Neurodivergence as dead end in thinking about mental health

What's happened with neurodivergence is the inevitable result of reducing mental illness to brain disease. People now talk about having different kinds of brains, when actually it makes no sense to do so. Of course we all have different brains because we are all different people. That's mere tautology. But to be suggesting there are particular kinds of brain that define conditions such as ADHD and autism has not been proven, however much people may hope that the hypothesis will be shown to be the case. In fact, of course, brains are only part of people. It's people that have problems diagnosed as ADHD and autism, not their brains. Such conditions are not like dementia, for example, which does reflect damage to the brain. Patterns of behaviour need to have something in common and diagnoses of ADHD and autism have become so broad that it is difficult to specify exactly what the defining feature is of people with these diagnoses. Of course rating scales are completed to make the diagnoses but their validity still needs to be established and they were only really introduced as screening, not diagnostic, tools.

What worries me in particular is the way people take from a diagnosis the implication that they have a different kind of brain causing their problems. However tempting it may be to blame the brain, why we do things and act in certain ways may not always be very easy to explain, certainly in terms of the brain. People are purposive beings, not machines. It's important to try and understand the reasons for our behaviour, however difficult that might be. But because people are not machines there is an inevitable uncertainty about such reasons. The difficulty of living with such uncertainty is what encourages the search for more concrete explanations in the brain, even though they don't really make sense.

However much neurodivergence is a developmental condition, the problem was calling it 'neurodevelopmental' rather than merely 'developmental', tending to imply a neurological abnormality. No definite biomarkers have been established in research. The results are so inconsistent and confounded that it is not possible to stipulate any underlying difference or abnormality. Speculations about the biological basis of neurodiversity are not facts, even if they may be presented as such.

Even people like Uta Frith, who encouraged a shift to neurodevelopmental theories, now question whether such diagnoses are meaningful because they have become so broad in scope (see previous post). Biological understandings were encouraged to get away from what was considered to be inappropriate blaming of families (see eg. another previous post). It is obviously wrong and naive to simply blame families for causing nuerodivergence. But it is important to understand the familial context (see yet another previous post). When I first trained child psychiatry was focused on family therapy but this aspect has been undermined by the biologisation within psychiatry spreading to children (see eg. even yet previous post). Psychosocial theories can still provide understanding even if they do not provide one-to-one causal explanations.

There needs to be a shift back to psychological and social understandings of mental health problems and neurodivergence. Reducing people to their brains has resulted in a conceptual system that is not fit for purpose and in which people are being misled about their problems and personality.