The Neurodiversity Movement: Confusing Illness with Stigma?

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In 30 years of psychiatry, I have frequently been in doubt about the true nature of attention-deficit/hyperactivity disorder (ADHD). Is it an illness? Is it simply a variation of normal? Is it a problem in our culture that might not be a problem in other cultures? The source of my doubt, I suspect, is that individuals just seem to ‘be wired that way.’ ADHD, it seems, is heavily influenced by genetics,1 and some individuals just seem wired to be more spontaneous, more distractable, more open to the next thing, and less able to keep themselves focused on things they find boring or tedious. It is just how they are.

Maybe ‘how they are’ would have been less of a problem in premodern times, when being open and exploratory may have been an advantage more than a hindrance. In premodern times, we did not ask children to sit in school for 6 hours a day doing work that would bore adults, nor did we ask adults to stare at screens and do mind-numbing tasks for 9 hours a day. Perhaps ADHD is just a mismatch between the demands of our current world and the nature of the world for which we evolved.2 Perhaps it is not a disease at all.

Yet I cannot fully bring myself to believe that ADHD is not an illness. For one thing, clinical experience proves otherwise. Once I worked with a patient who was about to be fired from his job in spite of working until late into the night to get his work done. Meanwhile, his partner was preparing to divorce him because he completely neglected the relationship in an effort to save his job. This person’s life was transformed by treatment, which saved both his job and his relationship, and brought him a kind of happiness he had never experienced

This brings us to the topic of neurodiversity. Neurodiversity is the idea that such neurodevelopmental conditions as ADHD and (especially) autism spectrum are not illnesses or even disorders.

In its strongest form, neurodiversity tells us that neurodevelopmental ‘disorders’ are not disorders or illnesses at all. They are really just normal parts of human diversity, as normal as different ethnicities, sexes, and sexual preferences. No one should try to ‘cure’ autism any more than one should try to ‘cure’ someone of being Black. Instead, societies need to stop excluding and pathologizing individuals who are different—in this case, who are neurocognitively diverse.

If the extreme form of neurodiversity is true, then a psychiatrist treating autism amounts to the same thing as a psychiatrist attempting to ‘cure’ someone from being gay, as psychiatrists did before the 1970s. By this logic, psychiatrists who diagnose and treat autism spectrum disorder are patronizing and pathologizing individuals just for being different, just for being divergent. “We don’t have a disease,” as one student at an Asperger’s School put it, “so we can’t be ‘cured.’”

As with moderate and severe forms of ADHD, I am convinced from both science and personal experience that moderate to severe forms of autism spectrum disorder represent a true medical condition. For that matter, I would guess that most mild forms of the disorder do as well. Of course, knowing where to draw the precise line for such neurocognitive and neurodevelopmental disorders may be humanly impossible. Where, after all, does normal human inattentiveness end and ADHD begin? Where does normal human geekiness (lack of social awareness and obsessive, narrow interests) end, and autism spectrum begin?

The work of advocacy today is not to deny the existence of well-researched illnesses, but to permanently rid those illnesses of the stigma that has traditionally accompanied them. Similarly, the work of advocacy is not to decide if this or that person has an illness—this is an individual decision made by patients and their families when they consult with clinicians. The work of advocacy is to make sure that everyone with an illness is treated with complete acceptance, compassion, and support.

I wonder if proponents of neurodiversity and psychiatrists might both agree to the following: What if we imagine a world in in which no one looks down on neurocognitive and neurodevelopmental conditions, a world in which those conditions are both accepted and treated, and we work together to make that kind of world a reality?

Unfortunately he parried that seemingly unbreakable belief that the ND movement is against all treatments. I have never seen that including “woke” ND movement supporters.

They don't want a cure but want treatments?

They want treatments for specific issues, but not attempts to "cure autism" as a totality.

Having read the post now, I like it. There is some movement to accept neurodivergent conditions as "just a neurotype, not a disorder". The Dr who diagnosed me as autistic actually seems to fall into that camp. Personally I do not - I think it's both a disorder and a neurotype.
(I wouldn't call it an illness, I'm not sick. A sickness can be cured. Autism is a condition that will never go away. It is an intrinsic part of me.)

I personally have not heard of anyone being against any and all treatment. ADHD is highly treatable and people objectively do better when they follow that treatment.
There isn't so much you can do for autism, aside from like.... stuff like speech therapy and controversial "treatments" like ABA. And that's more teaching skills than it is anything else. Aside from doing that, you really can only accommodate autism. There is no magic pill that will make you less autistic.

Heck, even learning disabilities (which are part of the neurodivergent spectrum) .... they aren't really treatable in the sense that you can take meds and they'll go away. You might be able to learn ways to deal with them more easily, but that's about it.

Remember "mutation" is not necessarily a negative thing. They can cause problems but are also the driver of evolution. If ASD is really on the increase it could just be evolution right before our eyes. Of course evolution is a messy business and many of us (with ASD) will not have a net advantage in this rapidly changing world.

Think of it this way, if we could "cure" all mutations in all life forms we would be halting evolution in it's tracks. Certainly that would be the doom of this thing we call "life on earth".

I agree with the article. While it is nuanced, it's essentially saying that a disorder is a disorder, even if you give it another name. Personally, I object to not calling a condition that causes significant difficulties a "disorder". It feels like a euphemism to call it a "difference", as if there was shame in admitting that one has a disorder so it's better to give it a more palatable name.

What if we extended that thinking to all mental and developmental disorders and just said that none are disorders, just differences? Where would that leave all the people who need help, including people with ASD and ADHD? So many are already being blamed for the behaviors they exhibit that are actually due to their disorder and being disbelieved that there is something serious that they are suffering from. Not calling these disorders "disorders" takes a huge step backwards in the struggle for society to recognize that mental, developmental, an neurological disorders are real illnesses that need to be taken seriously and treated medically by competent professionals.

An illness needs to be cured and that is that. The intent behind the perceived benign word “difference” and the perceived more flexible word “condition” is precisely to make disorders more palatable for the purpose of acceptance.

Most people with a disorder want to be cured of it. Autism is different in that most(not all) Autistics at least here view their difficulties both being caused by Autism directly and societies view of autistic behaviors/presentation. Outside of behaviors that are dangerous to oneself or others I feel reluctant to cede these judgment calls to medical proffessionals.

As an aside, very few illnesses, whether in the brain or elsewhere, can be cured. Heart disease, diabetes, cancer, just to name a few, are common conditions that are considered illnesses by everyone, but no one is cured of them (with cancer there's remission but it's not a sure thing). Just because something cannot be cured is not a test for whether or not it should be labeled a disorder.

I agree with the article. While it is nuanced, it's essentially saying that a disorder is a disorder, even if you give it another name. Personally, I object to not calling a condition that causes significant difficulties a "disorder". It feels like a euphemism to call it a "difference", as if there was shame in admitting that one has a disorder so it's better to give it a more palatable name.

The word "condition" is short for "medical condition", illness doesn't sound right.

ASD or Autism Spectrum Disorder is probably the correct way in my view.



Agree that is basically what the article is about if there wasn't any shame in acknowledging something as a disorder there would be no need to sugar-coat things with fake science and denying reality.