Are We All Just Having 'Understandable Human Reactions'?

Sami Timimi's new book paints neurodivergent and trans people as dupes of neoliberalism

We continue our exploration of diagnosis-critical books published this year with Searching For Normal: A New Approach to Understanding Mental Health, Distress and Neurodiversity, which I would argue is not new, and barely even an approach!

Timimi is a child psychiatrist in the UK who seems perpetually embarrassed of his own chosen profession. Why does he keep working in it, you have to wonder?? This man has never met a psychiatric diagnosis he liked, and he is working tirelessly to define mental illness out of semantic existence.

His previous titles include The Myth of Autism: Medicalising Men’s and Boys’ Social and Emotional Competence and Insane Medicine: How the Mental Health Industry Creates Damaging Treatment Traps and How you can Escape Them. I have not read these books, but I did once recommend a collection that he edited, Rethinking ADHD, because it was one of the only critical books on ADHD I could find.

After reading his new book, though, I have realized: critical for me means, let’s ask more questions about who gets to call the shots. Critical for Timimi means, if there’s not a specific biomarker that correlates with a specific diagnosis, then you’re all just having a collective hallucination!

So What Is Timimi’s Whole Deal?

If I had to pick a thesis statement in Searching for Normal, it would be this:

“Mental health ideology may be the biggest and most powerful cause of mental health problems today.”

In other words, the way that we think about mental health is actually giving us mental illness. ‘The problem is the problem’, he writes — we are all victims of a cursed tautology. What does he want instead?

“I call for a radical shift, a revolution no less, in which there will be no more use of psychiatric diagnoses, a dramatic decrease in the use of psychiatric medication, and the promotion to the public of a narrative that will help rehabilitate emotions back into the sphere of the ordinary and/or understandable.”

Timimi thinks that we have all been duped by psychiatry and neoliberal capitalism into believing that any negative emotion is a bad-feeling brain disease, and that what we really need to do is stop trying to control or get rid of those feelings, because they are ‘understandable human reactions’ to life in a capitalist hellscape.

Sure, that means we need ‘a more socialist-orientated economy,’ but that ‘by itself would not be sufficient’. We also need to change our mindsets, and learn to accept that suffering isn’t illness, it’s just a regular-degular part of life.

As an example, Timimi brings up his own struggle with insomnia, which is not a mental illness, but we’ll go with it:

“I used to get insomnia frequently and would struggle with it. Then one day my wife said, ‘You do like to make a fuss about your sleep.’ It was just a throwaway comment. It must have played on my mind because I recall a few days later having something of an emotional epiphany (I don’t know how else to describe it). I understood, at a level beyond language and intellect, that my struggle with insomnia was because I was struggling with insomnia. I understood how after a while insomnia causes insomnia, and to interrupt that process, I had to stop taking it so seriously and refrain from trying to find a solution to it.”

He decides that it’s fine, actually, and people don’t need that much sleep to function, anyway, because ‘people are resilient’ — which is definitely not ‘a flawed Western theory of suffering aligned with neoliberal ideology’!

Through his own recounting of case studies with young people in his practice, we learn that instead of diagnosing them or prescribing them medications, he gives them a little resilience training, and sometimes, unsolicited gender opinions.

In one scene, a trans, autistic, and ADHD college student named Andrew comes into his office looking to try medication. He’s having severe mood swings, and episodes of paranoia where he feels like he’s being stalked by a girl about his age.

Timimi ignores his request for meds and instead engages Andrew in a Socratic dialogue that was probably as annoying to experience as it was to read. He gives Andrew an etymology lesson about the word resilience,¹ before suggesting that the girl he feels is stalking him could be his past female self who ‘wasn’t ready to die yet’ and ‘felt betrayed’.

At this, Andrew ‘seems shocked’, and then requests to see someone else. Good for him! Not sure why you would tell on yourself like that in your own book, unless of course, you never once stopped to consider you could possibly be wrong!

But that’s just some fun little color to warm you up for my cold hard analysis. (I promise I have serious analysis!) Come with me as we jump ahead to Chapter 12: NOW That’s What I Call Gender-Critical, Greatest Hits Edition.

Wait, no, I’m sorry: Neurodiversity, Gender, and New Human Typologies.

Teaching Your (Autistic) Grandmother To Suck Eggs

In 2016, Timimi had an extended email debate with the critical autism studies scholar Damien Milton, in which he demands that Milton provide specific biological evidence for autism to justify his own identification with the term. He doesn’t understand why autistic people would use a word for themselves if there wasn’t a clear biomarker that showed it was actually a real thing (or, as the philosophers say, a ‘natural kind’).

