Part 2: Are We All Neurodivergent Nowadays?

Editor’s Note: Mad in America and Mad in the UK are jointly publishing this four-part series on neurodiversity. The series was edited by Mad in the UK editors, and authored by John Cromby and Lucy Johnstone. The series is being archived here.

In the previous blog, we attempted a broad overview of the recent and rapidly-expanding field of neurodiversity, and outlined some of its key principles, challenges and contradictions. In this blog, we will look more closely at the experiences most frequently seen as examples of neurodiversity—those that are given the label of autism/autistic spectrum disorder: ASD; or ADHD; or sometimes both (for which the composite term AuDHD has emerged).

We set the scene by noting that the phenomena we discuss have all arisen within Westernised capitalist societies. Some historians and scholars suggest that this is not a coincidence; the discipline of psychiatry itself, they argue, emerged in response to the need to sweep up people who were casualties of growing industrialisation in the 18th and 19^th centuries. Labelling them as ‘ill’ justified warehousing them in asylums, and this helped defuse dissent in the face of massive social changes (see here, here and here).

To recognise this is not to idealise pre-industrial, agrarian societies, or indigenous and non-Western cultures, which have their own characteristic stresses and limitations. Capitalism encourages improved productivity and efficiency, and—together with modern science—fosters innovation and technological development. Many of the ensuing products and technologies, in fields such as transport, sanitation and medicine, represent enormous advances that can potentially improve wellbeing for all.

Nevertheless, in recent years mental health problems have become the world’s leading source of disability, roughly corresponding to the spread of industrialisation. The increase has been particularly rapid in the last few decades under the present form of capitalism, which analysts call neoliberalism. In the UK, the Thatcher government of 1979 was the first to implement large scale neoliberal economic and social policies; in the USA it was the 1981 Reagan administration.

Even before neoliberalism, social inequality under capitalism was implicated in poorer physical and mental health. But since neoliberal capitalism has been adopted—in the UK, USA and other countries, and by parties from across the political spectrum—it has been accompanied by a rising tide of misery. What may be good for the economy is not necessarily good for our communities, or for individual peace of mind. We believe it is impossible to understand the recent rising tide of distress in general, or the neurodiversity movement in particular, without locating these phenomena within the wider context of neoliberal policies, practices and values.

What is neoliberalism?

A major aim of capitalism is that businesses can easily compete in (increasingly global) markets. This allows them to accumulate wealth, re-invest profits and fuel economic growth. But capitalism distributes profits unequally, with business owners receiving significantly larger shares than employees. In recent history, this inequality was often moderated by government policies that redistributed wealth (e.g. through taxation). Along with this, where competition was seen to matter less than consistency and universal provision, governments provided or mandated services and infrastructure: in the UK this included aspects of social care, transport, sanitation, water and health services. This was the so-called ‘welfare state’.

But under neoliberalism the role of government is minimised: its primary responsibility is to ensure the operation of businesses and markets. Indeed, businesses and markets now supply the core principles on which society is organised. Competition, cost efficiency, privatisation, flexibility and entrepreneurship are promoted as good for both people and society, as well as for the economy.

Neoliberalism rejects the idea of ‘jobs for life’. Instead, workers should be continuously mobile, flexible and entrepreneurial, always developing and marketing skills, always looking for opportunities. Jobs have become more insecure as employment rights have been eroded, employers introduce short-term or zero-hours contracts, and access to employment tribunals has become more costly. Simultaneously, financial support for those unable to work has been both cut in real terms and made more conditional upon ‘job seeking’. Together, all of these changes have had significant impacts on society, communities and individuals.

Society

Neoliberalism has led to many state-owned assets—public transport, utilities (water, electricity and gas), and parts of the UK’s NHS—being privatised. Elsewhere, faux markets foster competition by imposing targets, ‘key performance indicators’, league tables and rankings. The gap between rich and poor has widened, poverty has increased, and social mobility has declined. Wages are especially poor in sectors like nursing and social work that involve caring. Low wages mean that both parents increasingly need to work, so family and community life suffer. Childrearing often occurs within isolated nuclear families, with little support from relatives. Overall, research shows that most people are poorer, unhappier, lonelier and less healthy.

Communities

Competition, deregulation and privatization, together with longer working hours and increased job mobility, all impact negatively upon community cohesion. Engagement with local groups and voluntary organisations such as churches, youth clubs, community centres and trades unions, which used to ameliorate some of neoliberalism’s adverse effects, is reduced. Some communities have become ghettos of poverty and exclusion where streets are unsafe, amenities run down or absent, and opportunities scarce.

Individuals

Neoliberalism promotes individual freedom, autonomy, choice, self-sufficiency and responsibility as its core values. But these important attributes need to be weighed and contextualised against others, to avoid erroneously positioning people as fundamentally competitive and self-reliant, at the expense of interdependency, connectedness and cooperation. The competitive individualism of neoliberalism creates ‘status anxiety’, where we constantly monitor the perceived success of others, vigilant for any sign that we are falling behind. This widespread insecurity is frequently identified as a key driver of the poor mental health that accompanies neoliberalism (see, for example, here, here, here and here).

Neoliberal policies have massively increased income inequality everywhere they have been introduced. In the USA, since the 1980s, the annual incomes of all except the wealthiest have nearly stagnated in real terms. Similar trends are apparent across the global north.

