Institutions are, in theory, designed to serve the people inside them. The medical system exists to diagnose and treat. The education system exists to develop minds. The workplace exists, in some notional sense, to allow people to contribute their abilities in exchange for fair compensation and a reasonable degree of dignity. These are not controversial propositions. Everyone agrees with them in the abstract.
In practice, of course, institutions tend to serve themselves first, their stated purpose second, and the actual human being in front of them somewhere further down the list, usually around the point where the human being has stopped being convenient and started being complicated. A patient who doesn’t fit the diagnostic template, a student whose learning style doesn’t match the delivery method, an employee whose neurology makes them brilliant at some things and genuinely incapable of others. Complicated. Inconvenient. Filed accordingly.
I spent six years in the Royal Australian Air Force, several more decades inside corporate and academic institutions, and the better part of a career as a psychologist watching what institutions do to people who don’t quite fit the mould they were cast for. The pattern is depressingly consistent. It’s not malice, usually. It’s something almost worse: systems that were never designed with the full range of human variation in mind, operated by people who were trained within those same systems and therefore cannot easily see outside them. The fish, as someone once observed, is the last to notice the water.
Here’s what I’ve written about this, from different angles.
If you’ve been told by a medical system that nothing is wrong with you, when you know something is:Understanding the overlap between complex PTSD, autism, and ADHD
If the workplace is where the mismatch shows up most painfully: When the workplace decides you’re the problem
If you want to understand the psychology of why systems resist the people who challenge them: Why systems resist the people who notice what’s wrong with them
If you’re a leader trying to build something that doesn’t repeat the same failures: So you want to build something that doesn’t repeat the same mistakes
The book that came most directly out of this question is Misdiagnosed, which examines what happens when the medical system’s confidence in its own frameworks exceeds its actual accuracy. It exists because I lived the consequences of that gap, and because the question “why didn’t anyone notice?” turns out to have a second, darker version: “why did someone notice, and say so anyway, and get it wrong?”
For the deeper material, including the organisational psychology research, the clinical frameworks, and the occasional dispatch from someone who has now lived inside enough different institutions to have developed strong opinions about all of them, the Quiet Half is where I go further. quiethalf.com