Part 4 Neurodiversity: New paradigm or Trojan Horse?

Editor’s Note: Mad in the UK and Mad in America are jointly publishing this four-part series on neurodiversity. The series was edited by Mad in the UK editors, and authored by John Cromby, Lucy Johnstone and one anonymous contributor. The series is being archived here.

 This is the fourth and final part of our blog series on neurodiversity. Part 1 outlined the history of the neurodiversity movement, along with some of its implications, limitations and contradictions. In Part 2, we suggested that the rapid rise in the diagnoses most commonly associated with neurodiversity, ADHD and ASD, can be understood as consequences of neoliberalism – both in terms of the specific behaviours thus described, and their subsequent commodification and marketisation. Part 3 then showed the very damaging effects that the concept of neurodivergence and associated diagnoses can have in clinical practice, including limiting therapeutic work to the affirmation of identities.

In Part 4, we will examine the implications of the various strands of the neurodiversity movement for the medical paradigm of distress – the narrative that, from the point of view of Mad in the World, has failed, and needs to be replaced. To what extent does the concept of neurodiversity offer a new, inclusive, non-pathologising way forward, as some (including the founder of the movement, Judy Singer) intended? This will include addressing claims from one strand of the neurodiversity movement, that critiques of the kind often hosted by Mad in the World are ‘reactionary and outdated’, and based on extreme right-wing, supremacist, and ableist positions.

We remind readers that we wholeheartedly respect and uphold people’s personal right to describe their difficulties and differences in any way they find helpful (although we argue that clinicians do have a duty to use concepts that are in conventional terms evidence-based). While our stance toward neurodiversity and associated concepts remains critical, none of what follows either limits or changes that personal right, or imposes alternatives.

Neurodiversity and psychiatric diagnosis

As we have seen, the relationship between the medical/diagnostic paradigm and the neurodiversity paradigm is confusing and contradictory. The term neurodiversity itself, as originally put forward by Judy Singer, was intended to embrace everyone and thus de-pathologise our natural individual variations. In this sense, ‘neurodivergence’ does not necessarily imply any kind of disorder, disease or disability – only ‘difference’ of some kind.

Within this, some parts of the neurodiversity movement take an uncritical or neutral perspective on the validity of psychiatric diagnoses such as – but not limited to – ASD and ADHD, backed up by unsubstantiated claims about biological and genetic causal factors.

Others who describe themselves as neurodivergent see these terms as indicating identities: the kind of person you are, not the kind of ‘disorder’ you have, and as such, exempt from the critiques directed towards other psychiatric labels. These essentially arbitrary decisions are supported by some researchers in both critical psychology and disability studies, even while they dispute pathologisation and discrimination in general.

Even more concerning is the potential for this trend to be exported to non-Western cultures, as has happened with the diagnostic model under the much-criticised Movement for Global Mental Health. This appears to be a real, although currently not widespread, possibility, as discussed here. For example, this video from India encourages people to celebrate ‘Neurodiversity Pride Day’, and there is a newly established Centre for Neurodiversity Studies near Delhi. We have no space to discuss these developments at length so want to clearly state that, in our view, they raise serious questions and concerns.

Running alongside these developments is the argument that those who are diagnosed as, or who identify with, ASD, ADHD or AuDHD are disabled, even if not disordered or diseased, and have a right to appropriate supports and adjustments.

All of this combines to create one of the central contradictions of the neurodiversity movement – that the core creeds of non-pathologising and acceptance have in practice contributed to a massive increase in diagnostic labelling. We will now attempt to unpick some of the issues this creates, with a particular emphasis on their relationship to the diagnostic model of distress. We consider the consequences of diagnosis as a form of social identity; of neurodivergence as a form of disability; and of self-diagnosis.

The consequences of ‘diagnosis as identity.’

The re-framing of diagnosis as identity in some parts of the neurodiversity movement leads to an insistence on identity-first language – an ‘autistic person’ rather than ‘a person with autism.’ Confusingly, this is often accompanied by a desire to acquire an official diagnosis, even if the person does not see autism or ADHD as a ‘disorder’, because this is the gateway to the adjustments that are said to be necessary for a neurodivergent person to live in a neurotypical world.

This hunt for medical confirmation tends to be accompanied by a consumerist perspective on healthcare which sees the acquisition of the desired diagnosis as a right, not an expert opinion that may or may not be deemed applicable in a given case. The consequences for assessment and therapy were described in Part 3.

At the same time, the frequent conflation of label-as-disorder with label-as-identity reinforces the belief that an official diagnosis is more or less irrelevant to whether or not you actually are an autistic person or an ‘ADHD-er’. If this is just who you are, then only you can know whether the concept fits. So, non-specialist conferring of these identities by Tiktok, or by a mysterious process of recognising your ‘neurokin’, is as valid, if not more so, than a professional opinion. This conviction, as we saw, can lead to much determined ‘shopping around’ for a professional willing to confirm your belief.