None of this is surprising. Critics warned from the outset that neoliberal promises of ‘trickle down economics’ (where everyone benefits from increased wealth) were hollow. And there is good evidence that, if taken to extremes, consumerist and materialist values make people less happy. Yet neoliberalism continues to promote what has been called the project of the ‘perfectible individual’: more possessions, a bigger house, a fitter or slimmer body: an endless race where almost all feel left behind.

Consequently we are all, now, in a highly vulnerable state. Rising rates of significant distress reflect very real increases in experiences of isolation, identity confusion, failure, insecurity, discontent and despair which affect even the wealthiest and most privileged. These states of mind are ripe for exploitation by industries including psychiatry, psychology and therapy, which claim to offer both explanations and solutions. While the suffering caused by neoliberalism is all too real, these apparent explanations obscure the social and material roots of distress, mystify us about its causes, and promote primarily individual solutions to collective problems.

In what follows, the exponential increases in diagnoses of ADHD and ASD that have occurred over recent decades will be of particular interest, since they are unlikely to be attributable solely to the loosening of diagnostic criteria in DSM-IV (see Part 1). We will suggest that, once we look beyond both the brain and the DSM to identify possible reasons for these increases, the influence of neoliberalism becomes inescapable.

However, we are not proposing a single, simple explanation for these diagnostic trends. Despite the lack of evidence for neural or genetic causal factors in ADHD and ASD, individual temperamental differences certainly exist. In recent years technology and smartphones have significantly shaped our ability to focus especially for ‘Generation Z’, whilst Covid lockdowns adversely affected young people’s social development. Diet, environmental pollutants and many other factors may also contribute. Here, though, our main focus is on the broader economic, social and material circumstances of neoliberalism, under which the spectacular increases in diagnoses of ADHD and ASD have occurred.

Attention Deficit Hyperactivity Disorder: ADHD

The diagnostic category of ADHD has been extensively critiqued, on Mad in America and its affiliate sites, by child psychiatrist Dr. Sami Timimi; in numerous articles summarised on the site (for example by Peter Simons), in the academic research literature, and in commentaries by eminent psychiatrists. We refer readers to those sources for more detailed discussions.

Attention Deficit Disorder (the earlier version of ADHD) first appeared in DSM-III in 1980, then was revised to become ADHD in 1987’s DSM-IV. The meteoric rise in numbers of children so diagnosed—currently one in 10 in the US; about one in 30 in the UK—seems to have first become apparent in the late 1980s. The concept of ‘Adult ADHD’ is even more recent, although there are signs that it will also proliferate widely. This trend has been boosted by the completely unfounded claim that drugs such as Ritalin correct a chemical imbalance in the brain. The global ADHD market is projected to be worth US$18.69 billion by 2030.

The same lack of reliability, validity and scientific credibility applies to this diagnosis as to psychiatric diagnoses in general. In a detailed overview, Sami Timimi concludes that, although there certainly are children (and adults) who are unsettled, restless, impulsive and easily distracted (traits which may affect their relationships, education or employment) there has been ‘a failure to find any specific and/or characteristic biological abnormality’ to confirm the validity of the term ‘ADHD’.

Carefully worded acknowledgements of this failure are not uncommon in the research literature—even though, as in this example, they are typically gilded with reassurances of progress and predictions of imminent success:

‘Overall, this body of research represents a solid research base for the development of biomarker approaches and for the future allocation of patients to existing and novel pharmacological and non-pharmacological treatments based on their individual behavioral and neurobiological profiles … Nevertheless, despite this considerable progress, the available literature does not yet provide sufficiently strong evidence for actionable treatment biomarkers for ADHD in clinical settings’

Or, putting this in plain English, no ADHD biomarkers have so far been found. There is no known biological basis for ADHD, no evidence that some people have ‘ADHD brains that crave dopamine and struggle with attention regulation’, and no objective evidence of a ‘neurodevelopmental disorder’ that causes the difficulties which can attract this diagnosis—troubling though they may be.

DSM-5 nevertheless describes the behaviours grouped under the ADHD label as a neurodevelopmental disorder. This view is almost universally held, and repeated uncritically in the media; for example, a recent feature in a UK national newspaper described ADHD and other diagnoses as ‘neurodevelopmental conditions: consequences of how the brain forms in the womb or early childhood’.

Despite claims of a significant genetic component in ADHD there is no convincing evidence for this. Between 1989 (two years after ADHD was first described) and 2000, diagnoses increased by 381%. Similarly, ADHD-related drug prescribing in the UK was 34 times higher in 2013 than in 1995. These massive and sustained rises undermine claims that ADHD’s basis is genetic, because genes in our species simply cannot spread and mutate that quickly.

Similar arguments can be made in relation to Adult ADHD. In fact, the very concept of ADHD in adults has recently been challenged by two senior US mental health professionals They note that only 20 years ago ADHD was not thought to persist beyond childhood, and argue that this change:

‘fully coincides with marketing by the pharmaceutical industry when Eli Lilly and Company got the first US Food and Drug Administration indication for this label with atomoxetine (Strattera) in 1996. Since that date, the adult ADHD market has become a multibillion-dollar industry, with the rise of digital companies specializing in online diagnosis and treatment—some of which have come under legal scrutiny’.

