Psychiatric diagnoses & bioessentialism will not liberate us
Psychiatric diagnoses & bioessentialism will not liberate us
Letting go of my attachment to individual diagnostic labels is part of my decolonizing journey
“Dr. Khan, I love your work and your writings have been transformative! Do you identify as neurodivergent? If so, we’d love to have you do a workshop on…”
“Dr. Khan, we would love to have you come on the podcast and talk about the impact of capitalism on mental health, specifically on autistic people or ADHD-ers like you.”
These are samplings of emails I sometimes receive inviting me to talk about decolonizing medicine, neurodiversity, trauma or mental health. Often, these invitations are contingent on me identifying as neurodivergent, autistic, an ADHD-er, etc. However, my answer to the question “are you neurodivergent?” or anything along the lines is not a binary yes/no anymore. I don’t believe the neurodivergent/ neurotypical binary exists and struggle to answer these emails succinctly. It feels similar to an invitation to talk about intersectional feminism that asks if I’m a woman. Decolonizing to me (and to many of us) has involved questioning the whole premise & foundation of these identity labels and categories.
Psychiatric diagnoses have become increasingly prominent individual identity labels, particularly in the global north (aka western societies). There are movements (born in the global north) to reclaim and redefine these labels which understandably can be a source of empowerment for some. I also believe the long-term utility of diagnostic labels is limited by the oppressive premise and colonial foundation that they were built on… especially when they are used as “real” biological categories. Over the last few years, my relationship with psychiatric diagnoses (as a disabled person) has gone from “oh wow this is helpful in some ways” to “oh no this is colonialism and it needs to be dismantled” and I want to take time to explain the transformative steps in between that created this life-saving shift.
P.S. I rescheduled the February heal in community session for paid subscribers and you can still sign up for it with the link at the end of the newsletter!
Some clarifications off the bat
I am writing this from the perspective of communities in the global south who have always had alternative modalities to conceptualize human and planetary distress without pathologizing it. Our communities have been/ are being killed for our cultural traditions including medicine. Many of us in the diaspora are struggling to rediscover, reconnect with, practice, and preserve our traditions.
If terms under the umbrella of neurodivergence are important to you, then know that I’m not asking you to abandon them, nor am I framing them unilaterally as “bad”. I’m asking you to look beyond them, to be aware of how they can be leveraged for harm and to recognize that there are other ways for communities to make sense of their distress without these labels. I’m asking you to embrace complexity and create space for it. The rest of the world should not have to speak this precise language. The language of colonial psychiatry should never have been forced upon the global south and it shouldn’t be today, including any reclaimed version within the neurodiversity framework. Most importantly, if we’re attempting to abolish colonial/ capitalist systems while building collectivist systems of community care then I think everyone has a lot to learn from alternative frameworks created, nurtured & developed by communities who have always been fighting for the health of the planet.
I also urge you to be wary of biological essentialism that sounds like “I was born like this, I’ve always been like this, this is just how my brain works”. The concept of neurodiversity has been heavily co-opted in the global north, watered down, individualized, sanitized and DEPOLITICIZED. People often frame neurodivergence as atypical brain wiring which is the same biological essentialism that gave us race science. Many movements and spaces in the global north have a tendency to turn to bioessentialism (for gender/ sex and sexuality for example). Categories and labels like autism/ ADHD etc, whether they are reclaimed & redefined or not, are all social constructs, not biological realities with clear boundaries, definitions and measurable criteria. Usage of these terms as biological categories can be harmful and prevent revolutionary progress as we try to reimagine community care.
Aight, here we go…
The start
I received my first batch of psychiatric diagnoses when I was desperate for answers to make sense of the parts of myself that just didn’t “fit”. When I walked into the psychiatrists office and received multiple diagnoses, I initially felt relieved. I was looking for explanations to the ways I diverged from “normal” that didn’t necessarily seem related to oppression (or so I thought). I had come to understand the more obvious ways in which oppressive systems (colonialism/ capitalism, cisheteropatriarchy etc) impact our wellbeing. But I didn’t yet see how the rest of my more covert struggles were directly shaped by these systems. I’m expected to perform, excel, succeed, win, be positive, independent, strategic, cunning, self-motivated, self-driven, polite, articulate, productive, career-focused… and I struggled to meet these benchmarks seamlessly (my whole life and more so when I migrated to the US at 17). I was missing a lot of context that I would learn in the years after— because OF COURSE colonialism/ capitalism shape all of our struggles. In fact, there is nothing about me, my personality, behaviors, mannerisms, experiences and perception of the world that is insulated and shielded from my environment. It’s not just that we are shaped by nature, we are nature and everything is inseparable.
