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Neurodiversity and the Pathology Paradigm

Uncovering the forgotten history of normality.

Key points

  • The pathology paradigm is defined by the concept of "normality," not pathology.
  • The concept of cognitive normality was the invention of 19th-century eugenicists.
  • This gives a way of understanding how the concept of pathology can be reclaimed from within the neurodiversity paradigm.

Following my previous post, I have been thinking more about how neurodiversity theory has sometimes been conflated with the anti/critical-psychiatry argument that we should abolish the concept of mental illness or pathology as such. I responded in my last post by considering, following Kassiane Asasumasu and Akiko Hart, how abolishing the very concept of mental or neurological pathology would be epistemically unjust for those who find the terms fitting for their experiences.

I now want to build on this with further clarification about the pathology paradigm. Importantly, Walker defined the pathology paradigm as being built on a restricted conception of mental and neurological normality, not on the concept of pathology as such. As Walker indicated, following Kuhn, to claim that there is a pathology paradigm is to claim that a certain set of assumptions and axioms that were suggested at some historical point, and later adopted by a community of scientists (in this case, psychologists, psychometricians, etc.) as the basis for research and knowledge production.

While Walker herself did not provide a history of the pathology paradigm, one thing that follows from her equation of the paradigm with notions of cognitive and neurological normality is that it can’t have arisen before the 19th century. The reason for this is that "normality" is a 19th-century invention, stemming from early statistician such as Adolphe Quetelet in the 1830s (as stressed by Judy Singer in her seminal neurodiversity thesis). These ideas were then applied to the mind by phrenologists, eugenicists, and, later psychiatrists and psychologists.

Where the Idea of "Normal" Comes From

While I can’t justify this in detail here, I propose (based on a book I’ve been slowly working on for some time) that the founding of the pathology paradigm can be dated to 1869. In this year, the eugenicist Francis Galton synthesised these emerging statistical conceptions of normality with his half-cousin Darwin’s theory of evolution by natural selection, to apply them to mental ability for the first time in his book Hereditary Genius. In Galton’s words:

“I propose […] to range men according to their natural abilities, putting them into classes separated by equal degrees of merit […] The method I shall employ for discovering this is an application of the very curious theoretical law of 'deviation from the average.'” (1869, p. 66)

It was this that led Galton to rank individuals, families, and races (predictably enough with White, upper-class European men at the top, and Black Africans at the bottom) in terms of "natural ability," thus instigating a new approach to conceptualising and studying the mind.

Importantly, Galton’s approach was the first to blend Darwin and the concept of normality—along with ableist, racist, classist, and sexist ideological baggage—to rank different kinds of minds in relation to an idealised norm. And this method and its assumptions are what formed the basis for contemporary approaches to psychological and psychometric testing, the ensuing division of people in functioning levels ("high IQ," "low-functioning," etc.), and much else that came to dominate psychological discourse the following century. Hence, as autistic sociologist Damian Milton writes, “there is no neuro-typical to deviate from other than an idealised fantastical construction of Galtonian inspired psychological measurement.”

Yet while the paradigm instigated by Galton in 1869 is, I argue, the underlying target of the neurodiversity critique, he certainly did not invent the idea of mental or neurological illness or pathology. In fact—and although they may have used different terms—various concepts of mental health go back to the oldest texts and oral traditions in pretty much all corners of the earth (see, e.g. in Europe, China, and the Americas). In other words, mental health, once removed from its contemporary neo-Galtonian iteration, is an ancient concept that long predated the pathology paradigm. Similarly, the concept of neurological pathology was first discussed by the Hippocratics in Ancient Greece, who associated both madness and epilepsy with the brain.

What This Means for Neurodiversity

Why is this important for understanding neurodiversity? One reason is that it helps clarify how overcoming the pathology paradigm does not require dropping the concept of pathology. Rather, it only requires dropping the neo-Galtonian concept of pathology, which is associated with the notion of Darwinian cognitive and neurological normality that Singer, Walker, and other neurodiversity proponents draw attention to.

With this in mind, a final thought I will leave with is that overcoming the pathology paradigm will also require developing a deeper, more nuanced understanding of its still relatively hidden history. After all, as Sun Tzu and Rage Against the Machine equally knew, you can't win the war if you don't know your enemy.


Further reading: beyond Singer and Walker, the classic disability studies text on the history of normality, which Singer drew on in her seminal thesis is Lennard Davis' excellent 1995 book Enforcing Normalcy: Disability, Deafness, and the Body, published by Verso.