• disability
• sociology
• Politics
• Neurology
• Medical humanities

This article is an attempt to resituate disability in relation to neurodiversity. At the time of writing, as we move towards the end of the thirteenth year of Conservative rule in the UK, the situation for disabled people has rarely seemed bleaker. In the past week alone, two pieces of news have broken—quietly—that bring this situation into stark relief. The first is the emergence of plans to further cut spending on benefits for disabled people who cannot work. On the basis that home working, following the COVID-19 pandemic, is now commonplace, ministers are planning to enact these cuts by removing bladder and bowel incontinence, impaired mobility and ‘inability to cope with social interaction’ as grounds for inability to work (Pring 2023). For anyone familiar with disability politics in the UK, it will not need stating that access to the paltry benefits supposedly available to disabled people is already subject to processes so cruel and so degrading that they have resulted in deaths (Mills and Pring 2024). The second piece of news revealed Department for Education plans to cut local council spending on already chronically underfunded ‘special educational needs and disabilities’ provision for children by 20% (Jayanetti 2023). Meanwhile, as his party continues this long-standing campaign of degradation against disabled people, Conservative MP Robert Buckland has launched a campaign aimed at ‘closing the employment gap for autistic people and those with other neurodivergent needs’. The campaign supports businesses to ‘improve the life chances of neurodivergent employees’ (Buckland 2023) in order that they might ‘reap the benefits of a neurodiverse workforce’ (Savage 2023). A charity, Neurodiversity in Business, is on board as a partner.

That neurodiversity has become firmly embedded in the mainstream, and that it has become increasingly separated from disability, is nowhere more clearly illustrated. Neurodiversity, neurodivergence and related concepts can no longer be referred to as simply descriptions, identities or even as a movement. Their take-up across a range of key institutions, including but not limited to businesses, charities, clinical and educational practitioners, schools and universities, trade unions and, most recently, politicians, puts this beyond dispute. Neurodiversity is increasingly taken as a given, needing no explanation. Perhaps more significantly, it is also treated as essentially progressive, held aloft by both private and public institutions as proof of their putative commitment to equality and inclusion. This elevation of neurodiversity against a backdrop of deepening structural violence against disabled people calls for closer scrutiny of the relationship between the two. Yet while neurodiversity has been subject to critique from a range of disciplines—including bioethics, philosophy of psychology, legal philosophy, education and the history of science—these critiques have tended to skirt around any commitment to disability as a political entity and experience. As a result, a concrete sense of what is at stake for disabled people in these debates is frequently lacking. Our article seeks to correct this tendency by foregrounding disability in its consideration of neurodiversity’s foundations, omissions and exclusions. Expanding in part on Ari Ne’eman and Elizabeth Pellicano’s 2022 mapping of potential risks stemming from the concept’s current political mobilisations, we suggest that neurodiversity functions to distance its proponents from disability through a dual process of dehistoricisation and insistence on neuro as neutral or progressive. Debates on the various political implications of the suffix, then—neurodiversity versus neurodivergence, for example—miss that any potential for genuine social change is already forestalled by the meanings implicated in neuro. We begin by laying out the nature of current debates around the term, identifying areas frequently excluded from discussion, and consider what exactly is at stake in these omissions. We then look back to one of the formative texts of neurodiversity—Judy Singer’s 1999 chapter—to discuss the origins of its oversights, before reflecting on proponents' use of historical narrative and what it engenders.

Our analysis focuses specifically on published scholarship and institutional practice. We have intentionally chosen not to include social media discourse, despite its close association with neurodiversity, for two reasons. First, we are primarily interested here in the way that neurodiversity-as-concept circulates through and around institutions, a dynamic that relies on the legitimation offered by publication and other processes of formalised visibility. Second, as we hope becomes clear in the later parts of our article, the very idea of an essentially inclusive online ‘neurodiversity community’ is flawed such that treating it as a reliable proxy for any particular group would be misleading. Throughout the article, we follow Price (2011, 9) in using the deliberately non-specific term ‘mental disability’ to describe the disablement of individuals and groups on the basis of pathologised differences and states culturally assumed—but, crucially, not necessarily proven—to reside or originate in the brain or mind. Ultimately, we seek to understand the tensions between neurodiversity’s increased visibility (Crawshaw 2023) and the ongoing harms of structural ableism.

The origins of neurodiversity as concept are generally traced to online autistic spaces in the mid-1990s, and its take-up in academia to the work of Singer from 1998 onwards. Some accounts trace the concept, if not the term, back to Jim Sinclair’s (1993) essay ‘Don’t mourn for us’ (Pripas-Kapit 2020), but given that Sinclair’s text makes no mention of neurology or the brain, it seems more accurate to locate this early text within the field of autistic self-advocacy, which has often overlapped—or been conflated—with neurodiversity but is ultimately distinct in terms of locations and aims. Following Singer’s popularisation of the term, neurodiversity became subject to debate and critique in the overlapping arenas of academia and online activism, and rapidly entered the mainstream from there. Within scholarship, theorisations and defences of the concept have tended to foreground narratives of lived experience and personal identity, with limited consideration of concrete structural concerns or pre-1990s historical context. Meanwhile, where the term is questioned or challenged, it is generally from a dispassionate or even abstract standpoint that often gestures towards structural oppression in non-specific terms but is scarcely concerned with individuals or groups on the ground. Thus, any dialogue between these two formations is on these terms—either hyperspecific or decontextualised—and questions of concrete structural impact or political implication fall by the wayside.

