When Does a Difference Become a Disorder?

A common form of hate minority communities face is people pathologizing their differences—telling them that they have a disorder, that they’re mentally ill, that they need treatment, etc. Queer deal with this a lot; people tell them that their sexuality or gender identity is an illness that needs to be “cured.” Far from good-faith attempts to advocate for the health of neurodivergent people, these remarks are typically malicious in nature. The goal is to disparage queer people by associating them with something even worse: neurodivergent people.

When psychiatric diagnoses are slung as insults, this raises the question of what that says about people who actually have diagnosable mental disorders. Even people within neurodiversity communities sometimes dislike disorder labels when used outside of a medical context because of the terrible stigma of having a mental disorder. Generations of hate against neurodivergent people means that even medically accurate terminology comes with a lot of baggage and loaded meaning. Disorder labels can perpetuate stigma against people who are different and can be used to exclude people who aren’t able to pursue an official diagnosis from neurodiversity communities. So what differentiates a disorder from any other kind of difference? What purpose do diagnoses serve in our culture other than to perpetuate prejudice and gatekeeping?

Of the queerphobic people who acknowledge that being queer is more than just a lifestyle choice, many try to argue that being queer is a mental disorder. And, in fact, homosexuality was officially classified as such in the US by the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1973. Most queer people have to deal with these sort of attacks, but asexual people are a special case. A lot of well-meaning people who consider themselves to be LGBT allies insist that asexuality is a mental disorder. In this case, however, it’s typically out of genuine concern rather than malice. There are a few reasons why people think this. First, most people don’t know that asexuals exist. Even if they’ve wrapped their head around the idea that people can be non-straight, they might not understand that it’s possible for someone to not feel sexual attraction. Second, a drop in libido can be indicative of an underlying medical condition in some cases—a fact these people use to support their convictions. Of course, plenty of asexual people do have a libido, and many of those who don’t never had one to begin with, but obviously these people don’t know that.

Rather than defend acephobic people, the point of bringing this up is to demonstrate that pathologizing others’ differences doesn’t just happen when people are looking for a cheap insult. Given the way mental health is stigmatized in the US, it isn’t hard to understand why using disorders as insults is as common as it is. It is interesting, though, that even people with good intentions love to give armchair diagnoses. In this case, the purpose of the “diagnosis” is to encourage the person to seek help. But help for what? Most asexual people will tell you that they are perfectly content being asexual, something the acephobe in this scenario rarely has a sensible answer for. Why diagnose someone with a mental disorder if there’s nothing that needs fixing? This reveals something fundamental about how mental disorders are viewed in American culture. People don’t think of the disorder as a label for an underlying issue; they think of the disorder as an issue in and of itself. People aren’t diagnosed with disorders because they need help; people need help because they have a disorder.

The attitude that disorders are inherently bad has given rise to discussion about the language surrounding disorders and disability. Some people propose we replace the term “disabled” with “differently abled” to remove the negative connotation and emphasize that a disability is just a difference. Others have popularized the concept of “person-first” language which favors terms like “person with autism” or “person who is blind” over “autistic person” or “blind person.” The idea here is that people should not be defined by their diagnoses, but rather be considered people above all else. Person-first language actually receives a lot of criticism from neurodiversity communities, the autism community in particular. To autistic people, their autism is a fundamental part of who they are, and person-first language erases that by making it something they have rather than something they are. Additionally, the motivation behind person-first language—the idea that people should not be defined by their disorder—implies that it is something wrong with having a disorder, an attitude many autistic people consider ableist.

Discussions like these are important because language is an incredibly impactful tool for fighting ableism. The problems with these discussions is that disabled people are often left out. Autistic people are regularly talked over and excluded from discussions about autism, which has bred resentment within the community. Many autistic people dislike the organization Autism Speaks because, among other reasons, they claim to speak for autistic people despite having few if any autistic people in leadership positions. Part of the reason why some disabled people oppose these attempts at language reform is that they tend to happen without their input. These are discussions primarily led by parents, families, educators, and healthcare providers, and they’re often viewed by disabled people as a cheap grab for allyship points rather than something that they actually asked for.

