Kaufman chose the MDD diagnosis over other forms of depression because it sounded more enduring and less likely to be caused by something specific, which tracked with her feelings. She was only in the eighth grade, but decided she was doomed forever. Her behavior reflects a larger trend of teens diagnosing themselves with psychiatric conditions, using information gleaned from friends with official diagnoses, or from the internet, and therapists on TikTok. 

Young people are sometimes using “these digital platforms as a substitute for mental health treatment,” according to a Canadian study published in the journal Acta Psychologica. Moreover, the study found that “the overwhelming majority of TikTok videos on mental health are not created by professionals, and most contain misleading information.” 

Kaufman would spend the next three years fighting with her parents, smoking weed, vaping, and getting involved with sketchy older guys. At the time, these behaviors seemed like symptoms of her mental illness. But looking back, now 21 and happy, Kaufman thinks they were just symptomatic of being a teenager. 

We worked a retail job together in 2022 at the infamous one-size-fits-all clothing store Brandy Melville, often commiserating over a can of Diet Coke. I thought she was the “cool coworker” because of her vaguely apathetic aura, platinum-blonde hair and affinity for sad music. At the time, I had a raging eating disorder and thought of the 1990s Kate Moss as my personal Jesus — a delusion fueled by my employment at the shamelessly body-type-exclusionary store. (The “one” size is extra-small.) 

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Compared to what’s happening today, Kaufman’s form of self-diagnosis was low-tech. In 2018, Kaufman relied on WebMD and Mayo Clinic articles. Now, mental-health influencers are rampant on TikTok, and social media are rife with infographics listing symptoms of OCD, autism, and everything in between. The trend started during the pandemic, with content creators offering users easily accessible resources for therapy. But the result has been to flood young people with potential diagnoses, and has made us very quick to call ourselves crazy.   

Many never seek professional help, but some do, often in order to validate the conclusions they have already reached. Frequently, those conclusions turn out to be wrong. “At least three-quarters of the time, we are talking about normal variation,” says Dr. Jennifer Katzenstein, a pediatric neuropsychologist at Johns Hopkins School of Medicine.   

Katzenstein says she’s seen an increase in self-diagnosis in the last three to five years among her teenage patients. Many don’t realize, she says, what normal stress looks like, or what normal social anxiety looks like, or that sometimes it’s normal to be inattentive and easily distracted. “A lot of our kids who feel awkward in social situations think that they’re on the autism spectrum,” she says. “They’re coming in thinking that’s the diagnosis.” 

Katzenstein notes that the problem is a side effect of a well-intentioned and mostly beneficial nationwide push to remove the “stigma” from mental-health conditions. Destigmatization means we aren’t bullying people for their diagnoses anymore. And the lobotomies and forced sterilizations of the past have become inconceivable. We can now openly have conversations about mental health. But the side effect is that these conditions have gone viral and are seducing vulnerable young people who want explanations for their emotions. 

Moreover, as teens and early-20-somethings tinker with their identities, they’re working these supposed conditions into their self-images and behaving accordingly. When they view themselves as sick, they accept and anticipate sick behavior. “We go in looking to affirm,” Katzenstein says. “Our brains want to be right.”  

Kaufman landed on MDD because she thought of herself as someone who was fundamentally sad, not someone who experiences sadness. Her supposed condition became her identity. During this period, she says, she also expected less of herself and would excuse bad behavior as symptomatic. Her social circle echoed and amplified her conclusions. “There have been times where most of the people I’ve surrounded myself with treated their real or perceived diagnoses as a personality trait,” she says.   

The social consequences of destigmatization have been much more far reaching than might have been expected, and have created many negative downstream consequences. At 23, I have become used to the idea that I’m “crazy” — that everyone is. A guy at a party recently said to me that he was interested in me because he was “into super skinny chicks who act insane.” Offensive words, but my first response was to be flattered by “skinny.” I barely clocked the “insane” part.    

This is the cultural ambiance now. On dating apps like Hinge, it is alarmingly frequent to encounter guys who’ve answered the “I go crazy for … ” prompt with “girls who are slightly autistic.” Friends of mine have been told that their ’tism is cute (yes, Generation Z abbreviates autism now).  

