Why ‘normal’ is a slippery concept in mental health.
What Is Neurodiversity?
The ‘neurodiversity’ paradigm is a concept that recognizes and celebrates the diversity of human brains and minds.
When it was first coined, the term offered an alternative to the traditional medical model. Neurodiversity advocates acknowledgement that neurocognitive differences are normal variations rather than disorders or deficits that must be cured or eliminated.
Advocates argue that neurodivergent conditions should be accepted and accommodated just like any other form of diversity. The fundamental premise is that, just as society recognizes diversity when it comes to race, gender, and sexual orientation, it should also recognize and value diversity in the ways that people think, learn, and communicate.
Neurodiversity is not an exact science, and the debate over its definition continues. So does the debate over who is considered neurodivergent. According to the traditional perspective, it includes the autism spectrum, ADHD, learning disabilities, and tic disorders.
Neurodiverse, neurodivergent, and neurotypical
There are endless natural variations in the way our brains are made up. So, in that sense, the human species is inherently ‘neurodiverse’. No two brains or nervous systems are exactly the same, after all.
However, the neurodiversity paradigm goes beyond recognizing this biological fact, by also acknowledging the value that ‘neurodivergence’ brings.
Neurodivergence refers to someone’s neurological difference from what is considered “normal” or “typical” for their age group. Some dislike this term because they find that it highlights being different and assumes that there is a normal.
Finally, the word ‘neurotypical’ has been used as an umbrella term for those who do not have any major neurological differences in comparison to the norm.
Nick Walker, author of Neuroqueer Heresies, explains that we should never refer to people as being neurodiverse. After all, diverse doesn’t mean different from the majority, but made up of multiple different types. So by definition, individuals can never be diverse on their own.
Walker suggests that the term neurodiverse should only be used to describe groups of people who differ neurocognitively from each other. A classroom full of autistic students is not neurodiverse, but one where neurotypical and neurodivergent students are mixed together is.
Defining Normal and Abnormal
The concept of “normal” is often used to define what is socially acceptable and desirable in society. But who gets to decide what normal is?
The ‘bell curve’, or ‘normal distribution’, can serve as a reference to determine what is common in a particular population. It is a statistical tool that helps to define a range of frequently occurring values and can be used to identify outliers or extreme values that fall outside this range.
However, although the bell curve itself is a statistical concept, the interpretation of what is considered normal is not always clear-cut or objective. It can be subject to bias and is heavily influenced by cultural, historical, and societal factors.
For instance, what is considered a normal weight or height can vary across cultures and time periods.
Despite this, the use of the bell curve to define normality can still be helpful in many situations, such as in the diagnosis and treatment of certain medical and mental health conditions. It allows clinicians to compare an individual’s characteristics to those of the general population and identify any significant deviations or abnormalities.
The Social Construct of Normality
The idea that there is one single definition of what it means to be normal can be damaging. In his book, The Myth of Normal, psychologist Gabor Maté explains that things we consider normal – like stress, adversity, and trauma – are often toxic.
Because what is considered normal tends to change over the years, it has been proposed that the concept of ‘normal’ is a social construct. To understand this perspective, we don’t even have to go back so far into the past.
As recently as the 1970s, homosexuality was categorized as a mental disorder in the Statistical Manual of Mental Disorders (DSM). Similarly, in the Southern United States before the Civil War, a Louisiana physician named Samuel Cartwright once pathologized the desire of slaves to escape slavery as a medical disorder called ‘drapetomania’.
Today, we would be quick to call these things absurd, but at the time, this was passed off as objective science.
In his book, The Power of Neurodiversity, psychologist Thomas Armstrong, suggests that many of the things that we consider disorders in some way violate the specific values that are currently upheld in our society. An example is when being able to read became more important and expected after the Industrial Revolution, turning dyslexia into a “problem”.
An Interconnected Spectrum
Binary ‘normal versus abnormal’ thinking doesn’t acknowledge the complexity and interconnectedness of neurocognitive differences. Neurodiversity challenges this by recognizing that these differences are part of a spectrum rather than two distinct categories.
This is in contrast to certain medical conditions like Multiple Sclerosis and cancer which have clear diagnostic criteria and a binary classification of whether an individual has the condition or not.
