How mental illness became an identity
Christianity Today
October 27, 2026
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Illustration by Kensuke Koike
Only twice have I met my cousin Jason, who lives in Florida. This isn’t only because I grew up a time zone away: Jason is profoundly autistic, with little ability to communicate. He’s lived most of his life in a group home with the specialized care he needs—which is a lot, even on the best days.
## All in Your Head: Illness as Identity, Trauma as Fashion, and the Desire to be Disordered
Fredrik deBoer (Author)
Simon & Schuster
336 pages
$27.96
A thousand miles away, my wife works with patients with a variety of less disabling psychological conditions. And at my university, the counseling center stays busy all year with students who’ve endured childhood abuse, are seeking treatment for depression, or are struggling to adjust to college life.
When you think about mental illness, what comes to mind? Is it people like my cousin? Or is it something that can be managed as part of a more ordinary life? The sheer scale of that spectrum is the central problem considered in Fredrik deBoer’s new book, All in Your Head: Illness as Identity, Trauma as Fashion and the Desire to be Disordered.
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Mental illness in the 21st century is an expanding category—and one increasingly dominated by its most functional and therefore visible members. That displacement—in our collective imagination and public discourse—of the profoundly mentally ill by my college students didn’t happen all at once. And how did it happen? Was it because of the closure of traditional mental hospitals, like those of One Flew Over the Cuckoo’s Nest? Was it because of the internet-driven phenomenon of self-diagnosis by very functional influencers? The marginalization of psychiatry as a profession? Or denial, romanticization, and politics?
DeBoer tells a comprehensive story in compelling detail. In the last century, he says, growing suspicions about psychiatric methods led to demands for reform. The changes that followed largely prioritized including the mentally ill in normal life, and that shifted our default image of people with mental illness from those who required full-time care to those who could manage in public spaces.
In the internet age, when public space is always just a click away, that shift became more pronounced. Clinical language is now popularized, and self-diagnosis is prevalent. Along the way, the more profoundly mentally ill—among whom deBoer, with bipolar disorder, counts himself—have been overshadowed, even forgotten.
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A key factor here, deBoer writes, is that disability is increasingly understood not as a deficit within a person but as a problem of how society is organized. In this new model, all mentally ill people really need is proper accommodations, including an end to stigma around mental health. DeBoer certainly isn’t against accommodations, but his contention is that this assumption is often naive. And because it has taken hold so widely, institutions that could actually aid the profoundly mentally ill have been shuttered and functionally replaced by homeless shelters, prisons, and emergency care.
Then, deBoer argues, as those whose mental illnesses were more responsive to treatment and compatible with public life became the face of this disability movement, mental illness ceased to be seen as a liability. Instead, it became an identity marker and source of camaraderie in a fragmented world. Influencers whose public personas centered on their autism, ADHD, bipolar disorder, or other conditions provided a vision of mental illness as a source of individuality—even an asset.
The shift away from institutionalizing the mentally ill was born of compassion. But compassion cannot, deBoer writes, be a reason to set aside expertise. Compassion can and must coexist with policy reforms and clinical judgments. (For churches that seek to include the mentally ill, there’s a lesson here: We must pair compassion with acceptance of practical limits, recognizing that mandates to love must often be coupled with the wisdom of professionals.)
All in Your Head is a well-argued call to return to a world where clinical expertise is weighed more heavily than selfdiagnosis, where mental illness is not a character trait that can ground personal identity. But it’s also a broadside against the way online communities in particular have appropriated mental illness, devalued clinical judgments and public mental health institutions, and shifted our entire culture toward thinking in terms of self-diagnosis.
At the heart of deBoer’s book is a concern for the profoundly disabled, those who will never go viral on TikTok or advocate for their own inclusion. They suffer when our efforts to treat mental illness compassionately overcorrect and give the most attention to those who need it least.
DeBoer’s approach here is brusque. At times it is the kind of jarring rhetoric necessary to awaken a reader, but at times it is too sweeping in its handling of milder forms of mental illness.
The book is a challenging read for Christians, because the dynamics deBoer identifies have shaped our conversations around disability ministry for years. Many churches now emphasize inclusion in ways that, though not wrong, are not always realistic. Part of the controversy during the COVID-19 pandemic, for example, stemmed from the fact that disability does not come in one easily managed form. Some people with mental or physical disabilities could navigate the pandemic with the right assistance. Some could not, however great the accommodations.
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All in Your Head also raises a second and perhaps more difficult matter for churches. In the same years that inclusion movements became mainstream in the church and wider culture alike, Christians have increasingly begun to use therapeutic language for the work of ministry. We talk about narcissism, coping, and resiliency alongside sin, grace, and virtue. This new language has its uses. But it’s worth asking what we gained and lost when clinical terms migrated into church just as they were adopted by online influencers.
Reading deBoer’s book, my mind turned from Jason to my students and back again. Jason knows nothing of “taking a mental health day” or educational accommodations. He falls far outside the neurodivergence framework or conversations about access.
It is here that deBoer’s case lands the hardest: Our efforts to avoid stigmatizing disability have not helped Jason—indeed, they’ve made it more difficult him to receive the care and understanding he needs. He has been fortunate, but many profoundly mentally ill people have not, going from institutionalization to the inadequate care of jail cells, shelters, and hospitals equipped to focus on physical ills.
But the question of how best to care for the mentally ill should not be a zero-sum game, pitting milder and severer sufferers against one another. Two things can be true: Jason needs institutional care, and my students experiencing mild depressive episodes need attention too. Their needs are vastly different but both real, and are not always best served by the institutional approach deBoer champions.
In this way, All in Your Head offers a sharp diagnosis with an incomplete prescription, precisely because not all the proliferation of diagnoses has been in vain.
Mental illness is, as he says, increasingly exaggerated, and for many it has become a form of identity instead of something to treat. But some new approaches—which might come from untested sources—could aid more minor cases. Similarly, it can also be true that societies—and churches—need a more professionally guided approach to mental illness and that clinical approaches cannot do the same work as informal communities of care for the suffering.
DeBoer’s criticisms of mental health discourse should be heard, and heard clearly, particularly given how much influence this discourse has in church ministry and online communities. This book is strong medicine. But accordingly, it is best taken in small doses, sorting out where recent developments need to stay and where the new mental health discourse has run aground.
Myles Werntz is the author of books including Contesting the Body of Christ: Ecclesiology’s Revolutionary Century. He writes at Taking Off and Landing and teaches at Abilene Christian University.
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