The conflation of ‘disorder’ with ‘identity’ is helped by the fact that, despite long lists of criteria, psychiatric diagnoses such as ASD and ADHD are ultimately based on subjective judgements (by the clinician) about subjective experiences (of the client), rather than on biomarkers – because there are none. As a result, there is no easy or definitive way of resisting the expansion of the number of people said to be neurodivergent.

This conflation has other undesirable consequences, some of which we have already discussed. A label which has the authority of a medical diagnosis, and is at the same time experienced as a kind of valued identity, is extraordinary powerful – more so than diagnostic labels such as bipolar, major depression and so on. At least in theory, recovery from medical conditions – if that is how they are understood – is possible. But you cannot ‘recover’ from an identity, or from being a certain kind of person. The implications for therapeutic intervention were discussed in the previous blog. If ‘symptoms’ are at the same time an expression of your ‘authentic self’, then change is not only impossible but undesirable, and any suggestion to the contrary is likely to be viewed or felt as offensive, oppressive, or worse.

Perhaps the most unexpected – and from our perspective, regrettable – consequence of the conflation of label-as-medical-condition with label-as-identity is the reframing and reclaiming of some of the most contested and stigmatising psychiatric diagnoses through identity-first language. For example, some who claim to be on the progressive frontline of the neurodiversity movement are arguing that we should once again start talking about ‘schizophrenics’. The reasoning is that, from a neurodiversity perspective, ‘schizophrenia’ does not refer either to the symptoms of an illness, or to reactions to toxic circumstances and life events. Instead, it describes a specific ‘neurominority’, a particular kind of person. Just as there are autistic persons, so there are schizophrenic ones whose experiences of distress are actually ‘..a natural way for schizophrenic persons to develop and perhaps respond to their environment’.

This implies that the construct of ‘schizophrenia’ is, contrary to decades of critique and the admissions of DSM committee members themselves, a reliable and valid way of categorising a certain group of people. At the same time, it reproduces the damaging myth that ‘schizophrenia’ describes a permanent, lifelong way of experiencing the world. The same is true of attempts to reframe other diagnostic labels as ‘identities’ – including the most contentious, ‘borderline personality disorder’ which, it is suggested, can be ‘destigmatised’ through ‘neuroqueer feminism’.

This is likely to have a range of unhelpful consequences. First, obscuring the connections between people’s experiences and their relationships and environments (by emphasising instead a supposedly ‘natural’ developmental trajectory) will invalidate some of the ways that people (including Mad in the World contributors) attribute meaning to their distress. Second, this emphasis on ‘natural development’ increases the risk that people in impoverished and marginalised communities, or with histories of trauma, will have their difficulties attributed to biology or genetics rather than toxic circumstances. Third, there is a risk of reviving prejudicial stereotypes that high rates of diagnosis among ethnic minorities, poor people and womenare reflective of a constitutional susceptibility to madness, rather than the result of greater abuse, exploitation, hardship and discrimination. In all these ways, psychiatric notions of distress are reinforced, at the expense of social, biographical and environmental explanations.

Veteran campaigners against unscientific and pejorative psychiatric labels that were once seen as ‘the heartland of psychiatry’ will be horrified at the attempt to reclaim terms such as ‘schizophrenic’ (a term forbidden by most media guidelines) under the guise of progressive neurodiversity politics.

The consequences of ‘neurodivergence as disability’

As we saw in Part 1, the neurodiversity movement aligns with the social model of disability. This model proposes that while impairment is an individual and (sometimes) medical matter, disability only arises when individual impairments encounter disabling environments. Thus, someone who finds it hard to walk because of damage to their muscles, is disabled only to the extent that transport, buildings and so on are inaccessible to people who use wheelchairs. Disability, then, is not simply located in the individual, but emerges from failures to accommodate the needs of those who are not part of the non-disabled majority.

From the start, disabled feminists such as Jenny Morris and Susan Wendell had concerns about the model. They suggested that it reproduces a masculine stereotype of strength and independence, ignores illness, and in considering only the body-environment interaction it excludes the actual, fleshy, physical body. More recently, prominent disability scholar Tom Shakespeare argued that the model has become increasingly rigidly applied over the years, and has now outlived its usefulness. Nevertheless, it remains important and influential.

As we have seen, many people who identify as neurodivergent want a formal diagnosis in order to secure adjustments (at school, at college, in work). Some of them self-identify as disabled, a category which – like neurodivergence itself – is extremely heterogenous. Disabilities can impact such embodied functions as mobility, dexterity or sensory ability. Some people have ‘invisible’ disabilities, or disabilities that fluctuate and change, while others are permanently unable to walk or physically care for themselves, and will be disabled in almost any imaginable environment. Disabilities can be transient, static, relapsing or progressive; can arise singly or in conjunction with other health-related events; and can affect both physical and mental functioning.

