Tag: Autism

Content Notes: Images Depicting Racist Caricatures and Slurs of Māori People and Discussions of Ableism, Child Abuse, Child Murder, Eugenics, The Holocaust, Medicalisation, Nazism, Racism and Self Harm

I didn’t grow up autistic. Well, I was always autistic to be fair, even my family agrees that much was obvious once I received my diagnosis in adulthood. And since my confirmation into the church of dinosaur hands and overstimulation from the deadliest of lasers (the sun) I have been reflecting on old memories. A lot of late diagnosed adults go through this process, and many wish their symptoms had been recognised earlier. Though, in researching for this essay, I wonder how much good it really would have done. Since we have already tackled SCP-818’s backstory and its relation to black medicalisation. Let us turn to a further dimension of horror and discuss how neurodivergent children are forsaken.

Refrigerator Psychologists

As always, since I am an insufferable academic essayist, we have to start with a history of autism. And another condition. Because it is equally critical with SCP-818 to discuss not just autism, but intellectual disability, especially since the two histories are intertwined. Although it is never explicitly stated in the story, it is my opinion that TroyL was trying to portray SCP-818 as experiencing some form of intellectual disorder. Therefore, this historical recap will interweave both accounts.

Intellectual disabilities were first conceptualised in 1908 by Alfred Tredgold, a British psychologist and eugenicist.^[1] A selection of words which will appear a lot here. He implemented the term Amentia for intellectual disabilities, a label which continued to appear in textbooks until the end of the 20th century. However, governmental language used the phrase feeble-mindedness, to describe the intellectually disabled and morally defective as part of the 1913 Mental Deficiency Act. This act allowed for the institutionalising of both groups against their will and was not repealed until 1959.

This move towards institutionalisation was inevitably helped by the rise of eugenics in the late 19th century and early 20th century. The Binet-Simon Intelligence Test was developed in 1905 by French psychologists Alfred Binet and Theodore Simon.^[1] It was utilized in Britain to show that convicts, sex workers and other forms of the “deplorable” were illiterate and feeble-minded, beginning the illustrious history of connecting intellectual disability to criminality. Allowing for the subjugation of all intellectually disabled people, regardless of their actions.

To this day most diagnoses of intellectual disabilities rely on standardised IQ testing.^[2] Typically focusing on deficiencies in areas like spatial memory (my nemesis), perceptual reasoning and verbal comprehension. Modern-day psychiatrists also look at adaptive capabilities, including your ability to do household chores, manage money, reading, writing and decision making.

I do think this definition fits SCP-818 quite well, especially with the spatial memory, where he struggles to remember objects he has created when they are out of view.^[3] As well as issues with perceptual reasoning such as him creating phosphenes where there are none. On an interesting and not at all related side note, one of the things the ICD-11 includes in its symptom list is avoidance of victimisation.^[2] I am will leave that hanging as a form of subtle foreshadowing. Like a sword of Damocles screaming at you to run away.

As IQ testing was being implemented in the UK, the term autism was first being developed by Swiss psychiatrist and rampant eugenicist Eugen Bleuler.^[4] However, Bleuler originally intended for it to refer to a subset of schizophrenia, another term he introduced. Specifically, those with autism had hallucinations like we expect in modern stereotypical depictions of schizophrenia, but also exhibited extreme detachment. It was not until Leo Kanner in 1935, that we approach something resembling the modern depiction of autism.^[4][5]

Kanner produced a seminal text from his observations of a whole eleven children, stating their need for sameness, aloneness and unusual obsessions.^[5] I would state that eleven participants barely qualifies as valid in contemporary practice, but he has precisely targeted me with that description. Safia Abdulle notes this as the beginning of the pathologisation of childhood, where lines were drawn between normal and medically abnormal adolescence.^[1] But if you know anything about autistic history, you will remember another contemporary of Kanner.

Hans Asperger, whose name is always followed with expletives in my notes, was a German psychiatrist in the 1930s and 40s. One infamous for his involvement in the Holocaust where disabled people were imprisoned, experimented on and murdered.^[5] And for his research involving four boys, he noted that autistic kids had difficulty forming friendships, a lack of empathy and struggled with social communication. Unfortunately, he was also the first to suggest autism could exist on a continuum, which would only be reintroduced in the 1980s by Lorna Wing.

