Podcast Summary: Plain English with Derek Thompson

Episode: America in the Age of Diagnosis

Date: September 9, 2025
Guest: Suzanne O’Sullivan, neurologist & author of "The Age of Diagnosis"

Overview

In this episode, Derek Thompson sits down with neurologist Suzanne O’Sullivan to discuss the explosion of medical diagnoses in America and other western countries. The conversation explores why rates of autism, ADHD, depression, anxiety, and other medical conditions have soared—not necessarily because these conditions are more common, but because definitions and diagnostic criteria have broadened dramatically. The episode critically examines what O’Sullivan calls “the age of diagnosis”: the social, medical, and cultural forces driving overdiagnosis, the costs to individuals and society, and how this modern phenomenon affects our identities and perceptions of health.

Key Discussion Points & Insights

The Rise of Diagnosis: Context and Trends

• Derek opens by citing rapidly increasing diagnoses in America:

  • Autism: up nearly 60-fold since the 1990s
  • Bipolar disorder: 40x increase among American youth (1990s-2000s)
  • ADHD: 7x more adolescent diagnoses since 1990
  • PTSD and depression: sharp recent rises ([02:19])

• Main Thesis: The increase in diagnoses often reflects not more disease, but more labeling of what used to be considered normal variation or mild issues ([04:55]).

  • “We used to be merely forgetful. Now we have ADHD. We used to lack motivation. Now we're depressed.” (Derek, [04:55])

Suzanne O’Sullivan’s Clinical Perspective

• Clinical change: O’Sullivan describes patients, especially young people, now arriving with multiple overlapping chronic diagnoses—ADHD, migraines, anxiety, depression, and more ([07:57]):

  • “What worries me... is that people are accruing kind of long lists of medical diagnoses, and they're not getting any better. Their lives don't seem to be being made easier. Their symptoms don't seem to be alleviated.” (O’Sullivan, [08:50])

• Questioning the purpose of diagnosis:

  • Medical diagnosis is meant to help and support, but over-medicalization may be failing to provide real benefit.

Diagnostic Inflation: ADHD & Autism

• ADHD Case Study ([09:40]):

  • Expansion from hyperactive children (1960s) to adults and milder forms over time.
  • The DSM (Diagnostic and Statistical Manual) regularly broadens ADHD criteria ([12:55]):
    • “Every time a new version of DSM comes out, it slightly tweaks what it means to have ADHD deliberately in order to make the diagnosis available to new sets of people.” (O’Sullivan, [12:55])
  • ADHD now serves as a “culturally acceptable way of expressing distress” and accessing support ([13:50]).

• Autism Case Study ([15:13]):

  • Growth in autism diagnosis is “all at the mild end of the spectrum.”
  • No objective marker for autism or ADHD; they are “collections of symptoms.”
  • Societal changes have systematically shifted diagnosis boundaries, especially via gendered reinterpretations (e.g., looking for autism in girls by retrofitting new behaviors into the definition).

The Age of Diagnosis: What Drives It?

1. Deliberate Broadening in Medicine ([19:12]):

   • Medical community’s well-intentioned aim to pick up milder forms of disease leads to increased diagnosis but not necessarily better outcomes.
   • “We have more and more diagnoses based on the assumption that we can help more people if we diagnose more people. But I'm afraid that assumption [is] proving to be wrong in many ways.” (O’Sullivan, [20:49])

2. Societal Demand for Explanations & Certainty:

   • People seek answers for everyday imperfection and distress (e.g., pain, sadness), pushing doctors to label more experiences as medical problems.
   • Derek: “We used to turn to priests for who we are. Now we turn to the DSM…” ([23:29])

3. Institutional and Parental Incentives:

   • Diagnoses can unlock accommodations and resources in schools, further fueling demand.

4. Role of Culture and Pharma ([24:21]):

   • O’Sullivan acknowledges some influence but pushes back against the idea it’s an orchestrated conspiracy: “We are begging for it. Also... technology and scientists and researchers and profit makers are responding to something that we are desperate for.” (O’Sullivan, [24:41])

Costs of Overdiagnosis

To the Body: Overcare and Overtreatment

• Cancer screening case studies ([25:55]):

  • Overdiagnosis during routine screenings leads to unnecessary interventions, biopsies, surgeries, anxiety, and sometimes harm.
  • Study cited: Screening millions for cancer generally did not reduce overall mortality except for colon cancer.
  • “You will help one individual and you will harm other individuals...” (O’Sullivan, [29:14])
  • Introduction of the term “incidentaloma” — accidental, often irrelevant findings in healthy people that lead to further tests and anxiety ([35:25]):
    • “I instruct patients quite blankly, not to have whole body scans, if the truth be known. … It’s almost impossible to get a completely normal array of test results back on someone once they get into middle age.” (O’Sullivan, [35:25])

• South Korea’s thyroid cancer screening ([32:26]):

  • Incidence skyrocketed, but mortality did not change, later plummeting after reducing screening rates.

