ideas simultaneously.

People with genuine ADHD, POTS, hypermobility disorders, ME/CFS, fibromyalgia and other conditions deserve appropriate assessment, diagnosis and treatment.

But we should also be willing to ask whether some people are being diagnosed too readily, self-diagnosing through social media, or interpreting relatively common human experiences through an increasingly medicalised framework.

That question should not be regarded as dismissive. Asked properly, it may be therapeutic.

In my clinical work at The Health Equation, I increasingly try to move the conversation away from simply asking:

‘What diagnosis does this person have?’

towards asking:

What is increasing their regulatory load?

What is reducing their physiological resilience?

What mechanisms are maintaining their symptoms?

And, importantly, which of those mechanisms might be modifiable?

A good diagnosis can be liberating. It can explain years of difficulty and open the door to appropriate treatment.

But a diagnostic label should remain a tool for understanding the patient.

It should never become a prison.”

Clinical Disclaimer
This article is intended for general information and education only. It does not constitute medical advice, diagnosis or treatment, and should not be used as a substitute for individual assessment by an appropriately qualified healthcare professional. The discussion reflects the author’s clinical experience and interpretation of the available evidence. Individual circumstances vary, and anyone concerned about their physical or mental health should seek appropriate professional advice.

Why are young women using walking sticks?

A disproportionate number of Gen Z females are affected by vague syndromes and may be victims of social contagion

Kathleen Stock

In 19th-century Paris, walking with a cane was a symbol of the dandyish flâneur, strolling elegantly around the city with an ironically arched eyebrow. In 21st-century Britain, canes are the unironic preserve of vulnerable looking girls.

Sometimes you see groups of them, each leaning on a walking stick as they edge gingerly along. Startlingly fresh-faced users have been visible at Pride parades for a while, and there are growing numbers on university campuses. The message sent to onlookers is about a life spent in pain; though what kind of pain, exactly, remains unclear.

TikTok has hundreds of videos on the subject: how to match your stick to your outfit, how to dance with a cane, how mobility aids can still look hot. And the trend is not just for walking aids.

This week a video went viral of a young woman in a wheelchair at a train station, filming the laborious attempts of staff to get her chair up some stairs after the lift failed. Towards the end of the video, somewhat unexpectedly, she gets out of her chair and walks upstairs herself, saying she “had a bit of energy that day” so could do it. In another video, she films herself putting on roller skates before pushing off from her wheelchair and skating happily away, Lazarus-like.

Even severely debilitating physical conditions produce good days as well as bad. On some bad days, a person may need extra help. But when a disproportionate number of young women are insisting this applies, we need to find out what is going on. Why do Gen Z females, apparently unlike every generation before them, have strangely unstable bodies that intermittently require support?

When you dig into their explanations, a few officially medical-sounding words tend to recur: postural tachycardia, joint hypermobility, fibromyalgia, chronic fatigue. What these syndromes all share is a set of non-specific symptoms, versions of which are familiar to all of us: dizziness, a racing heart, exhaustion, brain fog, muscle pain.

And of course, many of these are also symptoms of anxiety, the defining emotion of teenage years. Saying this doesn’t indicate that the syndromes in question don’t exist, but only that it can be unclear whether you really have one.

Could it be, then, that some are taking a cue from internet influencers, overanalysing normal experiences and talking themselves into a disabled state? If true, it would hardly be the first time that young women were in the grip of social contagion — indeed, they are famously good at it.

In her 2017 book How Emotions Are Made, the psychologist Lisa Feldman Barrett argues that emotions are a form of prediction, with the mind trying to decipher bodily feelings according to scripts learnt from the past. She starts with a vivid example of her own. As a young woman on a first date, her stomach started to flutter and she couldn’t concentrate. Soon afterwards she threw up, and realised that what she had assumed were emerging feelings of lust was actually a stomach bug.

What was true of the author then is true of all of us. Our inner sensations don’t come with labels attached but require mental interpretation, which is why cultures differ in their emotional ranges. Humans gradually learn the meaning of their feelings from society around them.

The old-fashioned repressed British script, still beloved of many middle-aged men, said: “Just ignore the painful twinge or weird sensation and it will go away.” Some are so adept at this they literally don’t notice injuries or signs of illness.

These days, the medical profession encourages us to take our physical experiences seriously in case some disease or other can be caught in time. But in certain subcultures, young people are being told that unpleasant feelings should be focused on more than anything else.

These feelings may be frightening; but they also make you different, special, excused from the pressures of life, pleasingly fussed over by strangers. And if a person then spends a lot of time sitting or lying down, she will naturally become unfit, so that the next time she stands up or walks any distance she will feel even worse; and the cycle of confused self-interpretation will continue.

When my ADHD diagnosis was removed, it was a relief

To point this possibility out tends to produce anger in those affected or those that care for them. Arguing that certain kinds of disability are socially created, particularly in females, looks at odds with the dictum that young women with chronic illnesses tend to be disbelieved by doctors, and that this is a very bad thing.

When talking about trends across huge populations, though, both things can be true — indeed, they might even be connected. And in the socially constructed case, we are still talking about illness rather than deliberate feigning. It’s just that the source of illness is, in part, a story the sufferer has unconsciously learnt. And this is very good news. For unlike biologically fixed disorders, stories can be changed for the better, and happier endings produced for the sufferers concerned.

Rather than it being cruel to say this, in fact, it is cruel not to. We owe it to potentially able-bodied young people to challenge their tendencies to neuroticism and fear; to get them out into the world as functioning adults, wherever that is possible. For their sake, we need to help them ditch the props, and — quite literally — to stand on their own two feet.

Kathleen Stock