Though generally Kanner and Asperger noted there was likely more than one cause for autism, the 1940s was a time of psychodynamic theorising. Predictably, this led to pseudoscientific riffing on already shaky ground. Such as refrigerator mothers, brought to us by a man without a psychiatric qualifications, Bruno Bettleheim.^[5] He proposed that autism was the fault of cold and detached mother as in their callousness to not be feminine enough for Bettleheim, they managed to forge complex neurodevelopmental disorders. This, of course, completely checks out.^{[Citation Not Found]}

In addition, during this time period, there was an increase push for mandatory childhood education. As a consequence to this overall positive move children were increasingly surveilled outside the family.^[5] Allowing educational and developmental psychology to blossom like belladonna. And for intellectual disabilities to move into the realm of an educational issue.^[1] People deemed “ineducable” were segregated to a separate structure of schooling and were not permitted to reintegrate into the general UK education system until the 1970s.

But this was not the only violation inflicted. Control of reproduction was an established practice across many Western countries. In Sweden, Iceland and the USA during the middle of the 20th century, it was required that a “patient” be sterilised to be released from imprisonment. Or as they termed it, involuntary institutionalisation. Even if they were released, most had to hide their history of institutionalisation and even lied to partners about their scars due to the severe social stigma of intellectual disabilities and infertility.

In fact, in New Zealand, there is evidence for sterilisation of children without their consent or their parents consent into the 21st century.^[1] But do not think the UK got out of this cleanly. Despite no active policy on eugenic sterilisation, many children and adults with intellectual disabilities were prescribed birth control without their agreement or even their knowledge. Moreover, some families considered and even went through with sterilising their children privately.

Unfortunately, general medical practice never really progressed past these notions.

Modernising Ableism

In the 1960s onwards, the treatment of people with intellectual disabilities underwent a shift. Though eugenic practices were still common, there was a push for de-institutionalising. This meant the last UK institution for the intellectually disabled opened in the early 1970s with the Princess Marina Hospital and the Lea Castle Hospital.^[1] And the last one to close was…Orchid Hill in 2010. I was in primary school when that closed.

To supplement this snail pace shift from locking up the intellectually disabled, psychiatric practice moved towards normalisation. A process that, depending on your level of cynicism, is exactly like or not at all how it sounds.^[1] As Woldensberger and others put it in a 1972 essay, the practice involved:

“The utilization of means which are as culturally normative as possible in order to establish and/or maintain personal behaviours which are as culturally normative as possible.”^[6]

Put differently they wanted to teach the intellectually disabled how to hide their symptoms. Which could include abusive punishments to incentivise normalised behaviour. Though Jan Walmsley focuses on intellectual disabilities, it should be noted this thought process was shared by psychologists specialising in autism too. In 1974, Ivar Lovaas, a UCLA researcher and homophobic ableist, was quoted saying the following about autistic children:

“You have a person in the physical sense – they have hair, a nose and a mouth – but they are not people in the psychological sense. One way to look at the job of helping autistic kids is to see it as a matter of constructing a person. You have the raw materials, but you have to build the person.’^[7]

And then there is Third Diagnostic and Statistical Manual (DSM-III) publishing the first widespread clinical description of autism in 1980.^[5] This initial version, called Autism Spectrum Disorder, had a triad of symptoms, involving deficiencies in social interaction, communication and exhibition of restrictive repetitive patterns.

In the DSM-IV, a distinction between Asperger and Autism was made.^[5] Most favourable accounts of the distinction will try obfuscating the very apparent point that led to this decision. To separate autistic people without intellectual disabilities from those with them. Which in and of itself, led to a lot of anti-intellectual disability rhetoric in autistic spaces. Something which still lingers today with “Aspie Supremacy.” Which is something we will unpack later.

However, the 1990s saw a rise in genetic instead of psychogenic theories for the cause behind autism and intellectual disabilities. With a focus on the 15q and 7q chromosomes, there was a boost to funding to research genetic therapies that could cure autism amongst other conditions.^[5] This has remained pretty prominent up to the modern day. Something I can say with authority because during my degree for Neurobiology and Psychology I had the displeasure of being taught by one of the most prominent scientists engaging in such rhetoric.

