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Mental health and the diagnostic process: A neurofuturist perspective

As I discussed in my recent article about co-occurring conditions, the diagnostic process in psychiatry is inherently flawed on the basis that we have failed to find any meaningful relationship between the so-called “symptoms” of psychiatric conditions, and physical biomarkers which can be measured. Despite this lack of physiological cause, we are still diagnosing people as mentally “ill”. Despite this model not improving outcomes for around half a century.

So now we are faced with the issue of how diagnosis is not just given, but also how it is given responsibly.

One of the biggest flaws of psychiatry is the circular logic that dominates the diagnostic process. A person is Schizophrenic because they have symptoms of Schizophrenia, and they have those symptoms because they are Schizophrenic. This logic does not allow for a nuanced understanding of why a person may experience this particular cluster of traits, it simply follows that A = B, which is because of A.

If this is the case, how does one escape from circular logic?

We have to look for causes for traits and “symptoms” outside of the realm of medicine. While I have often remarked that external factors are the only thing with a meaningful relationship to these experiences, medicine is yet to catch up. It seems reasonable to assume that traumatic experiences are the cause of psychiatric conditions and not a problem within the body. This has ramifications for the future of psychiatry.

If people are not “unwell”, psychiatry now has a moral duty to advocate for it’s patients. Psychiatry needs to evolve into a tool for social change, and cease to be a weapon wielded by normative society. Beyond this, psychiatry needs an understanding of the relationships between neurodivergence, trauma, and psychological distress. It is not enough for psychiatrists to bandage the wound, they need to remove the knife from the hand of society.

This requires us to radically rethink our entire perspective on normality and cultural normative standards. We can not just medicate people and expect them to assimilate into society. We need to help them understand their own unique space in the environment and how to embrace their journey through that space.

As I discuss in my book A Treatise on Chaos, identity is a shifting and ever changing value. We are, at our core, beings of chaos. Psychiatry needs to be a tool for supporting us in the more challenging parts of that chaos, and not serve as a ring-fence around the Self.

Psychiatry is not completely off the trail. Medication can serve as an important tool to support a person’s wellbeing, and can be very helpful for reducing the more troubling and distressing aspects of psychological distress. The most important thing is that we all put in the work to evolve psychiatry and mental health support into a means to challenge the oppressive systems that exist within our world.

It’s time to stop the navel-gazing, and build a better future.

Neuroqueer: Depathologising psychiatric “conditions”

This article was co-authored by David Gray-Hammond and Katie Munday

Trigger Warning: Ableism, pathology paradigm, sanism, use of words insane and madness, medication, therapy and trauma.

Neuroqueer theory evolved out of the neurodiversity paradigm. It was a logical progression in the field of depathologising natural variations in the human bodymind. This concept appreciates the neutrality of neurodivergence, as neither good or bad, it simply is.

While this concept has been widely explored in the area of intrinsic neurodivergence, (such as autism and ADHD), there is less discussion regarding acquired neurodivergence; neurodivergence that is typically acquired through trauma or the intentional alteration of ones bodymind (such as through the use of psychedelic drugs). Specifically, we wish to discuss the concept of psychiatric “conditions”.

Psychiatry itself is one of the youngest branches of medicine, first mentioned by name in the late 19th century. Due to its infancy the field still remains fallible, and is largely governed by the contents of a single textbook; the Diagnostic and Statistical Manual of Mental Disorders (DSM) currently on its fifth edition, and the recipient of a recent text-revision (DSM V-TR). Unsurprisingly, this textbook is based entirely in the pathology paradigm, with all bodyminds described in its pages as “disorders”.

The use of the word “disorder” is important. This word places a level of responsibility on the individual to return to a more “ordered” state, dictated by cultural norms. This has historically been achieved through the use of psychoactive drugs, which are often prescribed before the use of talking therapies.