Obviously, this trivializes real mental-health issues, and it fetishizes them, too. When guys say they are into girls with autism, what they mean is that they’re looking for quirky girls who are a little awkward and random. They want the effervescent and pink-haired Ramona Flowers from Scott Pilgrim vs. the World, not the girl with sensory issues who can’t interpret facial expressions or understand sarcasm. Not to mention that people with legit autism diagnoses would probably prefer to be chosen for themselves, rather than their neurodivergence.  

It’s difficult for everyone, from peers to parents to mental-health professionals, to navigate this new landscape. Gwen Schubert Grabb, a Los Angeles-based therapist, says she’s seen the “come one, come all” attitude of the mental-health movement being taken advantage of. Increasingly, she says, young people — and some older adults, as well — arrive with a list of symptoms to rattle off. And sometimes they have an agenda. “Look at the emotional-support and service-animal industry,” she says. “People I don’t even know will call me up and ask me to write a letter so they can bring their dog to some kind of event. I am like, ‘No, I’m not doing that.’”  

But she’s a professional and can discern when something illegitimate is afoot. Most others can’t, or are afraid to. 

Anna Caruso, 22, a senior at Northeastern University, has long suspected she has an anxiety condition and, at times, depression. But she kept it to herself growing up because the attitudes at home and at school were not sympathetic. However, she noticed a pivot in acceptance toward mental illness during Covid.  

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Caruso says that when her high school reopened during her senior year, a student body that once seemed perfectly healthy was now largely mentally ill. It seemed unlikely, but difficult to challenge. “You never want to be the person to say, ‘Hey, I really don’t think that you have a mental illness,’ right?,’” Caruso says.

She does not underestimate the impact the pandemic had on young people’s psyches — social isolation and a rise of deaths across the world should be, by anyone’s standards, a valid reason to be unhappy — but the sheer numbers struck her as unbelievable. And to be fair, she’d diagnosed herself, as well, with some combination of anxiety, ADHD and depression.

“During Covid, I feel like everyone wanted to be, I don’t want to say a victim, but people wanted to be felt sorry for,” says Caruso. 

The pandemic years were also the era of George Floyd and McCarthyism-levels of cancel culture. I’ve long been tempted to believe that some of my straight, white, affluent peers were using neurodivergence to join the ranks of the marginalized. If someone was “mentally ill,” then they, too, were a part of America’s disadvantaged class.  

I’ve seen white classmates trade stories with students of color about times they’ve been subject to “mistreatment,” because education systems designed for the neurotypical, for example. Classmates have also established “safe-space” social circles. Sometimes it’s as subtle as nodding along to a black peer speaking on prejudice, with an attitude of: “we’re in this together.”

In a cultural atmosphere that systematically rewards suffering, people tend to find a reason to suffer. But there is a crucial difference between sympathy and empathy. And as with the mental-health discourse, there is a grave risk of romanticizing, or trivializing, the real issues. So far, destigmatization has been many things: a flytrap for teens trying to understand their identities; an excuse for guys to be weird about girls who “aren’t like the others”; and a means to expiate white guilt. Mental-health problems should not be stigmatized, but this trend should be.

I was moved. By the end, I teared up, though I couldn’t discern whether my sorrow was solely a tribute to the artistry of the film. My older brother also staggered around with the help of canes and a walker. My brother also suffered from congestive heart failure. In 2009, my brother also died from the medical complications of morbid obesity. To say that I likewise approach this subject matter with intense sympathy is an understatement.

Still, I could have warned Aronofsky that he’d get stick. I channelled the loss of a sibling I loved and admired into my novel Big Brother, which similarly riled the “fat acceptance movement”. (Predictably, none of my aggrieved correspondents read the book.) No amount of sympathy cuts it with these people. I did not have the qualifications to address this topic. I wasn’t fat.

For what it’s worth, my own minor criticism of the film is stylistic. It’s adapted from the eponymous play by Samuel D. Hunter, who also wrote the screenplay. Occasionally, stilted dialogue and stagey acting keep one foot in the theatre. Otherwise, scenes where Charlie jerks off to gay porn while having a heart attack, or joylessly crams his mouth with doubled slices of pizza topped with ranch dressing, do entail an element of spectacle and voyeurism. But all film viewers are voyeurs, and these scenes are supposed to be painful. Charlie is sad, and his confined, shame-drenched life is meant to make us sad, too. That is the naysayers’ real primary objection: Charlie’s weight is tragic. Charlie’s weight is bad.