Robert Plomin is currently a fellow at Kings College London and wrote the 2018 “hit” book Blueprints: How DNA Makes Us Who We Are. Additionally, he teaches molecular genetics, during which my class had the displeasure of interviewing Robert Plomin. My highlight of this is Plomin arguing that it doesn’t matter how his research is used, so long as it is accurate. This was in response to a question by a brilliantly incomparable trans student, asking how he feels that his studies contributes to present day eugenics arguments against people with Down’s Syndrome and autism. Specifically regarding genetic screening and abortion of these groups in utero.

Another L for KCL.

I say this about Plomin, not just because I bear a grudge against the man and many other scientists mentioned in this historical recap. But to illustrate that in modern institutions there are still scientists who are firmly of the opinion that autism and various other similar conditions can and should be cured via genetic manipulation. And that these people are at least ambivalent towards that prospect or actively encouraging it. Which means we have to discuss why it would be wrong to fully medicalise autistic people.

The Harm of Medicalisation

As I did previously with the history of black medicalisation, I want to use SCP-818 as a narrative personalisation og the issues brought up. Starting with the most obvious, how modern eugenics is an atrocious endeavour.

When you get a substantial shift in academia away from practices aimed at aiding people now, to an idealised future where autism and intellectual disability is completely eradicated, you do not only harm subsequent generations. You also harm those who are currently disabled or struggling, because the focus is no longer on caring for them. There is little research, funding or even development of best practice for how to help autistic people or those with intellectual disabilities. In other words you completely abandon the present, to chase a pipe dream.

Furthermore it is just a straight up heinous prospect. Because, short of incredibly totalitarian and frankly disgustingly unethical policies, you are not going to expunge autism or intellectual disabilities. To do so, you would need to uproot the choice of all parents and the rights of any person with said disabilities. Also you would have to be fine aborting in-utero based on genetic screening and killing kids who slip through the gaps.

In other words, you’d turn into the kind of society that mirrors the SCP Foundation as portrayed in 818. Totally dehumanising actual children, to the point that exterminating them when they become useless is not only considered justified but wholly normalised. You gain the ability to coldly murder children, who present no more danger than anyone else. This is not an ideal to live up to, it is a warning that more scientists, activists and lay people really need to heed. Especially when other neurodivergent people are screaming from the rooftops about it.

And this dehumanisation escalates for the non-verbal and the intellectually disabled. Both groups often face severe communication barriers and as such are considered to be lesser beings than neurotypical people or even other autistic people. As researcher Mitzi Waltz eloquently stated:

“ Humans who do not or cannot speak challenge this definition [of humanity], doubly so when there is no easily observed organic cause for the difference, like injury to the speech apparatus or deafness. When faced with a non-verbal person with autism, the lack of speech has bothered many people so greatly that the person cannot be seen as human.”^[8]

Because of their inability to communicate to in a manner others recognise or they behave in a manner deemed inappropriate, non-verbal people and those with intellectual disabilities are overly dehumanised even in autistic spaces. From which we develop terms like “Aspie Supremacy.” A hideously ignorant idea that to have Asperger’s confers some protected status that places you above autistic people and neurotypicals. That to have Asperger’s means you are of a higher intellect and reasoning than anyone else. Not only is it an impotent spin on eugenics, it is a flaccid attempt at escaping dehumanisation.

No matter your proclaims of exceptionality, unless you possess a plethora of other privileges to insulate you from the oppression the most vulnerable suffer. You will be mistreated too. I must state categorically for the people in the back; you are not Elon Musk. You will deal medicalisation, and you will experience dehumanisation. Any policies that seek to restrict disabled people’s rights will impact you.

It is genuinely unfathomable to me how people will read both fictional and real accounts like SCP-818. Only to decide that they can shield themselves from oppression by taking on the mantle of the dominant ideology. How any person, but especially those with similar experiences, can read tales of autistic and intellectually disabled people being imprisoned, tortured and murdered. Only to subsequently decide that this will never effect. All it achieves is fracturing an already divided community thereby making us all easier to target.

Providing Value By Force

One of the most clear aspects of the disabled experience that resonates through 818, is the emphasis on worth. Specifically how to make an autistic, intellectually disabled child provide value. Not in the way you or I may see it, where value is to some degree intrinsic to a person. But economic value. It gets back to the idea of normalisation, where intellectually disabled children were expected to behave normally. This was not for their benefit, but in the interest of neurotypical people and the economy. So they, like everyone else, could provide monetary value as a worker.