The introduction to Steven Kapp’s 2020 edited volume, presented as ‘the first historical overview of the autistic community and the neurodiversity movement’ (2) and bringing together early and more recent neurodiversity proponents, provides an instructive entry point into the field’s current principles, and the various convergent and divergent lines of thought that characterise discourse on the subject. Kapp acknowledges that neurodiversity, which he sees primarily as a ‘movement’ that covers those with ‘neurocognitive differences’ (2020, 2), is itself diverse, and that individual scholars and activists have their own interpretations of the concept, but identifies as basic shared principles the ‘primacy of biology’ (3) and the espousal of ‘brain-based explanations’, rather than psychological ones, for autism (6). He is also convinced of neurodiversity’s absolute inclusivity, noting that it ‘accepts and fights for the full developmental spectrum of autistic people’ (2020, 5), but questions whether mental illness falls adequately into ‘neurology’ to be included (4). That neurodiversity, at least in principle, is fundamentally inclusive is reflected across scholarship endorsing it, including by Walker (2014), Graby (2015), Woods et al. (2018), Dyck and Russell (2020), Chapman (2020a, b), Bertilsdotter Rosqvist, Chown, and Stenning (2020), Raymaker (2020), Stenning and Bertilsdotter Rosqvist (2021) and Beck (2023). Graby, for example, states that ‘AD(H)D, dyslexia, dyspraxia’ and learning disability were ‘acknowledged as being part of neurodiversity from the start’ (2015, 233) . Bertilsdotter Rosqvist, Chown and Stenning recognise that neurodiversity as field of study has lacked certain perspectives—limited in their account to the exclusion of non-autistic ‘neurodivergences’—but see neurodiversity as concept as having the potential to ‘redefine what it means to be human’, enabling us to ‘unlear[n] the cognitive normative gaze, as a way of cognitive decolonialisation’ ⇓.

Likewise, while there is variation among scholars as to their intellectual comfort with biology and neuroscience as underpinning knowledge systems, the ‘primacy of biology’ identified by Kapp is evident even where it is critiqued. Damian Milton, in a published debate with Sami Timimi (2016), states that he sees autism as socially constructed rather than biological, but then returns to ‘diverse neurology’ as organising principle. He affirms that ‘embodied differences between people in terms of ‘disposition’’ that have ‘a biological aspect’ are responsible for ‘neurodivergence’, and that ‘diversity in neurological development will impact on perceptions and experiences of the social lifeworld’. Similarly, Stenning and Bertilsdotter-Rosqvist note that clinical disciplines have ‘failed to reveal any useful knowledge in the past 80 years of research’ ⇓, and yet are convinced that ‘these brains – labelled as impaired and autistic, ADHD, dyslexic or Tourette’s by psychologists […] conform to categories that reflect the underlying structure of reality as “natural kinds” that will eventually be confirmed by neuroscientists’ (1532) and that ‘who or what counts as neurodivergent will depend on underlying neurology and physiology’ (1535). Chapman sees attempts to biologise autism as ‘committed to neuro-centric essentialism’ (2020b, 802), but continues to refer to ‘neurocognitive norms’, ‘neurotypes’ (2020a) and other terms whose coherence relies on neurology.

To these two shared lines of thought identified by Kapp—that neurodiversity is, at its heart, inclusive and that neurological explanations for mental disability are central to its legitimacy—we would add the principle of depathologisation. While Kapp himself refers to this aspect only in passing, in the same volume Russell highlights its pivotal role within neurodiversity scholarship (2020, 298–99). Indeed, Walker notes that ‘the neurodiversity paradigm rejects the pathologizing’ of ‘innate or largely innate neurodivergence, like autism’, but not conditions like epilepsy that ‘could be removed from an individual without erasing fundamental aspects of the individual’s selfhood’ (2014). She sees anyone who ‘consider[s] autism to be a medical pathology or 'disorder'’ as ‘at odds with the neurodiversity movement’ (2014). Generally speaking, pathologisation is conflated within neurodiversity scholarship with medicalisation and thus with the eliminationism underpinning curative approaches to, most prominently, autism. This is evident throughout Chown’s contribution to Bertilsdotter Rosqvist, Chown, and Stenning (2020, 27-38), which sees the construction of autism as pathology as synonymous with eugenic research into its eradication; similarly, Woods et al discuss the ‘deficit-laden, pathologising autism discourses favoured by the medical community’ (2018, 974). The pathologisation of ‘neurodivergence’ is sometimes drawn into analogy with queerness and transness as examples of ‘psychiatry’s policing of mainstream societal norms’ (Beck 2023, 5; see also Dyck and Russell 2020, 177–79; Chown 2020, 30 Milton and Timimi 2016). Walker, for example, notes that ‘pathologizing frameworks have been used time and again to lend an aura of scientific legitimacy to all manner of other bigotry’, comparing ‘the framing of autism and other minority neurological configurations as disorders or medical conditions’ both to the classification of homosexuality as a mental disorder and to the white supremacist ‘drapetomania’ construct (2016).

Where there is disagreement or critical reflection within neurodiversity scholarship, it tends to fall on issues of language use—‘neurodivergent’ versus ‘neurodiverse’ versus ‘neurodiversity’, or paradigm versus movement (Beck 2023; Bertilsdotter Rosqvist, Chown, and Stenning 2020; Walker 2014); discipline formation and ownership (McWade, Milton, and Beresford 2015; Woods et al. 2018); and what ‘counts’ as neurodivergence as opposed to, for example, mental illness, and whether mental illness should be included in neurodiversity’s remit (Chapman 2019; Kapp 2020; McWade, Milton, and Beresford 2015; Graby 2015). There is occasionally some reflection on the lack of effort of proponents to include learning disability (Chapman 2019; Kapp 2020; Russell 2020), but rarely is this considered cause for interrogating neurodiversity’s foundations or political potency. When external criticism is engaged with, it is generally of the transparently ableist sort endorsing a deficit model of (almost exclusively) autism, undermining autistic agency, or seeking to hierarchise autistic people with specious ‘functioning’ labels (such as Casanova 2015; Frith 2008; Jaarsma and Welin 2012). Sometimes these and similar criticisms are taken as a given to the point that specific examples are not cited (see, eg, Beck 2023; Chapman 2019; Kapp 2020; Russell 2020).