This heterogeneity makes it difficult to generalise. Nevertheless, it does seem that there are ways in which neurodiversity may differ from many other categories of disability. Should awkwardness in social situations or difficulty prioritising daily tasks, for example, count as ‘disability’ in the same sense as using a wheelchair, recovering from a stroke, or perhaps having extreme mood swings?

These questions arise because, as we have seen, the definition of neurodivergence relies wholly on social norms. The social model locates impairment in the body, and any consequent disability is a result of the body’s encounter with the environment. But for the great majority of instances of neurodivergence – notably, people given diagnoses of ASD or ADHD – there is no identifiable bodily impairment. Rather, diagnosis largely focuses upon self-reports, so can only be based on social norms.

In one sense this is nothing new: there have never been consistent biological correlates for these and other psychiatric conditions. But historically, they have been seen primarily as medical illnesses or disorders. As instances of neurodivergence, however, they are primarily disabilities – albeit also differences, not disorders. These shifts, from disorder to disability to difference, further accentuate the reliance upon social norms because, along the way, even the expectation that bodily impairment must be present seems to disappear.

For example, Part 3 of this blog series described competent, socially-skilled people acquiring diagnoses such as ASD, despite diagnostic criteria that specify marked functional impairment, on the basis that their ability to ‘mask’ entirely conceals their impaired functioning. This illustrates how, rather than just applying the social model of disability, neurodiversity modifies it by, effectively, making impairment optional. What is more, this is likely to be the case even when other versions of the social model are used. So the negative consequences of excluding the physical body, identified by feminist critics of the social model, seem to apply with even greater force to neurodiversity.

Another complication is the ever-present risk of displaying ‘ableism’ by, for example, implying that embodied limitations that are said to be associated with neurodivergence are a sign of inferiority to a ’neurotypical’ person. But this runs alongside the message that neurodivergence may, at the same time, mean that people are disabled and therefore need special treatment. After all, as we noted in Part 1, the ‘D’ that ends both ADHD and ASD stands for ‘disorder.’ This complication highlights a fundamental contrast between the neurodiversity movement and other social movements which Tom Shakespeare summarised very succinctly:

‘it is harder to celebrate disability than it is to celebrate Blackness, or Gay Pride, or being a woman. “Disability pride” is problematic, because disability is difficult to recuperate as a concept, as it refers either to limitation and incapacity, or else to oppression and exclusion, or else to both’

This dilemma becomes particularly apparent in relation to those people with severe and/or profound intellectual disabilities who are also described as having autism. This group is disabled by any accepted standard. Do we acknowledge this, and thus accept that in some cases, the ‘neurodivergence as individual difference’ model doesn’t fit? Or do we deny it, and as a result, run the risk of failing to meet the very real support needs of these people and their carers?

The picture is blurred still further by psychologist and neurodiversity researcher Steven Kapp’s proposal that the movement should expand to include people with chronic illnesses such as multiple sclerosis, sensory impairments such as blindness, and the effects of epilepsy or head injury. The proposal is based on the fact that they, like other diagnoses already deemed part of the movement, ‘[diverge[ from the dominant societal standards of “normal” neurocognitive functioning’.

Few would deny that these are serious difficulties, but it is far from clear that they belong in the same category as those who struggle with the vast range of daily difficulties now subsumed under the categories of neurodivergence, ASD and ADHD. It seems entirely possible that the primary benefit of including these conditions as instances of neurodivergence would not be to the individuals affected (not least because, once conceived as neurodivergence, people’s difficulties might be reframed as expressions of their intrinsic natures, and so not suitable for intervention). Instead, the main benefit would be to the neurodiversity movement itself, which would gain credibility, strength and influence by allying itself with these groups.

Rather like its perspective on diagnosis, the neurodiversity perspective on disability is confused and confusing. On the one hand, we have complaints from teachers and lecturers that large proportions of their students now require adjustments ranging from extra time for assignments, to software that automatically performs core academic skills such as sentence composition, essay structuring and so on, on the basis of neurodivergence. On the other hand, the narrative that autism associated with severe intellectual disabilities is just another way of being human is, according to some clinicians and parents, limiting support and resources for those most in need. Both outcomes are problematic.

The consequences of self-diagnosis

In the face of long waiting lists, there is a growing trend for people to ‘self-diagnose’, often after having Googled their complaints or watched a TikTok video. This is often claimed to be ‘just as valid’ as an official diagnosis, with one advocate of this practice asserting that:

‘We can be trusted to know ourselves, do our research, and self-diagnose with a full understanding of the weight of what it means to be autistic.’

To be clear, however, describing this as self-diagnosis is actually a misuse of language because:

‘”Diagnosis” is a conclusion that follows a medical examination by a qualified professional. Lay people may apply psychiatric labels to their experience before or even in the absence of any professional consultation, but those labels have no formal standing’.

