Three Papers on the Relational Foundations of Self-Diagnosis: Social Influence, Medical Authority and Implications

Abstract

In an era when mental health self-diagnosis is alternately described as a worrying fad or a rallying cry against medical gatekeeping, it is easy to lose sight of the deeply relational dynamics through which individuals come to adopt mental health labels. Friends, relatives, and communities do more than spread beliefs about illness; they actively transmit insights and offer validation that make possible new relationships to medical authority. This dissertation investigates the emergence and persistence of mental health self-diagnosis—identifying with a psychiatric category without receiving a formal diagnosis—by examining the social, cultural, and interactional mechanisms behind it. Rather than treating self-diagnosis as a moral puzzle or hastily declaring it either harmful or empowering, I explore the relational contexts in which it unfolds, the resources people rely on to name their experiences, and the broader implications for public health.Drawing on a mixed-methods approach, I combine longitudinal communication data, personal network surveys, and in-depth interviews with university students who self-diagnose. The first study introduces pre-diagnostic self-labeling, revealing how both peer diffusion processes and perceptions of support can encourage people to see themselves as having an undiagnosed mental illness. Next, I highlight the pivotal role of formally diagnosed friends and relatives, who operate as authority brokers by extending medicine’s legitimacy to self-diagnosing individuals. Finally, I turn to policy implications, showing that despite their high medical literacy, many students who self-diagnose face attitudinal and structural barriers not easily surmounted by simply expanding access to information.By centering the interplay between social networks and medical authority, this dissertation positions self-diagnosis as a collective response to contemporary changes in medicine, where expertise and everyday life converge. I argue for a more textured conversation—one that acknowledges how relational ties, expert knowledge, and lived experience intersect to reshape the evolving landscape of mental health care.