External criticism of neurodiversity scholarship that meets it on its own terms, meanwhile, tends to demonstrate a preoccupation with either ‘proof’ of neurodiversity per se, its internal coherence as an ontological position, or the hypothetical dangers of overdiagnosis and pathologisation, to the detriment of any sustained or specific structural or political critique. Timimi’s side of the published debate with Milton referenced above is illustrative in this regard. A child psychiatrist who is heavily critical of psychiatry, Timimi questions how autism can be anything other than a ‘pseudo-scientific construct’ when there is no biological marker for it, insisting that ‘the idea of dividing humanity into 'neurotypical' and 'neurodiverse' and that such a categorical division is possible is different to medical diagnostic discourse only in its value judgements about such categorical divisions’ (2016). In response to Milton’s characterisation of autism as an ‘embodied experience’, he asks how we ‘figure who can or can't relate to the embodied experience’ in the absence of a biomarker, and later derides neurodiversity as ‘some home spun philosophy untethered from any factual/empirical evidence to 'prove' its existence’. While he makes gestures towards structural concerns, these are largely hypothetical: referring to autism as the ‘desirable’ alternative to learning disability, he warns that ‘its 'desirable' status may change […]. If it gets conflated with 'dangerousness' beware’ (2016). (Milton rightly counters here that such conflation ‘happened long ago’.) Timimi identifies one concrete danger: that children diagnosed with autism might obtain access to a service that other children could benefit from but are denied due to lack of diagnosis, and conversely that a child diagnosed with autism might be denied access to a service they could benefit from due to the said service’s inability to ‘deal with’ autism (2016). While this specific criticism alludes to a key absence within neurodiversity scholarship—the consideration of disabled children, and the structural violence committed against them—it is not developed or contextualised in these terms. The root of this ‘danger’, as Milton partially notes, is the dearth of meaningful services available at all, rather than any particular diagnostic practice (2016). Similarly, in a 2019 intervention consisting of reports by proponents and critics of neurodiversity on the experience of being trained in a new ‘tool’ used to diagnose autism in children, Timimi refers to the tool as ‘a diagnostic trap’ whose commercial proprietors ‘shamelessly promote and sell […] around the world subjecting ever more children and adults to its perverse normalization/pathologisation agenda’ (Timimi et al. 2019, 6). Yet the harms caused by the tool’s supposed overdiagnosis are neither identified nor analysed. Indeed, all five contributors to the discussion—both critics and proponents of neurodiversity—agree that the tool poses a ‘danger’ of overdiagnosis and pathologisation. The precise harms this will entail for the children subjected to the tool’s use, however, go unexamined, forestalling any deep engagement with wider power structures. Neither is there any reflection on what depathologisation would mean for the provision of services, exemptions and adjustments that hinge entirely on autism as pathology. What, then, does ‘pathologisation’ mean and do, such that both proponents and critics of neurodiversity not only take its negativity as given but are also able to leverage it in undermining each other’s arguments?

This tendency towards abstraction at the expense of political specificity is a common thread running through academic critique of neurodiversity. Jonathan Hughes (2020), for example (see also Nelson 2021), challenges the ‘claims’ of neurodiversity as concept on the basis of autism’s ‘heterogeneity’ . His argument is that these claims ‘are unhelpful to some of the most profoundly affected [by autism]’ (Hughes 2020, 54), and that neurodiversity as basis for identity is damaging because ‘some autistics publicly oppose the neurodiversity movement because they do not identify with their autism in this way, and would want to be 'cured' if that were possible’ (59)—an uncited statement. Hughes identifies what he perceives as various logical incoherencies in neurodiversity scholarship: for example, that neurodiversity denies that autism is intrinsically harmful while endorsing accommodations that ameliorate its ‘symptoms’ (2020, 54), that it posits autism as fundamental to identity whereas psychological and philosophical accounts of identity suggest it can radically change (59), or that it hinges on the assumed social value of diversity where no evidence of such exists (51). But even if we were to assume the validity of these arguments, there is no sense of what is truly at stake here. What specific potentialities are being invoked? If, as Hughes claims, the ‘key question for assessing the neurodiversity paradigm […] is whether denial of the intrinsic harmfulness of autism is plausible’ (2020, 54), how does either answer serve us? His later affirmation that ‘even a just society has to make hard choices and cannot fully meet the needs of all groups’ and that therefore ‘the failure to provide for particular needs is not necessarily unjust’ (2020, 54) suggests no political concern for those he arbitrarily deems to be ‘the most profoundly affected’ in any case.

Francisco Ortega’s critiques of neurodiversity on the basis of its relationship with a broader societal shift towards neurocentrism (2009; 2013; Vidal and Ortega 2017, among others) come closest to drawing out its political ramifications. However, even these analyses largely remain at the philosophical level, divorced from on-the-ground realities. Ortega’s early critique of the concept (2009, first published in Portuguese in 2008), for example, examines Singer’s embrace of ‘neurological self-awareness’ (1999, 65) and neurodiversity’s invocation of ‘an atypical neurological 'wiring'’ as part of ‘the diffusion of neuroscientific claims beyond the laboratory and their penetration in different domains of life in contemporary biomedicalized societies’ (2009, 426). This ‘cerebralization of autism’ (2009, 427) allows autistic people to reject psychology—Ortega goes into little further detail but is presumably alluding here to the dehumanising psychological and psychoanalytical explanations and interventions inflicted on people diagnosed with autism through the early mid-twentieth century—but, more significantly, also posits autism as residing in the body, rather than the mind (434). For Ortega, this has a tacitly exculpatory effect, since whereas the mind is culturally perceived as a domain that can and should be individually controlled, ‘the body is always morally innocent’ (2009, 434). The insistence on autism as neither mental nor generally physical, but specifically neurological furthermore allows advocates to invoke ‘the prestige of the neurosciences’ as a legitimating force (2009, 435). Ortega concludes that if ‘seeing oneself as a cerebral subject bolsters one’s sense of identity and helps erase the social stigma often associated with mental pathology, it may, on the other hand, somewhat solipsistically narrow the notion of what it is to be a person’ (2009, 441). Along similar lines, Katherine Runswick-Cole’s critique of neurodiversity warns that proponents’ production of a binary division between ‘neurodivergent’ and ‘neurotypical’, and their reification of this as a basis for political identity, may ‘fail to pay attention to the other forms of marginalisation that underpin exclusionary and oppressive practices, including heterosexism/sexism, racism, poverty and imperialism’ (2014, 1126). Ortega’s insinuation that neurodiversity relies on a latent disowning of madness, and the assertion that it benefits, however indirectly, from the ‘hard science’ veneer of a neuroscientific authority foundationally hostile to mentally disabled people, are significant (see also McWade, Milton, and Beresford 2015). The lack of dialogue in either direction between neurodiversity scholarship and work critical of neurocentrism is unfortunate for this reason. Perhaps due to Ortega’s limited engagement with disability studies, though, his attempts to bridge this gap leave us once again with little sense of the stakes. At points he underestimates structural concerns, overlooking that autistic self-advocacy is not primarily concerned with others' surface prejudices, but rather with the very real disablement engendered by ceding advocacy to non-autistics. At others, he falls into the pattern identified by M. Remi Yergeau of seeing autistic people as either—or both—‘too autistic’ or ‘not autistic enough’ to make accurate claims as to our identities (2018, 33).