As this author says, a better term would be ‘self-identification’ with a certain set of criteria – which may, of course, offer reassurance, if only initially.

Once again, there is a profound confusion between, and ambivalence about, whether neurodivergence and autism are seen as disorder/medical condition, or as identity. Clearly, using the language of ‘diagnosis’ for both purposes does not help.  There are, in fact, many non-medical terms that have emerged as ways of grouping together people who have similar experiences of the world – ‘highly sensitive person/HSP’ is one, as are astrological signs, or personality types such as extravert, ‘INTJ’ or empath. In the childhoods of the 60s, 70s and 80s, young people ‘found their tribe’ by identifying as hippies, mods, Goths, emos, or punks.

Many people have found these and similar terms helpful, whether or not they are scientifically-based. However, the social power of medicine and psychiatry means that they just do not carry the same authority as a diagnosis. It may be for this reason that the term ‘diagnosis’ is preferred by many in the neurodiversity movement, even while its conventional meanings of illness/disorder are often denied.

­­­­From a professional point of view, good practice would suggest that we respect, but do not necessarily agree with, self-diagnosis: but as illustrated in the previous blog, it is increasingly hard to resist the demand that self-diagnosis should automatically be seen as qualifying you to receive a formal diagnosis if that is what you want. 

The neurodiversity paradigm as ‘collective liberation’

We now turn to an emerging aspect of the neurodiversity movement which in some ways is directly opposed to many other uses of the concept of neurodiversity (although, as we will see, not to psychiatry). Even whilst claiming to be critical of them, this strand of the movement has a particularly cosy relationship with psychiatry’s diagnostic categories.

Below, we will situate this aspect of the movement more broadly. First, we will primarily illustrate it through the writing of UK philosophy lecturer Robert Chapman, who self-describes as ‘proudly neurodivergent and disabled’. Chapman’s 2023 book ‘Empire of Normality’ is being hailed in some quarters as ‘an instant seminal text’, and its ideas lauded by some commentators and academics, and by those service user/survivor groups that Chapman supports (broadly speaking, ones that wish to retain a role for the diagnostic model of distress.) Chapman’s influential supporters include senior US psychiatrist Dr Awais Aftab, a tenacious defender of psychiatry and a long-standing opponent of MIA’s work such as its exposure of the flawed STAR*D antidepressant trials.

A prominent theme of Chapman’s writing is that work of the kind represented by many contributors to MIA and MITUK is part of a ‘reactionary and outdated’ movement that needs to be jettisoned in favour of the ‘collective liberation’ promised by ‘a more radical politics of neurodiversity.’  According to Chapman, the loose grouping of ‘white, wealthy, able-bodied’ contemporary critics who are challenging the diagnostic paradigm represent a regressive, potentially sinister movement with alt-right and even white supremacist links. The effect – indeed, perhaps the aim – of their work is said to be to entrench oppressive norms and systems, to the disadvantage of the disabled, in order to maintain their own power and influence. Chapman’s own invention, ’neurodivergent Marxism’, is proposed instead as the truly radical way forward.

Chapman’s arguments in the book and related articles are complex and often confusing, but can be summarised as follows:

‘Anti-psychiatry’ (which for Chapman includes a great many past and present critics of psychiatry, whether or not they describe themselves this way) is allegedly based on the premise that changing the language of diagnosis will magically dissolve the problems of psychiatry. As a consequence, it fails to make any link with wider social/political contexts; it denies the reality of people’s distress; and it is driven by and reproduces extreme right-wing ideologies and the oppression of marginalised people. The main current perpetrators of these reprehensible attitudes and practices are frequently named as the UK Critical Psychiatry Network, and specifically Joanna Moncrieff; James Davies; Sami Timimi; Lucy Johnstone; Peter Kinderman; and Mad in America, ‘a popular online publication closely aligned with critical psychiatry leaders’.

This depiction is so far from the truth that frequent misrepresentations are needed to lend it even a veneer of plausibility. Chapman’s main strategy is to claim, repeatedly and falsely, that these critics are all ‘Szaszians’—i.e. blind adherents to the right-wing libertarian values and politics of US psychiatrist Thomas Szasz, whose work is described as positioning the ‘mentally ill’ as malingerers who have invented their distress, are not deserving of welfare support, and so on.¹ This core theme frequently appears in its bluntest form in social media accusations by Chapman and allies, who are honing ‘Szaszian’ into a term of abuse.

As part of this strategy, Chapman misquotes work by critics. For example, in an article published in revised form² in the journal Philosophy, Psychiatry and Psychology (for which Dr Aftab is an editor) Chapman refers to the UK Critical Psychiatry Network website as follows:

‘The Critical Psychiatry Network began in the UK in 1999….. By 2019, Middleton and Moncrieff, the then co-chairs of the network, were able to describe critical psychiatry as a global “movement” based on Szasz’s philosophy (Middleton and Moncrieff, 2019)’.