Stigma has been on the way out for a while. In the early 20th century, divorce was at last a legal option. But as novels such as Edith Wharton’s Age of Innocence demonstrate, that didn’t make the dissolution of a marriage acceptable in the drawing room. Divorce was a scandal. Even as breaking one’s solemn vows at the altar grew more common, into the mid-Sixties the iconic female “divorcee” was a wanton loose cannon often preying on the happy marriage. Come to think of it, we seldom use the word “divorcee” anymore, since an identifier is pretty useless when it applies to nearly everyone you know. Nowadays, having been divorced multiple times barely raises an eyebrow.

But this is not the most momentous eradication of stigma during my lifetime. Facilitated by the Pill, that would be the abruptly permissive attitude towards sex outside marriage — although (lucky me) I had morally conservative parents who exposed me to the scathing repudiation and hysterical disgust to which earlier “fallen women” were subject. When I announced that I planned to live with my boyfriend at 18, my mother screeched that I was a “harlot” and a “kept woman” whose “shacking up” would ruin me for the purity of Christian marriage. (Both my parents claimed to be virgins before they wed, and I don’t even think they were lying.)

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Spitting parental disavowal didn’t stop me from having a good time in my young adulthood, but it did give me a taste of stigma at its most effective; in my mother, my transgression triggered a visceral revulsion that she couldn’t control. Yet these days the only debate is whether to have sex on a first date, if we bother with dates.

Once unmarried sex became no big deal, the “out-of-wedlock pregnancy” followed suit. Presently, single parenthood can prove an economic challenge, and that’s about it. Yet not that long ago unmarried pregnancy was such a social horror that young women rushed to marry men they didn’t love or sometimes committed suicide. One of my mother’s college classmates starved herself for nine months to conceal her disgrace.

Homosexuality was next, and to be fair the exoneration of same-sex attraction (which, though she later pretended otherwise, my mother also found revolting) was a long slog. But now the stigma attached to same-sex relationships has so evaporated that being gay or lesbian isn’t even interesting anymore. As for cross-dressing, once a deep dark secret hidden literally in the closet, it is now so reputable that drag queens are reading stories to children in public libraries, and the furtive, old-school habit of struggling into your wife’s frock while she was out shopping seems to have been swallowed by the transgender movement. All that time you weren’t excited by dressing as a woman. You were a woman.

The rehabilitation of masturbation may still have a way to go, though, especially for older generations, since post-hoc mortification and an urge to concealment are instilled so early and run so deep. Yet masturbation must be the most ridiculous of no-nos. This free, universally available entertainment has no dire social consequences. The killjoy demonisation of harmless self-stimulation springs from a puritanical discomfort with sexual pleasure.

On balance, all these historically recent permissions probably make life better. Men and women aren’t stuck married to spouses they detest until death, mercifully, parts them. Having been around the sexual block meant that when I hooked up with my husband, I knew we were a good fit. I’m glad homosexuality is boring now, so gay friends and I can talk about something else. If I still feel a residual sheepishness after getting off in private, at least I know, abstractly, that I shouldn’t feel sheepish.

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But even the hunky-dory-ness of divorce and casual sex is a mixed bag. Marriage is not as meaningful; both parties know they can always get out of it. If I’m relieved divorce is possible, I’m also relieved my own parents didn’t get one; the cost of divorce for children is well known. And thanks to what we used to call promiscuity, sex is less meaningful as well. The much-lauded sexual revolution has produced more kids with only one parent to turn to, more children in care, and more venereal disease.

My point being that stigma isn’t always bad. It can attach to particular conduct for good reason. Collective disapproval is a powerful tool for encouraging behaviour that’s in the collective interest. More recent campaigns to remove the stigma clinging to overtly destructive conduct are therefore questionable. That includes the crusade to embrace “fat pride”, which wages a two-pronged war on conventional assumptions about both aesthetics and health.

