A Neuroexpansive Approach to Psychoanalysis: Thoughts, Questions, and Desire for Praxis
By Sophia Sandhu, M.A., M.Ed.
Passed down through a culture of ableism, I internalized a decades-long, disorienting experience of muddled self-identity, all in an effort to appear neurotypical. Years of working in various esteemed clinical, research, and academic settings focused on supporting neurodivergent youth and adults only furthered my desire to reject the notion of my own neurodivergence. Before I understood why, I felt deeply that I did not want to be connected to the diagnostic and clinical language used to describe neurodivergence, the language of deficit and disorder. Eager for a view of neurodiversity that centered the person, not pathology, social media became my primary teacher.
Through social media I found people who had lived experience with neurodivergence, wanting nothing more than to be seen for their humanity and to connect with others. I learned from advocates who encouraged curiosity and offered wisdom to challenge my internalized ableism, prejudice, and academic elitism. There I learned from those who used art, poetic language, augmentative alternative communication (AAC), photos, blog posts, anything, to shatter and remold something that clinical language made so exclusive, complicated, and othering. I learned terms like neurodiversity, neurodivergent, neuroexpansive, and neuronormativity. I found people who saw others with dignity, not through a lens of deficit. As my learning became more immersed within the social media space (largely due to the COVID-19 pandemic), I observed how the content of those I followed evolved. Advocates spoke about how the fields of psychiatry and psychology historically focused on compliance with neuronormativity. They skillfully highlighted how its particular intersection with race and gender impacted treatment from medical and therapeutic spaces. Across many intersections of identity and socially constructed norms, conversations united across my social media feed, becoming increasingly intricate and nuanced. Complex and communal, multiply marginalized disabled people offered an education that allowed me to grapple with ableism at the intersection of culturally held beliefs, white supremacy, and colonialism.
“I learned from those who used art, poetic language, augmentative alternative communication (AAC), photos, blog posts, anything, to shatter and remold something that clinical language made so exclusive, complicated, and othering. I learned terms like neurodiversity, neurodivergent, neuroexpansive, and neuronormativity. I found people who saw others with dignity, not through a lens of deficit.”
The education from social media rarely, if ever, bridged to the training and education I received in clinical psychology. This exclusion of education and training on neurodivergence reflects a clear microcosm to the broader historical interplay of clinical psychology, psychotherapy, and neuronormativity. Psychoanalysis easily found a way to perpetuate white-centered neuronormativity by devaluing the experience of multiply marginalized disabled people. Early psychodynamic authors theorized that neurodivergent “individuals could not develop internalized conflicts...[and] were thought incapable of suffering from underlying mental disorders.” (Butz et al., 2000, p.44). Though recent psychodynamic literature has shifted its understanding, the lack of intersectional frameworks persist, with current literature maintaining that a neurodivergent identity is “value-neutral, akin to race” (Brotha et al., 2020, p. 435).
There is virtually no literature written by psychoanalysts of color with multiply marginalized identities regarding neurodiversity affirming psychoanalytic practice. Undoubtedly, a core paradigm shift must occur. A new paradigm within psychoanalysis must consider how marginalization due to neurodivergence, at the intersection of other marginalized identities, deeply impacts an individual's wellbeing.
In conjunction with psychoanalysis’ struggle to create literature that promotes a neurodiversity affirming framework and my observations from social media, I was led to the following questions. I hope to use these questions as an invitation for dialogue within the psychoanalytic community.
Do current psychoanalytic frameworks understand how multiply marginalized disabled people develop unconscious ableist internalizations through systemic influences including family, cultures of origin, laws and policies, racism, sexism, and classism?
Can psychoanalysis embrace the neurodiversity affirming paradigm in order to support people of the global majority (PGM) in the process of developing a positive self-identity?
How can clients explore their mind and body in relation to whiteness and ableism within a psychodynamic framework?
Most importantly, can psychoanalysis encourage multiply marginalized people with disabilities to develop an understanding of and in creating “beloved community” as a primary psychotherapeutic intervention (Jensen & King, 2017)?
Creating a neurodiversity affirming model of clinical practice within psychoanalysis first requires practitioners to contend with the history of ableism and the social constructs of pathology. The dominating nature of the medical model to understand neurodiversity shifts a neurodivergent client’s intersubjective experiences into manufactured “deficits.” Pathology is another way in which people become othered; in which a person is “disordered” because they “diverge” from the white mind-body. (see term: neuroexpansive; Alston, 2022). This model, enmeshed with the disregard for intersectionality, further influences a client’s underlying psychic process aiding in the internalization and identification to having “deficits'' and being “disordered.” Accordingly, the neurodiversity paradigm is a rejection of the self-identification to disorder and deficit (Singer, n.d.; Walker, 2014).