However, the Middleton and Moncrieff paper that Chapman cites actually says the opposite:

‘The Critical Psychiatry Network (CPN) started in the UK but now extends globally. It accommodates a wide range of opinions rather than claiming to speak with a single voice’

There are other misrepresentations and distortions of this kind in Chapman’s work. Further on, the same article claims:

‘Although different criticals target different groups, the marginalization of relevant groups ……is a feature of the critical theoretical position, not a bug…Szaszian assumptions ….. (are) epistemically harmful for people who deviate from abled, sexed, racialised, and gendered norms’.

And the preprint of Chapman’s article, still available online, states:

‘Perhaps some criticals would be happy to commit to reinforcing oppression of some minorities in order to potentially liberate some mentally distressed people (but) Szasz’s reactionary politics are….reproduced in contemporary critical psychiatry’

The article supplies ‘evidence’ for this allegedly pleasurable targeting of oppressed minority groups in the form of serious and extensive misrepresentation of the work of Lucy Johnstone, James Davies, Joanna Moncrieff, Sami Timimi and others.

One of the more puzzling aspects of this strand of neurodiversity is the overlap of its arguments with those who are being dismissed and derided. For instance, Chapman makes claims about ‘Szaszianism becoming mainstream in the UK through the PTMF’. Yet the PTMF (the Power Threat Meaning Framework: a conceptual alternative to psychiatric diagnosis which has received widespread recognition) neither discusses Szasz nor endorses his politics. The PTMF does, however, pre-empt many of Chapman’s own criticisms of capitalism, and is based on the entirely non-Szaszian argument that people’s very real distress must be understood and addressed within its social and political circumstances. The difference is that neither the PTMF, nor the extensive work of the ‘anti-psychiatrists’, see the answer in what one UK critic has called the ‘neurofication of everyday life’.

The influence of identity politics on the neurodiversity movement makes the determination to impose upon UK critics an identity, which they have explicitly rejected, somewhat paradoxical. But it makes sense once we realise that Chapman is actually making a moral judgement that loosely follows this conceptual form:

All who reject mental-distress-as-illness are ‘anti-psychiatry’ so must be ‘Szaszian’.  All Szaszians are bad: probably eugenicist, certainly ableist, perhaps even fascist. As such they are unworthy of respect, so genuine engagement with them and their work is unnecessary.

This moralising underpins Chapman’s recent blog for Dr Awais Aftab’s Substack account, which claims that UK critic Dr James Davies, author of the books ‘Cracked’ and ‘Sedated’, is a leading figure in a ‘war on disabled people’ – despite his having been an activist for the rights of those disabled by psychiatric interventions for over a decade. Chapman makes strenuous attempts to justify this libel, even managing to bring in a reference to Hitler (on the basis of a favourable review of one of Davies’ books in a UK newspaper which is ‘notorious for having supported Hitler in the 1930s.’ ) Davies is accused of ‘collaborat(ing) with Conservative MP Danny Kruger….(who) is on the furthest right end of the Conservative party and has even been recently described as “the dangerous saviour of British nationalism”’.

The much less dramatic truth is that Davies and colleagues have been involved with an All-Party Group of UK Members of Parliament: APPG,. By definition, APPGs include politicians from across the political spectrum, who come together to address particular issues of concern to all – in this case, the need for action on the social determinants of mental health problems, and for support for those disabled by psychiatric interventions. So, an important victory for non-partisan politics has been distorted by Chapman into a personal attack – to the benefit of no one, especially not those most in need of the proposed social interventions and disability support. And, tellingly, Dr.Aftab used his ‘moderator’ powers as blog owner to block any comments that corrected these lies.

 Perhaps more seriously, a recent review by one of us (JC) shows how Chapman’s book ‘Empire of Normality’ omits important elements of historical context; makes far-reaching assertions on the basis of little or no evidence; and presents, as though they were definitive, historical analyses that are contradicted by other, well-regarded histories. As the review asks:

‘Why do Empire of Normality’s arguments seem to require distortions of the evidence? Do Empire of Normality’s flaws suggest a fundamental weakness in the neurodiversity position? Are Chapman’s misrepresentations calculated and deliberate, or careless and accidental?’

One example of this poor scholarship will suffice. Chapman’s book attempts to blame ‘anti-psychiatry’ for the adverse social consequences (homelessness, drug use and rising rates of incarceration) that, in the USA, coincided with the closure of large asylums and hospitals from the early 1960s onwards. ‘Empire of Normality’ concludes its brief account of the closures by claiming that:

‘Szaszian ideology turned out to be useful for the ruling class rather than helping to resist the dominant system’

In fact, so-called anti-psychiatrists had little or no influence over the process of deinstitutionalisation, which – notwithstanding the shortcomings of some of the alternative ‘care’ provided – was welcomed across the political spectrum as heralding more enlightened treatment. A far more convincing account is given by historian Michael Staub, who showed how in the mid-1980s, when President Reagan’s neoliberal economic policies caused USA homelessness to surge, ‘anti-psychiatry’ was strategically blamed. Ironically, Chapman’s version of history uncritically reproduces a baseless myth concocted by President Reagan’s advisers in the mid-1980s – a myth designed to conceal the harmful impacts of neoliberal policy decisions.

