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Negotiating the Neurodiversity Concept

Towards epistemic justice in conceptualising health.

Key points

  • A recent essay argues that neurodiversity paradigms are increasingly being co-opted by those who are using it to defend the status quo.
  • Including mental or neurological illness within the paradigm of neurodiversity can be seen as part of inclusion, not its antithesis.
  • Constructing the neurodiversity paradigm in a way that avoids the imposition of a single story may allow space for individuals to self-define.

I was glad to read Jesse Meadows' interesting essay “You’re Using the Word 'Neurodiversity' Wrong” published last week.

Meadows' key point is that neurodiversity paradigm vocabularies are increasingly being co-opted by those who are essentially using them to defend the status quo. Among other things, they are now often used as fluffy terms to promote being a little bit kinder to some neurodivergent people, or to make workplaces slightly more accessible, while leaving everything else – and, in particular, the underlying default pathologisation of neurodivergence – wholly intact. This is what Meadows refers to as "re-branding the pathology paradigm we already live in."

Neurodivergence and Inclusion

Unsurprisingly, I agree with Meadows on this key point. But I also want to add what I hope is understood as a friendly departure from both Meadows and other neurodiversity proponents on a more specific matter. What I am concerned with is Meadows' wholesale rejection of there being a "wrong" brain or mind on the neurodiversity paradigm. As Meadows puts it, on their understanding, "The neurodiversity paradigm says: there is no such thing as a normal brain. Variation in neurology is natural, and none is more right or wrong than another."

Meadows' aim here is to be inclusive in who "counts" as neurodivergent, and I think that aim is noble. But I understand the requirements of inclusivity differently. For me, rejecting the idea of a single kind of “right” brain or mind (which I agree with) does not imply that there can be no “wrong” kinds. By analogy: multiculturalism rejects the idea that there is any “right” culture, but it's still consistent for multiculturalists to think totalitarian culture is "wrong."

Similarly, Kassiane Asasumasu, who coined the term "neurodivergent," emphasised that “Neurodivergent refers to neurologically divergent from typical,” which includes “Autistic people. ADHD people. People with learning disabilities. Epileptic people. People with mental illnesses. People with MS or Parkinsons or apraxia or cerebral palsy or dyspraxia or no specific diagnosis but wonky lateralization or something.” As she goes on, then: “It is not another damn tool of exclusion. It is specifically a tool of inclusion."

Importantly, Meadows also argues that neurodivergence should be understood in an inclusive way. Yet while Meadows seems to take this to mean being inclusive in wholly depathologising all kinds of currently pathologised minds, Asasumasu sees mental or neurological illness as an aspect of (some kinds of) neurodivergence. For Asasumasu — and while I suspect she would sympathise with Meadows' timely critique of the co-option of neurodiversity paradigm vocabularies — including illness within the paradigm is part of inclusion, not its antithesis.

Epistemic Justice in Conceptualising Health

My own views on how pathology or illness should be conceptualised from within the neurodiversity paradigm have changed over time. In my late teens, I was more influenced by the anti-psychiatry and critical psychiatry movements, and I used to think that it would be liberatory to reject the idea of mental illness as such. But that was long ago — before I realised how ableist most critical psychiatry is — and my views have often changed since.

On my current understanding, a more helpful way to frame this is as an issue of cultivating epistemic justice in our concepts of health. This is suggested by Akiko Hart in her insightful critique of claims by trauma-informed critical psychiatry proponents who argue that the concept of mental illness is just a "myth" and diagnoses mere "lies." As Hart writes:

"Once we opt for a single story around mental health, whether that’s the story of illness, or the story of trauma, then we by definition exclude others. Arguing that all distress stems from trauma and adversity might not speak to those who experience their distress as spiritual renewal; those who see it as neurodiversity, as part of who they are and how they are in the world; those who understand it as a psychosocial disability; and of course those who see madness as an illness, a sickness of the brain. Many of us will probably see themselves in some or all of these stories, a patchwork of identities. Some of us won’t make sense of our distress. That’s OK too. There are in fact as many stories as there are people. The single story, whether that of illness or that of trauma, doesn’t honour this multiplicity and this complexity."

In line with Hart's worries regarding contemporary critical psychiatry, I am similarly concerned to construct the neurodiversity paradigm in a way that avoids the imposition of a single story. Thus for me, once we recognise that the boundaries of health are intimately intertwined with and reflect oppressive power structures, as Meadows rightly notes, we should still not jump to rejecting the very possibility of mental pathology, or of a "wrong" brain, as they conclude. Rather, we must work on allowing more space for individuals and groups to self-define as healthy or ill, different or disordered, perfect or broken, in need of either medical or political intervention, or whatever combination of these.

For me, escaping the trap of the single story requires centering the voices of neurodivergent and Mad people in the continued critique, construction, and reconstruction of the boundaries of health. It requires recognising that these boundaries never are or could be finished; they are always in flux and may differ from person to person. It also requires recognising that they can only be negotiated by deliberative, messy, and complex democratic processes. And it equally requires attempting to boobytrap our deliberative processes so that they neither reflect existing inequalities in our power structures, nor challenge them only to impose a new single story.

It is for this reason that I now prefer to argue only for the rejection of default pathologisation of neurodivergence, not of neurodivergent pathologisation as such. To be sure, this will be a more messy, complex task that will always require more work. And it will lead to no easy or lasting solution. But for the neurodiversity paradigm to be emancipatory more broadly — and to avoid the imposition of a new single story — I suspect such a move will be just as necessary as resisting the kind of co-option that Meadows so pertinently critiques.