Mental Disorder or Neurodiversity?
October 3, 2012
One of the most famous stories of H. G. Wells, “The Country of the Blind” (1904), depicts a society, enclosed in an isolated valley amid forbidding mountains, in which a strange and persistent epidemic has rendered its members blind from birth. Their whole culture is reshaped around this difference: their notion of beauty depends on the feel rather than the look of a face; no windows adorn their houses; they work at night, when it is cool, and sleep during the day, when it is hot. A mountain climber named Nunez stumbles upon this community and hopes that he will rule over it: “In the Country of the Blind the One-Eyed Man is King,” he repeats to himself. Yet he comes to find that his ability to see is not an asset but a burden. The houses are pitch-black inside, and he loses fights to local warriors who possess extraordinary senses of touch and hearing. The blind live with no knowledge of the sense of sight, and no need for it. They consider Nunez’s eyes to be diseased, and mock his love for a beautiful woman whose face feels unattractive to them. When he finally fails to defeat them, exhausted and beaten, he gives himself up. They ask him if he still thinks he can see: “No,” he replies, “That was folly. The word means nothing — less than nothing!” They enslave him because of his apparently subhuman disability. But when they propose to remove his eyes to make him “normal,” he realizes the beauty of the mountains, the snow, the trees, the lines in the rocks, and the crispness of the sky — and he climbs a mountain, attempting to escape.
Wells’s eerie and unsettling story addresses how we understand differences that run deep into the mind and the brain. What one man thinks of as his heightened ability, another thinks of as a disability. This insight about the differences between ways of viewing the world runs back to the ancients: in Plato’s Phaedrus, Socrates discusses how insane people experience life, telling Phaedrus that madness is not “simply an evil.” Instead, “there is also a madness which is a divine gift, and the source of the chiefest blessings granted to men.” The insane, Socrates suggests, are granted a unique experience of the world, or perhaps even special access to its truths — seeing it in a prophetic or artistic way.
Today, some psychologists, journalists, and advocates explore and celebrate mental differences under the rubric of neurodiversity. The term encompasses those with Attention Deficit/Hyperactivity Disorder (ADHD), autism, schizophrenia, depression, dyslexia, and other disorders affecting the mind and brain. People living with these conditions have written books, founded websites, and started groups to explain and praise the personal worlds of those with different neurological “wiring.” The proponents of neurodiversity argue that there are positive aspects to having brains that function differently; many, therefore, prefer that we see these differences simply as differences rather than disorders. Why, they ask, should what makes them them need to be classified as a disability?
But other public figures, including many parents of affected children, focus on the difficulties and suffering brought on by these conditions. They warn of the dangers of normalizing mental disorders, potentially creating reluctance among parents to provide treatments to children — treatments that researchers are always seeking to improve. The National Institute of Mental Health, for example, has been doing extensive research on the physical and genetic causes of various mental conditions, with the aim of controlling or eliminating them.
Disagreements, then, abound. What does it mean to see and experience the world in a different way? What does it mean to be a “normal” human being? What does it mean to be abnormal, disordered, or sick? And what exactly would a cure for these disorders look like? The answers to these questions may be as difficult to know as the minds of others. Learning how properly to treat or accommodate neurological differences means seeking answers to questions such as these — challenging our ideas about “normal” human biology, the purpose of medical innovation, and the uniqueness of each human being.
Not coincidentally, the neurodiversity movement accompanies an apparent boom in the number of people with mental disorders, especially children. In locations monitored by the Centers for Disease Control and Prevention (CDC), the number of children with diagnosed autism spectrum disorders nearly doubled between 2002 and 2008, from one in 156 to one in 88. Autism was not even included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) until its third edition was published in 1980. Similar stories are true of other disorders. In the 1970s, ADHD was known as “Hyperkinetic Reaction of Childhood Disorder,” and was not well known. Following revisions to the DSM, diagnosis has become increasingly common, especially in children. Psychiatrists’ improved ability to identify and treat such conditions has much to do with their increased profile, though there is some question whether environmental factors may be responsible as well.
A diagnosis of autism, ADHD, dyslexia, or depression does not necessarily mean that a patient has some definite set of observable traits. Each disorder exists on a spectrum, such that some cases are more evident than others — which complicates diagnosis as well as judgment of the patient’s wellbeing. But as psychologist Thomas Armstrong writes in Neurodiversity (2010; title changed in paperback to The Power of Neurodiversity), there are generally at least a few characteristics of each disorder that hold across the spectrum and cause difficulty for those affected.
Autistics, writes Armstrong, tend to be much better at understanding systems than understanding people. Perhaps the most famous person with autism is Temple Grandin, an animal scientist at Colorado State University, who wrote an autobiography on growing up with autism called Thinking in Pictures(1995). To demonstrate the systematic thought process of autistics, Grandin describes an experiment conducted by Uta Firth, a British researcher on cognition:
Joe, Dick, and a person with autism are sitting at a table. Joe places a candy bar in a box and shuts the lid. The telephone rings, and Dick leaves the room to answer the phone. While Dick is gone, Joe eats the candy bar and puts a pen in the box.
When the experimenter asks the autistic person what Dick thinks is in the box, the autistic person will say, “a pen.” Autistics do not know how to predict what others think…