Milton tells him that he knows autism is a social construct, he has been studying and publishing on it for years, but he still recognizes there are ‘dispositional’ differences in autistic people that translate into real struggles in life, and need some kind of label to make things like community-building, culture-making, knowledge-creating, and political organizing possible.

Timimi responds with like 800 word essays where you can almost hear him spitting his incredulity all over the keyboard, repeating his demand for biological evidence, reiterating that it has no essential nature, and arguing that, under neoliberalism, it is sold to the public as a ‘brand’.²

All of this Milton agrees with, at one point joking, “The term ‘teaching your grandmother to suck eggs’ springs to mind.”

As in, yeah, we know. Autistic people have been sucking these eggs a lot longer than you! Okay that’s a weird idiom,³ I’m going to switch to another one. You’re preaching to a choir that had the hymns memorized before you even graduated seminary!

This is, as you can imagine, supremely annoying. The most annoying thing ever, probably. What’s even more annoying is that, almost ten years later, Timimi still refuses to listen to input from the people in the categories he’s critiquing, and is instead expanding his argument to the scapegoat-du-jour: the transgenders.

Despite his ‘socialist-orientated’ leanings, Timimi makes a hard right turn at trans youth, citing the sketchy Cass Review against gender-affirming care in the UK, a Finnish doctor who practices conversion therapy, and the president of the anti-trans group Society for Evidence Based Gender Medicine.

He repeats fear-mongering rhetoric about ‘atrophied genitals’, suggests that ‘the construction of trans identity has emerged from ongoing homophobia’, and wonders if transition is just ‘an iteration of consumer capitalism’ urging people to re-invent themselves in order to be happy.

It’s aaaaall a neoliberal psy-op, basically, and those of us who identify as autistic or trans are victims who have been duped. Again, it doesn’t cross his mind that we could use psych labels and psych meds while also having critiques of psychiatry, or that there could be neurodivergent and/or transgender Marxists who despise the elite capture of identity politics as much as he does.

No, he’s really out here calling us sheeple in the subtext!

In A Critique of Critical Psychiatry, Robert Chapman is not surprised when diagnosis-criticals like Timimi turn on trans people:

“…the routine marginalization of both disabled and trans identities and voices follows much the same reasoning: each relies on the commitment that identities (whether gender or disability) must map on to biological essences to be real.”

Timimi’s argument hinges on the assumption that real = biological, and he says ‘the political problem’ for him is ‘disembodying the idea of ADHD or autism from any need for correspondence in material reality’. (Why this is a bigger political problem than structural ableism, state violence, and bodily autonomy, I do not know!)

He claims:

“Through social looping and contagion these constructs (ADHD, autism, neurodiversity, trans) come to be viewed as real, and become a naturalised category. This makes them ideal for commodification and profit mining.”

The Pokémon media franchise has made $113 billion dollars in revenue, which is like 10x more than the market share of autism (or something, I can’t do math), so not really sure how a thing being a natural kind makes it uniquely ideal for profit mining, but he suspects that ‘the profitability of gender-affirming care’ is driving the spread of trans identities like he suspects pharmaceutical sales are driving ADHD diagnoses.

This makes little sense when you look at what drugs are actually the most profitable. Psych meds and HRT don’t even make the top ten list this year — number one is Keytruda, a cancer drug, number two is Eliquis, a blood thinner, and number three is Ozempic. Yes, profit-mining our health is a huge problem, but it’s not unique to psychiatry or trans medicine, and it’s strange when your ‘socialist-orientated’ analysis doesn’t locate them inside this bigger picture.

How Many Ways Can A Thing Be Real?

Because science has not been able to pinpoint a specific biomarker that can differentiate autism or ADHD from the general population, that means, for Timimi, they cannot exist. We are merely ‘imagining it to be so’, and then it is ‘made real’.

Anti-trans types make a similar argument about trans people, claiming that chromosomes are the truest form of ‘biological reality’, and then accusing trans people of being totally divorced from it. But if you stop to think about this argument for like more than two seconds, it doesn’t make a ton of sense.

First of all, unless you work in a genetics lab, you will never directly interact with a chromosome. You only know it’s real because it’s a concept you learned about in science class. You can, however, directly interact with a trans person, whose real body and personality and behaviors you will really experience.

What, then, is more real? And what is a medical transition if not a direct reckoning with your own flesh?