With the ‘debate’ on neurodiversity limited to these partial encounters, several vital interrelated areas are left unexamined. These absences coalesce, for the most part, around disability and disablement as both political experiences and structural impositions. In one of the few examples of neurodiversity scholarship that reflects in depth on the political risks of the concept’s rapid mainstreaming in the USA, Ne'eman and Pellicano note that neurodiversity is becoming detached from its relationship with disability politics, with ‘neurodivergent’ used in a quasi-euphemistic sense to replace ‘disabled’ (2022, 152). They warn that ‘this disconnect from the larger disability context in which neurodiversity was born is a grave error’, questioning ‘the wisdom of terms like 'neurominority,' which introduce new and somewhat exceptionalist language to describe concepts with long histories in broader disability activism’ (2022, 152). We would suggest that this supplanting effect and appeal to exceptionalism are already dominant—and are very rarely taken up as part of a critique of neurodiversity’s political ramifications—but also that the seeds of this distancing gesture were present within neurodiversity from its earliest days, thanks in large part to its embrace of neurological schemas. There are echoes here of Bill Hughes’s distinction between disability activism centred on the social model and what he terms ‘biosocial groups’ or ‘biological citizens’: groups that coalesce around a particular diagnosis and attribute social exclusion to ‘the tyranny of biological norms’ rather than ‘a disablist social structure’ (2009, 680). Neurodiversity has usurped mental disability not purely as term but also as politic, meaning that understandings of the political-economic location of disability developed through sustained disability activism and scholarship, exemplified by the work of Russell (1990s, anthologised 2019), Malhotra (2017), Soldatic (2018) and Adler-Bolton and Vierkant (2022) are lost. As a result, scholarship from both proponents and critics of neurodiversity frequently limits itself to considering disability, and disability studies, only insofar as the basic tenets of the social model usefully serve their arguments either way. Mutually constitutive with this neglect is a lack of engagement with the long-term histories of mental disability so essential to contextualising present issues and debates, or with the institutional ecosystem that violently perpetuates mentally disabled people’s political-economic degradation. As we explain below, we would go so far as to suggest that neurodiversity has an actively dehistoricising effect on discourses of mental disability, and in particular that it sanitises the recent history of autism such that vital knowledge about it is obscured. A significant aspect of this knowledge is around the role of children, the institutional violence and sanctioned killing meted out on them in the name of research or therapeutic intervention, and the pervasive presence of ideas gleaned from these processes in contemporary clinical and educational settings. This sanitising effect has made neurodiversity all too amenable to co-opting by individuals and institutions who appear to see no tension between their enthusiastic appropriation of neurodiversity and their discursive or material debasement of disabled people. The paucity of attempts by either critics or proponents of neurodiversity to gather or reckon with these missing pieces has obfuscated what is truly at stake in discourses of mental disability, and in so doing has undermined proponents’ characterisation of neurodiversity as a political movement.

What is at stake? The examples we give over the next two paragraphs are only a small illustrative selection from a handful of Global North contexts. ‘Euthanasia’, ‘assisted suicide’ and/or ‘medical aid in dying’ on the basis of mental disability are now legal in an increasing number of countries including Belgium and Switzerland (De Hert et al. 2022), the Netherlands (Tuffrey-Wijne et al. 2023), Spain (Ramos-Pozón et al. 2023) and are included in a proposed expansion of existing euthanasia laws in Canada (Grant 2023). This extends, at least in principle, to children over 12 in the case of the Netherlands, with paediatric experts endorsing lowering this limit (de Keijzer et al. 2023). In Tuffrey-Wijne et al’s examination of physicians’ reports for 39 Dutch cases of euthanasia on the basis of autism and/or learning disability, they found that a vast majority cited social factors, such as isolation or unemployment, as key to their patient’s decision. Among these factors were failures of state support: one case described a patient having been moved between care facilities 15 times. In a final act of degradation, one physician noted of their patient that ‘people found her repulsive and nobody wanted to be near her’ (Tuffrey-Wijne et al. 2023, 4). Verhofstadt, Thienpont and Peters note in an examination of testimonials from Belgian psychiatric patients requesting euthanasia that poverty, iatrogenic trauma, being made to feel like a ‘guinea pig’ by physicians, and being involuntarily discharged from treatment featured in numerous cases (2018, 240–41). That death is considered an acceptable solution to the systematic abandonment, rejection and exploitation of mentally disabled people is explicit in these contexts, but is implied in many others. During the COVID-19 pandemic in the UK, learning disabled and/or autistic people were variously issued with Do Not Resuscitate orders (BBC 2020; Tapper 2021), coerced into agreeing to Advanced Care Directives and barred from hospital care (Care Quality Commission 2021), and denied access to testing (Albert 2020); the death rate for people with learning disabilities during the first wave of the virus was up to six times higher than that of the general population, according to Public Health England’s own report (2020). Similar circumstances were documented in the USA (Baker 2020). Staying in the USA, the death penalty has been ruled unconstitutional for intellectually disabled people since the Supreme Court decision on Atkins v. Virginia in 2002; as of 2020, the Death Penalty Information Centre (DPIC) had found 144 cases of people originally sentenced to death and then removed from death row on these grounds. Nearly 70% of these people were black. A further 10% were non-black people of colour. The DPIC notes that ‘some states have attempted to evade enforcing Atkins by adopting stringent definitions of intellectual disability that are scientifically unsupported or by imposing procedural requirements or burdens of proof that are impossible to satisfy’ (2020). Mentally disabled people in general, but particularly racialised learning disabled people, are dramatically over-represented in adult and child prison populations in both the USA and the UK. In both countries, children are subject to ‘restraint’—adult violence—and seclusion in both mainstream and specialist schools; in the USA in particular, they are additionally subject to physical or psychological aversives in the name of Applied Behavioural Analysis (ABA), still considered best practice by the American Academy of Paediatrics (Hyman, Levy, and Myers 2020).