So, while it is true that ‘adult human beings can exhibit problems with attention, concentration, focus, memory, and related abilities’, they conclude that ‘adult ADHD is not a scientifically valid diagnosis.’

This leaves us with the circular argument common to all psychiatric diagnoses (with a few exceptions such as dementia):

‘Why is my child so fidgety and restless?’, ‘Because he has ADHD’; ‘How do you know he has ADHD?’, ‘Because he is so fidgety and restless’.

Autistic Spectrum Disorder: ASD

Like ADHD, this diagnosis has also been subject to extensive critical examination (see here for example). Part 1 of this blog series described how the original, much narrower DSM criteria for autism applied only to people with severe, lifelong intellectual impairments. This presentation does seem to fit the description of a neurodevelopmental disorder of some kind (although confirmatory medical tests are currently lacking). In DSM-5 and ICD-11, this group was merged with ‘Asperger’s’ or ‘high-functioning’ presentations, which are now considered as opposite ends of a spectrum known as Autistic Spectrum Disorder or ASD.

Our arguments here do not apply to those at the severe end of this spectrum, who are disabled by any standards. Rather, we are concerned with the growing numbers of people without any obvious signs of neurodevelopmental problems (e.g. intellectual impairment, epilepsy, delayed milestones such as late expressive language) who nevertheless report more subtle difficulties in communication and socialising, perhaps along with a narrow range of intense interests, and difficulties reading social cues or coping with change.

At this end of the spectrum there is resistance to diagnosis based on stereotyped views of ASD, such as the assumption of lack of empathy; hence the phrase ‘If you’ve met one person with autism, you’ve met one person with autism’. This is fair enough; but a group in which no member necessarily has anything in common with any of the others is, by definition, not a coherent category.

Meanwhile, like ADHD, ASD has massively proliferated under neoliberalism, and as Part 3 of this series will illustrate, has become a highly profitable enterprise. We already know about the many vested financial interests in the development of DSM, and the enormous sales of psychiatric medications that generate huge profits for the pharmaceutical industry. However, similar critiques of the ADHD and ASD industries are less common. In fact, as we will discuss below, these diagnoses are often seen as liberating and empowering.

Why ADHD and ASD?

ADHD and ASD are not the only psychiatric diagnoses to have significantly increased under neoliberalism. For example, a systematic review and meta-analysis of 26 studies published since 1990 showed that the majority (19) revealed positive correlations between rising inequality and depression-related diagnoses, with the average increased risk of acquiring one of these diagnoses being about 19%. However, the rise in ADHD and ASD diagnoses is distinctive in at least three ways.

First, both the magnitude of the increases, and the rate at which they have occurred, is largely without precedent. One USA study estimated that by 2016 the prevalence of ASD diagnoses was 1:40—compared to around 1:10,000 in the 1950s. Similarly, USA population surveys show that ADHD diagnoses rose from 6.1% in 1997 to 10.2% in 2016. So at least 5.3 million children in the USA now have this diagnosis—as do growing numbers of adults. Increased awareness and looser diagnostic criteria alone cannot plausibly account for these very dramatic trends.

Second, the connection between misery and increased inequality is not only well evidenced (for example, see here, here and here) it is also common sense. As social inequality rises, diagnoses such as depression do so in tandem, for obvious reasons: impoverishment makes people miserable. But the connections between rising inequality and the experiences associated with diagnoses of ASD and ADHD are less obvious.

The third distinctive feature is that, unlike most psychiatric diagnoses, these two are increasingly sought out and desired. This unusual phenomenon will be discussed in more detail below (under ‘Reactions to Receiving a Diagnosis’).

Despite these three differences, we will now argue that the rising incidence of ASD and ADHD diagnoses can be understood in relation to the material effects of neoliberal policies. We will illustrate this for each diagnosis in turn, starting with ADHD.

Importantly, however, we are not claiming that all instances of ASD and ADHD are outcomes of the particular influences we identify. There are many ways of identifying/being identified as having ADHD or ASD, along with myriad biographical trajectories that might constitute them. So rather than account for every instance of these two diagnoses, we are identifying certain causal influences upon them which have become more prevalent and powerful in the neoliberal era.

ADHD

Child psychiatrist Dr. Sami Timimi identifies three kinds of material influence upon childrearing, parenting and schooling that have changed significantly over the neoliberal era, and which are, directly or indirectly, relevant to ADHD diagnoses. The list of influences is not comprehensive, and focuses primarily on those within or socially ‘close’ to children and families.

First, parenting: many more families with both parents working; parents working longer hours; more ‘hands off’ parenting. Second, schools and education: tightly regulated, exam-focused curricula; increased testing; more self-directed learning; budget cuts; fewer opportunities for imaginative play. And third, broader social changes in: diet (more sugar and fast food); media (smartphones, social media; 24/7 TV, more channels, shorter programmes with more advertising breaks); and play (less outdoor, more online).

As a direct consequence of all these changes, impacting in different combinations and to varying degrees from one child to the next, we have produced proportionately more children with shorter attention spans and less ability to concentrate. We also have a cohort of parents significantly more likely to be ground down by work and financial worries and so, understandably enough, less able to nurture their children’s restless inquisitiveness. Simultaneously, we have created education systems where children with these characteristics are far more likely to stand out as problems—rather than, say, as quick-thinking, creative individuals who pose interesting if unusual questions.