On the aesthetic front, alas, what qualifies as attractive cannot be imposed by cultural fiat. No number of Dove models spilling from their underwear in Tube adverts can make riders on the Circle Line yearn to take them to bed. Standards of beauty are stubborn; we don’t find certain bodies beautiful because we ought to. On the health front, advocates for “people living with obesity” — an expression that suggests they’re not overweight but have simply taken in a flat mate — like to claim that one can be “healthy at any size”. Yet the NHS estimates that obesity costs the service £6bn every year, a figure projected to rise to over £9.7bn by 2050. Matthew Crawford, who at 55 stone once earned the title of “the UK’s fattest man”, requiring four adjacent hospital beds to lie down, died last year from sepsis and organ failure. Purportedly quite nice fellow, he was only 37.

Far too many people make themselves miserable over their weight, sometimes anguishing disproportionately over a few extra pounds. Nevertheless, is it in our communal interest for obesity to become broadly condoned? Already, especially in the US, television presenters and commentators are growing ever portlier. What qualifies as a standard build has risen several sizes. That’s good news for bigger people, who may feel more socially at ease, but bad news for any nation’s medical bills.

The drive for alleviation of stigma doesn’t stop at fat. We are henceforth to spurn the word “prostitute” and substitute the less loaded “sex worker”. This linguistic tweak is intended to convey that selling sexual services is no more degrading than attorneys selling legal services. “Sex work” is merely a career path, as deserving of respect as accounting or interior design. If specialists in desire wish to perform certain physical acts for a price, that is literally their business.

The world’s oldest profession is never going away. Personally, I support decriminalisation of prostitution. Yet most of the prosperous progressives who advocate this new open-mindedness would never themselves trade intimate access to their bodies for money in a million years. These are the same people who, if their daughter announced that instead of studying Economics at UCL she aspired to become a “sex worker”, would be horrified and would probably send the kid to a therapist. These are the same people who, should their daughter indeed end up walking the streets at 2am in fishnets, would regard her as in some ways lost and themselves as having failed as parents.

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Expunging stigma is not so simple a matter as wiping down a sticky marble counter with Cillit Bang, job done. Stigma is more like the black mould on the wall of the loo, which has an exasperating tendency to grow right back. Moreover, any society that pushed its young to pursue “careers” in prostitution would either be very desperate or deeply disturbed. I know of nowhere in the world where selling one’s body for sex is a neutral option. It’s reliably a last resort, and no new terminology can make the experience of turning tricks any more agreeable or raise the status of the sex trade a jot.

Drug addiction and alcoholism are now subject to the same brisk Left-wing housecleaning. Enlightened social services have rechristened an addict or drunk, “person struggling with substance use” — we no longer say “abuse” — or “person with substance use disorder”. The most extreme manifestations of this new moral detachment are in San Francisco and LA, whose downtowns are now covered with tented encampments of homeless people — whom we’re now meant to call “the unhoused”, the grammatical inference being that their circumstances are wholly the responsibility of some delinquent outside party. These denizens of faeces-strewn pavements are almost all drug addicts or alcoholics who may also be mentally ill. The city provides food, pocket money, drug paraphernalia, and safe, sanitary venues for getting high, because consuming meth, fentanyl, or a bottle of vodka every day is merely a defensible life choice. Behold, no stigma. What’s an addict not to like? Big surprise, the population of substance users in these cities continues to soar.

California has also effectively destigmatised theft, by demoting shoplifting of goods worth less than $950 to a misdemeanour, which police ignore as inconsequential. Ravaged by losses, businesses are closing retail outlets. If everybody does it — if stealing is normal and never punished — California’s shoplifters have no reason to feel contrite. Likewise, in the riots following the death of George Floyd, the wholesale ransacking of shops was justified as a “mass protest against our dominant conceptions of property”, as the sociologist Russell Dynes put it. Vicky Osterweil, author of In Defense of Looting, commended widespread commercial theft because it “gets people what they need for free immediately”. Looting also, she says, “attacks the history of whiteness and white supremacy”.

Yet this takes the biscuit: the serious campaign to make paedophilia respectable. Apparently, the stigmatisation of “Minor Attracted Persons” is unfair, because Minor Attracted Persons (MAPs) are just doing what anyone sexually drawn to children would naturally do. This MAPs business so crosses a line that it makes the prospective rehabilitation of a range of other once-villainous behaviours short of fanciful. Rapists could soon become “people with a coercion disorder”.  Burglars might be reclassified as “people living with other people’s things”. Perhaps we’ll simply see “Murder Attracted Persons” as “being themselves” — and who are we to interfere with their sanguinary self-expression?

