Unshrunk and MAHA: A Diagnosis-Critical Case Study

a tangent inspired by my new video :)

My foray into Youtube continues! I made this primer on An Introduction to Critical ADHD Studies, a paper that came out last year which outlines the various approaches to understanding ADHD:

The main conflict in popular discourse about ADHD is the pathology approach versus the diagnosis-critical approach, where the pathologists claim brain disease and the diagnosis-criticals claim overmedicalization.

I mention in the video that I went through my own diagnosis-critical phase when I first started questioning the idea that the bipolar disorder I’d been diagnosed with was a disease that would progressively eat my brain!

The meds weren’t working, and when the meds don’t work, you start asking new questions.

This is the tale Laura Delano tells in her new memoir, Unshrunk: A Story of Psychiatric Treatment Resistance, which is getting a lot of publicity lately in the papers of record. I think it’s a great example of the diagnosis-critical approach, which I remark in the video can be taken from a right-wing or a left-wing perspective, and is ‘sort of right, but also sort of wrong’. Allow me to elaborate!

“I trust fully in my own process”

In my opinion, Unshrunk is a libertarian mental health text that advocates for a return to traditional American values. I made a similar argument about Anna Lembke’s Dopamine Nation, so you can imagine how I screeched when I noticed who gave the blurb on Unshrunk’s cover:

Delano’s story actually shares a lot with my own: we were both sensitive, angst-ridden white girls given diagnoses as teenagers, but resisted the labels then, and instead, drank a lot, fucked around, and self-harmed about it.

We both hit a point of suffering in our young adulthood that drove us on our knees to the psychiatrist, begging for help, and we both became the best little bipolar patients in the world, convinced that if we just tried hard enough to find the right meds and do enough therapy, what was wrong with us would be fixed.

We both, despite our privileges, had shitty experiences with the US healthcare system, and then read Anatomy of an Epidemic, a book that argues psych meds have caused iatrogenic harm on a massive scale in the US. We both love reading dense pharmacological texts, digging around in the archives, and questioning authority.

But this is where our stories diverge — when I started thinking critically about psychiatry, I got really into neurodiversity studies. I realized how my autistic traits had been misread by psychiatrists, and I embraced being queer and disabled. Delano started a blog called Recovering from Psychiatry LLC, and turned it into a consulting business.

In Unshrunk, Delano goes to a prestigious boarding school, a tradition ‘going back generations on both sides’ of her family. She is distantly related to the 32nd US president, Franklin Delano Roosevelt, and comes from a family I would describe as Legacy Old Money New England Pilgrim.¹ She was a nationally-ranked squash player (I honestly do not know what that is and refuse to look it up), and she graduated from Harvard.

The inciting incident in Unshrunk is an existential crisis Delano experienced in the eighth grade — staring in the mirror, she doesn’t recognize herself, and she realizes that her whole life is a performance. She’s about to start the school year as class president at her all-girls’ prep school, and it feels like she’s been cast in a role she doesn’t want to play anymore — the high-achieving good girl who is bound for success.

She asks her parents if she can drop-out and move to Maine with her grandma, and they refuse. She begins to fly into rages at her family, feeling trapped in a life she doesn’t want. They take her to a therapist, and eventually she is diagnosed with bipolar disorder.

Capitalist imperatives to accumulate and succeed can psychically fuck up the rich, too, but they rarely see it this way, instead finding other villains. For Delano, it’s doctors and pharmaceuticals and “modern industrial living.”

The ghost of squandered success haunts Delano throughout the book. When she survives a suicide attempt, she describes herself as failing ‘not only at life but at death.’ When she makes a friend during an inpatient stay — another child of wealthy New Englanders — they bond over being ‘treatment resistant’, and she writes:

“If we never again had the chance to be successful in society, at least we still had the chance to stand out in the realm of the mentally ill.”

In the clinical notes she weaves throughout the book, one of her psychiatrists wrote that “she is very ashamed of her failure to live up to expectations” and quoted her as saying “I should do it all by myself or I am a failure.”

How very American! But instead of actually freeing herself from the oppressive expectations of her culture, she ends up fulfilling them, anyway. Laura the protagonist doesn’t seem to learn much — she starts out in a crisis over the pressures to strive, and she ends up… still striving.

The book closes on a nice heterosexual life in the suburbs of Connecticut, two kids and a husband, working from home as business-owners. In the end, she gets her American Dream by taking personal responsibility for her pain, advocating for individual freedom, and turning all that into an entrepreneurial project.