These changes interact with other, more general and enduring causal influences upon the experiences associated with ADHD and other diagnoses, such as childhood abuse and neglect, socioeconomic disadvantage and changes in employment levels. Many of these pressures also apply to adults; Johann Hari has described the relentless distractions purposely created by powerful technologies which have systematically eroded our ability to concentrate and pay attention.

Together, these changes have contributed to a massive increase in ADHD diagnoses. These diagnoses reframe the psychological and behavioural consequences of combinations of the kinds of interacting factors described above as ‘symptoms’ of a supposedly neurodevelopmental psychiatric condition.

In this way ADHD diagnoses (like other psychiatric diagnoses) both medicalise and individualise a specific constellation of behaviours and characteristics that may become problematic in particular contexts. This obscures how, in all probability, these psychological phenomena are very largely the consequence of particular conjunctions of societal factors such as those described. As critic Bruce Cohen puts it:

‘The expansion of ADHD from a rare disorder to a popular disease among young people over the past 35 years can be understood as a result of capitalism’s need to enforce discipline, compliance, and authority on the future workforce at a younger age’.

ASD

Turning now to ASD, here too we can identify significant changes in social and material circumstances that could have propelled the startling recent rise in diagnoses. As with ADHD, the set of influences we discuss is illustrative rather than comprehensive. In this case they are associated more directly with work than education, although versions of them permeate schools and universities too (since education is preparation for employment). Two overlapping, neoliberally-driven changes in work and employment of particular relevance to ASD are: requirements for flexibility and adaptability, and emotional labour. As we will show, there are implications for our lives outside work as well—perhaps particularly for women, who are now said to be ‘underdiagnosed’ in relation to ASD.

Flexibility and Adaptability

Recall that under neoliberalism, employment is often short term and precarious as well as poorly paid. No longer able to anticipate a secure career, workers in many sectors increasingly understand that they are expected to be flexible, adaptable, pro-actively responsive to, and accommodating of, employers’ changing needs.

Perfectly reasonably, however, many people prefer their work to follow fairly predictable patterns, and feel unsettled if their schedule is altered. Most office workers prefer the ease, consistency and predictability of a designated desk, rather than the additional disruption that ‘hot desking’ generates. Similarly, many call-centre workers dislike being transferred from one ‘team’ to another: they would rather work alongside familiar people. Indeed, whatever their work environment, many people prefer their duties and hours to be characterised more by stability, continuity and routine than instability, unpredictability and constant change. Moreover, preferences for stability and continuity at work may be strengthened if—as increasingly occurs under neoliberalism—other aspects of life are uncertain and insecure.

Clearly, there is potential for conflict here. When workplace conflict occurs, the power imbalance between employers and employees means that it often gets ‘resolved’ by locating the problem within the worker. An employer’s unreasonable demand for flexibility, for example, might get framed as a worker’s irrational or abnormal needs for predictability, stability and continuity. These needs are then ripe for interpretation as precisely those symptoms stereotypically associated with an ASD diagnosis.

We are NOT stereotypically arguing that people with an ASD diagnosis always prefer predictability and routine. We are arguing that because neoliberal workplace dynamics undermine those aspects of employment, people who find it particularly hard to comply are likely to be stereotyped as having deficits in that area. This then shapes the criteria which are said to be features of ASD. It is not a coincidence that mentions of work as an aspect of DSM criteria have increased from 10 in DSM 1 to 385 in the most recent edition, DSM-5.

A recent article in the UK newspaper Financial Times reported that, in 2023, there were 278 UK employment tribunals for disability discrimination that mentioned autism, ADHD, dyspraxia or dyslexia—compared to just 3 in 2016. Also, growing numbers of people at workplace ‘performance management reviews’ are allegedly mentioning these conditions for the first time. The article featured interviews with employment lawyers, with diversity and inclusion managers at major companies, and with consultancy firms such as ‘Neurobox’ and ‘Genius Within’ who supply ‘neurodiversity workplace support’ to organisations including Microsoft and KPMG. The understandable need of employees for the protection offered by a diagnosis is fuelling the apparent increased prevalence in ASD—while individualising challenges to employment conditions that are, in fact, unreasonable for everyone.

Emotional Labour

In the global North the balance of economic activity since the 1980s has been shifted away from production and manufacturing and toward providing services: retail, hospitality, consultancy, and so on. At the same time, neoliberalism’s preference for an insecure workforce encourages individuals to market themselves as products or personal brands within the labour market. As a result, the requirement to display a certain type of outgoing social persona has proliferated. ‘It is no longer enough just to shift a product, one must now do it with a smile, with “sincerity”, with a friendly touch’ as one critic puts it.

Workers today are routinely expected to have good ‘social and communication skills’: to competently ‘read’ the emotions and intentions of others and respond appropriately—that is, in timely and commercially profitable ways. This in itself is work, and sociologist Arlie Hochschild called it emotional labour.

These skills are increasingly a requirement of employment in general (as the ‘person specification’ of almost any contemporary job description illustrates). But people have different dispositions or characters, so emotional labour does not come easily to everyone. In previous decades it was more permissible to be what was then called geeky, awkward, eccentric, unsociable, shy, or simply introverted, and easier to find a job where these qualities were not problematic. But in the contemporary workplace these qualities must often be concealed—ideally by what Hochschild called ‘deep acting’, where the performance comes to feel like an authentic expression of the self. Inevitably, though, many are ‘surface acting’.

