Mark Ruffalo just annoyed me by publishing The Problem with Neurodiversity in Psychology Today. He went out of his way, and his area of expertise, to insist that I’m defective, to oppose the societal changes that would help me. What an asshole.
This is his bio from Psychology Today:
Mark L. Ruffalo, L.C.S.W., is a psychotherapist in private practice in Tampa. He serves as an affiliate assistant professor of psychiatry and an adjunct instructor of social work at the University of South Florida, where he teaches courses on psychopathology, psychoanalytic theory, and the history of psychiatry. His main interest is in mid-twentieth century American psychiatry and the paradigm shift that occurred in the field during this time.
He cites only one paper, from 1979, called “On myths and countermyths: More on Szaszian fallacies.” That’s about 20 years before “neurodiversity” was a thing. Thomas Szasz wrote The Myth of Mental Illness, which we had around the house when I was a kid. Here’s Szasz explaining himself in about 4 minutes:
Does this have a lot of similarities with the neurodiversity movement? Yes, but so does Lacanian psychoanalysis, with the notion that “we don’t cure patients.” That doesn’t make all 3 sets of ideas interchangeable, which is what Ruffalo seems to assume.
It has become fashionable in recent years for some mental health professionals and others to assert that the problems called mental disorders are nothing more than normal variations of human cognitive experience—not illness or pathology, and not abnormal. Autism, attention-deficit/hyperactivity disorder, and even schizophrenia, it is insisted, are simply human differences that don’t require treatment but rather social acceptance, tolerance, and inclusion. The concept of “neurodiversity” implies that normality and abnormality in the realm of mental functioning are not objective facts but rather invented, socially constructed categories.
It is easy to see why these claims have some appeal. There exists no objective, demonstrable biological test for mental illness and, admittedly, the progressive expansion of the psychiatric diagnostic system in recent decades has left some questioning the validity of psychiatry as a whole. These factors, coupled with the natural human inclination to avoid illness, have resulted in the growing popularity of the idea of neurodiversity.
But this attempt to reconceptualize mental illness as existing outside of the domain of medicine is nothing new. The history of psychiatry is filled with failed attempts to depathologize psychiatric disease—with harmful consequences.
He’s conflating two separate things: the neurodiversity movement and the idea that psychiatric conditions exist on spectra without a bright line separating normal from abnormal. The idea of spectra does come from mental health professionals. The idea that mistreatment by normal people is the primary cause of our suffering, and the answer is acceptance and inclusion, comes from autistic people. The ideas are related, but not identical. The idea of spectra doesn’t question that schizotypy, autism, etc. are bad things. The neurodiversity movement is more related to the social model of disability, which acknowledges that everyone needs help, but some kinds of help are more stigmatized than others.
While the concept of neurodiversity may have some validity for the milder psychiatric conditions, to insist that the schizophrenic patient—who may, for example, be experiencing command auditory hallucinations and having the delusional belief that an electrical device has been implanted in his brain by foreign entities to monitor his thoughts—is mentally “normal” and simply the victim of stigma and social intolerance is, to me, the height of absurdity. Those who make such claims may do so from the comfort of the ivory tower or the glorious seclusion of private practice with mildly ill patients, but such ideas become utterly unconvincing when faced with the clinical realities of the psychiatric emergency room.
This study compares 20 subjects, in each of three different settings, with serious psychotic disorder (they meet inclusion criteria for schizophrenia) who hear voices, and compares their voice-hearing experience. We find that while there is much that is similar, there are notable differences in the kinds of voices that people seem to experience. In a California sample, people were more likely to describe their voices as intrusive unreal thoughts; in the South Indian sample, they were more likely to describe them as providing useful guidance; and in our West African sample, they were more likely to describe them as morally good and causally powerful. What we think we may be observing is that people who fall ill with serious psychotic disorder pay selective attention to a constant stream of many different auditory and quasi-auditory events because of different “cultural invitations”-variations in ways of thinking about minds, persons, spirits and so forth. Such a process is consistent with processes described in the cognitive psychology and psychiatric anthropology literature, but not yet described or understood with respect to cultural variations in auditory hallucinations. We call this process “social kindling.”
Look how confidently Ruffalo speaks out of his ass. Harsh clinical realities blah blah blah. The idea of the neurodiversity movement is that our culture is producing a lot of suffering. Well, it seems to be true even in the extreme case of schizophrenia that Ruffalo hoped would be a reductio ad absurdum.
Try this one on for size: If autism, for example, is simply a normal variation of neurologic functioning, then congestive heart failure must be a normal variation of cardiac functioning—one that kills 5 million people a year. The psychiatrist Ronald Pies has perceptively noted that identification of all medical diseases—not just psychiatric disease—rests on a subjective determination about what constitutes abnormality (see Pies, 1979).
“There is nothing either good or bad, but thinking makes it so.” — Shakespeare
Comparing me to congestive heart failure is a dick move. Ruffalo is the cancer killing autistic people.
He’s missing the point. We’re going to make judgments about what to accept and what’s a problem. There are different ways of making those judgments, and it matters.
The great paradox of the neurodiversity movement is that while its stated intent is to eliminate stigma and improve the social condition of those diagnosed with mental illness, the result is likely to be just the opposite. If the problems called mental illnesses are to be celebrated as normal differences and not seen as medical disorders, then there becomes no need to invest in treatment. Inpatient hospitalizations will continue to get shorter, state hospital beds will continue to decrease in number, and the most seriously mentally ill will be left without adequate care. Of course, these problems existed before neurodiversity was in vogue, but they will only worsen.
To insist that mental illness—especially severe mental illness—is a normal experience to be celebrated and not treated is to do the most vulnerable in our society a grave disservice. What is needed most is not a dismissal of the reality of mental illness but rather an approach that realizes the severity and abnormality of these problems and promotes the dignified and humane treatment of those so afflicted.
The neurodiversity movement asks questions like:
- Why does everywhere have to be so loud?
- Why can’t I work from home and flap my hands?
- Why do I have to make eye contact or face ostracism?
The neurodiversity movement comes from autistic people. We know the shit can be disabling. We have ideas on how to make it less so, called the neurodiversity movement. Nobody’s like, “LOL let’s put psychotic people on the street because they’re fine.”
What does human beings a disservice is to ignore the actually-existing, possibly situational benefits of things like autism or schizotypy. Autism has made me smart and good at things, too. Some things are easier for me. I could flourish better if people were more accepting and accommodated my needs more. That’s less likely to happen if I’m an abnormal, defective freak, which is how Ruffalo prefers to see us. Good thing he’s officially the helper of mentally ill people!