Neurodiversity and Mental Health
People’s brains vary. That’s probably pretty obvious, despite the egalitarian temptation to think of everyone as being born not just equal, but much the same. It’s not so obvious how brains vary, or what we should do about it; and it’s not obvious how much of the diversity of human brains is in-born, and how much comes from experience and other environmental factors. The neurodiversity paradigm suggests that it’s not altogether a bad thing that human brains vary quite a lot. Perhaps this diversity can make us stronger as a species, as communities, as individuals. This perspective is in opposition to the medical model of brain variations and disability, which takes for granted that ‘normal’ brains are both real and desirable, so that any deviations from that norm represent disorders, mistakes or diseases.
Also in opposition to the medical model is the social model of disability, which holds that disability is situational: for example, deafness is profoundly disabling in a society where the deaf are isolated, cannot communicate effectively with their peers and where provision of public services makes no allowance for their existence. In spaces where no such obstacles apply, many — perhaps most — of the disabling features of deafness can be lifted. Similar arguments can be made for blindness, wheelchair use and many variations of the human brain.
Conditions like autism, dyslexia and ADHD can of course be highly disabling in certain circumstances. Most obviously, these things have made life extremely difficult for many children in education, with schools often unable or unwilling to accommodate such different cognitive styles effectively. Schools (and workplaces) tend to be built on expectations of conformity, and assume things like an ability to sit still in noisy environments while following verbal instructions. Often non-conformity is greeted with punishment, rather than accommodations. Teachers (and bosses) are understandably anxious that too much deviation from the norms they try to enforce will lead to a general breakdown of order.
As with most disabilities, some forms of autism are likely to be disabling however much society accommodates them. Some things just are much, much harder for people on the autistic spectrum, especially for those a long way along it. Seeing autism as an aspect of the natural diversity of human brains does not mean denying this, but it does invite us to consider whether there may be good evolutionary reasons why so many people are autistic to some degree, and whether the continuing existence of autism might be valuable for modern humans, too.
The correlation between autistic traits and ability in maths, sciences and engineering — both within families and within individuals — is worth taking seriously. So is the apparent link between dyslexia and entrepreneurship. So is the suggestion that ADHD can be connected with creativity.
We should be on guard against taking this too far. For example, autistic traits are not definitely not required for success in maths or the fields that depend on it, and an expectation that anyone heading into such fields will fit ‘geek’ stereotypes can be quite damaging, especially for those belonging to other marginalised groups (as can the assumption that geeky people belong in the fields that are best-known for geekiness). But there is a reason for the joke ‘How do you spot an extrovert mathematician? They look at your shoes when they’re talking to you.’ The clustering of autistic traits in families rich in engineers, physicists and mathematicians has to be more than coincidence.
So brains vary, and this can lead to variations in cognitive style which can be disabling, but also seem to play a role in some extraordinary abilities. Seeing such variations through the lens of neurodiversity helps us see both sides of this. We are left with the question of what it is about brains that leads to these differences, and the even more interesting questions of what those differences are, exactly; and how we can make life better for everyone once we’ve acknowledged that they exist and are probably not going away.
There are several dimensions along with people’s brains seem to differ. Extremes of variation in any of these may be disabling. These might include things like the size of working memory, overall speed of processing, tendency to think visually, and tendency to focus intensely.
It’s worth expanding on that last one, because there’s a case for thinking that it’s at the heart of autism, and ‘tendency to focus intensely’ doesn’t fully capture it. It would be more accurate to call it a tendency to throw all your cognitive energy in one direction at a time. Consequences include ‘context-blindness’, which really means it’s hard to see the context that other people see if your own context is all about one or two things that are taking up your attention, and that has all sorts of social consequences; a related tendency to miss links that seem obvious to most neurotypical people, while noticing links that many miss; difficulty filtering, because there’s not enough processing power left over to keep irrelevant stimuli from getting through; overwhelming sensory experiences, because so much brain-power is assigned to stimuli that penetrate; and problems shifting focus and expectations — autistic inertia — because once you’ve invested so much attention into a thing, it takes a lot of work to put it all somewhere else.
This tendency is referred to as monotropism, and it ties together the known features of autism better than any other theory I know. It also fits particularly well within the neurodiversity paradigm — some people are unusually monotropic, including those who attract the label ‘autistic’ as well as a great many of those whose jobs or hobbies require them to be hyper-focused. On the other hand, the minority of the population that’s capable of multitasking really effectively is presumably less monotropic (more polytropic) than the average.
Mental Health vs. Neurodivergence
It is not obvious how much should be included within the neurodiversity framework. The main thrust has been to provide a way of looking at inborn differences between brains, and that is probably where this paradigm is most useful, but many differences between brains are acquired over the course of our lifetimes, and there is no inherent reason why these should not be seen as subsets of neurodiversity, especially since it is not always clear what causes these differences. In many cases people might be born with a tendency or a potential to acquire certain characteristics, but whether they manifest will depend on their environment in some way. Schizophrenic symptoms, for instance, seem to be quite strongly heritable, but sometimes only manifest after they are triggered by trauma.