As female readers will probably have been thinking for some minutes already, emotional labour also permeates everyday life, where it is usually called emotion work. This work is disproportionately and stereotypically expected to be the (unpaid, undervalued) responsibility of women. Clearly, for those women we might describe as reserved or introverted, this expectation will be particularly difficult to meet. As a result, it is likely to be associated with frequent, frantic and (sometimes) failed attempts to cover up, fit in and perform.

These efforts are so widely recognised that in neurodivergent circles they have a name: masking. In fact, learning to comply with social norms and manage our own behaviour and responses is a universal developmental task. To an extent, we all play roles in social situations. More importantly, use of the term ‘masking’ as if it was something unique to the neurodivergent context obscures the fact that under neoliberalism everyone is encouraged to mask—often to an extreme degree. For example, the practice of personal branding encourages workers in general to mask, to perform, to pretend. Research has shown that materialist values are themselves associated with statements such as ‘I often feel like I have to perform for others’ and ‘In order to relate to others, I have to put on a mask’.

The predictable result is that, with rare exceptions, no one feels good enough. No one feels clever enough, attractive enough, slim and healthy enough, successful enough or happy enough. There is widespread and genuine anguish here, since everyone else seems to ‘fit in’ better than us, and yet, behind all the masks, no one feels accepted and OK as they are. Once again, a shared difficulty caused by powerful ideological demands is individualised into the symptom of a ‘disorder’.

It is perhaps unsurprising, then, that diagnoses of ASD have increased exponentially in the years during which neoliberalism was first implemented at scale: see here, here, and here. This has impacted everyone, but has particularly affected those who, due to their dispositions, to the developmental influence of family and other environments, all of these organised largely in accord with dominant gender role expectations—find the performance of ‘social skills’, and the presentation of a certain kind of persona, more challenging.

ADHD, ASD and Women

The diagnosis of ASD has historically been associated with men and the extreme male brain theory. This sex ratio is now changing and instead we see numerous claims that girls and women are ‘underdiagnosed’ due to their exceptional ‘masking’ skills. And many girls and women are accepting, and indeed celebrating, this short cut to self-acceptance.

In a related development, Adult ADHD—that previously unknown condition—has become particularly popular as a way of offering redemption and salvation for middle-aged women. Many are deciding that their struggles to balance life in their 40s are not attributable to unrealistic societal expectations, or to experiences of sexual violence and discrimination, but to having undiagnosed ADHD. The reactions are described in similar language to a conversion experience; a life-affirming transformation, after which everything was different and they understood their true self. Having been ‘scarred by victimisation, from bullying to rape’ they were reborn so that now ‘I’m finally living as an authentic version of myself, and it’s indescribably empowering. I am free’. We can only hope they don’t end up with an autistic husband who ‘find(s) household chores such as washing and cleaning more overwhelming than the average person’—an excuse that is frequently being reported on women’s advice websites.

Until very recently, we might have drawn on a feminist analysis to understand why girls and women are disproportionately impacted by pressures to fit in, to look, dress and behave in a certain way, to undertake emotion work, and to conceal their real selves behind a veneer of compliance and positivity. Now, however, an attribution or self-identification of autism may be the chosen understanding.

An analysis of research into women’s experiences of the identity of autism challenges the idea that gender equality will be advanced by greater recognition of the ‘disorder’ in females. Instead, a prominent theme emerged of gender non-conformity being reframed as autism, for example: ‘Girls are sort of bothered about what they’re wearing and what their hair looks like […] it’s not actually possible for me to be less interested’. At the same time, the need to ‘mask’ evoked the typical gendered expectations faced by all women: ‘I’m going to have to make sure that I’m always perfect for everyone’.

Another theme in this research framed autistic young women as uniquely vulnerable to abuse, due to their difficulty in reading social cues: ‘We don’t sense danger and can’t… I think you not reading people to be able to tell if they’re being creepy, you’re that desperate for friends and relationships that if someone is showing an interest in you, you kind of go with it’. In these accounts, as the authors note, the role of the perpetrators in carrying out the abusive acts had vanished.

Researcher Ginny Russell came to similar conclusions in her exploration of women identifying as autistic. These were mainly high-achieving women in their middle years who had never felt able to accommodate themselves to gender norms:

‘Little girls and bigger girls are supposed to chatter and giggle and gossip and share secrets and have best friends and so on … I didn’t do that. My wiring (the neurological configuration of crucial parts of my brain) didn’t let me’.

Within their painful accounts of victimisation and ‘not fitting in’, an identity or diagnosis of autism offered these women a sense of relief, self-acceptance and inclusion. However, this may come at a cost: ‘While autism as an identity may offer community and freedom from normative expectations, dominant autism discourses act to restrict and police gender, reinforcing existing power hierarchies.’

These are very familiar themes to any critic of psychiatric categories. A whole list of diagnoses disproportionately applied to women—hysteria, borderline personality disorder and so on—has served to reinforce gender stereotypes and to punish and pathologise women who do not adhere to them. Identity politics, fuelled by market expansion, has given us a new twist on this; women have been persuaded to seek out these labels themselves. But their relief comes at the expense of individualising the ongoing struggle to ‘widen the ways all women (indeed, all people) are allowed or expected to behave.’

