Reframing Mental Illness: Neurodiversity and a new road to recovery
“Neurodiversity may be every bit as crucial for the human race as biodiversity is for life in general.” – Harvey Blume[I]
Reading through the 2nd Edition of The Blackwell Companion to Consciousness[ii], what strikes me is the fact that there is an entire section devoted to altered states of consciousness. This includes chapters on drug induced states, mindfulness, dreaming, psychopathology (symptoms of mental illness) and other anomalous experiences such as near death and out of body experiences. There is an exciting trend in academia, not only in philosophy, but in disciplines such as psychiatry, psychology, and neuroscience, where researchers are realizing that if we are to understand how the human mind works – if we are to understand normal cognition and brain states – we must also investigate ‘extreme’ or diverse forms of consciousness. In other words, our understanding of humanity cannot be a complete so long as we ignore this diversity.
Much of the 20th Century saw these states marginalized and overlooked. William James was an early pioneer in psychology who stressed the importance of these states. He believed that we could not have a complete account of the universe so long as we ignored diverse forms of consciousness.[iii] But, the focus on behaviorism in the first half of the 20th Century lost touch with much of our subjective experience. In terms of psychiatric practice, behaviorism was proceeded by what is now the dominant biomedical model of mental illness, with its emphasis on the use of pharmaceuticals. Somehow, the experience was once again left out of the equation. And this is the situation today, where most mental health practitioners dismiss the experiences of those who have psychopathological symptoms, regarding these as irrelevant to treatment.
But a trend is starting. There are researches who want to take this phenomenology seriously – that is, they seek to understand how these symptoms are experienced from the first-person perspective of the person that has them. It’s time to look at these experiences to gain a better understanding of mental illness.
Aside from this trend, where researchers are realizing the importance of altered states – there are trends occurring within communities of people who have lived experience of psychopathological symptoms. Firstly, there are Anti-psychiatry movements made up of those who have been treated within the mental health system and call themselves survivors of this system. This is a civil rights movement that argues against the dominant biomedical model of mental illness as disease. This position is supported by the often-random effect that psychotropic medications have in terms of treatment. There is research that shows that these medications are no more effective than placebos. In addition, the administration of these medications can seem more like ‘guess work’ on the part of psychiatrists. Medications have different effects on different individuals, and on the same individual over time. Often medications are used in (increasingly mixed) combinations, and often over the prescribed highest dose. Additionally, no biological markers have been found to account for the various psychiatric diagnoses. Manuals such as the DSM5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) that are used to diagnose people simply list symptoms without defining these illnesses. However, perhaps the greatest complaint of survivors is the disempowerment they have experienced in a system where many have been stripped of their rights.
While Anti-psychiatry advocates fight against the biomedical model, a second approach to understanding mental illness is the shift in thinking resulting from what has been termed the Neurodiversity paradigm. This arose from communities of people on the autism spectrum, but has come to include others with conditions that are considered adverse functioning of the brain, such as ADHD and bipolarity and schizophrenia. The chief idea here is that these diverse expressions of brain functioning are on a continuum of normal human functioning and that this diversity is to be accommodated within our community – not eradicated or pathologized. Some in the autism community have opposed this, stating that it only applies to high-functioning people on the spectrum, and that low functioning autism can be a severe disability where treatments/cures should be sought. In terms of mental illness, people are not denying that these conditions exist – but argue for a re-framing of these conditions where these symptoms, and the people living with them, are valued as part of the diverse expressions of humanity.
I haven’t researched these movements in depth, but I think it is exciting to see the push towards reframing mental illness that is coming both from researchers, and people with lived experience – and people with lived experience who are researchers. This is not to deny the distress that can arise because of these symptoms – and the fact that good treatment is necessary. Instead, what this suggests is that if we move towards re-framing mental illness we will develop better treatments. And this is both important and necessary.
I haven’t formed an opinion about the anti-psychiatry movement, but I’m excited by the ideas of neurodiversity. It’s important to note that within anti-psychiatry its accepted that if individuals choose to use medication, finding that it helps with their functioning, then this is a valid choice. The emphasis here is on choice. I see the need for psychotropic medications – but am aware of the problems. For example, it can seem random as to who will respond well, and what medications will work for an individual. There are also major issues regarding the side effects of these drugs. However, the ideas behind neurodiversity seem to me to be well overdue, and I will briefly explain why.
Often, people in our community with a more severe diagnosis of mental illness find themselves marginalized and disadvantaged. However, in many respects this is not the result of the symptoms of these illnesses. A combination of the structures in society, stigma, and side effects from medication can play a devastating role in an the outcomes of an individual. For example, schizophrenia often has its onset in late adolescence/early adulthood. When this occurs, an individual may be unable to complete their education. They may be unable to enter the workforce, and may not develop independent living skills. This can have a profound impact on their socio-economic status for the rest of their lives. Social security benefits are inadequate, and this can leave individuals struggling to pay rents, or trying to cope in dysfunctional housing commission complexes. This struggle with poverty results in individuals fighting for survival – and this only serves to exacerbate symptoms. Stigma from society leads to further marginalisation, and this stigma becomes internalized as individuals blame themselves for their perceived ‘failure’. Side effects from medication can prohibit proper functioning, further alienating individuals. When people are excluded from our communities in this way, we end up with a minority that is demonized and dismissed and considered irrelevant.
But this situation is the direct result of the lack of social support needed to allow people to flourish and achieve meaningful lives. And – we are entitled to this.
By accepting the premises of neurodiversity, you accept that we are an essential part of the community. We have our own strengths and gifts to offer. But we need the right support if we are to flourish and share these gifts. By reframing the way society views mental illness we seek to eradicate the shame around these disabilities. Instead, we work towards developing systems that support each unique individual to reach their potential. So long as individuals are perceived as dysfunctional they will be sidelined and marginalized. But it is this marginalization and lack of support that is the real devil with these illnesses.
There is a spectrum in terms of our ability to function while having these illnesses. But positive outcomes, in terms of recovery and flourishing and contributing to society, can be far greater than they currently are. Society must respect these differences and accommodate people with these differences. We cannot afford not to.
[i] Blume, Harvey (September 30, 1998). “Neurodiversity”. The Atlantic. Retrived from https://en.wikipedia.org/wiki/Neurodiversity 5 June, 2017.
[ii] Schneider, S. and Velmans, M. (ed) (2017) The Blackwell Companion to Consciousness: Second edition West Sussex, UK: John Wiley & Sons Ltd.
[iii] James, W. (1961) The Varieties of Religious Experience: A Study in Human Nature. New York: Collier. (Original work published 1902).