Neurodiversity and Psychiatric Validity

In recent years, more people interested in neurodiversity advocacy have found themselves faced with the problem of psychiatric validity—the issue of whether the various classifications used in psychiatry (e.g. "autism") are valid.

Its an important question for a number of reasons. For instance, scientifically, the validity of the construct might determine the extent to which it will be helpful for research. While politically, whether, say, autism is a meaningful construct will be important to consider when asking whether a self-advocate's claims to be representative of autistic people more generally are legitimate.

There's at least two key issues when we look at this from a psychiatric perspective. First, each “disorder” classification has many different definitions at any given time—and moreover, the dominant definitions continually change over time in relation to various factors. Second, few (if any) disorders seem to have core underlying traits that explain all the symptoms. Indeed, many people with the same diagnosis have few or even no overlapping traits.

In defence of psychiatric classifications, philosophers of psychiatry have constructed various models and standards of validity. Some draw on similar debates regarding species taxonomy to characterise psychiatric classifications as "fuzzy" cluster concepts that may be meaningful despite having no essential defining trait. Others propose a standard of validity that relies on their medical utility only, thus bypassing some of the issues noted above and instead refocusing on whether any given classification is helpful or not for those so classified as well as for researchers.

Against this, it's sometimes said that very few psychiatric classifications actually do seem to be helpful from a medical perspective. Indeed, they may even impede research and confuse patients and clinicians. Given this, organisations such as the National Institute of Mental Health still have argued that we should focus on specific symptoms and one day get rid of broader classifications altogether. This seems to be the direction biological psychiatry is going, at any rate.

The Neurodiversity Perspective

Much of my own research has been on how we can approach this issue from a neurodiversity rather than psychiatric perspective. There is a tendency to think that just because any given classification lacks scientific validity, then we must give up labels such as “autism” for advocacy purposes. But this isn’t my view.

One key difference is that on the neurodiversity framing, what we reclaim as “neurominorities” are seen more as political identities rather than medical classifications. Given this, while it's clear that they need to be meaningful in some respect, it's not clear that they need to be scientifically valid. For unlike medical disease classifications, there’s no requirement for political identities to be scientifically valid or medically useful at all.

Consider some (partial) similarities with race. The notion that our race classifications are scientifically valid is now widely rejected. But race classifications can be valid and useful as political identities, allowing marginalised peoples to group together and resist oppression. And because those doing this are not purporting to be using such terms (e.g. “black”) in a scientific way, the question of scientific validity doesn’t arise as a potential worry.

Of course, this alone doesn’t answer the question of whether concepts like “autism” are valid or how we should conceptualise them. It only shows that from a neurodiversity perspective, we can use different standards of validity that may not be open to those who see it as a medical classification. In short, we can see them as meaningful social constructs. But then we need to clarify what we mean by "social construct," since there are loads of different kinds of social construct and debates over what terms like this mean (see, e.g. debates in the social metaphysics of race or gender).

Autism as a Serial Collective

For my own research, I’ve found feminist philosopher Iris Marion Young’s notion of gender as a “serial collective” particularly helpful for conceptualising autism in relation to a social model of disability. This model is favoured by neurodiversity proponents and takes disability to be caused by social organisation more than as an individual medical issue.

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Like the social model, the notion of a serial collective focuses on the external. The concept indicated human groupings defined by the shared relations of its members to an external world rather than through shared internal traits. A very simple example of a serial collective would be all the people listening to a specific radio show: They may or may not share internal traits, but what combines them is that they share with the others a specific relation to a material external world that others (in this case all those who aren't listening to the show) don't. And in light of this shared relationship to a part of the external world, members of serial collectives will have shared experiences and perhaps interests too.

Young herself used this concept to try to clarify the nature of class and gender, albeit as much more complex and shifting serial collectives than the example I just gave. Similarly, I think we can use it to help clarify the nature of autism as a highly complex serial collective.

For instance, we can say that autistic people share a relationship with each other since we all live in a world that doesn't currently accommodate for our sensory processing. This acknowledges how the sensory processing of each autistic person is different from that of each other autistic person (which is true), but also that we all still share similar experiences such as constant sensory overload, sensory fatigue, and so forth (which is also true).

This doesn't deny that we tend to share very rough clusters of similar internal traits; it just doesn't reduce us or define us by this. Moreover, it has the benefit of predicting that the autism construct and how broad it is will continually change, since it would do so as the organisation of the external world changes. So this fits with the facts that were hard to accommodate from a psychiatric perspective (see my article here for much more detail).

Currently, this is the only existing proposed metaphysics of autism that both coheres with the neurodiversity paradigm and is built on social-model rather than medical-model thinking, given its emphasis on the external. But I hope in the years to come, other neurodiversity proponents will build on this or suggest alternatives, for both autism and other neurominorities. My own proposal shouldn't, then, be seen as an attempt to give the final word, but more as an attempt to start a new conversation.