In a 2016 paper, Harvard University professor Elise Robinson and colleagues, showed that the same genes involved in predisposing people to autism appear to influence social skills in the wider population too.
She likens viewing someone as either having or not having a neurodivergent condition to trying to pick a point where you say someone is tall or not.
In other words: the line at which we say someone is affected or unaffected is arbitrary – there is no clear cut-off point.
Similar to many mental health conditions, we all lie on a spectrum.
Language: person-first or identity-first?
‘A person with autism’ or ‘an autistic person’. What do you think is the more appropriate term?
This is the difference between person-first language and identity-first language.
Person-first language is frequently used in professional settings, but it has faced opposition from both self-advocates and scholars. Critics argue that being neurodivergent is an inherent part of someone’s identity – it is fundamental in shaping who they are and how they interact with the world, and it cannot be separated from the person.
They liken it to other descriptors like ‘Lesbian/Gay/Bisexual/Transgender/Queer,’ ‘African-American,’ or ‘Jewish.’ If you wouldn’t say ‘people with homosexuality’ or ‘adults living with blackness’, then why would you say ‘people with autism’? Using identity-first language is often seen as more empowering – it fights the idea that being neurodivergent is something to be ashamed of.
In contrast, many supporters of person-first language find that it prioritizes the person’s individuality over their condition. They believe that it acknowledges that a person is, first and foremost, a person.
Ultimately, the choice of language should be left up to the individual and should be based on their own preference and self-identification.
The Strengths-Based Approach
The strengths-based model of neurodiversity (SBMN) aims to identify and nurture individual strengths. It started as a response to the limitations of the medical model which traditionally focused on researching and correcting deficits – be they real or perceived.
The SBMN draws on several developments in psychology and psychiatry, including positive psychology, positive psychiatry, and Gardner’s theory of multiple intelligences, which suggests that human abilities are more diverse than proposed by most current IQ tests.
One common misunderstanding about the strengths-based approach is that it ignores or downplays the challenges and difficulties that neurodivergent individuals face. This has led some to worry that it may be used to justify not providing necessary support and services.
However, strengths do not nullify difficulties. The SBMN acknowledges that neurodivergent people may face unique challenges, and it seeks to support them in overcoming these while also building upon their strengths.
After all, both the denial of ability and the denial of difficulty can be problematic.
The Challenges of Being Neurodivergent
Many of the challenges that neurodivergent people face stem from societal expectations and treatment. Society generally expects individuals to conform to certain standards of behavior and communication. Neurodivergent individuals may struggle to meet these expectations, which can lead to social isolation, discrimination, and feelings of inadequacy.
For example, autistic people may have difficulties with social norms and sensory processing. This can make it hard to navigate social situations and engage in typical activities. However, these challenges are often exacerbated by societal expectations that prioritize extroverted behavior and require individuals to constantly interact with others.
Similarly, someone with ADHD may struggle with focus and attention, which can impact their academic or professional performance. However, they may also be labeled as lazy or unmotivated, rather than receiving the support they need to succeed.
Furthermore, neurodivergent individuals may face stigma and discrimination, which can further worsen their challenges. This stigma can manifest in many forms, including bullying, employment discrimination, and negative media portrayals.
Methods for Understanding Neurodiversity
While there is still a lot left to be discovered, there are several tools at our disposal to better understand neurodiversity.
Case studies, experiments, and observation methods are often used to gain a better understanding of neurodiversity. An example would be observing neurodivergent people interacting with their peers to understand if and how they process social cues differently.
Brain imaging techniques can reveal structural and functional differences between neurotypical and neurodivergent brains.
Surveys and questionnaires provide valuable insight into how individuals perceive themselves and others around them – allowing researchers to gain a deeper understanding of what it means to be ‘neurodiverse’.
Finally, twin studies help us separate nature from nurture. By comparing twins with similar or identical genetic makeup, scientists can better identify potential environmental factors that could influence an individual’s behavior and neurocognitive abilities.
Importantly, all these research tools can be carried out as longitudinal studies, allowing researchers to track changes over time. This is particularly useful for studying conditions like autism and ADHD which may manifest differently at different stages of life.