As Chapman points out, the idea that mental illness doesn’t exist because psychiatry isn’t based on hard bio-facts like the rest of medicine comes from one Thomas Szasz, and it lives on in the work of many critical psychiatry figures from the UK.⁴

Even though I don’t think he shares Szasz’s right-wing politics, Timimi’s book is very clearly part of his intellectual tradition. He tries to paint psychiatry as a subjective branch of medicine that has unique problems with social injustices which other branches of medicine do not, because they’re objective and evidence-based.

But this is very plainly not true — all branches of medicine have been, and continue to be, all kinds of fucked up,⁵ because medicine is a human social practice, so it reflects social biases and injustices.

As an example, Timimi contrasts depression with the supposedly-objective diagnosis of diabetes. But, as Chapman writes, this is not a great argument, because ‘the concept of diabetes has continually fluctuated in relation to racialized biases’ and who gets diabetes is ‘still determined largely by factors related to race and class.’

When Timimi uses diabetes as an example of an objective medical diagnosis, he’s sanitizing the truth that all of healthcare under capitalism is an unjust, for-profit enterprise, in order to make it seem like mental illness is a myth. He also overlooks the fact that the structure of ableism exists independent of psychiatric diagnoses.

Psychiatry did not invent ableism by labelling people with mental illnesses. Historically, it offered a way to control and manage people who were already being disabled by the economic system’s demand for productive bodies.⁶

If we got rid of diagnostic categories tomorrow, ableism would remain — disabled people would still be more likely to get arrested, experience twice the violence,⁷ be more likely to live in poverty, and have much higher healthcare costs, but worse access to healthcare.⁸

All of this seems like some serious material reality to me, and we don’t really need a biomarker to know that these populations are experiencing it!

We do, unfortunately, need diagnoses if we want to access treatment and accommodations, so unless we, I don’t know, got stuff like universal basic income and truly socialized medicine, and designed a system where everyone could get the material support they needed without having to navigate some bureaucratic maze designed to deny as many resources as possible, deleting psychiatric diagnoses and calling them ordinary would only fan the already-raging flames of ableism.

Is it possible for diagnoses to be useful and scientifically rigorous without being tied to a specific biomarker? The autistic researcher Sam Fellowes thinks yes. This year, he put out a book called In Defence of Psychiatric Diagnoses,⁹ which draws on modern interpretations of Kant, an 18th century philosopher who was trying to settle an argument between the rationalists and the empiricists.

Rationalists said knowledge comes from thought, and empiricists said knowledge comes from the senses. Kant was like, obviously, it’s both, but also, the true nature of the world can’t really be known by us, because we have to apply our own constructs to our sensations so we can make them make sense. Fellowes writes:

“His clearest example is when he argues that things in themselves do not exist in space and time. Rather, space and time are imposed upon the world and we cannot help but see them as existing in space and time. Space and time are concepts we apply to the world…

..Any attempt to see things which exist outside us will require imposing space and time upon them. Consequently, we cannot see them as they are in themselves but only as they appear to us.”

For Fellowes and the Neo-Kantians, this applies to all of science. None of our models of the world reflect its true nature, because it’s all coming to us through the concepts we created to be able to understand the mish-mash of shapes, sounds, colors, and smells bombarding our brains:

“In relation to psychiatry, we see one person exhibiting one set of symptoms, a second person and a third person exhibiting different overlapping sets of symptoms, and unify these together by positing the psychiatric diagnosis of autism. We take different people and abstract those differences by unifying them under the thought object of autism. The legitimacy of unifying these different people under autism depends upon applying principles to the data. These principles are what convey scientific legitimacy to the thought objects (assuming that the data we apply the principles to is reliable) because the principles themselves are based in reason.”

Where Timimi thinks of diagnosis as scientific only if it’s based on a ‘causal and physiological framework’, Fellowes bases it on the systematic application of reason. But there’s another way of looking at them that doesn’t require an extended philosophy lesson.

Philosopher Sanneke de Haan frames diagnoses as ‘disorders of sense-making’. In a talk last year, she explained:

“..our sense making is no longer attuned to the situation but is stuck in a certain groove. If, for instance, we are anxious without the situation giving us any reason to be anxious, if we feel hopeless even when we do things that we normally enjoy, or if we see deeper meaning in coincidences like the letters on a driver’s plate, if our sense-making is biased in a certain direction, so to speak, and if this happens not just once but structurally, and if we or our loved ones suffer from this bias in our sense-making, then I think we can speak of a mental illness.”

