Autism: Difference vs Disorder

Hello Dazzle! Thanks for coming and hanging out with me today, I’m glad that you are here. Today I want to talk about a video that I just watched that was shared with me in my discord server by catloverjerrygarcia. Thanks for sharing the video, I enjoyed watching it! This video touches on a topic that has been brought up to me a lot as of late and I have decided to write about the thoughts this video has provoked. I want to start out by saying that I don’t disagree with anything that was said in this video, it simply sparked thought and touched upon ongoing discussion which has lead me to thinking which leads me to writing…

The idea that this video is talking about is that Autism should not be considered a Disorder, but rather a Difference. While the speaker doesn’t get into this, I think it important to note that what is meant here is that they feel Autism should be considered a variation of Normal rather then a Disorder. Before I can really get into my thoughts on this, I think it important to define some terms since they are not always used in the same way, I want to be sure that it is clear how I am using them in this post.

Disorder: a derangement or abnormality of function; a morbid physical or mental state.

-Free Medical Dictionary

Normal: 1. Functioning or occurring in a natural way; lacking observable abnormalities or deficiencies. 2. In psychiatry and psychology, denoting a developmentally appropriate level of effective functioning of personality, cognition, and affect that is satisfactory both to people and to their respective social [setting].

– Free Medical Dictionary

Illness: Poor health resulting from disease of body or mind.

– Free Medical Dictionary

Disease: An interruption, cessation, or disorder of a body, system, or organ structure or function.

– Free Medical Dictionary

Now that we have established the manner in which we are using these terms, I think we can get into some of my thoughts on this topic. So, the video is presenting the idea that we should stop considering Autism a disorder but instead consider it a variance within the realm of normal. I hands down agree that in the context outside of the medical field, we should absolutely start doing this. But until the majority of the general population considers Autism to be normal, the medical field should continue to consider it a disorder; they need to for our protection. So, let’s get into that.

First, let’s talk about what normal is and isn’t when we are talking about human behavior. When we talk about normal in the context of medicine, most people think in context of the first definition provided above. Something along the lines of being natural and not having deficiencies. But in reality, this isn’t how we define normal when we are talking about human psychology. Normal is defined by what the majority of people in that society say normal is: “satisfactory both to people and to their respective social [setting].” [1]

What this means is that as long as the majority of people in a society believe that Autism is abnormal, it will clinically be defined as being abnormal. If we as a society accept that Autism is a variant of normal behavior, then medicine will redefine it as being normal. Granted, we all know that how definitions are written and how things work in practice do not fully equate. Thus, it is highly likely that the Neurodivergent movement will need to confront the American Psychiatric Association (APA) when the time comes if Autism is going to be removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM). But I argue that now isn’t the time.

Alright, so this is a really wild way to define normal psychology, right? Well, kind of. The problem with human psychology is that there is no fixed definition of normal and there isn’t a good way to evaluate or test for normal in context of psychology. Most people are very busy masking what ever traits they believe are not normal or are unwanted by society so how do you observe for them in society to see how many people have those natural tendencies? This is one reason that so many people with Autism go undiagnosed. Add onto that the biases that are inevitability programmed into all of us and it becomes impossible to measure normal in psychology. This leaves us with society’s standard as the only measure to go by. And while that seems like an awful measurement to use, it does have value. And I argue that the value is better then the first impression suggests.

When a person is evaluated for a psychological disorder, the provider is supposed to consider “the 4 D’s” before diagnosing them with anything. Let’s review those 4 D’s and then we’ll talk about how they factor into all of this.

  1. Deviance. This is where the provider is supposed to evaluate if the person’s behavior, mental state or mood state is different then what is considered normal for their society.
  2. Distress. Does having these deviations from society’s expectations cause the person any distress?
  3. Disfunction. Does having these deviations from society’s expectation cause the person any disfunction?
  4. Danger. Does having these deviations put the person or those around them in any danger?

