April is Autism Awareness Month. I’m not autistic, but I owe a great deal to autistic activism and research, particularly sociologist Judy Singer’s coinage in 1998 of the term “neurodiverse”. Neurodiversity recategorized me along with millions of others with pathologized mental functioning; we became different rather than less.
I have bipolar disorder, post-traumatic stress disorder (PTSD) and dissociation. Before I came across neurodiversity, I harbored a great deal of shame and self-loathing about my mental health. I’m not alone: according to a 2015 study, 80% of those suffering from a major depressive disorder have feelings of self-blame. Around half reported feeling disgusted by themselves.
These self-flagellating tendencies aren’t confined to depression: the vast majority of self-harm and suicide are linked to mental health issues including schizophrenia, psychosis, PTSD, generalized anxiety and borderline personality disorder. It’s a vicious cycle. There’s a lot of evidence attributing self-blame and disgust to the cause and worsening of depression, anxiety and PTSD, for instance. The mistreatment of those with mental health issues often originates from the idea – one we internalize – that we are less-than.
More than half of Americans believe that depression is caused at least in part by personal weakness. It’s unsurprising, then, that 90% of people with mental health issues experience stigma; two-thirds say this discrimination is as bad as the mental condition itself. Negative perceptions of people with mental health issues being dangerous or violent also persist, despite the fact that we’re three times more likely to be the victims of crime than the rest of the population.
Introducing neurodiversity as a framing doesn’t fix this entirely, but it helps. For me, it meant I had more confidence that I wasn’t “making up” my condition. It also meant that I could ally myself with others, could share the creativity, vibrancy and abstract ways of thinking facilitated by mania, depression, psychosis and dissociation. I had the knowledge, backed up by decades of research, that these were not just glitches in my psyche, but mental states that could open up different ways of experiencing reality.
Neurodiversity is intimately linked to an idea known as the social model of disability, first developed by British activist-scholars with physical disabilities in the 1970s. The social model distinguishes between impairment and disability. Impairment is a physical or mental biological characteristic that makes it challenging to interact with the world as able-bodied neurotypical people do. Disability, by contrast, is socially-generated. For example, if somebody needs to use a wheelchair (as I often do), the material and social fabric of society disable us. A journey on the London Underground requires crossing broken pavements with cambers that slope towards traffic, unnavigable steps to platforms and yawning gaps to train carriages. If the pavements were smooth, lifts installed and ramps built into trains then, the impairment would remain but the disability would evaporate.
This applies to mental health issues, too. To take one example, people with cyclical depression and anxiety disorders often find it hard to navigate the conventional work environment. Insecure contracts, nine-to-fives and pervasive status competition can lead to burnout and breakdown. The lack of meaningful mental health support in offices, persistent stigma (and the resulting tendency to hide conditions from employers) as well as a lack of substantial sick pay means that the neurodivergent are disabled in the same way wheelchair users are by shoddy pavements and platforms gaps. Nor is it just the workplace that disables us: insecure housing and health inequality both generate and exacerbate mental health issues on a mass scale To cast the net wider, inequality, poverty and unemployment also play significant roles in both causing mental health crises and trapping people in cycles of ill-health. This particularly affects young people: the number of children in England admitted to A&E for psychiatric conditions more than tripled between 2010 and 2019. It’s also compounded by other forms of discrimination: in the US, 23% of Native American and Indigenous people have diagnosed mental health conditions; 36% of the US LGBTQ+ community have an anxiety disorder.
As the autistic scholar Patrick Dwyer put it, the social model of disability “perhaps exists more as a political tool than a scholarly attempt to understand reality.” For me, it’s both. We have to reshape society so that fewer people are driven into illness and, for those already ill, make it easier to get well. Rather than force those of us with neurodiversities to live in an unforgiving neurotypical society, it is society that must change to support everyone in it to flourish. We neurodiverse have the capacity to live extraordinary lives, but the world around us is often disabling. Instead of insisting on conformity, society needs to get the fuck out of the way and let us thrive in our own way.
Even by conventional standards of productivity, my mental health shouldn’t necessarily disable me: in my upswings I know I can be productive and creative enough to compensate for depressive spells. The problem is that most workplaces don’t allow for the flexibility or trust for me to feel safe being myself. Instead, I along with many others are driven into cycles of unhealthy behavior and we’re forced to internalize the capitalist logic of overwork, rigidity, hierarchy, competition and status anxiety. This not only makes it impossible for us to fulfill our potential – it endangers people’s lives.
Work patterns developed by and for neurotypical people have cost me a lot. Thankfully I’ve learned the benefits of stating my needs. My neurodiversity is much less of a hindrance than it used to be. I can balance my health against work, for one, but I’m also starting to find a better fit for different kinds of work depending on contemporary mental states. The people I work with have made that possible.
Neurodiversity and the social model of disability don’t completely free us from the constraints of impairment and disability. While being open about my needs is powerful, what we need is cultural and structural change. The responsibility to change can’t be put on the shoulders of the neurodiverse, overburdened as we already are. It’s able-bodied and able-minded people who must do the heavy lifting.