The instances we referenced in the opening paragraph of this article are only the most recent developments in the destruction or privatisation of public services for mental disability in the UK. Cuts to public spending under the New Labour regime in the mid-late 2000s, intensified by the coalition and then Conservative governments after 2010, have razed this already weak and inadequate provision to the ground. People in need of inhome care are forced to either pay a private service or forgo the most basic support and social interaction (Pring 2022). National Health Service (NHS) waiting lists for assessment for autism, attention deficit hyperactivity disorder (ADHD) and dyspraxia—often the only way to access even the most meagre rights and support in welfare, education and work for children and adults—are months or years long; private assessment is prohibitively expensive and lacks the institutional clout of the NHS equivalent. It is not possible to access dyslexia assessment via the NHS. Access to the poverty-level financial support theoretically offered to disabled people who cannot work is subject to their successful completion of multiple rounds of paperwork, attendance of online and inperson meetings and workshops, and the punitive and degrading Work Capability Assessment, after which they still live under perpetual risk of having benefits withdrawn or reduced—a system that has resulted in further disablement as well as deaths (Mills and Pring 2024). There is currently no sign that a change of ruling party at the next election will resolve this, with the Labour Party refusing to commit to reversing austerity or even halting further cuts to welfare. People at risk of suicide or catastrophic self-harm are routinely discharged against their will from NHS mental health services (Watts 2019), or outright criminalised for soliciting crisis services ‘too often’ (StopSIM 2021); meanwhile, people who are both autistic and mentally ill find themselves shuttled between autism or learning disability services, for which they are deemed too mad, and mental health services, for which they are deemed too autistic.

The stakes, as Yergeau states, are nothing less than ‘bodily annihilation’ (2018, 149). The question to ask of neurodiversity proponents, then, is not whether the concept meets an academic standard of logical consistency, nor whether its existence can be empirically proven by piling additional money into neuroscientific research, nor whether it is ‘representative’ of people deemed by whoever is writing to be autistic enough to count. Neither is it generative to question whether the increased visibility of certain mental disabilities granted by neurodiversity will result in a level of ‘overdiagnosis’ whose harms are never fully explained, when diagnostic processes are inaccessible to a large majority in the first place. Rather, the question is: what does, or can, neurodiversity do for the people whose position at the intersection of mental disability and poverty or race puts them furthest from institutional power and closest to structural violence? That proponents characterise neurodiversity as a political movement implies that it agitates for a group whose needs are not being met, whose personhood is not being acknowledged. What needs are these, if not those arising from the situations described above? Whose personhood is in question, if not that of the people at the sharpest end of structural ableism?

In considering these questions, it is instructive to return to the text deemed by most accounts to have taken a concept hitherto confined to niche online spaces—neurological diversity—and introduced it to wider audiences, particularly academic ones, as neurodiversity. Singer’s (1999) influential 1999 chapter describes in detail a painful childhood haunted by a ‘problem with no name’ (60) that affected her mother, herself and, later, her daughter. Her belief that her daughter had ‘an organic, not a psychological, difference’ (1999, 61) led her to extensive research, and eventually to both the social model of disability and the work of autistic writers Temple Grandin and Donna Williams (62). She was struck by the revelation that people ‘didn't necessarily have to have learning disabilities or lack emotional awareness to be autistic’ (1999, 62). She felt she ‘knew at last who [her] people were’ (1999, 62). Later in the article, she describes the diagnosis ultimately attributed to herself and her daughter—Asperger’s syndrome (AS)—as distinct from the ‘images of rocking, emotionally cut-off, intellectually impaired children’ and ‘‘Rainman’-like savants’ generally associated with autism (1999, 63). This allowed her to begin articulating ‘a politics of neurological diversity, or neurodiversity’ based on nature rather than nurture and neurology rather than psychology, a shift in thinking she credits to Lorna Wing (Singer 1999, 64). She describes how the circulation of this information through ‘AS’ online spaces led ‘people with 'marginal' neurological differences’ to ‘clamour at the gates’ of GP surgeries in pursuit of diagnosis (1999, 65). Specific online spaces are referred to as ‘our own country’, and the (at that point relatively new) rise of ‘cyber culture’ as carrying the promise of ‘a new ecological niche for people 'on the spectrum', allowing them/us to flourish and come out with pride’ (1999, 65–66). Singer sees the internet as ‘able to supply whatever communicative capacities high-functioning autistics lack’ (1999, 67).