ADHD, ASD and Social Media

We now turn to the role of social media in magnifying the neoliberal influences discussed above.

Not everyone given an ASD diagnosis can use a computer or smartphone. Those for whom the diagnosis is accompanied by severe intellectual impairments may be unable to speak or read, let alone access social media. Inevitably, then, under this heading we are talking only about people sometimes described as ‘high-functioning’, with lower support needs, and/or the ability to ‘mask’ successfully most of the time. For this group, social media may provide a more controllable environment for interactions both with similar others and with people described as neurotypical, due to a reduction in emotional, social and time pressure and the possibility of anonymity. Online ASD communities can also facilitate significant mutual support, and the same is true for people given a diagnosis of ADHD.

Less positively, social media have intensified and proliferated our exposure to status-relevant messages. Not only might these messages endure almost indefinitely, in archives or screengrabs, they relentlessly assail us 24/7. Together, these two factors make it difficult to avoid the continuous potential for negative social comparisons that social media creates. In fact, social psychologist Jonathan Haidt argues that the mental health crisis in Generation Z (roughly those born in the mid-1990s to the early 2010s) is largely attributable to the destruction of their childhood and adolescence by the introduction of smartphones. This conclusion both overstates social media influence and downplays the material effects of neoliberalism. Nevertheless, as Haidt observes, young people on average now spend 10 hours per day online, so opportunities for negative comparisons, bullying and so on are rife. Time for real world interactions, and experiences that might supply other perspectives and build confidence, is correspondingly reduced.

Social media also promote the belief that a range of difficult feelings and experiences can be attributed to ADHD or ASD. This belief has spread extraordinarily rapidly, and is contributing to their rising prevalence. Camille Williams, writing in the online magazine ADDitude, warns:

‘#ADHD videos on TikTok have now received 2.4 billion views. These short, viral clips are spreading ADHD awareness, building community, and destigmatizing mental health. They are also perpetuating stereotypes, ignoring comorbidities, and encouraging self-diagnosis’.

Williams describes how one video on ADHD generated more than 22 million ‘likes’ and more than 33,000 comments, including many along the lines of: ‘Watching this made me think I might have ADHD’; ‘All of a sudden I think I need to get checked’, and ‘Do I call up my doctors or what?’

Information websites about ADHD or ASD typically urge viewers to contact a professional to get a ‘proper’ diagnosis, and meanwhile to complete one of the numerous online self-assessments. Sites are careful to say that the results do not confirm the presence of a disorder. Nevertheless, it is almost impossible not to end up with a recommendation to contact a clinic for further investigation—with links helpfully provided.

No wonder therapists are reporting that: ‘More and more clients, primarily teenagers, are coming in and reporting that they have depression, bipolar, anxiety, ADHD, personality disorders based on a TikTok that reviewed symptoms of the disorder, or someone who shared their “day in the life” story’. Social media, especially TikTok, have been described as a potential ‘incubator’ for self-diagnosis, not just of ASD and ADHD, but of both neurological tics and Tourette’s Syndrome.

No wonder, too, that the internet is full of homemade videos about ‘My ADHD day’, in which someone rushes from task to task, never managing to complete one before being distracted by the next. And no wonder that, faced with the accelerated pace of life under neoliberalism, the increased demands, the widespread insecurity, the growing inequality, entrenched precarity and the utterly relentless, non-stop flows of information—all of these against a backdrop of economic stagnation, failing public services, falling life expectancy, climate crisis and environmental degradation—no wonder people turn gratefully to these videos, which promise to explain and excuse the all-encompassing anxious distraction that frequently dominates their lives.

The videos are posted as personal illustrations of ADHD ‘symptoms’, but can equally be seen as horrifying parodies, in miniature, of the operation of a whole society, an entire material culture. Neoliberalism is training us all to develop so-called ‘ADHD brains’. Huge commercial interests underpin the 24/7 technoculture of news, social media, work imperatives, and—of course—consumer opportunities. And driving, sustaining and feeding off all this is an entirely new and highly lucrative economic sector, one that trades in and profits from behavioural rather than financial futures.

Central to capitalism generally, including its neoliberal mode, is ‘commodification’. This term describes the way that almost anything can be extracted, plundered, packaged, marketed and sold back to us, including through social media. But commodities are not only physical or material. In his 2009 book ‘Capitalist Realism’, the late Mark Fisher wrote that ADHD is ‘a pathology of late capitalism—a consequence of being wired into the entertainment control circuits of hypermediated consumer culture’.

By disrupting our links to extended family, community and place, and eroding our sense of connection and security, neoliberalism leaves us highly vulnerable, uneasy and confused about who we are or should be. This intolerable state makes us open to being sold new identities, as well as new possessions: especially identities that promise to relieve, or even just explain, our overwhelming feelings of failure, shame and exclusion. Our unhappiness is ripe for exploitation by the very system that caused it. Neoliberalism contributes to distress, commodifies it, and sells us back the claimed solutions. Gen Z blogger Freya India puts it like this:

‘Everywhere I look it seems like someone is selling me my authentic self. Through cosmetic surgeries, through therapy, after downloading this app, I can discover who I really am. It’s reached the point where I feel like that’s what being young is now. Coming of age isn’t about fulfilling duties or responsibilities or milestones, it’s a search for one thing: finding your true self. Or, more accurately, buying it… But that sort of marketing speaks to us because so many of us have lost touch with our true selves… Gen Z is trapped in this constant struggle between curating an artificial self online and then grappling to rediscover an authentic one offline’.

