When it comes to human neurodiversity, the dominant paradigm in the world today is what I refer to as the pathology paradigm. The long-term well-being and empowerment of Autistics and members of other neurocognitive minority groups hinges upon our ability to create a paradigm shift – a shift from the pathology paradigm to the neurodiversity paradigm. Such a shift must happen internally, within the consciousness of individuals, and must also be propagated in the cultures in which we live.
THROW AWAY THE MASTER’S TOOLS: LIBERATING OURSELVES FROM THE PATHOLOGY PARADIGM • NEUROQUEER
Discourse and education on autism, in the academic and professional realms, has thus far been dominated by what I have termed the pathology paradigm. At the root of the pathology paradigm is the assumption that there is one “right” style of human neurocognitive functioning. Variations in neurocognitive functioning that diverge substantially from socially constructed standards of “normal” – including the variations that constitute autism – are framed within this paradigm as medical pathologies, as deficits, damage, or “disorders.”
AUTISM & THE PATHOLOGY PARADIGM
The pathology paradigm starts from the assumption that significant divergences from dominant sociocultural norms of cognition and embodiment represent some form of deficit, defect, or pathology. In other words, the pathology paradigm divides the spectrum of human cognitive/embodied performance into “normal” and “other than normal,” with “normal” implicitly privileged as the superior and desirable state.
Toward a Neuroqueer Future: An Interview with Nick Walker – PMC
The core assumptions of the pathology paradigm are that mental and cognitive functioning are individual and based on natural abilities, and can be ranked in relation to a statistical norm across the species. And while there were earlier notions of the mean understanding and normal body, I locate Galton as the founder of the pathology paradigm proper. Walker describes the pathology paradigm as being the place where the neurotypical mind became ‘enthroned as the “normal” ideal against which all other types of minds are measured’. And it was also with Galton that this, and mass normalisation, was formalised.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
In recent years a new paradigm has begun to emerge, which I refer to as the neurodiversity paradigm. The term neurodiversity, coined in the 1990s, refers to the diversity of human minds—the variations in neurocognitive functioning that manifest within the human species. Within the neurodiversity paradigm, neurodiversity is understood to be a form of human diversity that is subject to social dynamics—including the dynamics of oppression and systemic social power inequalities—similar to those dynamics that commonly occur around other forms of human diversity such as racial diversity or diversity of gender and sexual orientation.
AUTISM & THE PATHOLOGY PARADIGM
Through the lens of the neurodiversity paradigm, the pathology paradigm’s medicalized framing of autism and various other constellations of neurological, cognitive, and behavioral characteristics as “disorders” or “conditions” can be seen for what it is: a social construction rooted in cultural norms and social power inequalities, rather than a “scientifically objective” description of reality.
The choice to frame the minds, bodies, and lives of autistic people (or any other neurological minority group) in terms of pathology does not represent an inevitable and objective scientific conclusion, but is merely a cultural value judgment. Similar pathologizing frameworks have been used time and again to lend an aura of scientific legitimacy to all manner of other bigotry, and to the oppression of women, indigenous peoples, people of color, and queer people, among others. The framing of autism and other minority neurological configurations as disorders or medical conditions begins to lose its aura of scientific authority and “objectivity” when viewed in this historical context—when one remembers, for instance, that homosexuality was classified as a mental disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) well into the 1970s; or that in the Southern United States, for some years prior to the American Civil War, the desire of slaves to escape from slavery was diagnosed by some white Southern physicians as a medical “disorder” called drapetomania.
AUTISM & THE PATHOLOGY PARADIGM
Thus, for me, the key problem is not the pathology paradigm alone, but how capitalist logics and the pathology paradigm mutually reinforce each other, leaving no possibility of neurodivergent liberation without deep systemic change.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
since the pathology paradigm is a product of the broader economic system, overcoming it will require more than a revolution in how we think about neurodiversity. It will also require changing much deeper structures in our society, in ways that are usually left unclarified in existing neurodiversity theory.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
The rise of capitalism – through its colonial roots and then imperial stages – thus finally brought the modern notion that the mad need to be treated, to ease their suffering and return the idle to the workforce. It was in this new context of viewing the population as a malleable economic resource that we see the emergence of new professional roles that paved the way for early pre-paradigmatic psychiatry and related disciplines such as psychology and psychometrics to emerge. And the new mechanistic understanding of the body and mind, coupled with new conceptions of normality, brought a new way of grounding these projects. As we will see in the next chapter, this would then be combined with the emerging statistical notions of normal functioning to ground not just the rise of eugenics but also the psychiatric paradigm that still exists today – the pathology paradigm.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
This provided white, cognitively abled, middle-class people to justify the various hierarchies that had emerged given the rise of capitalism as well as colonialism and imperialism. It also allowed cognitively abled people to begin establishing a monopoly on property and the means of production. As such, the normality concept mirrored contingent social hierarchies while at the same time framing these hierarchies as natural.