If you think I sound like a bit of a Marxist, that might be because I am cribbing from Bruce Cohen’s Marxist Theory of Psychiatric Hegemony.^[9] A man after my own heart for being both a Marxist academic and one who initially got his sociology degree in the North East. There are three parts of his thesis I want to focus on. How psychiatry enforces compliance at work, how it medicalises youth and how it subverts dissent.

The first aspect is perhaps best humorously summed up by the following quote from Cohen himself:

“I woke up one afternoon recently to find that the 2014 Noble Prize winners in psychology were suggesting that my tendency to stay up late rather than get up early was a sign of “Machiavellianism, secondary psychopathy, and exploitive narcissism.” Obviously, some of psychiatry’s little helpers had been getting up very early in the morning to grapple with the theories of evolutionary psychology and the problem of vampires.” (Page 98)^[9]

Being transgender, I already knew I was a narcissist but its nice to be made aware that I have the full triad of disorders now. Slightly more seriously, this shows how even sleep pattern can be medicalised, that a preference for staying up late is apparently a sign of moral and mental deficiency. This thinking did not come out of nowhere. I have been slightly pithy with my comparisons of institutions to prisons, but both share the same ultimate goal. Both are used to extract labour from the imprisoned.

In mental institutions it was standard practice for inmates to be “employed” with minimal to no pay.^[9] The justification was that it created daily regimes for the mentally unwell and a disdain for idleness, promoting a moral imperative to work. It is notable that all this work benefitted the organizations. Since inmates were expected to do the laundry, tend to the farms and otherwise provide cheap labour, there was no need to pay professionals.

Yet again, there is a strikingly similar echo to 818. There is this constant evaluation of his usefulness to the Foundation. Though they never specify what kind of value they want to extract, my guess would be either as a manufacturer or as a weapon. Either way, the Foundation is seeking to profit off of 818, to cut costs by training an imprisoned child to work for them. They even use research conducted on him to control other people like him. Outside of this he possesses no value to them.

This is further reflected in how medical institutions, even those under universal healthcare systems are not treated like as necessary humanitarian services. They are handled as businesses, incentivising cost cutting at any expense, including the patients own care. News and governmental outlets often emphasise how novel treatments will save taxpayers and businesses money. In the bleakest capitalistic manner, there is sense in making children work for your foundation to keep costs low. It just completely defeats any reason the institution was set up in the first place. And also defies the concept of medical care itself.

From the 1970s onwards, with the shift towards white-collar jobs, psychology became even more important in the workplace.^[9] As those with mental health issues were being encouraged to be normalised, industries began to focus more on social communication, team-working and flexibility. Skills usually marked as difficulties for autistic and intellectually disabled people. From all of this comes to the modern messaging for the unemployed and the unemployable.

To acquire a job you must be upbeat, positive, and never complain.^[9] Moreover, if you do get work, you should grateful, never suggesting that the workplace could ever be improved. This level of mental and emotional gymnastics is difficult for a variety of marginalised groups, especially on top of the abuse they will experience in at work. To refuse or denigrate labour that you are forced to do due to imprisonment or even financial need, is considered the antithesis of modern values. To work without complaint is to be moral.

At it’s most extreme, this ideology devolves into SCP-818. To a child banging their head against a table, an explicit act of rebellion at borderline enslavement and absolute abuse of power, being considered a tantrum. He cannot or refuses to work in a manner that those around him desire. Which means to the Foundation, amongst others, he is useless. And what do you do with useless people, but prevent them from being a drain on society. Permanently.

The Correct Childhood

Childhood as a concept only really began in the Enlightenment period, where we started to think of children as more, and yet less, than little adults.^[9] Though it was solidified during the Industrial Revolution where, understandably, people did not like kids working in factories. Probably because they would frequently die before reaching their 18th birthday. In this reasonable defiance against perilous working conditions and child labour, the creation of childhood innocence and delinquency was born.

To curtail the increased presence of lower-class juveniles in plain sight (amongst other more benevolent motives) public schooling became mandatory.^[9] And as previously stated, with that came the increase in educational and developmental psychology. In fact before the advent of the Binet-Simon IQ test, it was incredibly rare for children be diagnosed with a mental health condition. But during the 20th century that increasingly became more common. For better. And for worse.

Children began to be screened for their academic performance, because that is what most IQ tests actually cared about originally.^[9] You cannot quantify the sum of intelligence in a sole simple psychometric test with just one score, and in fact, you cannot even measure academic performance like that either. But it was still used to decide how valuable any child would be in the future. Or, put more simply, how good they would be at working.

