Some Thoughts from a Neurodivergent Perspective on Casual Use of Clinical Diagnoses

It seems like a common thing to come across clinical terms like “psychopath” or “autistic” being used as shorthand for “someone with a reduced capacity to feel empathy” or “someone who is lacking common sense and/or is shortsighted”, respectively, in non-clinical conversation. That is a problematic practice. Clinical diagnoses are not general adjectives, they are terms for specific conditions that affect real people who are marginalized already, through no fault of their own, due to the manifestations of said conditions. Using the terms as insults or emotionally-charged descriptors just adds social stigma unnecessarily. These are people who can (by and large) lead safe, healthy, happy lives if they get the necessary attention and care. They are not freaks or monsters to be shunned, ostracized, and burdened with further stressors.

I am not saying this is what people are trying to do when they use clinical diagnoses in such ways. But often, one’s intent is superseded by the consequences of their actions. Using clinical terms in this manner causes unnecessary pain and suffering as well as spreading misinformation, something that affects both the people who live with these conditions and the people who care about them.

Let me be clear: watching some movie or documentary about a given mental health condition does not mean you understand it. Reading DSM-5 (or ICD-10, or whatever other text) does not convey true understanding. Taking a psychology course does not mean you know what it means. Even being a psychologist or psychiatrist does not mean you understand it in truth. You might grasp it in an academic capacity, possibly even to the degree of being able to follow many of the thought patterns of people who have it, but unless you have actually lived with the condition, you will not truly understand what it means. Period.

I am not saying that to be dismissive or for gatekeeping. There are simply objective limits to how much can be communicated about what a person’s “normal” daily existence is like to someone else with a significantly different frame of reference, to say nothing of overcoming the hurdle of getting someone with a mental condition to consent and cooperate in good faith with studies/sessions/etc. that are fundamentally trying to find something broken in them. Observation alone is not enough to build understanding; even neurotypical people have secrets or subconscious compulsions/imperatives that cannot be understood just from them watching each other.

As an aside, those alleged-professionals who take part in diagnosing people based on public records of their behavior are acting incredibly unethically, if not also presenting an active hazard to people diagnosed properly with the actual conditions that they end up throwing around, because they have no real idea of what the subject is actually thinking nor any insight into what the subject is doing in their private moments. But since my interest here is to focus on casual use, I will not pursue that train of thought further.

That all said, building enough understanding for empathy is a reasonable goal and definitely a worthwhile one. It just has to be approached with the awareness that it will never be an entirely complete understanding, just as a cisgender person will never be able to understand all of the intricate, understated, and unstated difficulties that transgender people live with; it is not a matter of transgender people trying to keep secrets, but rather of cisgender people lacking the frame of reference to truly comprehend why something is not “normal” or “fine” to them. The same applies for neurodivergence.

The goal also has to be approached with the awareness that it may be very difficult to build that understanding, because the actual thought patterns and processing of information often feel very alien to someone without those same mental conditions. I would offer the same advice here as for understanding a person with a different gender identity: do not worry about all the details of how it fits together; just try to empathize with individual elements. Be prepared to be patient with learning how they connect.

Most manifestations of mental conditions come from imbalances in individual processes, such as narcissism being an extension of the same processes used for protecting one’s self-image and for feeling remorse or shame for how the consequences of one’s actions impact others. The core concepts should be relatable for neurotypical people, and for most neurodivergent people, even if the full experience is not. While I cannot explain exactly what it feels like to switch between multiple tracks of internal dialogue all the time in my mind, I can draw parallels to the disorientation and information gaps that can crop up when a conversation goes off on a tangent and then tries returning to its previous topic. While I cannot explain exactly what it was like to feel naught but muted embers of empathy, I can try to make analogies to experiencing a work of media where the audience feels no bonds with any of the characters, yet feels no animosity towards them either.