Here, then, we see the beginning of what I call the Empire of Normality. This new apparatus, made up of a complex nexus of different carceral systems, legal precedents, institutions, concepts, and practices, led to populations beginning to be systematically ranked in terms of mental and neurological ability, while positing this as part of a timeless natural order. This was not an accident, but was rather built into the logics of capitalism from the beginning. And it was in this context, as we will come to next, that a British polymath named Francis Galton developed the pathology paradigm – the precise paradigm the neurodiversity movement would later arise to name and resist.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
It is curious that, despite his influence being acknowledged elsewhere, Galton is barely mentioned in general histories of psychiatry, whether those written by mainstream psychiatrists or anti-psychiatry critics. Yet it is my contention that he was the founder of the pathology paradigm, in the sense that he provided both its metaphysical basis and developed many of the experimental methods that provided blueprints for later researchers. And it was this – Galton’s paradigm – that would then be taken up by Emil Kraepelin, often described as the ‘father’ of modern psychiatry, and other influential clinicians and researchers across the psychological sciences. This would form the basis of the approach that has remained dominant to this very day, and which functions to naturalise and scientifically legitimise the neuronormative domination of capitalism as it continues to develop.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
The most fundamental limitation, which I have sought to address in this book, is that neither Walker nor any other neurodiversity theorist until now has provided a historical materialist analysis of the pathology paradigm. But here, by showing how the paradigm arose and caught on specifically because it allowed the individualisation and reification of neurodivergent disablement, we can better understand the significance and power of the pathology paradigm, as well as what it might take to overcome it. Since the pathology paradigm, and the way it naturalises increasingly restricted conceptions of normality, grew precisely to mirror the needs of the capitalist economy, it is these material conditions that need to be changed, not just our thinking. While changing our thinking is vital, we are unlikely to fully supplant the pathology paradigm while the capitalist global economic order remains dominant.
More generally, the key limitation of existing neurodiversity theory and activism is that it is more focused on changing our thinking and attitudes than on changing material conditions.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
It is vital to say here that some neurodivergent disablement and illness will always exist, and that imagined worlds where they do not exist at all are fascistic fantasies. But mass neurodivergent disablement and constant, widespread anxiety, panic, depression, and mental illness, combined with systemic discrimination of neurodivergent people, is a problem specific to the current historical era. Hegemonic neuronormative domination, in other words, is a key problem of our time. For the Empire of Normality, and in turn the pathology paradigm, emerged in the context of capitalist logics, but have now become pervasive and partially distinct systems of domination in their own rights.
Empire of Normality: Neurodiversity and Capitalism by Robert Chapman
When we recognize neurodiversity as a form of human diversity, and recognize the pathology paradigm as a form of systemic oppression like racism or heterosexism, it’s easy to see that the concept of a “normal mind” is just as absurd and innately oppressive as the idea that white people are the default “normal” race or that heterosexuality is the one “normal” sexuality. And the pathologization of neurominorities—the framing of autism, for instance, as a “mental disorder” or a medical “condition”—is no more valid and no less oppressive than the framing of homosexuality as a “mental disorder.”
The two paradigms—the pathology paradigm and the neurodiversity paradigm—are as fundamentally incompatible as, say, homophobia and the gay rights movement, or misogyny and feminism. In terms of discourse, research, and policy, the pathology paradigm asks, “What do we do about the problem of these people not being normal,” whereas the neurodiversity paradigm asks, “What do we do about the problem of these people being oppressed, marginalized, and/or poorly served and poorly accommodated by the prevailing culture?”
Toward a Neuroqueer Future: An Interview with Nick Walker – PMC
I’d define the neurodiversity movement as the movement to shift the prevailing culture and discourse away from the pathology paradigm and toward the neurodiversity paradigm.
Toward a Neuroqueer Future: An Interview with Nick Walker – PMC
