“No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time”
– Winston Churchill, 11 November 1947
The term ‘neurodiversity‘ has been used in recent years to describe the natural variations in human neurological functioning, such as autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), dyslexia, bipolar disorder, schizophrenia, and depression, among others.
This diversity is still often described in medical terms as pathologies or disorders, and the goal is to ‘manage’ conditions or ‘correct’ behaviours. More recently, however, some of these conditions have been more widely recognised as examples of human variability, leading to an approach that focuses on optimising the support that different people need, rather than trying to “fix” them.
As an example of this shift, consider ‘stimming‘, which is common to almost everyone, but often more frequent and intense in people experiencing ASD or ADHD. Stimming is described in the DSM as “stereotyped or repetitive motor mannerisms”, such as humming, clapping, repeating noises or words, and a wide variety of other behaviours, ranging from the unnoticeable to the actively harmful.
Traditionally, the goal was to ‘control’ or eliminate the behaviour, which can negatively impact mental health and repressing it is a common part of ‘masking’ behaviour in order to appear ‘normal’. More recently, there has been recognition that stimming is part of self-regulation and is mostly subconscious, so the focus has shifted to helping people manage their sensory and emotional environment, or trying to redirect harmful stims (such as scratching or tearing the skin) to something more healthy.
We have a long way to go, in terms of learning what works and deciding how best to support people, but we’re making progress and are starting to ask better questions. As a bit of a pedant, however, one question which occurs to me is whether the concept of neurodiversity requires a corresponding concept of neurotypicality. And, if so, what does that mean?
Whether you consider neurodivergence as inherent to a person’s genetic makeup (i.e. ‘nature’), or influenced by experience or environment (i.e. ‘nurture’), it seems clear that all of these conditions fall within the range of human variability.
To illustrate, let’s consider a thought experiment using Alice and Bob, well-known among cryptographers for their frequent (though often fruitless) attempts to have a private conversation. Using current diagnostic criteria, let’s say that Alice is ‘neurodivergent’ and Bob is ‘neurotypical’. Both stim regularly, but Alice’s stim involves traditional ‘fidget’ behaviour that she has learned to mask, while Bob’s stims are more noticeable.
Alice’s neurodiversity may well be overlooked, leading to struggles which may affect academic and social development, and even health outcomes, due to stress and behaviours resulting from her masking. Bob, on the other hand, is more likely to be ‘noticed’, and more likely to be sent for some form of assessment. And, while he does not fit the diagnostic criteria for neurodiversity, he is still pressured to mask his stims, leading to stress which will likely have negative effects.
In this scenario, no one is well-served.
Did you catch the twist, though? If you define ‘neurodivergent’ as ‘autistic’ and ‘neurotypical’ as ‘non-autistic’, the example works to a limited degree. But our definition of neurodiversity includes not only ASD, but also ADHD, dyslexia, bipolar disorder, and other conditions. These are so different, and some of the criteria are so hard to measure, that it is practically impossible to describe them as part of a single spectrum of human variability.
The answer to this conundrum is that we shouldn’t even try. Instead, we need to recognise that there is not one spectrum of human variability, but as many as we find useful. The true value of the neurodiversity paradigm lies in establishing a framework for understanding human variability.
Reducing stigma
From the scientific perspective, the paradigm can help reduce the stigma associated with using terms like ‘disability’ or ‘illness’, and allow researchers to simply consider the variability of whatever characteristics are relevant to the question at hand. It is vitally important to recognise that there are nuances to any framework, however. An uncritical internalisation of the neurodiversity paradigm might have led, for example, to people discounting evidence of lead poisoning, and assuming that those symptoms which affected brain development were simply part of the variability within a given community.
The social value of the concept of neurodiversity lies in reducing stigma associated with the ‘medical model’, and in helping to break down societal barriers and improving access to support for people who need it.
Going back to Alice and Bob, the neurodiversity model would involve less stigma and social pressure, so Alice would feel less need to mask, and might ask questions which would lead to obtaining better understanding and support, and thus to better outcomes. Bob, on the other hand, would continue to stim, and have it be accepted as simply something that people do, while knowing that he had access to support if he needed it. Vastly better than our current situation, but not optimal.
In a perfect world, there would be no stigma, and education about the variability of humans would be an integral part of the curriculum. We could then have some form of screening to identify those with challenges, so supports could be tailored to each student without judgment, with the goal of allowing them to maximise their potential and set their own goals.
Rather than attaching social labels to each facet of neurodiversity, we could be identifying whether a given support was warranted and/or desired, and identify those experiencing challenges at a point where intervention had the best possible chance of success.
As an example, while ASD is not ‘treatable’ with medication (though they may sometimes be used as part of a broader management strategy), medication is often a critical component for managing conditions such as bipolar disorder and schizophrenia. It all depends.
To sum up, the term neurodiversity implies the concept of neurotypicality, but I would argue that the term has no practical value. Instead, the neurodiversity model is currently helpful for reducing the stigma associated with the medical model, which looks at things in terms of ‘illness’ or ‘disability’, and for supporting advocacy for societal change, where we recognise that people who are neurodivergent are not ‘sick’ or ‘disabled’, but simply different from the ‘norm’… whatever THAT is.
So, ‘neurodiversity’ is a bad way of describing these conditions… except for all of the other ways that have been tried from time to time. At least so far.