This way of looking at mental illness includes brain chemicals without reducing a person to them, and it leaves a lot of room to consider their social context and personal history, but it’s meaningfully different than Timimi’s ‘understandable/ordinary human reaction’.

An ‘understandable reaction’ is a bad day, but an illness is a re-organization of your entire lifeworld.¹⁰ Collapsing all mental distress into the ordinary erases this difference and denies the reality of disablement.

Squishy Lenses

I don’t think the kids are brainwashed victims of ‘mental health ideology’. I think they are probably more critical than we give them credit for.

Some research bears this out. A 2020 paper by Linholm and Wickstrom explored how young people interact with labels like anxiety and depression, and what they found was that, although they use clinical words, when asked to explain what they meant, they didn’t talk about chemical imbalances, but instead social pressures:

“Rather than reproducing a sense that the battleground is inside young people’s heads, they locate the battleground in their social and structural context of managing school, their social relations, and norms and ideals of society and their peer groups.”

The authors point out that if teenagers are using diagnostic words in cultural ways, and adults are using them in medical ways, this could lead to a misunderstanding — adults focusing too much on clinical issues, when the kids are actually more worried about their social world.

In the metamodern age, we use multiple lenses at once, toggling between them like tabs in a grand narrative. I’ll give you an example from my own intellectual journey with anxiety.

At first, I placed the lens of ‘brain disorder’ over my life, but over time I found that it didn’t work for me. Discovering the neurodiversity movement made me realize I could take off that lens, and try on a new one. The autism lens and the ADHD lens clicked a lot of things into place.

Then I started getting into critical psychiatry, where I tried on the trauma lens and the human reaction to capitalism lens and the existential lens.

All of these lenses allowed me to view my anxiety in different ways, and learn new things about it. I had a deeper, more complex understanding, but anxiety was still dis-ordering my sense-making as much as ever. So this summer, I dusted off the brain disorder lens, and started seeing an OCD therapist.

But I didn’t so much circle back as I spiraled up, retaining all these lenses I acquired in my thought-detours. When my therapist tells me that I ‘have’ OCD, and asks me to speak about it like an entity in my head, I understand this now as a psychological technique, not a literal claim.

OCD is a lens I can use when it’s useful, but it doesn’t preclude all my other lenses, and it doesn’t make me a victim tricked by psychiatry into ignoring politics. It’s an imperfect, abstracted model, as all models in science are, but in concert with my other lenses, it’s helping me make sense of a disordered pattern and weave a new one.

If Timimi truly wants ‘a radical shift, a revolution no less’, dismissing mental illness as a myth is a mistake. The experience of illness puts you in personal, daily contact with ableism, which often reveals far more about politics than it obscures.

For some people, this could be the first thread they begin to pull, leading them to unravel the curtain that has hidden how capitalism and power are at work in their lives. If you tell them they’re just having ordinary reactions to life, to be resilient and get on with it, you could just be drawing that curtain closed.

More in this series:

Unshrunk and MAHA: A Diagnosis-Critical Case Study

The Age of Overdiagnosis Panic

1. but he misses the fact that it only became popular in public parlance with the rise of positive psychology, and has been called one of ‘the central frameworks for organizing mental health care in the Western world’ and ‘a technology of looking inward,’ both of which he spends a lot of the book railing against..

2. For more on this you could read The Autism Industrial Complex (or watch this lecture) and War on Autism, two books that analyze how autism has been commodified and used for profitable ends in the neoliberal era without also arguing that autistic people do not exist or disrespecting autistic knowledges. Robert Chapman has also been writing about ‘neurodiversity-lite’ for a long time now, which is basically what Timimi is mad about, he just collapses all neurodiversity thought and politics into this instead of understanding it as a form of elite capture.

3. I had to look it up, apparently it refers to a time back in the day when old people who lost all their teeth would poke tiny holes in eggs and suck on them for protein. yum.

4. their paper explains why they think this idea can’t deliver the liberation that critical psychiatrists say they want, because it’s basically just reinforcing the oppressive ideas of normality already in psychiatry.

5. The history of gynecology springs to mind, for one example

6. See Slorach’s A Very Capitalist Condition for an accessible read about this history

7. Kennedy et al, 2017

8. Mueller et al, 2019

9. open access, babyyyyy!!!!

10. Toombs, 1993: “Illness is fundamentally experienced as a global sense of disorder, a disorder which incorporates not only specific bodily dysfunction, but a concurrent disruption of one’s self and of the surrounding world.”