:: If neurodivergent people can’t be trusted to know who we are, what we are, how can we be trusted at all?

How do I know that I’m autistic? How do you know that you have ADHD, anxiety, or bipolar disorder?

In his article “Why We’re Turning Psychiatric Labels Into Identities” (New Yorker, May 6, 2024), writer Manvir Singh argues that neurodivergences themselves are created by the book that describes them—the Diagnostic and Statistical Manual of Mental Disorders (or DSM).

In it, Singh casts doubt on a neurodivergent person’s ability to know themselves, an old pastime for those studying psychiatry.

Singh describes on the DSM tells neurodivergent people who they are, “Psychiatric classification shapes the people it describes. It models social identities. It offers scripts for how to behave and explanations for one’s interior life.”

In other words, not only did autism and other neurodivergences get recognized because doctors described them, the descriptions literally created them.

It is true that the DSM has had an enormous social influence. For example, the DSM’s listing of homosexuality as a mental disorder caused enormous harm to gay people. (It delisted it in 1973.)

In his article, Singh suggests that neurodivergent people’s experiences of autism, ADHD, and more are constructed by the DSM. This notion is not only insulting and patronizing, it is dangerous to neurodivergent people.

Contempt for Autistics and Autism

In his article, Singh shows particular contempt for autism.

He builds his case using autistic writer Paige Layle’s memoir about being diagnosed at fifteen, “But Everyone Feels This Way.”

He opens and closes the long article with Layle, using her as an example about what is wrong with the diagnostic process and autism in particular.

Ironically, the words he selects from her memoir to debunk new autism diagnoses are words that I’ve heard in some iteration from every late-diagnosed adult, ever. Layle is not an outlier.

He writes, “She describes the rush of clarity she experienced when hearing the DSM-5 criteria: ‘I’m not crazy. I’m not making it up. I’m not manipulative or trying to fake anything. . . . There’s a reason why I’m the way that I am.’”

When I was diagnosed, finally, at age 43, I felt like my past snapped into focus. A “rush of clarity” if you will.

My forty years of life experience did not suddenly shift because of diagnostic criteria. Rather, autism explained decades of bullying and relationship abuse—and also my accomplishments.

Singh quotes Layle’s book further: “She also struggled with anxiety; she was, in her words, ‘the weird kid who cried all the time and was so stressed that she wanted to die every single day.’”

Layle’s words described me every day in middle school, where I felt weird, isolated, and depressed.

He not only tries to use her words to discredit her, he also attacks her social media presence, describing her this way: “Bubbly and socially perceptive, with expertly applied makeup and a way of looking into the camera that’s both intimate and intense.”

There is misogyny baked into this language: she’s ditzy, vain, and pretty, andautistic. She’s like a unicorn. Or maybe an attention-seeker. Or maybe not actually autistic at all. Right?

Wrong.

Labels Do Not Create the Diagnosis

Singh’s point is that labels change peoples’ behavior. He’s not wrong. When a person joins a fraternity, for example, they may change to fit the group’s code of behavior.

But does that rule hold true for autism, ADHD, or bipolar disorder? He writes, “People’s symptoms frequently evolve according to the labels they’ve been given.”

As evidence, he gives this: “Following Layle’s visit to the psychiatrist, her mother observed, ‘You’ve been acting more and more autistic since we got the diagnosis.’”

What was Layle’s response? Singh writes, “Layle took the comment as a sign that her mom didn’t understand her—‘I hate it when someone thinks I’m a liar,’ she writes.”

Indeed, neurodivergent people frequently aren’t believed when talking about our very own neurodivergences. Layle isn’t wrong in her anger.

But her mother isn’t wrong, either. After diagnosis, autistic people tend to embrace their autism and stop “masking.” Masking happens when neurodivergent people hide their neurodivergent traits to appease neurotypical norms.

We don’t have to know we are neurodivergent to mask. As psychologist Devon Price writes in their book Unmasking Autism, “Autistic people are born with the mask of neurotypicality pressed against our faces.”

For many of us, it is only after we learn we are autistic that we unmask.

Perhaps Layle’s mother perceived her daughter acting more autistic because Layle stopped masking her autism.

Too Much Influence for a Fake Diagnosis

Singh has another problem with autism. Not only does the diagnosis, in his opinion, make people act autistic, but the diagnosis itself lacks credibility. He writes: “What it means to be autistic, however, is constantly in flux.”

It is true that the testing criteria of autism has changed so that it no longer includes only the stereotypically white, cisgender-male child presentation from the early days. But Singh is not convinced that this broadening of the criteria is a good thing.

Singh writes, addressing these changes in diagnostics, “Leading researchers, such as Laurent Mottron and Uta Frith, worry that the heterogeneity dilutes a natural category.”

But I ask—is autism “a natural category” or a fake construct? And how can a diagnosis that is so in flux exert such a strong influence over people diagnosed with it? Singh can’t have it both ways.

Why This Debate Matters

As I wrote in my book, A Light in the Tower: A New Reckoning with Mental Health in Higher Education, “How we talk about mental disability affects how we—our society at large or our smallest communities—treat mentally disabled people.”

After Singh quotes Layle’s memoir where she is upset that her mother questioned her autism, Singh points out that he agrees with her mother: “People everywhere encounter models of illness that they unconsciously embody.”

He gives a few examples, including this one: “In 2006, a student at a Mexican boarding school developed devastating leg pain and had trouble walking; soon hundreds of classmates were afflicted.”

This is the comparison he makes to autism, to Layle’s memoir, to DSM diagnoses generally. His words are dangerous and harmful.

Why?

Neurodivergent people struggle to be trusted, believed, and understood on a daily basis by doctors, police, lawyers, teachers, and employers. Singh, in a well-respected publication, writes that we lack the ability to understand our own selves.

If neurodivergent people can’t be trusted to know who we are, what we are, how can we be trusted at all?

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