These bridges of understanding can be built, but they have to originate from a variety of people for whom the conditions are a normal element of their lives, in order to give an accurate and well-rounded representation. Getting those people invested in building the bridges is undermined every time they come across their personal “normal” being used as a weapon. Every time someone around me uses “sociopath” or “psychopath” to refer to someone lacking empathy, it feels like they are attacking me with the same negative associations. When I have tried explaining that there are other conditions that inhibit empathy without posing an increased threat to others (schizoid personality disorder, in my case), they tend to end up viewing me as a monster, likely in no small part because of social stigma. That is why I have gotten used to just asking them to not use the term.

It is not difficult to simply describe characteristics without relying on clinical terms. I should know, seeing as I wrote a whole novel where mental health conditions are a critical component without using shortcut labels. I do not know if the readers all understood the undertone, but I do know that those who I have spoken with connected with the characters and felt the authenticity behind the depictions, even if they did not always understand the reasons for the decisions that the characters made. The same can be done in conversation; say what you actually mean instead of being lazy.

Every time someone with a mental condition is given indications that they are lesser, worthy of derision, deserving of mockery, inhuman, a menace to be feared and cast out, they are being harmed. Additionally, that experience makes achieving understanding of their actual lives exponentially harder, and they will have more reasons to not try. Remember, from their perspective, their existence is the normal one. Stigmatizing it will not convince them otherwise, but it may push them to become what the rest of the world seems to expect them to be.

If you have been linked to this post to help explain why your use of a clinical diagnosis was inappropriate, you can stop here. If you want some more understanding of why this topic is important to me personally, you are welcome to carry on.

MY BACKGROUND

In the interest of full disclosure, I have no formal training in psychology. I am just someone who lives with multiple mental conditions. All of them are on the mild/high-functioning side, and I do not believe I pose an increased threat to anyone but myself, and yet I have felt all of them hamstring my life. These include conditions that I was born with and ones that I developed later as side effects from aggressive medication or as coping mechanisms for personal trauma. I have seemingly recovered from some of the latter; the rest became just another piece of me.

Any specific manifestations that I describe here are anecdotes based strictly on my own personal experiences and should not be taken as general statements about all people with the same conditions. This is especially true when it comes to anything that I say about living with a reduced or almost non-existent capacity for empathy (which are two completely different experiences), because it is extremely difficult to find people with such manifestations who are willing to be studied in good faith due to both our own gaps in perceiving the manifestations themselves (because they are entirely normal from our perspectives) and how often such manifestations are vilified instead of being seen for how tragic and alienating they are to actually live with. For multiple reasons, I do not trust the greater medical community and so will not consent to being studied any more than I have been already, but I am willing to talk about my experiences in an informal and open way in hopes of building some understanding for the sake of others.

I will provide links to Wikipedia for any specific diagnoses mentioned hereafter; it is not a definitive source, but it tends to be a reasonable starting point for a remedial-level academic explanation of what neurotypical people think the conditions mean. I am willing to speak more about any of them if you contact me directly (I would suggest either using the link in the top ribbon or speaking to me on whatever platform I linked this post on, since I believe the Disqus comment module is not working properly at this time); you need not be shy about asking for any details or clarifications because I am not shy about letting people know if their curiosity is crossing any of my personal boundaries. Also, please do not bother telling me worthless platitudes of support, as you can read my thoughts on that at this link.