For the consistent pattern here is an accelerating, positively demented refusal to make judgments. The stigma that once attached to socially unacceptable conduct has shifted from the transgressor to the adjudicator. If you use the word “addict” and ever suggest that maybe getting clean would make this person happier and more productive, you’re the problem.

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Furthermore, the language of mindless moral neutrality — “people living with obesity”, “people with substance use disorder” — distances people from their own decisions and deprives them of agency. The plight of alcoholics, drug addicts, and the life-threateningly overweight is medicalised, ascribed to having innocently contracted a disease. For erstwhile outcasts, the price of acceptance is helplessness, if not hopelessness. If your behaviour played no role in determining your current circumstances, then presumably behaving otherwise won’t improve those circumstances, either. You’re stuck.

Stigma has its place. We’re not obliged to celebrate everything our neighbours get up to. For the sake of a liveable country, we should fiercely discourage addiction to substances that turn people into stupefied dependents on the rest of us. Stealing, looting, prostitution, medically burdensome obesity, and sexual predation on children don’t make the world a better place. We should want thugs who break into our homes to feel shunned. For shame, guilt, and remorse also have their place. AA’s classic “hitting bottom” often involves self-disgust, which can finally motivate folks to pick themselves up.

If not all stigma is bad, some stigma is still both poisonous and unjustified, and it remains the case that pariah status can be whipped up with a vengeance almost overnight. Not long ago, one group was singled out as homicidal, delusional, and stupid. Pundits and politicians alike urged us to spurn their company; complex bureaucracies sprang up to keep the scum from restaurants, cinemas, and planes. Social media’s pitchfork brigade demanded this subhuman dross be denied access to healthcare or brazenly hoped they’d all die. That’s right, the unvaccinated. Stigma at its most ferocious. (For the record: I am triple jabbed.)

Clearly, stigma is a powerful force — for ill or good — which, having been firmly planted in a collective psyche, is not necessarily subject to top-down control. Stigma is sticky. Once a population is stigmatised, it’s hard to take the stigma back. When most of us watch Charlie showering his infeasible naked bulk in The Whale, no number of lectures from fat activists or censorious comment pieces in the New York Times can mitigate an unsettling sense of revulsion — which, even if tinged with a vertiginous sympathy and sorrow, still rivals my mother’s disgust at her daughter’s “shacking up”.

Back then, heterosexuality looked as easy as falling off a log. They say that onlookers see most of the game, and I found the push and pull of it all, the simple animal processes overlaid by human sophistications, endlessly interesting. I still do.

Today, though, heterosexuals are an endangered species. A recent survey uncovered that 21% of young adults (born between 1997 and 2003) in America identify as “LGBTQ+”. It also reported the frankly incredible stat that the number of self-identifying non-heterosexuals in the American population as a whole has doubled since 2012, from 3.5% to 7.1%.

It is, of course, vanishingly unlikely that a fifth of a population has turned spontaneously away from heterosexuality overnight. The rise of the insubstantial concepts of TQ+, which have little to do with sexual orientation but have been bolted on to LGB for some reason, obviously accounts for some of this. “Queer” is a particularly slippery category; it now seems to include anything from straight chaps wearing eyeliner to straight girls dyeing their hair shocking pink. Thus, it has elevated attendees of a Rocky Horror night or a Depeche Mode concert to the status of a persecuted minority.

But still, the survey finds that 57% of the respondees (of all ages) claiming to be non-hetero say they are bisexual. So, either this was always the case, but people concealed their sexuality due to social stigma. Or — and this is the far more likely scenario, in my opinion — heterosexuals are becoming socially embarrassed by their heterosexuality and trying not to be déclassé.