So although to readers of SCP-818, it may seem macabre to expect a child to work, the underlying philosophy has been present in Western culture for centuries. In the present, IQ tests continue to be employed in places like the US, whilst other countries simply screen in a more discreet manner. A lot of education is just funnelling children into a variety of jobs that will be economically advantageous to society. Hence the prioritisation of Science, Technology, Engineering and Maths (STEM) in the UK, over the arts and the humanities.

As well, childhood innocence itself is usually correlated with obedience to authority figures.^[9] Hence why disobedience can be so damning for children, especially those already marginalised. If a child opposes the systematic control an adult wields over them, they place themselves on equal footing with the adult.

This breaks the illusion of innocence. And by standing up from themselves, they challenge the structures that allow adults and privileged people to wield power over them. Which results in greater systemised violence against kids, like what is seen in 818. Where basic items and pieces of furniture are withheld from him, because of his “tantrums.” Questioning power, even accidentally, leads to punishment as correction.

In this sense, schools of all kinds have become places for modelling moral behaviours, where traits such as complete obedience to authority figures are seen as paramount.^[9] Anyone who cannot fulfil such roles is considered to have behavioural or mental pathologies. This is why some people never actually end up being diagnosed in childhood. Because schools only care if you do not achieve their standards for moral or academic attainment, not if you are actually experiencing internal psychological issues.

And this argument equally applies to institutions and prisons. Their existence is not to rehabilitate prisoners but to correct their behaviour through punishment. I am not saying we do nothing with the people in these facilities, in fact I am suggesting we can do much better than isolating them and extracting value from them through menial labour. Or just abandoning them to a Kafkaesque nightmare of medical bureaucracy. Especially since the vast majority of people in these situations are capable of enjoying a happy life with the right support.

Even if it is not a profitable life.

Colonising The Mind

Cohen, rather reasonably, argues that psychiatry as an institution, needs the backing of the state to uphold its monopoly on psychological discourse.^[9] In other words, there is a symbiotic relationship between psychiatric systems within countries and their governments. The former gains power over the mentally vulnerable as well as financial reward for specialised work. The latter gains scientific excuses for the atrocities they carry out.

Unfortunately, the prime example of this quid pro quo is Nazi Germany.^[9] Contrary to popular belief, the psychiatric apparatus that allowed for the murder, sterilisation and abuse of those with mental health conditions and developmental disabilities was not isolated to a few bad apples in Germany. From 1939 to 1945, 6,000 children between the ages of three and seventeen were murdered due to their disabilities. This was approved by three separate physicians who would then kill the child with:

“A combination of gradual poisoning with toxic drugs and slow starvation” ^[10]

It was never one murderous doctor, acting out on their own. It was the entire medical institution which approved formally of the death of thousands of children. They became an arm of the state itself, to carry out their policies of extermination. This history did not end with Nazism, though. Contemporary colonialism has always used psychological power to delegitimise their enemies.

The Chinese government labelled dissidents as having delusions of persecution and paranoia, often branding them as schizophrenic.^[9] The French condemned the subjugated North African Muslims by stating they all had a persecution complex. White psychiatrists treated Maori populations who wish for independence and their own land back as violent psychotics, even connecting it to a supposed genetic predisposition. And most oppressed racial groups are often portrayed as intellectually disabled or simply stupid, compared to the dominant racial power.

It is difficult to overstate how common it is across history for systems of oppression to utilise psychiatrists to justify their atrocities. And I would argue, that this extends even to those with said psychological issues. To pretend that to have psychological or developmental problems bars you from fighting against oppression is sheer paternalistic oppression itself. It is the silencing of the most vulnerable populations for the belief that they lack capacity.

But even if SCP-818 can not utter eloquent speeches about the history of medicalisation as it applies to his situation. His history, his lived experience, the way he acts in a situation of torturous imprisonment, is perhaps more damning than any words I or many other academics can muster. The manner by which non-verbal and intellectually disabled people rebel against their own oppression is not less valid simply because medical institutions would besmirch their capability to express themselves. If anything, it is all the more reason to pay attention.

The Intersection of Medicalisation

In all of this, it is critical to address the confluence of SCP-818’s race and disability. Because he is both simultaneously and cannot ignore either side. Certainly, both fictional and real life medical institutions never ignore a chance to double down on oppression. To start us off with, we will consider a point I have made throughout this essay.