DEPRESSION

As a first example, let me talk about something that is understood fairly well, at least among people who take it seriously, and where the clinical term is often used in a neutral connotation: depression. In case it needs to be said, this is more than just feeling down or unhappy. The best way that I can describe it succinctly is as a pervasive, irrational, irresistible inability to recognize my self-worth, to the point of seeing myself as an active drain on the resources, happiness, and general well-being of the people around me. I know it is irrational because there is objective evidence of ways that I have enriched the lives of my friends, whether in the short-term (like giving a gift or helping with a report) or in the long-term (like being seen as a comforting and understanding person to turn to in times of distress). Knowing that does not matter when I am having a bad depression day, because there is still that (figurative) voice in my head I cannot ignore telling me that everyone around me is lying and tolerating me out of pity and that I am a worthless abyss sucking in precious time from their lives that would have been better spent on anything else if only I was not too selfish to die. Knowing that I have had romantic relationships does not matter when that voice is telling me that I am a repulsive loser undeserving of love or kindness who has only ever felt either because the other person saw that as an easy way of exploiting me. Knowing that I have achieved personal success in various metrics does not matter when that voice is telling me that the total fruits of my life are naught but dust waiting to crumble and be forgotten as soon as I am dead. While I have my depression under enough control that I no longer engage in overt self-harm or serious suicidal contemplations, it is still something that I need to grapple with regularly that can spring up with no warning.

One of the worst aspects of that last part is that the common reactions to explicit manifestations of depression make it feel worse, meaning I am far more likely to try hiding it behind an empty smile while I am around other people, at least until I have a private moment to break down into a huddled mess, gouging at my rib cage to stop myself from doing anything else until I can regain control. For instance, a recent conversation I had with a close friend went from me being excited about a potential new body mod to me lamenting why I bother with anything related to my appearance when it is all just plaster over a broken, rotten core. With most other people, I would have just kept the second part to myself because I would not trust them to see it as a moment of venting some internal tension to help process it by putting it out in the open. At best, they would blow it off as trying to be edgy or melodramatic. At worst, they would try to cheer me up in a misguided attempt at being comforting, which would have made me feel worse for draining their effort on a lost cause. In either case, I would end up feeling more isolated and worthless. In the case of what actually happened, I had enough history with this friend to trust that I would be given the space I needed to let it out and work through it with the added safety net of having someone else around to keep me from veering off in an actually-dangerous way (it helped that this friend also had enough personal history with depression and psychology to have a good sense of how to handle his part, and the whole episode was mild enough that I was able to get through it and recover in about an hour).

Now, granted, depression is somewhat at the forefront of general public sensitivity and recognition for being an unfortunate hindrance rather than a personal failing or a mark of bad character. I am genuinely happy that younger generations are likely to have an easier time finding the support and care they need to live with it than I did, as I would be for anything else mentioned here. That said, I think there are still plenty of misconceptions about what depression is and how you should act if someone around you is living with it, in part because the term is also used as a casual synonym for being unhappy. Trying to make someone dealing with depression feel happy is likely to fall into toxic positivity because it is not just a matter of feeling down, it is a matter of being unable to not think in a way which, at least in my experience, causes attempts by others at cheering me up to be reinterpreted negatively and leave me worse off. This is something that I need to work on myself because my first instincts when faced with a problem are often to want to take immediate action, so please do not take it as a personal attack if I am essentially saying that you have handled it poorly in the past, dear reader. If we can render that casual use of “depression” obsolete, which is easy enough to do by just making a mindful effort to use different terms for the exact same idea, I believe it would help improve social response practices for when someone is unhappy versus when they are depressed because there would be a clearer distinction between the two.

AUTISM

As a second example, let me talk about something that is receiving sensitive treatment by the public at large, despite some areas continuing to use it as a casual adjective or pejorative: autism. This example and the next both have far more personally-diverse sets of manifestations compared to depression, so I will once again stress that any specifics I talk about in this post are from my own personal experiences and should not be generalized as applying to all people with the same conditions. When it comes to autism, honestly, I tend to be hesitant to bring it up at all because my particular case is high-functioning enough that it is probably the condition that has caused me the least difficulties, though with the caveat that the boundaries can be blurry for whether certain manifestations come from autism or schizoid personality disorder and I should probably be more open to accepting anything that might be from either as coming from both. But I digress.

