It's Time to Embrace the Term "Psychodiversity"

"Do I really still have PTSD?"

Marina is a mom in my Post-Traumatic Parenting class. Her trauma occurred when she was very young, resulting in flashbacks, panic attacks, hypervigilance in certain situations, and a general sense of mistrust in the safety of the world.

Marina has been through many years of psychotherapy, including “best practices” treatments, like TF-CBT and EMDR. She still occasionally experiences flashbacks, when a specific trigger occurs very suddenly, but these are rare. She is a cautious mother, tending to double-check on her kids’ safety, in a manner that isn’t disruptive to her life but would probably be considered excessive by many of her peers. Most of her peers seem to have the instinct “the kids are alright” unless there’s some indicator otherwise. Marina’s instinct is “the kids are not alright, until I check to make sure.” She’s the mother who re-reads the safety manual twice to make sure she gets it. She calls the daycare’s references and asks pointed questions before enrolling her children. She’s careful and cautious, but not to the point of dysfunction.

Marina had been brutally attacked by a loose dog in her neighborhood when she was eight years old. Her parents told her that there was a marked change in her personality after the attack, and those changes never really reversed.

"They tell me before the attack, I was a regular, happy-go-lucky kid. Afterwards, during the height of my PTSD, I was a nervous wreck. I was terrified of basically everything. My brain contents could have been summarized by the words 'The ways in which this world can kill you and everyone you love.'

"I wasn’t just scared of dogs. I was scared my mom would die in a car crash. I was scared that the doctor would mess up my shots and accidentally poison me. I was scared of germs, and being outside, and nuclear war.

"Definitely, all the different therapies helped, in different ways. Remember, I was also having plastic surgeries during all this time, so it’s not like the story was just over. But play therapy helped me deal with the hospital experience, and TF-CBT helped me make sense of the story for a 9-year-old’s brain. Exposure therapy helped with my phobia of dogs. And EMDR helped a lot when I was a teenager and young adult. Still, today, no one would call me easygoing or happy-go-lucky."

Diagnosis or Diversity: That is the Question

At what point does a psychological diagnosis simply become an aspect of who a person is? Is Marina still a PTSD patient? Probably, for reimbursement purposes. However, her PTSD no longer affects her daily functioning.

From the Freudian definition of health as the ability to “love, work, and play,” Marina is mentally healthy. She is in a stable romantic relationship. She is a mother who is committed to growth in her parenting skills and has a lovely relationship with her children. She was the first in her family to achieve graduate-level education, and she has a career that she finds fulfilling and challenging. She seems to have the capacity to experience joy as well. In short, she can live, love, work, and play.

Now, if Marina goes to therapy, she will be treated under the diagnostic category of PTSD. After all, she still can be startled into a flashback, on the rare occasion that she unexpectedly is exposed to a vicious-seeming dog. She worries more than the average parent, although she does not allow that to rule her life. She is somewhat hypervigilant, easily startled, a light sleeper, and easily spooked.

Has the time come to think in terms of psychodiversity, instead of psychological dysfunction?

Source: tai11/123RF

But at what point do we look at Marina, and see someone who is “psychodiverse,” not “psychologically disordered?” There is no question that her PTSD altered some aspects of her personality. She was on a trajectory towards a different adulthood before her trauma. The fact that her parents described her as “happy-go-lucky” and “easygoing” suggests a different type of personality in development. At what point do we look at the psyche that developed around the disorder, and see diversity, not disorder?

Developmental Trajectories

I developed this lens because I am a clinical psychologist who specializes in treating children. If you’re going to work with pediatric patients primarily, at some point, you’re going to meet them in adulthood. This is especially true if you teach parenting classes, as I do, that are specifically geared towards helping parents work with their own histories. In my Post-Traumatic Parenting class, I meet a lot of survivors of childhood trauma. In my classes about parenting anxious children, or moody children, or reactive children, I meet many parents who had similar profiles when they were kids. This is my manifesto, based on my professional experiences, rather than an analysis of existing research. This is the viewpoint from the trenches, not the viewpoint from the ivory tower.

Many of those parents are psychology’s success stories. These are the adolescents who were correctly diagnosed with bipolar disorder, generalized anxiety, or OCD in their childhood or teenage years. These are the parents who did attend psychotherapy, and who, by and large, got better! These parents are often the reason being a psychologist is such a rewarding job. When I hear a story from an adult about having been a 15-year-old in therapy, learning to cope with and gradually master an anxiety disorder, it reminds me that I’m in a field that can change the trajectory of a life, reduce needless suffering, and provide empowerment experiences.

And these are also adults that clearly still have some tendencies toward their diagnoses. I’ve never met someone who is entirely laid back and relaxed who has a history of generalized anxiety disorder or OCD. I’ve met people who are like Marina—entirely functional, aware of their tendency towards disordered thinking or behavior in some contexts, and committed to health, but clearly still psychodiverse.

Neurodiversity

The autism community has embraced the term “neurodiversity” to fully describe what it’s like to function in the world with a brain that perceives the world somewhat differently than other people. There’s a rejection of a dysfunction model that views people with autism or ADHD as inherently “broken” in some ways, compared to people who are “neurotypical.”

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The term "neurodiversity" was first coined by sociologist Judy Singer in the late 1990s, to honor and point out that differences in neurology should be considered as an aspect of diversity, just as cultural, ability, or ethnic differences are. Rather than seeing herself as “less than” due to her Asperger’s, she defined herself as “neurodivergent.” Today, the term has largely been accepted by both the neurodiverse community and the professional community.

In the same way, I argue that it’s time to embrace the term “psychodiverse” to describe people whose psyche functions differently than the "psychotypical." At some point, after initial treatment and mastery of a condition—like Marina’s psychotherapy for her PTSD—there’s an aspect of accommodation and assimilation of the condition into the personality that’s being formed, and it’s no longer dysfunction. It’s simply different. And who is to say that different is an aspect of psychopathology?

Don’t get me wrong: I’m all for symptom relief, and I’m all for raising levels of functionality. After all, I engage in a pursuit called “psychotherapy,” which implies fixing something that is broken. But if we only focus on the dysfunction, we miss the ways in which people’s personalities grow and develop around and with their “diagnostic categories” and we miss the crucial ways that dysfunction becomes altered functionality, and then simply, an aspect of the self.

We also perpetuate the ongoing stigma of having a "disorder," the ongoing reluctance and shame people feel about attending psychotherapy and owning their own divergence. By using a divergence model, we help people understand that while symptom relief is possible, psychological functioning is inherently diverse, and that's OK.

It's time to embrace the concept of psychodiversity and end the stigma of the dysfunction model. So, does Marina still have PTSD? Sure, if PTSD stands for “post-traumatic stress divergence.” I believe it should.