I have been considering SCP-818 to be intellectually disabled, and I expect most people who have read the story would likely agree with me. However, as pointed out by Abdulle, black children with a diagnosis of autism are over-represented in Higher Needs education and in intellectual disability diagnoses.^[4] And really, you can come up with two explanations. Eugenics is right. Or this is an example of racism. I am going to hedge my bets on the latter, for what should be obvious reasons.

The reason I present this is not to discredit the value of an intellectual disability lens to SCP-818. But rather to complicate the matter further, as it is absolutely possible that all these hints conveyed to us represent another example of the Foundation’s racial bias. That since he is treated as a black boy, the Foundation psychologists just assumed he is intellectually disabled. Though I will admit, this may be giving TroyL perhaps more credit than he deserves and it is probably more of an accidental evocative point. But one still worth considering all the same.

Furthermore, racialisation influences the diagnosis and perception of the exact same clinical behaviours. In a completely shocking and not at all predicable study, Mandell and co found that black autistic children were two times more likely to be diagnosed with conduct disorder and five times more likely to be diagnosed with adjustment disorder than white autistic children.^[11]

For those not in the know, conduct disorder is the childhood precursor for Anti Social Personality Disorder or what most people call psychopathy.^[12] In simple terms, it is a condition where a child displays a persistent pattern of rule breaking, usually involving deceitfulness, aggression towards living beings and destruction of property. On the other side, adjustment disorder is a person’s abnormal reaction to one or several stressors.^[13] This includes excessive worry, distressing thoughts, constant rumination and a failure to adapt to the stressor.

Now I would encourage you to read the clinical definitions for yourself. But my analysis of black autistic children being over-diagnosed with these conditions is that white medical professionals view this population as stupid, psychopathic, violent and hysterical about the issues within their life. At least more so than their white counterparts. Suggesting a blatant enmeshment of racism and ableism. If a black child is not only black but displays developmental issues, they will be subjected to stereotyping and systematic bias for both parts creating exponential harm.

I really do wonder how such biases would play into SCP-818 too. How his self-harm when he bashes his head, his tendency to showcase heightened emotions, may be considered to be part of some disorder. That he simply can’t adjust to his environment like neurotypical white children do. How he is perceived as more aggressive, more easily distressed and therefore more of a danger. How his completely reasonable reactions are considered disordered.

And this is not without historical precedent. In the 1960s, black Americans began launching the civil rights movement. Completely by coincidence, white American fears of young black people were exacerbated. And white academics were not immune to racism:

“Growing numbers of research articles from leading psychiatric journals asserted that schizophrenia was a condition that also afflicted “Negro men”… In the worst cases, psychiatric authors conflated the schizophrenic symptoms of African American patients with the perceived schizophrenia of civil rights protests, particularly those organized by Black Power, Black Panthers, Nation of Islam, or other activist groups” (Page XIII)^[14]

Furthermore, in the 1990s, the US declared a war on crime, which relied on psychiatric drugs to “vaccinate” against criminality and conduct disorder in children deemed at risk.^[4] And wouldn’t you know it, black children were strangely over-represented. A belief exemplified by this quote from Fredrick Goodwin, an American psychiatrist, made at a National Institute of Mental Health conference about the rise in violent urban crime:

“If you look, for example, at male monkeys, especially in the wild, roughly half of them survive to adulthood. The other half die by violence…the same hyperaggressive monkeys who kill each other are also hypersexual…maybe it isn’t just the careless use of the word when people call certain areas of certain cities jungles” ^[15]

Pair this with the prevalent racist stereotype of black people as monkeys, most recently seen in that horrific AI meme Donald Trump shared of Barack and Michelle Obama. And the fact that most black people are forced into urban areas due to geographic segregationist policies. And the fact that black people are portrayed as hypersexual and overtly aggressive in so much media. And you develop a recipe for racism on so many levels it is almost astounding.

All of this, shows how inextricably linked medicalisation of black people and medicalisation of disabled people is. Not just with 818, or even just with the medicalisation of real black people. But even the mechanisms by which medicalisation happens to non-black people with disabilities is inevitably tied to colonialism and racism. To me, this gets to the heart of what Cohen mentioned about psychiatric institutions working in tandem with the government. For all of its history, psychology has been used as a weapon of colonialism and oppression.