To Identity and Agency

• Diagnosis as Destiny:
  • Diagnoses, once “recovery identities,” now become lifelong labels that can limit self-esteem and agency, especially in youth ([39:39]):
    • “If you explain problems that people are having through medical illness, you potentially make those problems concrete... It can become a sort of self-fulfilling prophecy that stops people from getting better.” (O’Sullivan, [40:04])
  • Risks of forming communities based on medical identity, which disincentivizes recovery.

Counterpoints & Nuance

• What if “the Age of Sickness” is real? ([43:13])

  • Derek challenges O’Sullivan: Could it be that diagnosis is merely catching up to rising rates of sickness caused by modern life?
  • O’Sullivan replies that actual symptoms (like for ADHD) have not risen in tandem with diagnosis rates, often due to increased self-monitoring and awareness, not true prevalence.

• Potential Psychological Benefits of Diagnosis ([46:57]):

  • O’Sullivan agrees some people are empowered by diagnoses (feel validated, treat themselves more kindly), but questions if medicalization is the best or only way to provide that validation or support.
  • “You were never a terrible person. We need to create a society where we’re a little bit kinder to ourselves without the need for medical explanation.” (O’Sullivan, [48:30])
  • Warns overdiagnosis diverts resources and trivializes serious disorders.

Politics of Diagnosis

• Both left and right have interests in the diagnosis debate:
  • Left often defends the expansion of neurodivergent or Long Covid diagnoses; right has promoted conspiracy theories about vaccines causing autism ([50:40]).
  • O’Sullivan: “If there’s one thing we know with 100% certainty, it’s that vaccines don’t cause autism.” ([52:14])
  • The social contagion of diagnostic seeking may reflect unmet needs, not necessarily a medical reality.

Memorable Quotes & Moments

• On the nature of diagnosis:

  • “We are not getting sicker. We are attributing more to sickness.” — Derek ([04:47])
  • “There is no single brain scan abnormality [that] will tell you that somebody has ADHD or autism. There is no test you can do. ... They are collections of symptoms.” — O’Sullivan ([15:31])

• On the societal quest for a diagnosis:

  • “We used to go to priests to know how we fit into a community, and now we go to doctors to learn how we fit into diagnoses.” — Derek ([06:21])

• On overtreatment:

  • “You do enough blood tests, you do enough scans, you’ll find lots of little incidental findings.” — O’Sullivan ([36:20])

• On the trade-off of longevity and anxiety:

  • “Is a good life one in which you live to 100 but for the last 20 years of it you are on multiple different tablets and having endless, endless amounts of tablets, tests?... We should be aiming to be as well as possible for as long as possible, but live a full life rather than a long life.” — O’Sullivan ([55:18])

Notable Segment Timestamps

• [02:19] — Framing the age of diagnosis: rising labels, not necessarily rising disease.
• [07:57] — O’Sullivan’s clinical worries: “tsunami” of diagnoses, overlapping, not alleviating suffering.
• [09:40] — ADHD as an evolving, inflationary diagnosis in both US and UK.
• [15:13] — Autism: all recent diagnostic expansion is at the milder end, powered by shifting social definitions.
• [19:12] — The deliberate medical and social expansion of diagnostic categories.
• [25:55] — Costs of overdiagnosis: breast/prostate cancer screenings and iatrogenic harm.
• [32:26] — South Korea’s thyroid cancer screening experiment—incidence up, mortality flat.
• [39:39] — Identity and agency under threat: diagnoses as lifelong markers not paths to recovery.
• [46:57] — The psychological upside of diagnosis, but at what collective cost?
• [50:40] — Diagnosis and politics: left and right, anti-vax, and the culture war.
• [53:21] — Philosophy of diagnosis: The trade-off between anxiety and longevity, "priests versus doctors."

Tone

The conversation is clear, inquisitive, and thoughtful. O’Sullivan is measured, deeply informed, and careful not to diminish legitimate suffering, while Derek brings a journalistic curiosity and a willingness to challenge both guest and listener to consider all sides of a controversial issue.

Closing Reflection

O’Sullivan and Thompson close by reflecting on what makes a good life in the age of diagnosis. They agree that living longer should not come at the cost of living perpetually as medical patients, anxious and overly medically managed. The conversation urges listeners to balance our desire for answers and certainty with an appreciation of normal human variation, and to ask whether medical labels are always the best—or only—path to relief, support, or a sense of self.