It was relieving at first to have some language and terminology (in English) to cleanly package the aberrations “in me” into distinct simple buckets with labels. I spent my life trying to conform & assimilate under these violent systems, bending over backwards to stay alive & not anger them. I “successfully” managed to conform in some ways. For example, I painfully tried to train myself to get rid of my Indian accent, “nonwestern” mannerisms and body language so I wouldn’t be even more otherrized than I already was the moment I stepped into a room. I mirrored people, relied on scripts (some would call this “masking”) and still couldn’t manage to rid myself of all traces of my communities.
I struggled with lots of other things: couldn’t focus in college classrooms for extended periods of time, the compulsive/ repetitive/ jittery shaking and tapping, the endless pacing, “excessively” animated hand motions while talking fast, or the more serious things like my chaotic disorganized lifestyle that simply couldn’t keep up with the demands of school, losing track of day-to-day life itself, overwhelmed by the simplest of tasks like cleaning while seamlessly tackling other complicated crises, social anxiety especially around “westerners”, desire to constantly be around people or self-isolate, the unexplainable sadness, fear of the worst happening any moment, never-ending grief, questioning my attachment to life, etc etc etc. I thought these “defects” emerged from within, untouched by my sociopolitical/ cultural context. I also thought that these “mental” disorders were somehow distinct from the many other “physical” ailments that disabled me. But I was wrong. I just hadn’t fully questioned the society and the standards that I was so desperately trying to belong to (including who came up with them).
The growth
It was also relieving to find other people who identified with these labels so we could have some similar experiences to potentially bond over. However, eventually I started feeling just as “other” in western neurodivergent spaces as I did at school, work or any other institution… despite the fact that these spaces claimed to be inclusive and “diverge” from norms. Initially, I chased cures and fixes. I glorified psychiatric medications as “life-savers”. However, as time went on, the side-effects piled on and they were so bad, they destroyed my organs and my will to live. I was less like a human, more like a dissociated, tunnel-visioned, hollow shell of a person with strained relationships— at least I was somewhat “productive” right?
In these western spaces, I was drawn to the idea that some symptoms could actually be exceptional, “positive” traits that somehow made us better or different than “normal neurotypical” people. I felt empowered reclaiming these disease categories and redefining them in a way that diverged even a tiny bit from the DSM5 or ICD10. I kept trying to look for ways that I was different or exceptional— in my pain and in my joy, but really this was individualism rearing it’s ugly head. I would assume that others who superficially appeared to conform were “neurotypical” as in they had brains that were built to thrive under these oppressive systems— a dehumanizing assumption to be honest. While layers of privilege definitely shape one’s level of access to resources, no one is biologically built to prosper under colonialism and capitalism, including the privileged. No one is carved out and genetically or physiologically predisposed to thriving in a lonely, exploitative society where no one has the right to live, not even the land. Those with more boulders on their back undoubtedly suffer more.
As my political awareness grew, I began to understand how our collective health is wrecked by colonialism/ capitalism. As I began to see the structural and systemic roots of our distress, I increasingly moved away from “born this way” thinking. The more I prioritized intentional community building and reconnecting to my cultural roots, the more impossible it became to see my pain as separate from other people’s struggles. It’s all interconnected and psychiatric labels simply failed to capture these nuances that collectivist communities are built on.
The more I anchored into the collective, the less attached I was to even the redefined, radical derivates of these labels. The diagnoses that were always foreign to my community, imposed on us by our colonizers, were again feeling foreign to me. Though I see the power in reclaiming some things that have been used to oppress you, I don’t see the utility in everyone reforming and repackaging every aspect of colonialism. If anything, I see the global north’s obsession with spreading colonial models of mental health, including psychiatric diagnoses, to the the global south as being one wing of modern day colonialism.
Excerpt from article “No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished” by Sami Timimi —
“For the last few decades, Western mental-health institutions have been pushing the idea of ‘mental-health literacy’ on the rest of the world. A new global campaign for greater ‘recognition’ of mental illnesses in the non-industrialised world has developed, which assumes that ICD/DSM descriptions are universally applicable categories (World Health Organisation [WHO], 2010). Cultures are viewed as becoming more ‘literate’ about mental illness the more they adopt Western biomedical conceptions of diagnoses like depression and schizophrenia. In the process of doing this we not only imply that those cultures that are slow to take up these ideas are in some way ‘backward’, but we also export disease categories and ways of thinking about mental distress that were previously uncommon in many parts of the world. Thus, conditions like depression, post-traumatic stress disorder, and anorexia appear to be spreading across cultures, replacing indigenous ways of viewing and experiencing mental distress and opening up lucrative new markets for Western drug companies (Summerfield, 2008, Watters, 2009).”