“Pathology is another way in which people become othered; in which a person is “disordered” because they “diverge” from the white mind-body.”
Neurodiversity affirming psychoanalysis must include prioritizing the client’s lived experience, enhancing client’s awareness in how internalized ableism at the intersections of other identities impacts wellbeing, as well as providing access to accommodations within the therapy setting and process. My hope is that psychoanalysis can become a home where clients are supported in creating a complex narrative that honors their experience in relation to a neuronormative, white mind-body centered world. Psychoanalysts can support clients in noting how their neurodivergence appears in all aspects of their life. This requires psychoanalysts to understand, and then empower the client to recognize the social construction of “neurotypical,” rooted in ableism, racism, and colonization, as a means of promoting wellbeing and liberation through the “recovery of historical memory” (Gaztambide, 2019, p. xxix):
“We often say that our ancestors and those who have died are resting in peace, but many of our disabled ancestors cannot do so because their stories are incomplete. How can our disabled ancestors rest in peace when many of them, especially those who lived before the disability rights/arts movements, did not have the opportunity to talk openly or act creatively with their disabilities in an open and free environment? Even in death, our ancestors' disabilities are erased. This is why many disabled writers today, like myself, are putting disability back into our history, and in so doing, are learning from our ancestors” (Moore, 2019, p. 515).
Developing a praxis for neurodiversity affirming psychoanalysis, at its foundation, must take steps to address how social, cultural, and systemic inequities impacts PGM in a way that prevents wellbeing. Shifting from the pathology paradigm to promoting principles of the neurodiversity paradigm includes: valuing neurodiversity as a part of healthy biodiversity, understanding “normal” neurocognitive functioning as a social construct, recognizing the interweaving nature of neurodivergence at the intersection of other marginalized identities is not “value-neutral”, respecting a person’s autonomy and personal agency when defining and making meaning of their experiences, and understanding that “neurodivergence is not a disorder or disease but it can be a disability” (Singer, n.d.; Walker, 2014; Wise, 2023). In order to sustain wellbeing, the psychoanalytic community must create a praxis that supports clients in building connections between internal processes and historical knowledge, while bolstering the creation of multifaceted, interdependent communities as a means for strengthening resilience.
References
Alston, N. (2022, December 27). Neuroexpansive™️ thoughts. Medium. https://medium.com/@ngwagwa/neuroexpansive-thoughts-9db1e566d361
Botha, M., Dibb, B., & Frost, D. (2020). "Autism is me": An investigation of how autistic individuals make sense of autism and stigma. https://doi.org/10.31219/osf.io/gv2mw
Butz, M. R., Bowling, J. B., & Bliss, C. A. (2000). Psychotherapy with the mentally retarded: A review of the literature and the implications. Professional Psychology: Research and Practice, 31(1), 42–47. https://doi.org/10.1037/0735-7028.31.1.42
Gaztambide, D. J. (2019). A People’s History of Psychoanalysis: From Freud to Liberation Psychology. Lexington Books.
Jensen, K., & King, P. (2017). Beloved Community: Martin Luther King, Howard Thurman, and Josiah Royce. AMITY: The Journal of Friendship Studies, 4(1), 15-31. https://doi.org/10.5518/AMITY/20
Moore, L. F. (2019). Black Disabled Ancestors Can’t Rest in Peace Until We Write the Whole Story. Peace Review, 31(4), 515-519. https://doi.org/10.1080/10402659.2019.1800938
Singer, J. (n.d.). Neurodiversity: Definition and Discussion. Reflections on Neurodiversity. https://neurodiversity2.blogspot.com/p/what.html
Walker, N. (2014, September). Neurodiversity: Some Basic Terms & Definitions. Neuroqueer: The Writings of Dr. Nick Walker. https://neuroqueer.com/neurodiversity-terms-and-definitions/
Wise, S.J. [@livedexperienceeducator]. (2023, December 4). Whenever I talk about shifting from the pathology paradigm to the neurodiversity paradigm, I always get questions about whether neurodivergent people can [Photograph]. Instagram. https://www.instagram.com/p/C0cwpRBvNa0/?igsh=MTBlZjE4YzMxOA%3D%3D
About Sophia
Sophia is a 5th year doctoral candidate in Clinical Psychology at the Wright Institute in Berkeley, CA. She obtained her M.Ed. in Child Studies with a special emphasis on Poverty and Intervention from Vanderbilt University, and a B.S. in Psychobiology from UCLA. Her clinical training has focused on supporting the psychological wellbeing of children, families, and adults within multiple community mental health settings. Her therapeutic approach is largely informed by liberation psychology, disability justice, and culturally attuned relational psychodynamic psychotherapy.
For questions and comments about this essay, please send them to Coloring Psychoanalysis (coloring.psychoanalysis@gmail.com) and we will forward to Sophia.