For a more thorough account of Chapman’s book and its claims, we refer readers to the review. They may then wish to judge how successfully the book fulfils Chapman’s aim of showing that:

‘..some forms of (wealthy, white, able-bodied) resistance to the increased pathologisation of brain/mind may be driven partly by a need to preserve the white supremacist framing of white brains/minds as superior and pure’

Strikingly, Chapman omits any mention of survivors and former users of psychiatric services from the malign group of Szaszians. This is very strange because thousands of them worldwide, including those who host and write for Mad in the World affiliates, not only reject psychiatric notions of distress-as-illness but are allies of and contributors to ‘anti-psychiatry’ (as defined by Chapman). They are also leaders of change in their own right. Presumably, acknowledging their existence would spoil Chapman’s image of a group consisting solely of privileged professionals who depict service users as ‘gullible victims …who have been tricked into believing they are ill by the “myths” or “lies” invented by psychiatry or pharmaceutical companies’. To the contrary, we suggest that survivors of psychiatry are very capable of making up their own minds about how to understand their distress, and of avoiding anyone who views them in this patronising way.

To be clear, UK critics do not endorse the kind of identity politics that uses attributions such as ‘reactionary’ or ‘white, wealthy, able-bodied’ both to sidestep, and to substitute for, actual arguments and evidence. In any case, members of the loose group of UK critics – not all of whom are white, and none of whom are particularly wealthy (some, in fact, are from disadvantaged or working-class backgrounds) – live with disabilities including severe arthritis, Parkinson’s and an inoperable brain tumour. We mention this not to reduce the discussion to the personal level, but to highlight the cheap weaponisation of (presumed) privilege upon which Chapman’s arguments depend. This tendency reaches a peak on Chapman’s X (Twitter) account:

10.8.22 They are mostly posh liberals who don’t understand what words like ‘ableist’ mean. Some seem to think it’s a word lefties made up to smear them, or that it should only be used to describe people who are openly eugenicist, rather than it being the core of their ideology.

31.7.22 I’m pointing out that the CPN [Critical Psychiatry Network] and certain members have been platforming and legitimising far right conspiracy theorists for years, inviting them to give talks to universities, etc.. Now we’re seeing the effects of that. And far right trolls harass whoever points it out.

 27.3.23 Despite their differences I think Szaszian and fascist responses to mental health share an underlying fantasy of the world where mentally ill or disabled people no longer exist. One seeks to literally eradicate us while another seeks to eradicate all concepts that recognise us.

 In today’s neoliberal universities, personal brands and academic careers are largely determined by competition. Currently, as the psychiatric narrative falters new market opportunities are opening up, and brands with radical packaging – like ‘neurodivergent Marxism’ – may achieve considerable market penetration, even if the actual product is more of the same. But if the new brand still validates psychiatric diagnoses or illness assumptions, as Chapman’s does, its overall effect will be to sustain existing power relations. Neurodivergent Marxism is an example of commodified and recuperated rebellion, naively upholding the very mystification that neoliberalism encourages.

How important is this new strand of neurodiversity activism?

Transparent distortions and personal attacks such as those described above are typically best ignored. We have given them space in this blog only because they seem to be gaining traction: as we said, Chapman is not alone in promoting these critiques and other voices have begun echoing these misleading messages.

Unsurprisingly, this includes Dr Aftab (15.4.23 ‘@DrRJChapman brilliantly reveals… the neo-Szaszian nature of a lot of contemporary UK ‘critical’ discourse’). Similarly, UK philosophy lecturer Alastair Morgan published a paper (again in Philosophy, Psychiatry and Psychology) claiming that ‘The PTMF unfolds a broadly Szaszian critique of the concept of mental illness’. A researcher, Nunez de Prado-Gordillo, also picks up the theme and cites Lucy Johnstone, Peter Kinderman, Joanna Moncrieff and John Read in support of his statement that there has been ‘a resurgence of Szasz’s…longstanding criticisms against the medicalization of mental distress. A primary example are so-called “critical psychiatry” views which have gained increasing popularity in recent years’. And Micha Frazer-Carroll’s 2023 book ‘Mad World’ warns about the entirely fictional danger posed by professionals who ‘follow in the tradition of the right-wing anti-psychiatrist Thomas Szasz’ and dictate ‘how Mad/Mentally Ill people must understand themselves’.