It’s an intuitive libertarian health politic summed up poetically in the book’s last line:

“I trust fully in my own process—in this intelligence within me, within each and every one of us, I believe, that sits deeper than thought, that knows where to take us each from here.”

“Let your body be your guide”

Self-reliance is a bread-and-butter American value, so the book has mass appeal, and there’s nothing too weird in it. But you know what I always say: ye shall know them by their podcast appearances!

Last week, Delano went on The Dark Horse Podcast, a show by evolutionary biologist, Ivermectin-pusher, and guy-who-thinks-poppers-cause-AIDS, Brett Weinstein. They’re friends, he explains (he’s been to her house!) and they know each other through something called the Brownstone Institute.

That sounds like some kind of think tank, doesn’t it? Yes, it is! “A libertarian think tank that advocates for anarcho-capitalism,” actually! Delano is giving a talk to promote her book at the Brownstone Institute’s Supper Club next week!

According to the NYT, her husband, Cooper Davis, took a trip to Capitol Hill recently to pass out copies of Unshrunk and ‘explore whether Inner Compass might find new sources of funding in the new, pharma-skeptical dispensation.’

Their non-profit provides information and support groups for people who want to taper off their psych meds, which is a needed resource considering that they can cause painful withdrawal symptoms, and most doctors do not know how to taper patients off them slowly enough.

And, to be fair, Delano does realize that a lot of people need these drugs to work and survive in our current world as it now stands. There’s a scene in her book where she gets a job as a peer support specialist, and she writes that she’d initially thought the job would involve:

“helping people stand up against psychiatric coercion, spring themselves from locked wards, and successfully get themselves off meds they’d decided they no longer wanted to take.”

But actually, the people she worked with were not interested in any of that. They wanted rides to the store, and help making doctor’s appointments.

She realized that “without a radical transformation” of the system, it was impossible for poor disabled people living on government assistance to go off their meds like she did, with the financial support of her family. And in our current political shitfire, that healthcare system is going to get way, way worse.

“We need to take better care of ourselves”

In February, Trump dropped an executive order establishing the Make America Healthy Again agenda, which views autism, ADHD, and chronic illnesses as ‘health burdens’ and ‘a dire threat to the American people and our way of life.’

The MAHA order decrees that the government should:

• “empower Americans through transparency and open-source data”

• “ensure the availability of expanded treatment options and the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes”

• “assess the threat that potential over-utilization of medication, certain food ingredients, certain chemicals, and certain other exposures pose to children”

• “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs”

Chemicals in food, the danger of psych meds, ‘flexible’ insurance coverage (meaning, free market-ized) — that’s the MAHA Agenda, and Inner Compass fits right in, possibly counting as one of those ‘expanded treatment options’ that ‘support beneficial lifestyle changes’.

In an interview in Psychiatry at the Margins,² Davis described their non-profit dream: creating an alternative space where doctors could refer ‘non-compliant or otherwise resistant’ patients to ‘a community of other people’ who ‘figured out for themselves the non-medical, non-clinical solution to their shared problems.’

What are those solutions? “Let your body be your guide,” the Inner Compass website reads. One page, Reclaim Your Health, urges people who are tapering off their psych meds to:

“[take] back the innate power to heal and reclaim your brain and body through…‘common sense’ methods such as nutrition, movement, contemplative practices, breathwork, and more.”

These include eating only organic foods, cutting carbs and sugar, journaling, and mindfulness — wellness slop that aligns perfectly with the neo-Reaganomic goals of MAHA.

In The New Republic, Eric Reinhart describes MAHA as a ruling class ruse to harness rightful anger at our shit healthcare system and use it to make rich people richer: ‘a eugenics campaign in the guise of reform.’

The movement takes its name from a 2020 book by radiologist Nicole Saphier, Make America Healthy Again, which argues:

“We don’t need socialized medicine—we need to take better care of ourselves.”

MAHA has been led by concerned mothers who want to hold food manufacturers accountable for making products that have more sugar and additives in the US than their products in Europe. RFK Jr. calls them his “MAHA Moms,” and he credits their support for getting him into position as Secretary of Health and Human Services.

In her Washington Post review of Unshrunk, Judith Warner argued that Delano’s book will give RFK Jr. and MAHA ‘more ammunition’. In response, Delano took a screenshot of this and proudly pinned it to the top of her feed:

And listen, I’m no fan of the Bezos Post either, but Warner’s not wrong! Unshrunk’s message, which might sound progressive to some because of its critique of corporate and state power, actually falls on the conservative side of diagnosis-critical.