This is what Dr. Sami Timimi means when he says ‘we have brands not diagnoses’. These brands essentially work in the same way as any other. First, the brand must be named—‘depression’, or ‘social anxiety’, or whatever—because ‘it is the moment when it becomes a “thing” that it becomes consumable and, therefore, open to commodification’.

Markets, such as those for drugs, therapies, books, clinics, training courses and research institutes, then develop around these brands. People are persuaded that they need these products. And when one brand (or diagnosis) fails to deliver answers or provide relief, falls out of favour or becomes less profitable, another fills the gap. Today, what is effectively social media viral marketing is integral to this process.

We will now explain how this perspective may help explain the enormous relief often reported from receiving a diagnosis of ADHD or ASD.

Reactions to acquiring ADHD/ASD diagnoses

In Part 1 of this series of blogs, we noted a paradox. The neurodiversity paradigm proposes that the experiences and behaviours said to be characteristic of ADHD or ASD are ones that fall outside of current social norms. Yet at the same time, they are often said to indicate an enduring neurological condition that requires better access to diagnosis. Moreover, while few people welcome diagnoses such as personality disorder or schizophrenia, this is much less true of autism and ADHD diagnoses. In fact, a frequent reaction is relief and gratitude:

‘Everything fell into place. I wasn’t crap because I found VAT returns painful, blurted out stuff and was messy. I wasn’t crap at all. I have a neuro difference, which gives me many advantages (Woman, 44)’.

‘I cried. It was wonderful. Wonderful. Because all my life suddenly made sense. And none of it—the beatings, the abuse—none of it was my fault. Apart from my family and Sandra, I’d put it in the top five greatest things that have happened in my life. Absolutely, incredibly wonderful (Man, 52)’.

‘I think a large part of my journey has been to accept myself the way I am and to stop trying desperately to “fit in”. I am who I am, I’m autistic and proud, I’m different, and for the first time in my life, I’m okay with that (Woman, 27)’.

Psychologist Mary Boyle refers to this phenomenon as the ‘brain or blame’ dilemma; the false binary that either ‘You have an illness, and therefore your distress is real and no one is to blame for it’ or ‘Your difficulties are imaginary and/or your or someone else’s fault, and you are abnormal, flawed, weak and a failure’. Given these polarised positions, it is not surprising that so many people opt for the ‘brain’ version. For them, the diagnosis comes to represent an escape from overwhelming feelings of despair, difference, exclusion, shame, guilt and failure, replacing them with a sense of acceptance as you join your new ‘tribe’.

These important benefits must be acknowledged. At the same time, we might ask why we are so bad at finding a middle ground which can recognise pain without locating its causes within the individual. We also need to ask why so many people, perhaps more than ever, have a deep sense of being ‘crap’—mad, lazy, or ‘just making a fuss’ about their very real struggles, while feeling personally responsible for the awful things that have happened to them.

In 2017 a leading ADHD campaigner, the American actress Jessica McCabe, gave a heart-rending TED talk which described people trying desperately to succeed ‘in a society that wasn’t built for them’. McCabe herself spent ‘years trying to be normal—to fit in’, only to conclude that she was ‘a failed version of normal… I thought I was what needed to change to be successful’. Indeed, the title of her talk is ‘Failing at normal’. But her solution does not involve questioning accepted notions of ‘fitting in’, ‘normal’ or ‘successful’. Rather, she found her way forward through a diagnosis of ADHD (which she presents, wrongly, as a known deficit in brain functioning that can be corrected by drugs). In her words: ‘I wasn’t alone… I had an ADHD tribe. Welcome to the tribe’.

And here is another very typical account, this time about ASD:

‘I can say from my own experience that the social pressure of growing up can be a toxic environment for us autists as we are forced to conform to the norms or stand out and risk bullying and trauma. With hindsight, the next warning sign that I was autistic was my first experience of university, at a place I’d like to forget, to study English literature. I arrived with a car-full of books, and was shocked at the person who parked next to us unloading crates of alcohol. I struggled immensely with the social side of university including the loud bars and clubs, which assaulted my senses and left my ears ringing for days afterwards. I left after two terms…’

‘[After being assaulted in the street.] Eventually, I had an appointment with a top psychiatrist in Oxfordshire. I spent three hours with him talking in depth about my life, my mental health and my feelings of being different. After this mammoth session, he turned to me and said: ‘Louise, I believe that you are autistic’. He informed me that female autism is more difficult to detect because we tend to be better at ‘camouflaging’ our social difficulties. At the same time, he explained how the pressure of relentlessly trying to fit in can have an understandable toll on our mental health. Receiving this diagnosis was a huge relief. Finally, someone was sure about something—to an extent, I didn’t care what it was, I just wanted an answer. Now I had an explanation for why I had always felt different (Woman, 27)’.

One of us (LJ) readily sympathises with this young woman, who was so much more comfortable in a library than a nightclub, who didn’t drink, hated noisy bars, and struggled to play the social game when others seemed totally at ease; it precisely describes her at the same age. The dilemma of being ‘forced to conform to the norms or stand out and risk bullying and trauma’ is an excruciating one. One response, which the narrator clearly found helpful, is to offer her a label of autism. But surely another is to question the norms she was expected, by others and by herself, to conform to.