Given the variety of ways in which autism can manifest, it is not possible for me to give a core definition of what it is. My personal case of autism does not include some of the more noticeable manifestations like echolalia or ritualistic behavior, though I do have some minor compulsions to do things in symmetry (for instance, if I scratch one side of my head, it can cause me some mental discomfort to not also scratch the other side) or maintain certain arrangements (for instance, if I am playing a TTRPG with a variety of physical dice, I keep laying the dice out with the maximum value facing up and grouping them by the number of sides). My autism is more pronounced in areas like feeling significant discomfort about initiating communication with people who I do not know well (such as once taking more than a full week between deciding that I wanted to approach a coworker about becoming friends and actually doing so, to say nothing of the lead-up to the moment itself), showing intense interest in topics that spark my curiosity (such as vampires, as evidenced by this post), and lacking an intuitive understanding for common social conventions (for instance, I had a hard time understanding why people would see a corpse of someone they did not know as more deserving of being treated like a person than a realistic doll or mannequin, since they were both inanimate collections of matter in the likeness of an unknown person from my perspective).

I am sure some people will be horrified by that last example, so let me emphasize that I did say “an intuitive understanding”. I do understand grief and the pain of loss; it just was not clear to me on an intuitive level why the actual physical remains of an unknown person would invoke those feelings in a way that other reminders of mortality did not. Fortunately, I have had patient and understanding friends help explain that to me, along with countless other social conventions (such as maintaining comfortable eye contact), so I do have some academic understanding of it now.

Beyond those, I probably have a scattering of other minor manifestations. As I keep saying, all of them feel like entirely normal and reasonable things from my perspective, so it is difficult for me to even recognize many of them as being neurodivergent aspects.

At the risk of stating the obvious, none of those have anything to do with my intellectual capacity, for good or for ill. I am not “retarded”, nor am I a “Little Professor”/“savant”. I am simply, uniquely myself, and frankly, I am glad that I did not know I had autism until I was mature enough to hold onto my sense of who I am in the face of both positive and negative stereotypes, because they were commonplace when I was growing up. Either end of that spectrum brings up problems of stereotype threat, whether reinforcing inequalities or placing undue social pressure on a person for no good reason.

As should be obvious from that, casual use of “autistic” (or older alternatives like “retarded” or “sperg”) as an insult reinforces caricatures that do not accurately reflect the experiences of real people and instead harms them for something that is just a part of who they are. They are textbook cases of ableist microaggressions. On the flip side, “ASD supremacy” and the like also does not accurately reflect the experiences of real people and instead harms them by insinuating, if not outright saying, that they are somehow diminished if they are not living up to unrealistic lofty expectations (similar to the wide swath of people who suffer from mass media and social media depictions of unrealistic beauty standards).

PSYCHOPATH

Frankly, I doubt either of the prior two examples were particularly contentious in the present day, which is why I tried not to dwell on them overmuch. Allow me to take a little more time with one that is more contentious: the use of “sociopath”/“psychopath” for someone who lacks empathy and has some degree of detachment from reality.

To be clear, I have never been diagnosed with either condition. That said, I do live with schizoid personality disorder (which, among other manifestations, reduces both my capacity to feel emotions and my capacity to feel empathy [and yes, the former does make the latter even more of a challenge] as well as causes me to tend towards spending time in my own internal fantasy worlds) as well as psychosis (which causes some minor visual, auditory, and tactile hallucinations as well as the occasional false memories), the combination of which has significant common ground with what people often mean when they use those labels. Additionally, due to emotional trauma from a multiyear struggle with a physical condition (the details of which are beyond the scope of this post), there was a time when my mind had all but eliminated my ability to feel empathy as a coping mechanism that became my new normal for the better part of a decade.

