Neurodiversity: A Dangerous Extension of a Discredited Philosophy By Mark Ruffalo, LCSW on 11/27/18 - 3:15 PM

What started as a well-intentioned movement within the autism community to expand the civil rights of autistic persons has quickly become a dangerous and misguided exercise in mental illness denial. The concept of “neurodiversity” is now readily applied not only to autism but to bipolar disorder, schizophrenia, and the range of psychiatric disorders—even disorders long-established as serious forms of psychopathology. The concept has quickly become a “buzzword” used by patients, their families, social commentators, and mental health professionals alike.

In a nutshell, the concept implies that mental disorders such as those listed above should be considered normal variations of human cognitive experience—not disorders amenable to professional intervention and treatment. Thus, the individual suffering from schizophrenia who may be experiencing debilitating symptoms such as paranoid ideation and auditory hallucinations is told that he is not ill or diseased in any real sense but merely a victim of society’s inability to tolerate his odd behavior. It is not hard to see how such a concept can lead to treatment avoidance, unnecessary suffering, and the neglect of the most vulnerable members of our society.

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Upon closer scrutiny, it becomes apparent that “neurodiversity” is just another failed attempt at depathologizing mental illness, a flawed and dangerous extension of the “antipsychiatry” movement, based on the logical fallacy that mental disorder is not genuine disease. In a recent article in Psychology Today (The Reality of Mental Illness) Psychiatrist Ronald Pies and I set out to debunk many of the common claims of antipsychiatry, including the myth that mental illness is merely a metaphor and that psychiatry functions as a state-sanctioned agent of social control, intent on locking people up and depriving them of freedom.

Neurodiversity’s appeal is that it is well-intentioned. No one wishes to deny basic human and civil rights to autistic or other mentally ill persons. But as much as neurodiversity’s proponents seek to wish mental illness away, the problems remain. The patient with schizophrenia continues to hear voices. The patient with bipolar disorder continues to experience crippling mood swings. And patients with major depression frequently teeter on the brink of suicide. While redefining mental illness as something other than pathology may seem like an admirable attempt at improving the social condition of the mentally ill, its effect is the exact opposite. Paradoxically, the concept of neurodiversity serves only to perpetuate the myth that mental illness is non-disease and worsen the suffering of those so afflicted.

While it is understandable—albeit misguided—for patients and their families to endorse the view that mentally ill persons are just “different” and not sick (after all, human nature is to avoid disease, not seek it), it is grossly negligent for mental health professionals—those entrusted to care for the psychiatrically ill and the experts on human behavior—to do the same.

I contend that it is possible to simultaneously seek improved social conditions for the mentally ill, i.e. greater societal inclusion, tolerance, and human dignity, and accept the fact that the mentally ill are ill in the literal sense. Improving the lot of the mentally ill does not require the negation of the very real conditions from which they suffer. In fact, such denial of the reality of mental illness only makes matters a whole lot worse.

A multitude of factors have contributed to the current mental health crisis facing the U.S.,
but chief among them is the perception that the mentally ill are less deserving of care because of the nature of their illnesses themselves. The stigma surrounding mental illness is very much alive and well, and despite neurodiversity’s stated intentions, it is exacerbated by claims that the mentally ill are not really sick, their illnesses a social invention, the result of an intolerant society bent on casting them as mentally diseased.

What started as a grassroots effort by autistic persons and their families to improve the public perception of their condition, has morphed into a broader movement that represents our century’s version of Szasz’s “Myth of Mental Illness.” 600,000 inpatient beds have turned into 30,000. Admission to a psychiatric unit or hospital has become nearly impossible. Outpatient psychotherapy is offered only to those who can afford it. Those most in need are the most likely to fall through the cracks of the system and end up homeless, in prison, or dead by suicide.

While the proponents of the neurodiversity paradigm have the best interests of the mentally ill at heart—namely their dignity and worth as human beings, the movement misses the broader implications of their philosophy. Improving the social condition of the mentally ill requires, first and foremost, an acceptance of the reality of mental illness.

File under: Law & Ethics, The Art of Psychotherapy