The reason I believe this is the more likely scenario is that heterosexuality, among the great and the good, now seems more fraught than being bisexual did a decade ago. The grim academic neologism “heteronormativity”, thanks to Tumblr and Twitter, is everywhere. The last few days are representative: Trisha Greenhalgh, a Professor of Primary Care and a member of independent SAGE, exhorting her followers to avoid “preaching heteronormativity”; an Indonesian magazine telling its readers that heteronormativity was the creation of Dutch colonialism; and Dr Nick Gah of Harvard stating that history isn’t called “herstory” because — well, you’ve guessed it. (This will come as a surprise to anybody who knows the Greek word histor meaning witness).

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The powerful organs of the LGBTQ+ movement have spent the last decade saying, “let’s end stigma, break taboos, and stop judging”. What this actually means is “let’s move stigma, place taboos around other things, and carry on judging people but for different reasons”.

Who would want to be “normative”, when you can catch a little of the glamour previously hoarded by the gays? A “normative” identity is increasingly seen as ethically dubious in the West; to be socially acceptable, to gain cachet and status, people have to identify as some kind of minority. Race is increasingly rigidly policed and culturally segregated, with white people cast as original sinners because of what they look like. But fear not! Anybody can identify into some spicy high-status oppression at the drop of a rainbow-striped Stetson by claiming to be non-heterosexual, no questions asked.

At the further end of the culture, prominent heterosexuals such as Laurie Penny, Jameela Jamil and Demi Lovato now all claim to be “queer”. Heterosexuality now carries such low status, in their bananas world, that they’ve felt the need to disavow it.

There are further incentives for people to identify as non-hetero in Hollywood, the arbiter of our culture. Take the bizarre new “representation” quota for eligibility at the Oscars — where at least 30% of characters in a film must come from “underrepresented minority groups” or a main storyline must revolve around such groups or it won’t even be considered for an award. It would strike dead most of human culture accrued over millennia, but actors and writers must now obey this peculiar edict or lose their careers.

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It’s all deeply patronising, and borderline homophobic. There is a kind of fetishisation of non-hetero relationships going on here, an element of voyeurism not much different from straight girls who kiss each other at parties to get the boys’ attention. It is also artistically crass. It means that unalloyed heterosexuality can never be depicted, and has a trickle-down effect of making it culturally unacceptable.

It’s no coincidence that all this is happening where #MeToo came to a head — making heterosexuality seem not only embarrassing but frankly dangerous. But Hollywood is also representative of a wider social movement.

Beneficial changes in material conditions in the West have led, paradoxically, to increased angst and the sexes being increasingly wary of each other. So #MeToo plus the atomisation of social life, plus the grim commodification of reproduction and romantic love, plus the problematisation of male sexual desire for women and its expression have made heterosexuals of both sexes neurotic, jumpy and hyper-vigilant. It could be another factor in the so-called Sex Recession among Gen Z; the number of high school students in America having sex has dropped from 54 to 40% since 1991.

Every society has regulations and social standards around heterosexuality, often wildly variant. Ours have changed with dizzying rapidity. One might feel almost nostalgic for something as asinine as “Men Are From Mars, Women Are From Venus”. At least that didn’t come laden with drear politics and sweaty-palmed suspicion.

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Let me be clear, I’m not blaming heterosexuals for their current predicament; I am blaming the culture that’s increasingly scattering obstacles in their path. When I encounter a functioning straight couple nowadays, I want to cheer.

Because at a very basic level, heterosexuality is of major importance, as the great motor of humanity. Without it, nobody would exist. It is a responsibility and (I’ve observed) a great joy, to rear and to effectively socialise children. The devaluation of parenthood — and of stable heterosexual coupling — across the West has had serious social consequences, exacerbated by bad economic decisions taken by Western governments. It has become increasingly financially difficult to raise kids — the ONS reported in 2020 that the English fertility rate had reached its lowest recorded level — which should be the easiest thing in the world.

It is deeply foolish to ignore or wish away the material reality, and the importance, of heterosexuality, and wrong to judge different kinds of straight relationships entered into by choice. There is nothing wrong with traditional straight couples and nothing wrong with progressive straight couples. They don’t matter more than the rest of us, but they matter in a different and significant way. And they are, let us not forget, the majority.

Shame about innocuous things is dangerous. As a gay man (sorry) who came of age in the Eighties, I know that only too well. It should not be so boring or gauche to be heterosexual that people are desperate to deny it. So let us have more heteronormativity and end the stigma. Take it from a homosexual, you’re just fine as you are.