If a government decided to lock up all non-verbal people, autistic people, intellectually disabled people, black people, or any other group. Medical institutions, including psychiatry, will find a way to justify it. And if we are locked up, we are easily exterminated behind closed doors when we become useless to their needs. When we can no longer provide labour for them to extract. Though it may start with those who are intersectionally marginalised, who are the most vulnerable. It never ends there.

And if we genuinely believe that, as I do, then what do we do to correct for this.

Diversifying Medicine

Back in my third year of university I did an extended essay on gender dysphoria. Hold on this is important, I swear. In it, I came across a study that argued for an Informed Consent Model of Care.^[16] Put very simply, this model argues for a more equitable relationship between medical staff and patients.

In this version, instead of medical staff dispensing medications and diagnoses without much input from a patient, the process of care becomes more collaborative and clear. Healthcare providers are there to educate as much as they are there to provide care. As well for things such as gender dysphoria, a lot of red tape is cut, minimising the amount of clinicians you need to see in order to access care. Put differently, your informed consent to gain diagnoses and care becomes the most important aspect of accessing medical pathways. Emphasis on informed.

This is one of the many recommendations I would put forward to restructure medical institutions. Doing so allows greater control for patients and means that unchecked biases have a lesser impact. For children it allows them a voice in their care, so that their basic wants, needs and desires are not sublimated by parents or medical practitioners.

It isn’t perfect, and would require a myriad of balances to account for the inevitable biases that would still be present in the system. And we would need a variety of approaches to include those with reduced capacity or communication skills to consent. But it would move towards a more equitable version of healthcare for disabled people, especially those marginalised by a variety of issues.

Furthermore, this would help encourage the promotion of neurodiversity in healthcare and society. Neurodiversity was first coined by Judy Singer in 1999, though it emerged as a movement earlier in online autistic spaces.^[4] The basic idea of neurodiversity is that autism and other neurological differences should be considered as a form of biological diversity and not solely as medical. At it’s heart, neurodiversity emphasises that the experience of neuropsychological disability is not solely the realm of medical institutions.

It’s impact is felt in many other sectors. But more importantly, it’s joys and its pride can also be felt in other sectors. The degree to which any group feels neurodivergent pride will vary. For example, I have heard very little from the depressed desiring pride for depression. But autistic people increasingly champion autistic pride. In my opinion, this is neurodiversity working as intended. Empowering communities and individuals to decide what they wish to seek care for, how they wish to treat it, and how they want to live their lives.

It sounds somewhat utopic and perhaps to a degree it is. I don’t truly believe I will live to see the day Informed Consent Models are implemented for trans people or any group of people really. But that does not mean we should not champion changes which align with such values. That we should not argue against medicalisation, institutionalisation, sterilisation and so many other injustices that are inflicted on the neurodiverse and a variety of other marginalised groups.

Because it is worth it for ourselves and for future generations, to make their lives and our own easier. To make our existence less filled with pain, humiliation and dehumanisation. And to work together, to uplift us all from oppression.

Thank you all for reading, I hope this series has been insightful to you all. I will be back next time with hopefully a single essay on one of the psychologists I mentioned previously. If you would like early access to my essays you can join my Moon Tier on Ko-Fi or subscribe to my Substack. Please let me know your thoughts on this essay down below or on my Bluesky.

Until next time, stay safe and look after each other.

References

1. Walmsley, J. (2019). Healthy Minds and Intellectual Disability. In Healthy Minds in the Twentieth Century: In and Beyond the Asylum (pp. 95-111). Cham: Springer International Publishing.
2. World Health Organization. (2019).6A00 Disorders of intellectual development. International statistical classification of diseases and related health problems (11th ed.).
3. TroyL. (2011). SCP-818. Retrieved From: SCP Wiki
4. Abdulle, S. (2025). An Intersection of Race and Disability:: A Critical Analysis of the Racial Inequities in Autism and Neurodivergent Disability Diagnoses for Black Children. Canadian Journal of Autism Equity, 5(1), 22-42.
5. O’Reilly, M., Lester, J. N., & Kiyimba, N. (2019). Autism in the twentieth century: An evolution of a controversial condition. In Healthy minds in the twentieth century: In and beyond the asylum (pp. 137-165). Cham: Springer International Publishing.
6. Wolfensberger, W. P., Nirje, B., Olshansky, S., Perske, R., & Roos, P. (1972). The principle of normalization in human services.
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