In many cases, diagnoses are used to exclude others. Some neurodivergent people feel that self-diagnosed individuals should not be welcome in their communities. They argue that self-diagnosed individuals don’t really have the condition they claim to—otherwise they would have been officially diagnosed—and that this is harmful to the community as a whole because it invalidates the hardship and oppression that “real” neurodivergent people face. A similar issue exists in the transgender community, where some trans people—often referred to as transmedicalists—exclude trans people who don’t have an official diagnosis of gender dysphoria and don’t medically transition to an extent deemed acceptable to the transmedicalist. They argue that these so-called “transtrenders” harm the community by making people take the “real” trans people less seriously.

This phenomenon of excluding people without an official diagnosis is harmful because not everyone has the time, money, or opportunity to pursue one. It’s a long, expensive process that’s out of reach for some people, and just not necessary for others. If a person doesn’t need access to resources which are gated behind an official diagnosis, there’s no reasons to pursue one other than personal validation. Just because someone doesn’t have an official diagnosis doesn’t mean they don’t need a supportive community of people like them, and even if they conclude that they aren’t autistic or transgender, finding and engaging with these communities is still a critical step in reaching that conclusion.

While the neurodiversity community is by and large accepting of people without an official diagnoses, disorder language and official diagnoses are still important to the community. Often, neurodivergent people who weren’t diagnosed in childhood have to discover on their own what makes them different, and finding a disorder label that resonates with them helps connect them to supportive communities of people like them where they can learn more. For many neurodivergent people, receiving an official diagnosis, especially later in life, is an incredibly validating experience. It allows them to prove to themselves that they’re not broken—just different. Now, whether this a valid argument for official diagnoses or indicative of a larger problem that makes people with differences feel like they need someone else to tell them that they’re not broken is hard to pin down. When our society teaches people that they are cisgender, heterosexual, neurotypical, etc. until proven otherwise, people with differences go through all sorts of mental gymnastics in the process of trying to accept themselves, and this typically involves seeking external validation to confirm their suspicions. Any trans person who has googled “Am I transgender?” can relate to this.

Despite how important official diagnoses are to many neurodivergent people, the neurodiversity movement prefers to think of mental disorders as differences, not medical conditions. This isn’t so much a rejection of the concept of a diagnosis as it is a method of distancing neurodivergent people from the harmful stereotypes and prejudices surrounding mental disorders. Our society treats disorders as something inherently bad that needs fixing, and it doesn’t help that organizations like Autism Speaks push the harmful rhetoric that mental disorders are a disease and a plague upon society. Many neurodivergent people, while they may consider themselves to be disabled because of their differences, don’t consider there to be anything wrong with them. A lot of the prejudice neurodivergent people face is this cultural attitude that disorders and disabilities are inherently bad, but there are other ways of thinking about disability that don’t push this harmful attitude.

The social model of disability is a popular concept in neurodiversity communities and disability communities as a whole. The social model of disability teaches that people aren’t disabled because there’s something wrong with them, but because society isn’t accommodating of their differences. Blind people are disabled because the world was built for sighted people. People who use wheelchairs are disabled because the world was built for people who don’t use them. This goes for neurodivergent people too. For many autistic people, the strength of their support network is what determines how disabling their condition is.

We still haven’t addressed the core question of what differentiates a difference from a disorder and what purpose diagnoses serve. In a medical context, diagnoses help ensure that support and accommodation is available to those who need it and that these resources aren’t abused by those who don’t. However, diagnoses and disorder labels also serve a much broader cultural purpose. On the one hand, they help neurodivergent people find supportive communities and accept their differences. On the other hand, they make neurodivergent people targets for prejudice and they’re used to gatekeep people from communities and support networks. And ultimately, when it comes to talking about the issues surrounding the language of mental health, neurodivergent people are left out of the discussion. It’s easy to say that society needs to unlearn generations of hate and stop viewing disorders as defects, but practically, I think a label-focused and disorder-focused attitude toward mental health exacerbates the problem. We don’t need to abandon disorder labels entirely, especially since they form an important part of many people’s identities and are useful in medical contexts. What we need is to adopt a mentality closer to the social model of disability; we need to accept people as they are and provide the accommodation they deserve. No diagnoses. No disorders. Just people.

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