Several significant points become clear here. The first is that Singer’s conceptualisation of neurodiversity was, foundationally, a disavowal of learning disability—the ‘rocking, emotionally cut-off, intellectually impaired children’ (1999, 63) from whom she is careful to distance herself and her daughter. Neurodiversity, in her terms, is expressly and unambiguously for autistics without learning disability, to whom she refers as ‘high-functioning’ or having AS. Rarely is this considered in any depth in accounts of neurodiversity’s a priori inclusiveness. The second is that Singer conceived of neurodiversity as irreducibly located in the physical brain: neurological, not psychological; nature, not nurture. Singer thus adduces and endorses the work of Lorna Wing for having, in her view, provided a scientific basis for moving away from psychological understandings. The historical context that would call such endorsements into question is omitted entirely. Thanks to these first two points—the disavowal of learning disability on one hand, and the attribution of autism to the always-innocent body (Ortega 2009, 434) in a gesture of distancing from madness on the other—diagnosis becomes a risk-free, essential good. Finally, it is clear that Singer saw neurodiversity as near-synonymous with a narrowly defined, mostly online autistic ‘culture’ and ‘community’, both of which are underpinned by claims to sociality, although in a form still marginal in the late 1990s. Significantly, to judge by Singer’s account—and those of her contemporaries, such as Dekker (2020)—this community was also composed entirely of adults. With the exception of her own childhood and own daughter, children are present in Singer’s conceptualisation of neurodiversity only as the abject, degraded and disabled other.

While theorisations of neurodiversity have, in some ways, evolved over the intervening 25 years, and while Singer’s rejection of learning disability from her conceptualisation of neurodiversity is now subject to critique in some examples of neurodiversity scholarship (such as Stenning and Bertilsdotter Rosqvist 2021, 1533), our summary of more recent debate around the concept suggests that the key tenets laid out by Singer have proved persistent despite claims to the contrary. Outside of the social and philosophical disciplines in which neurodiversity is most extensively theorised, Singer’s 1999 text remains heavily and uncritically cited, and continues to underpin accounts of the concept in clinical and educational research (such as Dwyer 2022). It is common, as we outlined above, to read that neurodiversity is capacious and inclusive, including in its remit of ‘divergence’ conditions like ADHD, dyslexia, dyspraxia, and in some accounts learning disability, dementia and certain mental illnesses like schizophrenia and obsessive-compulsive disorder. Yet whenever a ‘case study’ or illustrative example is required—by either proponents or critics—it is, almost without exception, autism, and specifically autism as experienced by individual adults, notwithstanding some authors' references to their own childhoods (eg, Milton’s side of Milton and Timimi 2016). Likewise, while some neurodiversity proponents make mention of ‘neuroessentialism’, this never appears to extend to any in-depth exploration of the potential dangers of embracing the physical brain as source and site of mental disability.

Finally, it is evident, though tacitly so, that the ‘community’, ‘culture’ and ‘flourishing’ to which neurodiversity stakes a claim still extend only to those most able to actively participate in particular forms of sociality and social discourse, a group that largely overlaps with those least proximate to structural harms: in short, the ‘able-disabled’ (Mitchell and Snyder 2015, 12). This designation emerges from David Mitchell and Sharon Snyder’s account of the relationship between disability and ‘neoliberal inclusionism’: that is, the social recognition of a select few individuals from marginalised groups as a means of forestalling any meaningful social change, to the detriment of the group as a whole. Mitchell and Snyder are building here on Jasbir Puar’s ‘homonationalism’, a key element of which is the propensity of fundamentally queerphobic societies to grant conditional tolerance to those queers who adhere to normative models of kinship (Puar 2007, 21–22), which ‘enacts specific forms of disciplining and control, erecting celebratory queer liberal subjects folded into life (queerness as subject) against the sexually pathological and deviant populations targeted for death (queerness as population)’ (24). For Puar, the insistence on queer identity as always-already transgressive allows transgression itself to become ‘a regulatory queer ideal that demarcates the ideal queer’ by reifying ‘a normative notion of deviance, always defined in relation to normativity’ (2007, 22–23). Mitchell and Snyder see similar dynamics at play for ‘those disabled people who […] gain entrance into late capitalist cultures’ by means of ‘administrative 'creaming' or hyper-prostheticization’ (2015, 12), which they see as part of an ‘ablenationalist’ schema. Both Puar (2007, 10) and Mitchell and Snyder (2015, 15–16) are careful to make clear that this selective tolerance is essentially precarious, and does not by itself entail freedom from quotidian forms of discrimination or ostracisation. Likewise, we do not mean to suggest that those individuals who stand to benefit from the valorisation bestowed by the mainstreaming of neurodiversity are somehow exempt from ableist harm. What does merit deeper interrogation, however, is why and how neurodiversity is able to meld relatively seamlessly into existing institutional discourses of social value, elevating a select few mentally disabled subjects while the degradation of the mentally disabled population only deepens. Neurodiversity is limited to functioning in this way, we suggest, precisely due to its reliance on neurology as organising principle. Neuro, and its latent embeddedness in the innocent body, implies a sense of involuntarity that rehabilitates certain individuals—folding them into life, to paraphrase Puar, by demarcating ‘a normative notion of deviance’ (2007, 23–24)—while reinforcing the disposability of mental disability as a whole.

As Yergeau makes clear, this ascription of involuntarity—‘that autistic people are lacking in all things selfhood’—has subtended the history of autism from its early days, making possible the profound violence enacted on autistics throughout the twentieth century and into the twenty-first (2018, 8–10). It is by means of involuntarity, they affirm, that ‘autistics are absented from the larger project of being human’ (2018, 15), with involuntary logics feeding into ‘overmedication, eugenic futures, institutionalization’ (9), and used to rationalise the absolute divestment of agency of autistic children represented by ABA and similar therapeutic pathways, which ‘[refashion] autistic childhood into a full-time job’ (99). While Yergeau does use neuro terms, particularly ‘neuroqueer’, and never fully deconstructs the prefix in their work, what is distinct about their analysis is that they see absolutely no change for autistics in the supplanting of psy readings of autism with neuro ones. Indeed, their meticulous historicisation of autism in the USA makes abundantly clear that for autistic and other mentally disabled people these two knowledge systems are inextricable from one another (2018, 105), and that autism research in general is foundationally hostile to us. It is significant that Yergeau arrives at this juncture by means of thorough historicisation, something the large majority of neurodiversity proponents gloss over. When it is not omitted entirely, the historical narrative presented in such scholarship (Singer 1999, 64; Orsini and Davidson 2013, 2; Chapman 2020b, 799; Fein 2020, 13–14; Dyck and Russell 2020, 171–72; ⇓, 1326–27), and unquestioned or even reproduced in critical responses (Jaarsma and Welin 2012, 22; Fitzgerald 2017, 4–5; Hughes 2020, 53) is a sanitised version of the genealogy of autism whose repeated circulation serves to obscure the dangers of framing mental disability in terms of ‘atypical wiring’ or ‘brain-based difference’ for all but a select few.