Reinhart points out “the superficial resonance between MAHA and progressive critiques of psychiatry” in his New Republic piece:

“…psychiatric diagnoses often obscure the structural causes of suffering—poverty, social isolation, racism, homelessness, and exploitative labor conditions, for example—by reducing them to “brain diseases.” This transformation of social problems into medical diagnoses in turn feeds pharmaceutical profits and pathologizes oppressed groups. Meanwhile, an intense focus on neural networks rather than on human needs for social networks often exacerbates suffering, rather than alleviating it.”

True, true, true — Delano covers a lot of this in her book, and I agree. But the difference between diagnosis-critical conservative and diagnosis-critical progressive lies in the conclusions. What do we propose to do about these problems?

Progressives want to redistribute wealth and fund public services. Conservatives, however, want to go back — to traditional values, to personal responsibility, to some glorious before-time when humanity was all-natural.

“What would my hunter-gatherer ancestors do?”

The words “evolution” and “true nature” do not appear in Delano’s book, but they do appear in her book-promo interviews.³ This appeal to nature is a very popular trope in conservative pop psychology media (see my analysis of Digital Madness last year).

She says:

“..for me, if there was one framework that has felt the most helpful to me in understanding suffering and the mind and day-to-day life, it is the evolutionary framework, of seeing how much of my day-to-day life is out of sync with what my body has actually evolved for.”⁴

Another major influence on her work is the Catholic-priest-turned-philosopher Ivan Illich,⁵ who wrote a book in the 70’s called Limits to Medicine. Robert Chapman includes this book in a brief history of the moral decline narrative that conservatives like to resurrect every couple decades:

“For Illich, modern medicine itself is making the people of the 1970s unwell, already bringing cultural decline by then. His vision of health is one where we embrace and overcome sickness as part of life, not something we should try to escape. He believed this would help us become more healthy, more virtuous, instead of helping us run away from problems by curing them.”

This is, essentially, the moral of Unshrunk’s story, and as in Lembke’s Dopamine Nation, evolutionary psychology and traditional Christian values get shmooshed together into a Frankenstein’s monster of science-backed traditionalism.

Toward the end of the book, Delano discusses how her approach to health has changed since getting off her meds. She casts modernity as a villain, and laments ‘how far we are from our primal nature.’

Delano insists she was ‘properly diagnosed and medicated’, and says that she still experiences ‘intense emotional pain and paranoia and debilitating anxiety and unhelpful impulses.’ To deal with this, she teaches herself to meditate and sits for an hour everyday feeling pain.

She grows into a place of zen: ‘no state of being is permanent or anything to be attached to or worried about.’ She’s still diagnosable by DSM standards, she says — the difference is just that she changed the story she was telling herself, and decided to ‘live beyond labels and categorical boxes.’

It’s an individualized approach to health that strips disability of its politics — and it’s also a bit disingenuous, since she identifies herself using the labels ‘wife’ and ‘mother’ in the epilogue — but it will no doubt appeal to the wellness crowd.

She writes things like, ‘I chose to stop putting toxins in, on, or around my body,’ learning about the ‘endocrine-and reproduction-disrupting, autoimmune-inducing, and otherwise disabling chemicals’ in our food supply. She describes her ‘new orientation toward avoiding, wherever possible, foods that came from a factory or ingredients invented by scientists,’ which causes her ‘excess flesh’ to melt away. ⁶

This sounds a lot like the gospel of the MAHA Moms! Here’s influencer Vani Hari in an interview with The Free Press, describing what she thinks happens when you stop eating processed foods:

“When you opt out of that science experiment, you start to realize a level of health that you never thought was possible, and you start to get off all the pharmaceuticals. You start to lose weight. You start to feel better in a way that is incredible. Your brain starts working again. And then you find your calling and you’re not depressed anymore and you’re doing what you’re supposed to be doing in this world.”

“I have to do it all on my own or I am a failure”

Unshrunk is not a bad book, and I’m not going to be surprised if it becomes popular — the timing is right, considering how it vibes with the MAHA focus on health as a personal responsibility and SSRIs as the devil. But I find Unshrunk a frustrating book when it comes to how it deals with disability.