Psychiatry has a place in the world, but currently relies too heavily on the use of medication, without understanding the context around individuals. This is why it is important for psychiatrists to take a more trauma-informed, neurodiversity-affirming approach. There is a balance to be found between the use of medication, and the introduction of talking therapies that encourage the individual to co-exist with the traits of their neurodivergence.

It is important to understand and work with people holistically to reduce their distress, as many of us are seeking support due to ongoing trauma.

We are living in a world that overwhelms our senses, ignores our social communication differences, and treats us as second class citizens. Autistic people are made to adapt to norms that are both uncomfortable and harmful, and this creates complex-trauma for an increasing number of us. Once we experience bullying, isolation, and neglect, our self-worth takes a nose-dive. Often we mask our Autistic differences for fear of ridicule, perpetuating the low self-esteem that arises from forced conformity and assimilation. This becomes a cycle of shame that encourages us to hide our true selves, in return for a semblance of dignity.

So where does neuroqueer theory fit into this?

Cultural expectations of mental health are based heavily in sanist ideas of “normal”, and define our understanding of “madness” as anything that departs from these expectations.

Taking a neuroqueer approach allows us to embrace our differences, whilst appreciating that many of us still need accommodations. This is why emerging talking therapies that teach co-existence (rather than interventions that aim to change us) are an important step forward.

Subverting the expectations of our societies predominant culture, we reclaim ourselves, and learn to co-exist with our “psychiatric” self. No longer are we “insane” by normative standards, but neurologically queer, and refusing to be ashamed of that.

Guide to starting new psychiatric medication for Autistic people

This article is not intended as medical advice, please speak to your prescriber for any medical questions pertaining to medication. This article is something of a survival guide based on my own experiences, other’s experiences may differ.

Recently I started a new medication on the advice of my psychiatrist. This is the event that has acted as somewhat of a catalyst for this article.

As Autistic people, we often find ourselves taking psychiatric medication for a plethora of reasons. However, our experience of these medications is (anecdotally) often vastly different to that of our non-Autistic peers.

This bring me to my first point. Many Autistic people report having rare or paradoxical reactions to medications. Paradoxical reactions usually involve the effect or side effect being the polar opposite of that which is expected. Commonly this is seen in ADHDers with stimulants, and is in fact what underpins their use in the support of those of that particular neurotype.

However, trying to get your doctor/prescriber to understand your paradoxical reaction when it is unexpected can be very difficult. You have to be prepared to advocate for yourself. If a side effect is intolerable, do not be afraid to speak to your medic.

Something else to consider is that many of us report being very sensitive to medications, especially during the initial titration period. I personally always ask my doctors to stick to the rule “start low and go slow”. I find it helps to avoid intolerable side effects during the titration period, and allows me to better evaluate when a medication is working, and what the minimum dose I need to see a result is.

Don’t be afraid to learn about medications, but before to include your prescriber in your learning. They are the expert on medications. That said, you are the expert on yourself, so always be prepared to advocate for yourself. When starting a new medication, I tend to familiarise myself with the most common side effects, and any warning signs that I am having a dangerous reaction to the medication. After that point I will only consult the side effects leaflet if something unexpected happens. I find that this helps reduce anxiety around medication changes.

You don’t want to spend the first two weeks of titration constantly assessing yourself for every side effect, it’s exhausting.

This bring me onto my final point, starting new medications can be taxing on your spoons. Try to start medications when you have the opportunity to do nice things for yourself. Look for opportunities to rest and recuperate those spoons that you have expended. This won’t be feasible for everyone, but please do your best.

As I mentioned at the beginning, this is based on my own experiences. Yours may differ, and if you have an insight that you feel I have missed, please do feel free to drop it in the comments. We all learn from each other.

Finally, remember; sometimes medication is necessary. It’s okay to need this accomodation, and the only two people whose opinions should matter in this debate are primarily your own, but also your prescriber.

Do not allow space for the med-shamers.

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