 This is a curious inversion of the real situation, in which it is psychiatry that routinely imposes its understandings on people. The ‘anti-psychiatrists’ and related groups like ‘A disorder 4 everyone’ fully support people’s right to make their own choices of understanding, including medical ones. The real problem is that most people are not offered this choice.

As Robert Whitaker, founder of Mad in the World, frequently states: the psychiatric narrative has failed. And today, it is not necessary to have read Szasz to work this out. Studying subjects as varied as sociology, criminology, history, anthropology, literature, trauma studies or developmental systems biology might well lead you to the same conclusion, as might the work of Szasz’s (left wing) contemporaries Laing, Foucault and Goffman – not to mention the lived experience of receiving psychiatric interventions. In fact, questioning the notion of distress as brain disease or mental illness dates back at least to the beginning of modern psychiatry. Likewise, non-medical understandings of distress (e.g. as spirit possession, mystic visions, the consequence of trauma or a sign of misalignment with family or community) were prevalent long before Szasz began writing. And in any case, as UK critics have frequently clarified, interest in Szasz’s ideas in no way implies acceptance of his extremist politics.

Today’s UK ‘anti-psychiatrists’ have, naturally, done their very best to conceal their extreme right-wing political convictions by working in the public sector for decades and campaigning for better mental health care and a fairer, more inclusive and equal society, often in the face of considerable opposition and threats to their careers. But perhaps this is just another form of ‘masking’? We leave that for readers to decide.

Drawing all of this together, it appears that we are seeing a growing backlash just as the hegemony of the diagnostic model is crumbling. Mad in the World’s readers are very familiar with admissions from within the heart of the psychiatric establishment such as ‘there is no reason to believe that DSM 5 is safe or scientifically sound’; and that current diagnostic systems are ‘totally wrong, an absolute scientific nightmare’.This, surely, is a critical moment in the history of psychiatry.

In this moment, Judy Singer’s original vision of the neurodiversity movement – which was clear that it is‘politics not science – the name of a social justice movement, not a diagnosis’  – did have some potential to replace pathologisation with something more inclusive. However, in any moment of crisis there are those with an interest in the status quo. And so along came this contemporary version of neurodiversity, now retooled as an updated version of the failed medical paradigm – albeit one given a sheen of fake radicalism by identity politics.

By this means the individualisation of distress is being embedded ever more deeply, as social media spreads this version of the gospel of neurodiversity far beyond the clinic walls. As one commentator says, the concept ‘has been bastardised, twisted and pulled back under the psychiatric umbrella in order to harm and oppress everyone – when it was meant to protect everyone’.

Neurodiversity has been warmly welcomed by psychiatric establishment voices like Dr Aftab, by institutions such as the main UK political parties, and by big businesses, government departments and health services: all responses that clearly demonstrate the limitations of the challenge that the movement presents. We explore this issue further in our final section.

Neoliberalism, neurodiversity and psychiatric diagnosis

In this section we return to an issue we introduced in Part 2 of this blog series: the largely unacknowledged ways in which the neurodiversity movement reflects, embodies or enacts neoliberal precepts and characteristics.

The concept of neurodiversity gains credibility through the prefix ‘neuro’. At the same time, associating diversity with the brain in this way individualises and de-contextualises personal, social, material and political circumstances even more effectively than the medical model in psychiatry. What is more, the promotion and valorisation of neuro-identities, like all identity politics, deflects attention from inequitable social structures and associated practices, such as psychiatry, that sustain neoliberalism. Instead, we are encouraged to believe that distress is driven primarily by faulty brains (misunderstood as mostly-closed systems rather than massively-open ones). And dressing all of this up in the language of self-determination and consumer rights emphasises another core preoccupation of neoliberalism: individual choice. Conceived these ways, neurodiversity further divides us into competing minority groups, shattering solidarity by individualising and depoliticising shared human struggles.

The prominence within the neurodiversity movement of the two ‘super-labels’ of ASD and AHDH further entrenches these problems, particularly when they are said to describe a kind of person rather than a condition. In psychiatry, perhaps the nearest parallel is ‘personality disorder’, which also confers an enduring judgement not just on what you feel or do but upon who or what you are. Ironically, some of those most opposed to labels like ‘borderline personality disorder’ are also loudest in calling for recognition of ASD and ADHD as alternatives. The implications might be less damning – as we have seen, neurodivergent labels can be experienced as empowering and liberatory – but many of the disadvantages are the same.

In any case, a closer look at some of the characteristics that attract these labels clearly reveals their deeply embedded neoliberal assumptions. In particular, as Tony Attwood (a ‘world authority on Asperger’s’)  observes, people so diagnosed are ‘usually renowned for being direct, speaking their mind and being honest and determined and having a strong sense of social justice’.