So it’s not possible to cleanly separate neurodiversity and mental health, but it would still be a mistake to view conditions like autism, ADHD and dyslexia as mental illnesses. Thankfully this is not a common mistake any more, but there is still far too much talk about an epidemic of, or cures for, autism, where the idea that autism is a disease is implied. It is not impossible that something resembling a ‘cure’ might be found for some of these variations — but it would mean fundamentally changing who a person is. Other things that might be ‘curable’ in this sense include a lousy sense of humour, impatience with repetitive office work or a dislike of green vegetables. There are many things it could be desirable to change about ourselves or other people, given the right technology, but perhaps it might be safer to draw a line somewhere.
Many people do, of course, want to change their brains, whether temporarily or long-term — the popularity of psychoactive drugs of all sorts, not just psychiatric ones, attests to that. The whole War on (some) Drugs has been based on preventing people from taking chances with their own neurology, while people who are judged ‘mentally incompetent’ by the state lose the freedom not to take drugs, as well as losing their agency in many other ways. Children and many neurodivergent adults, as well as those committed to mental hospitals, have little control over the way they are treated, and are often assumed to be incapable of making sensible decisions about their own lives. In many cases there are good reasons for this, but the powerlessness that follows has profound impacts on a person, and is compounded by treatments like ABA which are largely designed to get autistic people to act like everyone else.
A case could be made that people in general should be allowed maximum autonomy over their own brains and bodies by default, but as things stand, with the exception of a few popular drugs like caffeine, alcohol and tobacco, the drugs that people are allowed (or forced) to take are intended to benefit their mental health. Whether or not anxiety, depression and detachment from reality are viewed as aspects of the rich diversity of human brains, they are very often undesirable both for the people experiencing them and those around them. Many people, with widely varying neurologies, self-medicate in an attempt to help them deal with these experiences. In common with brain-medication in general, such chemical interventions rarely address the root cause of any problem, and at best can be used to help break out of destructive cycles — which can, of course, be hugely valuable when it works.
The Mental Health of the Neurodivergent
People who are autistic enough to be identified as such are statistically far likelier than the rest of the population to suffer from anxiety and depression, another reason why it’s important to think about neurodiversity and mental health together, even though they are theoretically separate issues. It might be best to think about anxiety and depression as symptoms rather than diseases, at least in this context; they are readily explained by features of autism and society. Anxiety could stem from a tendency to be flummoxed by change, difficulty in reading people and knowing what to expect from them, sensitivity to unpleasant stimuli and so on. Growing up with these root causes unrecognised and unaddressed is likely to lead to autistic people’s physiologies being primed for near-constant anxiety. Likewise, depression is hardly surprising when so many people on the autistic spectrum have such difficulty fitting in socially, and finding jobs they can thrive in. Indeed, depression is generally much more common among disabled people who are socially isolated or excluded from productive employment.
Whether or not we apply a medical model to any part of this, these are things that neurodivergent individuals often desperately need support with, and — especially for those who are identified as autistic late in life — such support is often hard to come by. Even when autistic people end up getting assessed as such as a result of presenting with symptoms of depression or anxiety, mental health professionals are often ill-equipped to deal with neurodivergence. This can result in treatment options which are inappropriate thanks to variant neurology (which can result in people responding quite differently to medication, as well as to talking cures), people assuming that all of someone’s problems stem directly from their neurology, or even treatment being denied altogether because those responsible simply don’t know how to deal with neurodiversity. In other cases, support is simply inaccessible to people who can’t use phones or manage paperwork, have difficulty articulating their problems face to face, or have trouble pushing hard enough for it.
Well-Being for Everyone
Whenever we look at the experiences of any group disadvantaged by the way our society is currently set up, it’s worth taking a step back to think about the wider context. In many cases, steps taken to make life better for the most disadvantaged end up improving life for all but the most privileged. The heightened sensitivity of people on the autistic spectrum can act like a canary in the coalmine, bringing out problems that affect everyone but are rarely discussed.
Most people are unhappy with their jobs, and workplace stress is the biggest cause of work days lost to ill health. There are many reasons for this, and some of them are directly linked to the reasons so many autistic people struggle to find or hold onto jobs. Noisy environments, interruptions, long work hours and lack of autonomy are stressful for everyone, but often downright intolerable for autistic people. Expectations of conformity hit neurodivergent people especially hard, but they can be stifling or even ruinous for people from other cultures, too, not to mention anyone who doesn’t fit neatly into the gender roles assigned them by society. In a society that’s largely moved on from church-based communities and a central role for extended families, many of us lack the kind of social support networks that we need — not just those of us who struggle most with maintaining such networks. Cutting away at the safety net of social security harms everyone who’s unemployed, in insecure work or unable to work, or whose lives are affected by those are. Moving to a less bureaucratic, stigmatising and conditional system like Basic Income should benefit almost everyone, but could be an especially large boon for the neurodivergent, the disabled and the mentally ill. And everyone would benefit if all who require it had ready access to mental health support.
Perhaps above all, better recognition and respect for the things that make us different, as well as the things that unite us all, can bring us towards a more understanding society, better at helping everyone to realise their potential and less likely to leave people isolated and unsupported. Nobody is really normal, because everybody’s an outlier one way or another — even those who happen to be near the centre of every normal distribution are outliers by virtue of that fact. In many ways the internet, and the social sciences, have helped us start collectively coming to terms with how much we vary and what it means, but we have a great deal of work to do to build a society that makes the most of this understanding.
Illustrations are by Sonya Hallett, who also offered very useful feedback on an earlier draft.