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Published March 20, 2025
Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Advances in scientific knowledge have helped cardiologists, oncologists, and other medical specialists improve success rates for a variety of clinically important outcomes, confirming that current treatments are more effective than the ones that were available twenty or thirty years ago. Similar data is hard to find for psychiatric disorders. As a result, functional neuroimaging or other physical tests play no part in clinical decision-making.
Research from several countries has found that, despite continuous growth in the availability of mental health services, only about 15-25 percent of those referred significantly improve or recover in the long term. This dismal picture is found in both child and adult mental health services. [...]
The likelihood of positive outcomes for those with mental disorders is further hampered by the stigma associated with the idea that mental distress is the product of a medically malfunctioning brain. Nearly all studies that have looked at public attitudes toward mental illness have found that the medical model for mental illness ('mental illness is an illness like any other illness') is associated with increased negative attitudes, greater fear of patients, and a greater likelihood of wanting to avoid interacting with them. In contrast, the idea that mental distress, in all the variety of ways it may be expressed, is the outcome of adverse experiences is associated with empathy and a desire to help.
I have met, corresponded with and debated via email, meetings, conferences, and in person with some neurodiversity activists. I admire what they have done and set out to do, which is to move autism from the sphere of disorder into one of human difference. I think many people have been helped by this, particularly those who saw themselves in a negative light and were burdened by self-criticisms. However, taking something that is defined as a medical condition, often characterised as resulting in a lack of empathy, brings dangers when expanded rather than challenged as a notion. The sense of not being good enough is so ubiquitous in this hyper-individualised culture that an individualised explanation (having a neurodiversity that causes you to be 'not good enough') may reinforce rather than challenge or change cultural and economic systems encouraging that.
I understand that there are many who have found the act of naming helpful. Parents may be enabled to have new sympathy for their child and adults may feel something about their life now makes sense. But at what price? How long do these initial feelings of relief last? What goes missing from that person's narrative when a label that cannot explain is used to explain? I worry about the potential for a subtle kind of violence that can be inflicted on someone thus labelled, which may limit their own, their families' and a whole host of people's beliefs about what they can and can't do, what they need protection from and don't. I'm concerned that having the label of autism provides a cruel kind of hope. Parents may feel that something is now understood, so experts will know what to do to help. As the days, months, and years accrue with matters not improving, what does that do to parents' feelings about their 'disordered' child? These are the types of dilemmas I regularly see in my consulting room. [...]
Autism has become the new catch-all for young patients who don't follow the increasingly narrow boundaries of expected behaviours, and to such an extent that we overlook histories that would obviously have an impact on their presentations. It keeps coming up as 'maybe they have autism' by referrers, parents, teachers, in meetings and clinical reviews, as if that's going to provide an explanation for behaviours that concern, frustrate, or infuriate.
Companies have traded job security, stability, and a unionised workforce for employee well-being services, mindfulness classes, and mental health days. Anxiety, stress, depression are things that happen to the worker that our enlightened approach to mental health can now treat, so you can return to the insecure jobs we offer without the employer having to change working practises. This new world of pseudo-emotionally aware language of mental health with the requirement of having strong people skills in the workforce means there is now a greater political and personal demand for everyone to having the sort of enhanced social and emotional flexibility they didn't previously need.
In relation to autism this leads to an interesting paradox. One of the core features of the diagnosis implies a lack of empathy. However, improving the 'emotional intelligence' of the workforce is for the purpose of using empathy to successfully exploit and manipulate your customers and workforce into doing what you wish for your own personal (and company) gain. It seems strange that people who find it difficult to understand emotional nuances but who can be compassionate are pathologised, yet those who can use an understanding of others' emotional state to manipulate them for selfish ends are rewarded.
Just as alcohol can cause some social disinhibition whether you are socially anxious or not, antidepressants can produce a low level of emotional blunting (a kind of 'I don't care' feeling) in whoever takes them regardless of diagnosis. Calling drugs antipsychotics or antidepressants is a marketing not a scientific/theraputic term. Antipsychotics should be called 'neuroleptics' (inhibiting the nervous system) and antidepressants by their subcategory action. [...]
But in everyday life we refer to them as antidepressants, or antipsychotics, or mood stabilisers, or anxiolytics, or anti-ADHD medication. This is a sure sign that marketing not science is dictating the concepts used in practice and in the language that has since leaked out into culture. Psychiatric brands are ripe for exploitation and profit extraction, and the chemical imbalance story is ideal for medicalisation of mood, distress, difference, and the sort of widespread insecurities so many feel these days.
The child's gender identity is conceptualised as existing a priori, as though it is an essential quality of the child that is beyond the reach of social or environmental influences. Family dynamics, traumatic experiences, social issues, cultural exposure to how masculinity and femininity are constructed and regulated, all become irrelevant in this framework. This gets transformed into an ideological stance that can hinder more fluid and open understandings, and may obstruct the potential for other, less medically invasive, avenues to psychological change.
...No society really knows how to distinguish between mental suffering that's a sign of illness from experiences that are not. Sorrow and grief are often linked with inner depth and dignity, not pathology. Given these alternative perspectives of experiencing the world, some anthropologists have argued that the high rate of depression in the US is itself a product of a culture that prioritises the pursuit of happiness and consumption as a basic aim of human existence.