There are plenty of similar descriptions of ‘not fitting in’. Indeed, this experience is commonly cited as being a sign of ASD. A checklist on how to identify autism in girls, based on a number of key sources, includes:

• Feels trapped between wanting to be herself and wanting to fit in
• Rejects social norms and/or questions social norms
• Questions if she is a ‘normal’ person
• Longs to be seen, heard, and understood.

No one can survive without their tribe. To feel that you belong is an absolutely fundamental human need. But the pseudo-explanations of ADHD or ASD actually prevent us from identifying the roots of the problem in fragmented social structures and unrealistic demands and expectations. Rather, we are directed towards the rapidly expanding ADHD and ASD industries, which offer drugs, therapies, clinics, self-help books and the like, to help us ‘fit in’ better. But this distracts from the key question: How and why have we created a society in which almost no one feels they ‘fit in’?

Linking all this to neurodiversity

The preceding analysis helps us understand the material contexts and ideological drivers for the enormous rise in the diagnoses of ADHD and ASD. It suggests reasons why these particular labels have come to the fore, and makes some sense of both the relief that many people experience when diagnosed, and of the growing demand to make these diagnoses, and associated interventions, more widely available. At the same time it shows how poorly-evidenced claims, that these psychiatric diagnoses represent distinct neurological differences, tend only to distract from the complex interactions of political, sociological, psychological and biological processes that are actually responsible.

The analysis also offers powerful specific examples of the dangers of aspects of the neurodiversity paradigm. We can see the unintended but unfortunate effects of expansionism beyond the point at which any service can reasonably offer the expected forms of support, a trend unlimited by any kind of medical test to confirm or disconfirm the diagnosis, or to validate the claim that the behaviours in question can be attributed to some kind of neurodevelopmental disorder in the first place.

This is the worst of all worlds for the individuals concerned. While the neurodiversity movement celebrates difference, in practice the dominant message is that being ‘neurodivergent’ involves a cognitive deficit of some kind. But long waiting lists for assessment leave people in limbo, with only social media support groups to reinforce their hopes, anxieties and expectations. For many of these people, acquisition of a diagnostic label, or membership of a group described as ‘neurodiverse’, has increasingly come to seem desirable in the face of a profound feeling that they do not ‘fit in’—behaviourally, emotionally, socially, or educationally. And we do not judge anyone for this: it is a difficult world, and we all cope as best we can.

Yet a diagnostic label, or an identity of neurodivergent, is inevitably a mark of difference. It is as if we need permission to feel OK as we are, and yet self-acceptance only seems available through labels and identities that—in their everyday social meaning—pathologise us, mark us out as different from most others. The identity this creates may trap as much as it liberates. Moreover—a point that is sometimes seen as irrelevant in the era of consumer rights, choice and demands—professionals have an obligation to use concepts that are scientifically valid.

Why, then, does the political analysis inherent in the neurodiversity movement not see the risks of making diagnostic labels such as ADHD and ASD more widely available? Are they unconcerned about the ways in which these psychiatric diagnoses individualise people’s difficulties, obscuring the societal drivers of their distress? What happened to the feminist perspective? And how does their support for diagnosis fit with activists’ claims to be offering a radical new paradigm?

Some, following the arguments of UK critic Peter Sedgwick, defend diagnostic practice on the basis that these labels are essential to access services and welfare support. We have every sympathy with this situation, and no UK critic would refuse to endorse a diagnosis needed for such purposes. Yet we note that these labels are no guarantee of access to resources, and have not in any way mitigated the increasing brutality of the UK benefits system. Indeed, they are often used to exclude (e.g. on the basis that a service does not accept referrals for ‘personality disorder’), while in a competitive job market disclosing a diagnosis may appear to be a significant barrier to employment.

Our analysis suggests some deeper reasons why many are adopting—in good faith, and with the best of intentions—the language of neurodiversity even though the concept is unscientific, contradictory, and—we believe—ultimately harmful. What is more puzzling is why some neurodiversity activists have apparently been seduced by the neoliberal rhetoric of choice; by a view of citizens as consumers who have the right to demand particular responses from health providers, including their preferred label; and by a discourse which, no less than psychiatric diagnosis, individualises our very real distress and obscures its origins in social and material circumstances.

The recent shift from psychiatric diagnosis as unwelcome expert imposition of a stigmatising label, to desirable commodity and identity which is actively sought out by consumers, has been extraordinarily rapid. Whatever the original intentions of the movement’s founders, we see the neurodiversity paradigm as falling into exactly the same traps as the disorder-based one it claims to replace. Indeed, the core message of ‘difference not disorder’ appears in practice to mean the reverse.

Questions about identity go to the heart of who we are, or conceive ourselves to be, and because of this are intrinsically challenging. So we appreciate that discussions such as this one may stir up strong feelings, and perhaps even trigger a backlash. We have initiated the discussion anyway, because the issues it raises are far too important to ignore. As psychotherapist James Davies puts it, when ‘…diagnostic tribes come to replace political tribes… our suffering has been politically defused’.

The next two blogs in this series will illustrate in more detail how these contradictions and paradoxes play out with regard to other facets of the neurodiversity movement.

***

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