This week's post by Christophe Gauld, Laelia Benoit, and Floriane Brunet considers how the increasing prevalence of self-diagnosis influences the relationship between clinicians and young patients.
In recent years, many adolescents have begun arriving at psychiatric
consultations not to seek a diagnosis but to confirm one they
already believe they have. They describe themselves as, for instance,
autistic or having ADHD, after reading descriptions (online) that resonate with
their experience. This phenomenon
of self-diagnosis happily challenges
established hierarchies of knowledge in psychiatry, especially in child and
adolescent care.
But it also raises an important question, which we explored in depth in a
recent article: how should clinicians and young patients (re)position
themselves in relation to one another, especially when differences in age and
status necessarily influence the clinical relationship?
Let us recall that in most clinical contexts, diagnostic authority is concentrated in professional hands. And since psychiatric categories do not rely on biomarkers, the formulation
of a diagnosis remain closely connected
with social and moral judgments of harm. This interpretive dependence of diagnosis on clinicians creates
an asymmetric epistemic
space, in which the
clinician’s account can prevail over the patient’s own lived experience and interpretation.
In children and adolescents, this imbalance
could combine with childism, a form of discrimination
that assumes the child’s voice is unreliable, immature or irrelevant. Like ageism, which marginalizes people because of age, childism operates on the same generational axis by devaluing children through
assumptions of dependency and immaturity. It refers to a system of attitudes and practices that naturalise adult
superiority, treating children as incomplete or incapable of rational
understanding.
Its specificity is in the transformation of developmental difference into a
moral and social justification for inequality.
Childism operates structurally, embedded in institutional norms and
clinical routines that reinforce adult authority and marginalise children’s
voices. It frames adult perspectives as normative, establishing “standards of
reason,” credibility and emotional coherence that children are expected to
follow. In clinical practice, it appears to arise “naturally” from age
differences. This naturalistic assumption biases how clinicians listen to
patients whose discourse differs from their own. And this is compounded by the
fact that childism intersects with other forms of discrimination (e.g., gender,
disability, class, etc.), producing cumulative disadvantages that shape how
young people are heard and understood.
To see how this might play out in clinical
practice, consider an example. When, for instance, an adolescent comes to a
clinician declaring “I think I’m autistic”, they do not simply misuse medical
language. They reclaim interpretative power over their own experience. They demand
recognition as knowers. These acts are epistemically and politically
significant. They reveal how power and knowledge are interdependent in psychiatry: thus, although some
self-diagnoses may rely on incomplete or misleading information, they also open a space for rethinking how clinical knowledge is shared
and validated.
Due to their distinct conceptual histories and to the primary object of application of childism – i.e., childhood – epistemic injustice and childism are conceptually related and mutually reinforcing, operating across interconnected levels. Epistemic injustice designates a harm to someone’s capacity as a knower, which becomes visible within communicative and epistemic exchanges where authority and credibility are unequally allocated, and which contributes to broader structural patterns.
Childism, in parallel, refers to
the institutional norms, laws and professional practices that naturalise adult
superiority, and which are enacted and reproduced within everyday clinical
interactions. In this sense, childism both shapes and is shaped by
interpersonal clinical practices, and epistemic injustice reflects how these
normative assumptions are lived and negotiated in concrete encounters in child
and adolescent psychiatry. Together, these overlapping dynamics help explain
how self-diagnosis makes visible the ways credibility, authority and
recognition are distributed in clinical care.
Bios
Christophe Gauld is a French
adolescent psychiatrist with a PhD in philosophy of psychiatry (Université
Paris 1 Sorbonne).