In this selective version, the history of autism begins in the 1940s, when Leo Kanner ‘discovers’ it. Hans Asperger is occasionally mentioned as making a parallel ‘discovery’, though rarely features as anything other than a child psychiatrist or paediatrician. Initially it is understood as a psychological condition owing, most notoriously, to a lack of maternal warmth (the ‘refrigerator mother’ per Kanner and then Bruno Bettelheim). The psychogenic explanation is then supplanted in the mid-to-late twentieth century by a biomedical model. Where this is linked to specific professional figures, it is usually Lorna Wing in the UK and, less commonly, Bernard Rimland in the USA. Wing is generally credited, too, with the discovery and mainstreaming of Asperger’s ‘forgotten’ work in the early 1980s, which suggested (so the narrative goes) that some children otherwise diagnosable with autism did not appear to lack intelligence or linguistic proficiency and may in fact have extraordinary abilities.

There are several conspicuous absences and partial truths in this narrative. To give an overly brief and certainly incomplete account of these: the pre-1940s histories of ‘mental disorder’—that is, Kanner’s and Asperger’s own intellectual precedents and the social contexts that gave rise to them—are entirely absent. This means that the near-synonymity of ‘mental disorder’ as a medical designation with increased knowledge of biological heredity, racialised fears of (white) ‘degeneration’, and ultimately eugenics goes unexamined. Indeed, the person responsible for the very term ‘autism’, Swiss psychiatrist Eugen Bleuler, is rarely mentioned; his status as a committed eugenicist never is. Perhaps owing to this earlier omission, very few sources examine the histories and contexts of Kanner and Asperger themselves, despite the comprehensive archival work undertaken by historians such as Edith Sheffer and Herwig Czech to bring the trajectory of Asperger in particular to light. Czech’s (2018) and Sheffer’s (2018) exhaustive accounts make clear that Asperger was at best a dedicated eugenicist, antisemite and supporter of Nazism generally in all but name, and at worst an enthusiastic catalyst for the murder of disabled children at the Spiegelgrund facility that ran alongside (but was not part of, see Czech 2019, 3884) Aktion T4. He differed from some other Nazi clinicians at the time only because he considered a negligible number of the children who entered his clinic to have some limited social ‘use’. All others were to be exterminated in service of the nation’s genetic health (Czech 2018, 17). As De Hooge (2019) describes, Czech’s work was ‘received as revelatory’—as was Sheffer’s—due to its contrast with the narrative enabled by figures like Wing that posited Asperger as an opponent of Nazism and saviour of disabled children from murder. Yet, as De Hooge (2019) affirms, Asperger’s status was already known, or at least rumoured, in disabled communities for years prior. It is clear that the confirmed—if not entirely new—bodies of knowledge offered by Czech and Sheffer should necessitate re-examination not only, or even principally, of Asperger himself but more importantly of the genealogies of mental disability that flow from his influence. And yet even the basic questions that might arise from these ‘revelations’ are absent from neurodiversity scholarship. What are the implications, for example, of Wing’s (1981) stripping of historical context and terminology from Asperger’s work when she published the 1981 paper that brought it into the Anglophone mainstream and ultimately gave rise to the ‘Asperger’s syndrome’ designation to describe autism without learning disability (Sheffer 2018, 241–42)? Even absent this context, what does it say about the field of autism research in the late twentieth century that a distinction originally used by Asperger to separate ‘educable’ from ‘worthless’ children (Sheffer 2018, 107)—a distinction steeped in eliminationist ableism—was readily taken up by researchers to the point that it found a home in the medical mainstream? What does it mean for neurodiversity that its early proponents, not least Singer, found that same distinction so empowering? And finally, how does the mainstreaming of neurodiversity-as-valuable reproduce this distinction?

In short, neurodiversity’s insistence on autism and other mental disability as an essential, immutable part of one’s brain falls short of fully considering the dangers of the biological essentialism it implies because it does not reckon with this genealogy, among others. While, as alluded to above, more recent accounts occasionally disclaim Singer’s attachment to ‘Asperger’s’ as a diagnosis distinct from autism (such as Stenning and Bertilsdotter Rosqvist 2021, 1533), and while neurodiversity proponents like Ari Ne'eman were active in its removal from the DSM, there is no consideration of neurodiversity’s more submerged inheritances from the history of autism and what they mean for who the concept elevates and who it allows to be degraded. These partial and sanitised histories are not merely descriptive or scene-setting. As Nikolas Rose and Joelle M Abi-Rached state of the ‘truth-claiming disciplines’, in their case neuroscience, the repeated circulation of mini-histories ‘is performative’, legitimating the discipline in question by ‘viewing the past from the perspective of its own regime of truth’ (2013, 29–30). Citing George Canguilhem’s formulation of ‘recurrent history’, Rose and Abi-Rached note that such narratives use ‘the past to help demarcate a contemporary regime of truth, to police the present, and to try to shape the future’ (2013, 29–30). Salient again is Hughes’s ‘biological citizen’ designation, which he sees as characterised in part by a lack of ‘substantive emotional connection to a collective past and collective historical memory’ (2009, 686). There is a risk, here, then, of deploying history as simply a prelude to the present. A fuller attempt to historicise would help to prevent the emergence of mythologies around neurodiversity that reinforce its neglect of those closest to structural harm, such as Mark Haydon-Laurelut’s assertion that ‘bodies now labelled as autistic were perhaps closer to the norms of the late nineteenth and early to mid-twentieth century’ (2016, 222), an idea cited and reproduced by Chapman, who adds that ‘modernist ideals tended to celebrate autistic traits such as being single-minded, rational, and independent’ (2020b, 812). It is, of course, beyond question that disability is not a fixed entity: that the same person might be subject to disablement in some periods and geographies and not in others. But the suggestion that people now considered autistic would have been considered ‘normal’, or even ‘celebrated’, in the late nineteenth and early twentieth centuries—the heyday of eugenics and its manifold regimes of violence—is only plausible if we limit ‘autism’ to traits that are neither universal among autistic people nor exclusive to us, and that in many cases are limited to those furthest from structural harm, including ‘rationality’ and ‘independence’. Neurodiversity’s dehistoricisation here is mutually constitutive with its ‘creaming’ effect (Mitchell and Snyder 2015, 12).

