PSINKTOBER_DISCHARGE-REPORT-2

Subject: Definitions

This is the second of three follow-up posts to my PSINKTOBER series. In most of the comics I made for PSINKTOBER, I use several terms—disorder, disability, and neurodivergent, among others—without taking the time to define what I mean. This post will clarify my current thinking on the subject.

A disorder is a pathological personal epistemology¹ with compound biopsychosocial causes.

Disorder has a set of unique qualities:

1. Mutable: While the general mechanisms of disorder stay constant, their manifestations evolve and change over time.

2. Definite: Because the biopsychosocial model implicates consciousness and lived experience with the development and progression of disorder, disorder has a defined start point². As a corollary, a disorder can conceivably end without the consciousness it accompanies also ending³.

3. Negative: Disorder is either opposed to oneself or is identified with the self and opposes other people. It disrupts either the person or their interpersonal relationships.

4. Semi-material: The way disorder manifests partially depends on the host's information intake. The movies, books, and ads we see inform the pathological thought complexes we have.

5. Responsive: The presentation of disorder changes depending on circumstance, diminishing in response to surveillance but intensifying in response to other needs⁴.

Disorder is the real problem that psychiatry pretends to solve. It is distinct from the neutral or positive deviations from social norms that psychiatry pathologizes, because disorder is more disruptive and destructive to those who experience it than anyone else.

Under this paradigm, I do not consider brief episodes of disordered behavior such as Alison Bechdel's "childhood spell" of OCD or the depressive episodes most people experience during grief or dislocation quite the same thing as OCD or MDD. This is not to imply that episodes should not be taken seriously, nor that "real" disorder lasts forever; only to clarify what I'm talking about.

I deliberately chose a word that was expansive enough to include the whole array of chronic psychological pathologies regardless of severity, neutral enough to avoid demonizing or fetishizing the people experiencing them, and specific enough to include only people subject to continuous psychiatric surveillance or disrupted personal functioning as a result of disorder.

The concept of "disorder" as the natural consequence of a seemingly rational, constructive system that, at its heart, is irrational and destructive also appeals to me. While I do not think disorder can function as an organizing principle or identity for a social movement, I think the collapse of “the sick society” will involve the spread and intensification of chaos and disorder.

Other commentators on this subject, whether therapists, activists, or philosophers, use a range of other terms. Though I use several throughout PSINKTOBER, I do so only ironically or in a contextual manner:

Mad, psycho, crazy, etc.: These words are quite popular with the Mad Pride movement and the Psychiatric Survivor movement. I'm extremely dubious of attempts to "reclaim" oppressive labels, and even if I were fine with reclamation, I'm not “mad” enough to have the right to use them.

Unstable: This one feels like a safer version of the above slurs—like "disorder" is to "order," it can be read as a neutral alternative to "stable," but it's also a word I can only imagine people who think they're "stable" using. Thus, I use it in place of "disorder" when I want to speak in the diagnostic voice⁵.

Mental illness: This one lacks the neutrality of "disorder" and uses the body as a metaphor for the mind in a way that seems reductively dualist to me. I occasionally use it as a term for more serious disorders, because there are times when even "disorder" sounds euphemistically optimistic.

Mental Health: "Mental health" is a euphemism pretending to be neutral. No one uses it unless they're talking about mental illness—in this way, it creates a lie at the moment of usage. Worse, it has been so overused and broadly-applied so as to lack any meaning. The mind, by definition, is the only way we have to conceptualize and consciously experience the world. The stress I feel trying to write this essay while taking care of classwork is a mental health issue, your reaction to it says something about your mental health, and on and on. I only ever say the words "mental health" when I am being very sarcastic.

There are two other terms I often use, and that have their own special meanings:

Disability: A disability is a material condition that limits the process of social normalization and access. Disability is ethically neutral; it is not a "bad thing" except under the medical model which aims to cure it, as opposed to the social model which views disability as a result of an environment that is not accessible or that actively disables people.

I consider most disorders examples of disability, but not without exception. This is mainly because the perpetuation of disorder always involves some element of voluntary performance by the patient, and it does not always make sense to apply the disability framework to the effects of disorder.

As an example, I know a student who refuses to watch horror films or engage with any kind of disturbing content because she is worried about triggering her Anxiety and OCD. While I agree that some part of how her brain manages information will forever remain outside her control, she can also control how she receives and reacts to information in a way that someone with more disabling conditions could not. As a counterexample, I know several students with PTSD who do not engage with triggering content because they will have no control over their intense physiological reactions to it. The two situations are very different, and to call both disabling—or disabling to the same extent—is to empty the term of meaning.

Neurodivergent: I use this term to refer to anyone with a neurological disability that limits social normalization and access primarily through expressed behavior or communication. Any disorder that is also a disability is a kind of neurodivergence, but many examples of neurodivergence are not themselves disorders.

I would not use neurodivergent for non-disabling neurological abnormalities. Putting aphantasia or synesthesia in the same box as autism or ADHD invalidates the usefulness of the term, even though all four are technically examples of neurodivergence.

If you disagree with any of my points, please let me know, either here or offline—I’d rather know I’m wrong and learn something than feel right and learn nothing.

1. A way of conceptualizing and organizing information and knowledge.

2. Regardless of people who say “I’ve had ___ my entire life” or the camps for children with Bipolar Disorder mentioned in one of my comics, I think we can agree that newborns and infants are rarely psychotic.

3. Curing disorder does not necessitate killing or harming the person in the same way as curing a developmental or intellectual disability would.

4. You keep it hidden until you cannot.

5. Or when I get sick of saying “disorder.”