My Complicated Thoughts on Neurodiversity
Emily S. Cutler
I want to start off by stating that I fully agree with the neurodiversity movement's basic premise: that no cognitive, emotional, or mental state, trait, characteristic, or way of being should be pathologized or stigmatized. I wholeheartedly support the notion that the experiences currently categorized as "mental illness" or "mental disorder" should instead be accepted as part of the spectrum of human mental, emotional, and cognitive diversity. And I honestly could not be more appreciative of neurodiversity activists, researchers, and scholars for standing behind this idea in some incredibly brilliant, innovative ways. I think in a lot of ways, the neurodiversity movement has begun to accomplish the de-pathologization and de-stigmatization of the states, traits, and characteristics commonly categorized as "mental disorder" in ways that the psychiatric survivors movement has been unable to.
I believe that another one of the great accomplishments of the neurodiversity movement is uniting the disability rights framework and social model of disability with the movement for human rights and acceptance of people diagnosed with mental disorders or mental illnesses. In framing neurodivergence as disability, the neurodiversity movement has helped advance the notion that the same rights, accommodations, and acceptance given (ahem, that should be given) to people with physical disabilities should be applied to those with cognitive, emotional, and mental disabilities - and that both groups can fight for one another in solidarity.
Additionally, in framing neurodivergence simultaneously as disability and as something to be de-pathologized, the neurodiversity movement advances the notion that disability itself - physical or mental - is not something to be pathologized or necessarily medicalized. In my experience with the psychiatric survivors and antipsychiatry movements, I have heard many people claim that they do not wish to identify as disabled because they do not believe there is anything wrong with them. The neurodiversity movement assists us in understanding that there is nothing wrong with being disabled, and in fact, disability can result from societal barriers and exclusion, not from any internal medical condition.
I am also incredibly grateful for neurodiversity's inclusion of LGBTQIA+ identities. Many neurodiversity activists and researchers themselves identify as queer, trans, or nonbinary and frame these identities within the paradigm of neurodiversity - as different traits, characteristics, and ways of being that should not be pathologized but rather accepted as legitimate forms of human diversity. I think the neurodiversity movement is a space where in many ways, the disabled, queer, and mad communities can co-exist without pathologizing one another or even distancing themselves from one another, and that is truly an outstanding achievement.
So, in comparison to the above, my own disagreement and divergence from the neurodiversity movement are very minor. I feel that they are tangential side notes in comparison to the major aforementioned goals and achievements. I even hesitate to publish them because I do not in any way want to detract from the above.
My primary disagreement with the neurodiversity movement relates to categorization. In the neurodiversity movement, people diagnosed with "mental illness" or "mental disorder" instead identify as "neurodivergent," in order to promote the idea that they are not ill or in need of treatment but instead just different. People who do not meet the criteria for a psychiatric diagnosis are referred to as "neurotypical."
I want to state, again, that I wholeheartedly support the notion that people diagnosed with "mental illness" or "mental disorder" are not in fact disordered or in need of treatment. But I also worry that this catgorization upholds the idea of neurodivergence or madness as an objective or discrete entity rather than something that is culturally constructed or context dependent.
The reality is that psychiatric diagnosis is, in many ways, meaningless. What gets diagnosed as "mental illness" or "mental disorder" (as well as what gets diagnosed as one mental illness/disorder versus another) varies from culture to culture, from country to country, from individual clinician to individual clinician. In some cultures, hearing voices is universally seen as a sign of schizophrenia; in other cultures it may be seen as a sign of a spiritual awakening or psychic abilities. In some cultures, or according to some clinicians, experiencing extreme grief - including hallucinations and being unable to work - for years after losing a child may be seen as a normal way of coping with loss; in other cultures or clinical settings, this may be grounds for immediate hospitalization. The idea that the presence or lack of psychiatric diagnosis can decide whether a person is neurodivergent or neurotypical ends up reinforcing the notion that the medical model and diagnostic system can accurately categorize the human experience in an objective, consistent manner.
I also worry that the neurodiversity movement can, at times, reinforce the binary between madness and sanity, erasing the universality of what we consider "madness." In my opinion, anyone and everyone can experience the states, traits, and characteristics categorized as "mental illness" or "mental disorder," and the vast majority of people do at some point in their lifetime. A lot of people feel pretty depressed as a result of capitalism, for example, and most people experience intense grief and sadness as a result of death and loss. Most people have some sort of inner critic that could qualify as voice-hearing and experience something in the realm of "mania" as the result of being in love. To me, the idea of a "neurotypical" individual who has not experienced any of this is a myth.
Of course, this is not to say that some experiences of "madness" or neurodivergence are not significantly more stigmatized and pathologized (and in some cases, may cause more suffering) than others. The reality is that struggling with the voice of your inner critic is much less likely to land you in a psychiatric hospital, deprived of your rights and bodily autonomy, than being tormented by the voices of demons or abusers. And being so depressed by the death of a loved one that you try to kill yourself is much more likely to lead to social rejection or job discrimination than being sad or grief-stricken for a couple weeks. The unique forms of oppression that result from only some experiences of "madness" or neurodivergence absolutely need to be acknowledged and addressed, and for this reason, I do understand the desire for language like "neurotypical privilege" that describes the freedom some people experience from things like incarceration, involuntary hospitalization, discrimination, and exclusion on account of their cognitive or emotional states/characteristics.
At the same time, though, I feel that "neurotypical privilege" is somewhat of a myth. The truth is that even the so-called "neurotypical" person who never experiences any distress, extreme state, or other cognitive difference except for feeling depressed in the three days after the death of their grandmother (to be honest, I'm pretty sure that person is also a myth, but let's say they're not for the sake of a hypothetical example) will probably experience some amount of sanism, ableism, and oppression during those three days. They may not receive enough time off work; they may be looked at strangely or asked intrusive questions for crying in public (especially if they are a man); they may experience a lack of understanding or empathy from friends and colleagues; they may be encouraged to hide their grief at work...the list goes on. While this person's experience should not be compared to a lifetime of ableism or sanism that many voice-hearers or autistic people, for example, endure, this person's experience does show how sanism, ableism, and neurobigotry affect and oppress even "neurotypical" people.
I strongly feel that every single person can stand to benefit from the principles of the neurodiversity movement. To some extent, everyone is taught from day one that they need to hide their emotions and conform to societal standards of cognition and behavior in order to fit in. Everyone - whether they have been diagnosed with a "mental disorder" or not - can benefit from being more free to express their emotions, quirks, weirdness, extreme states, and other characteristics we have been taught to be ashamed of. I think the neurodiversity movement could perhaps do a better job exploring how even those with so-called "neurotypical privilege" can stand to gain from the de-pathologization of emotional distress and cognitive differences.
In my opinion, it is all of our extreme states, emotional crises, voices, pain, and distress that unite us, rather than separate us. Acknowledging the universality of "madness" and neurodivergence has the tremendous potential to help us all recognize our common humanity and connect on a deeper level. Instead of encouraging the categorization of "neurodivergent" and "neurotypical," I think we can all encourage one another to examine in what ways we are neurodivergent, and in what ways we can each use our own neurodivergence to make others feel more comfortable expressing their neurodivergence.
At the end of the day, my thoughts on the neurodiversity movement are not that complicated. It is a phenomenal movement comprised of some of the most brilliant and passionate activists and researchers in the world, and I am incredibly proud to be part of it. Like any other movement, there is room to improve. I am excited to see how the ideas of mad studies and the psychiatric survivors movement - which tend to recognize the universality of distress and "madness" - might enrich the principles of the neurodiversity movement in the future.