By repeating this sanitised version of history, and by accepting or even embracing autism as neurological without considering the historical processes responsible for its designation as such, neurodiversity has made itself particularly amenable to co-opting. We opened this article with a particularly flagrant example, but there are many more instances of incorporation and mobilisation by disciplines, organisations and institutions hostile to mentally disabled people as a whole. As Yergeau puts it, these are the fields that ‘behol[d] the mentally disabled as though they are ants writhing beneath a magnifying glass’ (2018, 207), seeing no more future for us than the psychoanalysts neurodiversity rallied against. Indeed, some of the institutions that have incorporated neurodiversity into their practice originated with those same psychoanalysts; a particularly acute illustration can be found in the Anna Freud Centre’s embrace of the concept in child psychotherapy and publication of a guide to it (Murphy 2023). Another especially concerning example is that of Simon Baron-Cohen, possibly the world’s most influential living autism researcher and responsible for decades of stigmatising and eliminationist theories about autistic and other mentally disabled people: theory of mind and ‘mindblindness’, autism and ‘personality disorders’ as inhuman lack of empathy, and ‘extreme male brain’ to name the most well known (Yergeau 2018, 47–48, 68–72). In 2021, in his capacity as leader of the Autism Research Centre based at the University of Cambridge, Baron-Cohen was awarded several millions of pounds in funding for the now-paused Spectrum 10K project, which sought to isolate ‘genetic risks’ for autism by amassing the genetic material of 10 000 autistic people. Yet he was endorsing neurodiversity as concept as early as 2017, and is now cited as an authority on it in papers describing, for example, the application of the neurodiversity paradigm to children’s services (Dunn, Gowda, and Horsfall Turner 2024). This is not to say that proponents of neurodiversity are responsible for these appropriations; nor is it to deny that individuals may be working towards meaningful change from within otherwise hostile organisations. But the ease with which the concept has been incorporated, embraced and even lauded by institutions and individuals responsible for some of the most profound material and rhetorical violence against mentally disabled people should be cause for reflection. This is particularly salient when we consider neurodiversity proponents’ tendency, whether explicit or latent, to frame autistic people (in particular) as in possession of unique or enhanced skills or abilities. To elevate some of us in this way is to buy into a hierarchy of social value that only deepens the immiseration of those unable to ‘produce’, and further entrenches the allocation of time and money towards their eradication.

Any such rethinking necessitates a return to disability, not necessarily and certainly not exclusively in linguistic terms, but rather in genealogical, historical, intellectual and political-economic ones. It demands critical scrutiny of the histories and texts not only of neurodiversity itself, but also of mental disability, a much longer genealogy inextricable from the histories of race, colonialism and white supremacy, homophobia and transphobia, nationalism and class. It also requires dialogue with the extensive body of scholarship that has been scrutinising neuroscience and warning against the neurologisation of identity, education and institutions for almost as long as neurodiversity has existed, but that (with the partial exception of Ortega) conspicuously neglects disability. Of particular interest here are Loraine Corrie’s early exploration of how ‘coupling neuroscience with early childhood may be a dangerous liaison that could lead to an erosion of social justice for some groups of children’ (2000, 34), Jan De Vos’s (2015) assertion that the increased prominence of neuro-terms in schools functions to ‘interpellat[e] us into the scientific vantage point’ from childhood (288), and Zsuzsa Millei and Mikko Joronen’s examination of ‘neugenics’ in Australian social policy and its production of ‘surplus life’ (2016, 397). So too is Rose and Abi-Rached’s extensive account of the ways utterly spurious pop-neuroscience ideas about the brain have become culturally naturalised to the point they are no longer questioned (2013). Finally, a rethinking of these ideas calls for a deeper consideration of the role of misogyny in our conceptualisations of mental disability, and a greater sense of caution towards the possibility of reproducing gender essentialism through, for example, our discussions of the ostensible differences between autistic men and women (Russell 2021, 78–79; Pearson and Rose 2021).

At this point in time, neurodiversity’s star is indisputably on the rise; the degradation of mental disability, meanwhile, continues apace. Our article has sought to understand this dynamic through an examination of neurodiversity’s foundations, principles, self-image and omissions, particularly those left untouched by key critiques levelled at the concept. While neurodiversity is in some ways heterogeneous as a field of study, a belief in the concept’s foundational inclusiveness unifies proponents. So too does the principle of neurologisation, even where this is outwardly disclaimed. While theorisations of neurodiversity have foregrounded the primacy of individual experience, critiques have centred on decontextualised questions of logical coherency, plausibility and occasionally hypothetical risks that are rarely grounded in concrete circumstances. Absent from these discussions are disability and disablement as political-economic entities, meaning that the stakes for those closest to structural harm are lost. A re-examination of the text that first brought neurodiversity to wider audiences (Singer 1999) shows that this sidelining of disability was present from its inception, and that the concept originally sought only to demarcate and elevate a select few: the ‘able-disabled’, in Mitchell and Snyder’s (2015, 12) terms. This dynamic is perpetuated by proponents' lack of reckoning with the genealogy of mental disability and repeated circulation of sanitised or partial historical accounts. These omissions have made neurodiversity particularly susceptible to co-opting by institutions whose fundamental ableism and proximity to structural power deepen the marginalisation of disability already latent within neurodiversity itself. At a time when the stakes for mentally disabled people are so high, critical reflection on these omissions, exclusions and vulnerabilities has rarely been so crucial.