Mental health disorders are all about how well a person functions and feels within their society. Thus, how society defines normal is rather essential to being able to help people better adapt to the conditions in which they are expected to live within. A mental health diagnosis is actually a diagnosis that declares that there is an impairment in the person’s ability to live well within their community.

So, let’s look at all of this in the context of an Autistic person. Society currently believes that I am not within the realm of normal. Autism is classified as a disorder because I have behaviors, a mental state and mood states that are deviations from what society considers normal. Not feeling like I am wanted within the community and feeling like I am an outsider causes me emotional distress. Needing to mask my Autistic traits causes me emotional distress. Because I do not behave in ways that others consider normal, I frequently struggle in social interactions. This struggle in social interaction has caused me to have difficulties with employment. This is a disfunction because it is impairing my ability to provide myself my monetary needs. There have been times in my life that I have been so distressed by feelings of not belonging, being unwanted and not being able to perform work well that I have been suicidal. Being suicidal means that there is a danger to myself. This means that as someone with Autism, I meet the criteria of the 4 D’s for diagnosis.

Psychology is about helping people reach a state of balance with their differences and society. High quality health care providers would first focus on ensuring that the safety needs are met. Then they would address the disfunction as this could impact essential needs such as food and shelter. Employment assistance would be essential or assistance with disability. Once the needs have been addressed, the emotional distress should become the focus. Trauma care should be provided so that the person can work to a state of personal acceptance. All of this care is based upon the understanding that this person must live in the society that currently exists and helping them live as well as they can while being seen as a person that is not normal.

As long as the majority of people in society believe that Autistics are not normal, they will treat us as though we are not normal. This means that our needs will not be recognized let alone considered or accommodated. We will continue to feel that we must mask to maintain our safety and functional level within society. We will continue to feel distress because we will know that we are not considered equal to others. We will continue to feel unwanted. We will continue to struggle in the environments that we are expected to work, socialize and live in. This means that many of us will have areas of disfunction. “Autistic youth are six times more likely to attempt suicide and twice more likely to die by suicide – and at a significantly younger age – compared to their non-autistic peers.” [2] Which means that as long as we are experiencing this distress and disfunction we are in danger.

Autism is associated with an increased risk of mortality from all causes. [3] When you consider that having the diagnosis of Autism means that you are more likely to die from anything and everything else, it is difficult not to consider it as having a significant impact upon a person’s health and well being. When something is associated with increasing mortality risk, we generally consider it a disease or an illness. While it is not believed that having Autism is the direct cause of this mortality risk, having Autism does mean that you are likely to die younger then someone that doesn’t have that diagnosis. This correlation exists because of our disfunction and danger risks due to society not considering us normal.

Thus, until society has accepted Autism as being normal, the medical field cannot. Why? Because if the medical field considers Autism normal before society does it will leave all of us without any assistance. If Autism is not considered a medical disorder, it cannot be considered a disability. Which means that we would no longer be protected by the American Disability Act for reasonable accommodations. It means that it would no longer be a protected status which people could not discriminate against. We would no longer be able to use health insurance to cover appointments to address our Autism related trauma. Having the label of being a disorder acts as a shield. While that shield is small and inadequate, it is the only one that we have.

So, please understand that those in the medical field, myself included, mean no offense when we continue to call Autism a disorder. The primary goal for those going into the Psychiatric and Mental Health field is to help people find wellness and stability within their communities. Until our communities can accept Autism as part of the wide and divergent variability of normal, let us continue to provide this small shield. Because if those of us within the medical field begin to deny Autism is a disorder, it will undermine the medical authority that the upholds the few legal protections that those with Autism currently have.

Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like what you read, click on that like button. It really does help! Until we talk again, you take care of yourselves!

References and Additional Reading

  1. Free Medical Dictionary
  2. Suicidality in autistic youth: A systematic review and meta-analysis
  3. Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis
  4. Disability Evaluation Under Social Security

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