Despite multiple hospitalizations and years struggling to work, she never calls herself disabled. The word appears only in a tragic context, speaking about other, less-fortunate people. Upon discovering Anatomy of an Epidemic in a bookstore, Delano reads that Whitaker’s ‘epidemic’ is actually ‘the huge number of American adults and children receiving government disability payments due to diagnoses of mental illness.’

This is a concern, we must assume, because disability is problem for society.⁷ She writes:

“…I considered that I very likely would have been included in this count had I not been born into a family with the economic means to insulate me from ever needing to go on disability.”

Later, after being on Lithium,⁸ she develops Hashimoto’s, an autoimmune disorder of the thyroid. Again, this is framed as tragedy, and she juxtaposes her doctor’s reassurance that it’s one of the most manageable autoimmune diseases as some kind of weird dystopic response to the horror of chronic illness.

There’s a patient story in Whitaker’s book that she describes as ‘an otherwise normal person being made chronically sick by diagnosis and subsequent treatment,’ and at this, her Aha moment dawns.

“Holy shit. It’s the fucking meds.”⁹

Delano sees herself as one of those ‘otherwise normal’ people turned abnormal against her will. Her own timeline of events negates this idea, though, at least initially. Her severe moods came before her meds, which she refused to take throughout most of high school, while her distress got worse.

What if her parents had responded to her intense rage episodes and ensuing self-harm by saying: “Everybody gets like that sometimes! Just normal human emotions!” That would be dismissive!

And what if, when she couldn’t keep a job because she was too depressed, someone told her: “You’re just being human!” That would technically be true — depressed people are human — but also dismissive, as well as just extremely unhelpful, because she would still be unable to buy groceries.

And herein lies the problem with a lot of diagnosis-critical stories — they reaffirm the concept of normality while erasing disability.

As Brown et al write, diagnosis-criticals adopt the same deficit framing as their opponents, the pathologists. This makes diagnoses offensive to the diagnosis-critical: bipolar means I’m deficient, so I can’t be bipolar, I have to be an ‘otherwise normal person’ who is being unduly pathologized!

At the end of her story, when she gets off all her meds, stops eating chemicals made by scientists, and learns how to meditate, she also weans herself off her thyroid medication and finds that her autoimmune disorder is cured, too.

What are disabled readers supposed to take away from this story? That if we just make enough ‘beneficial lifestyle changes,’ learn to suffer better, and take responsibility for our health, we can overcome our disabilities, too?

There’s a lot to hate about psychiatry, and again, I agree with a lot of Delano’s critiques. But I don’t think this is a book for disabled people, because the ultimate message is one of radical self-reliance.

I understand the need to change your story — like Delano, I changed mine, too. But the choice is not so binary.

You can ‘inhabit’ a label without ‘being subsumed’ by it. You can reject a framing of your suffering as strictly a chemical reaction, and still understand your experience as one of illness. You can turn illness into a weapon! And you can think critically about diagnosis without writing disability out of your story entirely.

1. The Delanos can trace their lineage back to one dude who came over on the Mayflower — somewhere along the line, according to Amitav Ghosh, they got into building ships, and then trafficking opium to China in the 19th century, where FDR’s grandfather made his fortune, fun fact!

2. See also: Awais Aftab’s review of Unshrunk from a clinical perspective

3. for that hunter-gatherer quote, see: How I Overcame "Treatment-Resistant" Mental Illness: Laura Delano’s Journey on Metabolic Mind, where she also muses about ketosis.

4. Radically Genuine #176 with Dr Roger McFillin

5. she says this on her Dark Horse episode

6. This also included getting off contraceptives, which she mentions very briefly in her book, but elaborates on in her interview with Dr. Roger McFillin. She says that she was shocked to learn in the 2010’s when she read Taking Charge of Your Fertility that she could not just get pregnant at any time, and remarks, “Why would I take a pill to shut down my whole body?” babe, what???

7. from Anatomy of an Epidemic: “The twenty-year-old who goes on SSI or SSDI will receive more than $1 million in benefits over the next forty or so years, and that is a cost—should this epidemic continue to grow—that our society will not be able to afford.”

8. a drug often presented as scary in the media, but which I actually had to bargain with my provider for months to let me try bc she didn’t want to be bothered with regular labs. I took it at a low dose and actually liked it, except for the peeing all the time thing. I did a ton of research on lithium before trying it and Unshrunk’s chapter on it seemed quite biased to me.

9. you could also look at a graph of disability claims going up since 1987 slapped on top of a graph of psych med prescriptions also going up and think, huh… “to the degree capital is accumulated… the spread and intensity of illness increases”!!