Curiously, I was able to still form some degree of bonds with people over text communications; such as email, instant messaging, or SMS; but anyone who I was around in person felt like a doll or a video game NPC, something that I could interact with but felt no real connection to. That description does not do justice to the actual experience, honestly, but there is no way that I can explain what it really feels like to be all-but-completely dead inside. It was different from the hollowness of depression or from the muted emotions of schizoid personality disorder by itself. I was an empty husk, and so it seemed entirely sensible that everyone else was as well, all of us putting on displays of emotions that were entirely faked because nothing was actually stimulating, engaging, enraging. The world was all a show, the other people just complicated scripts that I had to deal with to cover my necessities so that I could spend some time in front of a screen, reaching out to one of the few other actual people out there. And at times, I met some of those other actual people, only to realize that they were also just scripts that had been complex enough to fool me through the limits of text.

This did not bother me, though. Nothing really did, because there was nothing for me to feel in the first place, because all those displays of emotions were entirely faked. It was normal to me. I saw nothing wrong with feeling that way, despite having some memories of what my existence had been like before. This is a key point to emphasize, because it is part of the reason why it is very difficult to find people with diminished empathy who are willing to go along with psychological studies: that diminished empathy does not feel wrong when you are living with it. The study becomes another game to pass time rather than an earnest attempt at getting help. In hindsight, it was an extremely lonely way to live, with the isolation prompting further withdrawal prompting further isolation in a self-energizing cycle, but when I was living it, it did not feel wrong or weird. It felt like I was just living my life, and I just wanted to be left with the freedom to do that with minimal interference.

The only thing that got me out of that cycle was a chance friendship that combined in-person interaction with text in such a way that it convinced me I had met another real person. That brought back the slightest bit of empathy, and from there, with help, I was able to work towards healing and restoring what I had lost. I still have reduced capacity for empathy because of my schizoid personality disorder, but it is a far cry from where I had been.

Nothing that I wrote above will let you really understand what it was like to live like that, because it is very unlikely that you have had a second of consciousness without feeling something. I did not misspeak when I said that I was an empty husk; it was not an emptiness of despair or ennui, it was a complete lack of anything, and I do not have the words to truly convey what that means. However, if what I wrote was enough for you to imagine even a fraction of a moment of what it was like, I hope that can set you at the start of a bridge.

During my time without empathy, I was no more a danger to others than I am now; I was unlikely to be helpful because altruism was a fictional artifice from my perspective, but I did not try to cause harm to other people. If anything, I was more of a danger to myself, for the tangential reason that the loss of my emotional capacity in general meant immediate sensory stimulation was the only thing I could really “feel” and so I had an incentive to seek more extreme experiences while still being isolated. Lacking empathy did not make me a tyrant, an abusive manipulator, or a violent threat. When people use “sociopath”/“psychopath” in a casual way around me, it harms me because there is enough overlap in manifestations between what they mean and what my life has been that I cannot help feeling like it is being used against me, too. Despite that I might joke about it at times or even irrationally believe it temporarily during a spell of depression, I am not a monster. I do not appreciate other people indicating that they would think I am if they knew more about me.

And no matter how rare it might be for someone else to have the same mix of conditions that I do, there are enough people in the world that I am sure there are thousands if not millions of others who are also like me, people with constraints on their emotions or empathy who just want to be happy despite the challenges they have trying to feel anything at all. From my personal experiences, I think that a majority of that group can find that happiness and share it with the people around them, if they are supported enough to genuinely seek the help they need to do so. They are not monsters. Using labels like “psychopath” in that way shows that you think they are, whether you mean to or not.

CALL TO ACTION

As I have touched on throughout this post, I believe there are clear paths of action that everyone can take: stop using clinical mental health diagnoses and related terms outside in situations where they are directly and literally applicable, especially as insults. Talk about actual behavior or other manifestations instead of using diagnoses as shorthand labels. If someone around you has a mental health condition that they are comfortable discussing, try to get their views on how it affects their life so that you can have a better, even if still incomplete, understanding.

These are not complete solutions to addressing ableism and mental health stigma, but reducing harm and building empathy are key steps towards that eventual goal.