Mental Disorder Within the Neurodiversity Paradigm

Can neurodiversity proponents keep the notion of mental pathology?

Posted Jul 30, 2019

Neurodiversity typically refers to cognitive and learning disabilities such as autism, dyslexia, and dyspraxia. It can apply to these in so far as they do, in fact, seem to be part of human neurological variation. Moreover, we can use social models of disability to account for the disablement and distress encountered by those given such diagnoses. 

In this way, the rise of the neurodiversity paradigm is thus seen as a challenge to both the concept of mental disorder and medicalized accounts of cognitive disability. There is good reason for this, for a core part of the point of neurodiversity is that it is natural and desirable for humanity to have diverse variations in cognitive functioning—a view which contradicts the notion that there is a relatively restricted “norm" for psychological functioning that delineates who is mentally functional or not.

But some psychiatric classifications resist the notion of neurodiversity. Consider Post-Traumatic Stress Disorder (PTSD). This is typically defined as an anxiety disorder caused by traumatic, frightening, or stressful experiences, which can range from violence to psychological abuse. PTSD can be very distressing, and it is clearly a kind of illness, in the sense that it is a form of damage that is caused by a harmful environment, much as heatstroke is caused by an environment that is too hot.

One question this raises for neurodiversity proponents is how we can understand the concept of mental disorder from within the neurodiversity paradigm. That is, how we can re-conceptualize the concept of mental disorder, in such a way that excludes natural variation in cognitive functioning (e.g. dyslexia) from being counted as dysfunctional, yet which does include things like PTSD as genuine mental disorders.

The most obvious way to distinguish the examples I have given so far would be to use “neurodiversity” to refer to all inborn variation, and “mental disorder” to refer to those psychiatric disabilities caused by hostile environments. However, this would run into problems. On the one hand, there are inborn neurological variations that clearly are inherently harmful (for instance, infant anencephaly). So there are some natural human variations that should be counted as disorders rather than differences.

Moreover, it is at least conceptually feasible that someone could become neurodivergent due to a hostile environment. Imagine a hypothetical case whereby a neurotypical infant suffers head trauma that just so happens to alter their neurocognitive functioning in such a way that it is almost identical to autistic functioning. What if they then grew up and simply wanted to identify as autistic and neurodivergent, rather than as a damaged neurotypical? I would be very wary of anyone who excluded them from identifying as such, merely on the grounds that they were not born that way. If they functioned and developed autistically, and find it helpful to identify as autistic and neurodivergent, then the genesis of their neurodivergence shouldn't matter.

This points towards a different route to deciding who counts as neurodivergent or not, whereby whether one is neurodivergent, rather than ill, is primarily a matter of identification (a bit like with gender). That is, if any group or individual labeled with the same psychiatric diagnosis (say, autism, schizophrenia, etc.) decides to resist the pathologization of their cognitive style and instead identify as neurodivergent, then the very act of identification should be enough to count. 

I am quite sympathetic to this way of thinking about neurodiversity. But this conception might run into problems too. Consider here how some "pro-ana" anorexic individuals argue that anorexia is a way of life rather than an illness. It has recently emerged that anorexia is in significant part genetic. Given this, what if someone with anorexia decided to identify as merely neurodivergent, rather than ill?

A pressing issue here is that anorexia itself is often fatal, and that in those cases where death is due to starvation, then the fatality seems to be a direct product of the anorexia itself—making it hard to apply a social rather than medical model to anorexia in such instances. Given this, it seems hard to justify framing anorexia as societally-disabled neurodivergence, regardless of identification. 

It seems that we need some kind of objective, or at least consistent and reliable, way of distinguishing neurodivergence from disorder that makes sense within the neurodiversity paradigm. That is, we need a new model of mental disorder that somehow resists the relatively restricted species-norm that is currently used in dominant models of mental disorder, but which can also help identify genuine cases of mental pathology such as PTSD.

I don't know yet how this will turn out. But in the long run, it is vital that we do so in order to bring our conceptions of mental health and illness in line with the rise of the neurodiversity paradigm.