The forceful, violent invention and introduction of psychiatry continues to weigh most heavily on the black and brown people at the peripheries of the global production line- those who are most exploited, most commodified and least considered human. There is a reason we are headed into day 117 of the most recent intensification of the nearly 100 year long settler colonial genocide and occupation in Palestine. Black and brown massacres are MORE acceptable than us taking up arms to resist our colonizers. If people pity us, they want to save us and tell us how to do things rather than serving as accomplices in a joint liberation struggle that acknowledges our expertise, agency & autonomy. In the same vein, carceral psychiatric systems have penetrated our communities and pathologized our existence, traditions, rebellion and pain. This context matters. Psychiatric labels AND the neurodiversity framework do not speak to majority of the people in my community or to majority of people in the world.
This does not mean that I think it is bad if someone is empowered by these labels. But folks in neurodivergent spaces in the global north need to think about the fact that they may have a lot to learn from collectivist communities who have always had all-encompassing, transformative, land-preserving, care systems. These life-sustaining approaches to medicine were violently destroyed or are currently undergoing colonial erasure. Colonized people are criminalized, punished and killed for attempting to continue their traditions.
Decolonizing also means letting go of bioessentialism
Maybe we shouldn’t assume anything of people who do or don’t carry a neurodivergent label. Maybe someone identifying as neurodivergent or NOT won’t help you understand much about them or circumvent the process of getting to know them with care, over time. Maybe we should let people open our world to new worlds. Maybe we shouldn’t covertly or overtly force people to turn to a colonial tool like the DSMV to figure out “what they have” or “who they are”. Maybe we don’t need to push people into categories excessively to make them comprehensible. I see the utility of finding each other through short-hand labels but it’s equally important to be cognizant of who you’re excluding and what you’re preventing yourself from learning through over-reliance on these labels especially if they’re framed as real biological categories.
Colonialism brainwashes people into thinking they are “individuals” or atomized beings separate from everything, separate from each other, the land, the trees, the birds and the rest of our kin. These systems have concocted ridiculous bioessentialist boxes and categories to convince us that we are alone, separate, distinct, and unrelated.
This piece by
aptly captures the limitations of “born this way” thinking when it comes to gender and sexuality:"The “Born this way” idea remains fairly popular among many queer people. One reason why it seems so appealing to many is because it offers an easy way to justify the existence of queer people in a way that doesn’t upset cisheteronormativity, institutions and established identities too much.
The logic essentially runs down to “Oh we are just born queer, it’s not our fault, you can’t judge us for it. Just let us exist, we can’t and won’t make more people queer if you include us into your social structures, don’t worry.”
Many more radical-minded queer people and queer activists have challenged the “Born this way” narrative from many perspectives: From the perspective that it denies any fluidity and agency, that it undermines more radical politics to challenge the cisheteronormative gender system, that it comes from a place of queerness having to justify its existence, that it naturalizes historically relative and constructed gender and sexual categories (and therefore cisheterosexist structures as such), that it has insufficient scientific backing etc.”
People who use the neurodiversity framework, whether it is a binary or an expansive spectrum, psychiatrist diagnosed or self-diagnosed, co-opted or reclaimed, liberal or more radical, ANY variation of it— they need to consider that much of the world exists incomprehensibly beyond that spectrum, by choice and not because we are too backward or uncivilized or helpless to know better.
There is empowerment in complexity, diversity and multitudes
Over the last few years I have been more intentional into grounding in our communities, this means I’m connecting more with our elders, our children, our warriors, caretakers, healers, people who make up the backbone of our survival and sustenance. The more liberating relationships I build, the more I see that I want to root into truly collectivist identities that acknowledge our vastness and our indescribable, uncategorizable, undiagnosable, imprecise, fluid, ungeneralizable, complexities that can never be reduced to biology. This is not to say that our suffering doesn’t exist, it’s to say that I want to hold our pain with the respect, dignity and care that it deserves, such that we can get to the root of it and bear, address or navigate it as a collective.
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