Illustrating this, one article on an influential website describes a core feature of ‘autism’ with the quote:

‘I do have a strong sense of justice and fairness. If I find a cause that resonates with me, I will pursue a solution with a level of singular focus and passion beyond what could be expected from most neurotypical people and will fight for what is right with every ounce of who I am….. I also have a strong sense of what’s right and wrong, and this sense tends to guide me throughout my life.’

The same revealing article, which lists the “Top 10 Things” about being ASD (all of them said to be recognisable by ‘anyone on the spectrum’) also quotes someone expressing the view that:

‘I don’t pay much attention to many of the things that seem so important to neurotypical people. I don’t care if you’re fat, skinny, rich, or poor. I don’t care what kind of car you drive or the house you live in. If I like you, I like you because you’re kind and you make me feel happy. I won’t judge you by the outfit you wear or the job you have. I don’t care if you’re having a bad hair day, or if I’m your only friend. In fact, chances are I won’t even notice these things. Social expectations are unimportant to me, so I won’t judge you, just as I hope you won’t judge me.’

We sincerely admire this person’s independence of mind. The writer has found a way to jettison all the core neoliberal messages and values to do with appearance, possessions, competitiveness, achievement and status comparisons. We just wish that these attitudes were celebrated as the norm, rather than having to be filed under ‘neurodivergent’, while the ‘neurotypical’ world carries on unchallenged. Instead, these experiences require de-contextualising and individualising, so that our newly re-defined suffering can be sold back to us along with commodified solutions – psychiatric drugs, private clinics, self-help books and all the rest of it. And when these fail – as seems inevitable, since they are not addressing root causes – there will always be another such solution round the corner.

In the topsy-turvy, ruthlessly competitive, individualised and individualising world of neoliberalism, values such as kindness, co-operation and fairness are sufficiently at odds with dominant social norms that they can be reframed as symptoms of a ‘disorder’. This is profoundly depressing but not surprising. If there was one term to summarise the antithesis of neoliberalism, it is social justice: no wonder it has to be pathologized. Meanwhile, relentless self-surveillance is on the way to achieving diagnostic, disability or neurodivergent status for all of us – and many are already queuing to embrace it voluntarily.

Conclusion

In closing, we would like to repeat that many people have welcomed the neurodiversity paradigm in good faith. We understand their appreciation of its potential, at least as first conceived, for de-pathologisation and the acceptance of difference. These things are sorely needed in our conflict-ridden world.

We also agree with many of the changes the paradigm advocates, such as education and work environments that accommodate different learning styles and preferences. We just don’t think these changes need to be justified by claims of neurodivergence, with all the ensuing problems we’ve discussed. What is good for those identified as neurodivergent will very often be good for everyone.

To understand how the positive potentials of neurodiversity have turned sour, we have suggested in these blogs that the development and use of the concept of neurodiversity have been profoundly shaped by the forces of neoliberalism. This has ultimately sabotaged the movement’s benign intentions, just as its founder Judy Singer repeatedly warned. This is why we do not want to see this concept uncritically extended to non-Western cultures, where it could replicate and reinforce the damage already done by exporting the diagnostic model. In the words of James Davies, the neurodiversity movement ‘hasn’t led to spontaneous collective organising against systemic causes, as some promised, but to a gradual devolution into ‘me-ism’, siloed identity politics, despondency and pessimism. We need more action not labels.’

Additionally, and of particular relevance to MIA/MITUK readers, a minority strand within the neurodiversity movement has cynically weaponised the concept in order to discredit the significant aims and achievements of contemporary UK critics of psychiatry. While many who describe themselves as neurodivergent have a genuine wish to de-pathologise, this vocal minority – eagerly supported by allies in psychiatry – has mounted a sustained campaign to smear and distort the work of many of the individuals, both professionals and former/current users of services, who are at the heart of Mad in the World’s efforts.

There is a deep irony here, since the most prominent promoters of the neurodiversity movement see themselves as left-leaning challengers of the status quo, championing the causes of marginalised groups. To the contrary, we have shown that they risk replacing existing forms of oppression with new ‘neuro’ versions, which decontextualise and individualise people’s struggles just as effectively as psychiatry always has done. Despite claims to the contrary, ‘neurotypes’ are just another way of saying ‘diagnostic categories’; ‘differently wired brains’ is the new ‘chemical imbalance’. The last thing we need is a new term which, just like ‘mental illness’, obscures and mystifies the links between abuse, exploitation and oppression and their all-too real human consequences.

Important test questions are: Who is making money from this? Whose power is being reinforced? And what are we not addressing while this is distracting us? Neurodiversity, a term designed to promote acceptance, has become powerfully divisive. The belief that the world is divided into two fundamentally different types of person, with one doomed to misunderstand and oppress the other, is as destructive as any other binary. ‘Collective liberation’ will not be achieved through re-introducing the principles underpinning diagnostic practice.

We do not expect everyone to agree with this analysis, but we do believe that it is of central and urgent importance for Mad in the World to be aware that the neurodiversity paradigm may be a Trojan horse.

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