The Neurodiversity Smorgasbord: An Alternative Framework for Understanding Differences Outside of Diagnostic Labels

Before I introduce The Neurodiversity Smorgasbord, I would like to acknowledge that this framework which I started to develop in 2022 has been inspired, shaped, influenced by movements that have come before as well as Mad, Disabled and Neurodivergent Indigenous and Black scholars, thinkers, writers, leaders and activists. Individuals who have been imagining, creating and sharing alternative ways of understanding madness, disability and neurodivergence for decades. You can find a list honouring the works of some of these individuals at the end of this article alongside writings from the Mad community. Please use this list to expand your understanding of neurodiversity and to shift your understanding of altered states, hearing voices, madness and what we deem “normal”.

This was originally posted on my website.

The Neurodiversity Smorgasbord is an attempt to offer an alternative to diagnostic categories as well as an opportunity to understand neurodiversity outside of the pathology paradigm. It’s about acknowledging these differences and experiences as a part of being human instead of being a mentally ill or disordered human.

Consider the Neurodiversity Smorgasbord as a way to understand our unique profile, or plate, of individual differences beyond the DSM.

You might be wondering why we need a trait based approach to understanding neurodiversity; an alternative framework when we already have diagnostic labels.

Perhaps my own story will explain why the neurodiversity smorgasbord is so important in discussing human differences that don't rely on explaining said differences as a mental illness or disorder.

I was diagnosed when I was 8 years old in 2000. I was told I had a disease and an illness and that there was something wrong me, I was taught that I needed to be fixed, treated and cured. I was taught that I wasn't normal, I was abnormal in the worst possible way. I was chemically restrained with psychiatric medication from age 8 to 20 and I was taught to hate myself by the people around me - because of the Autism. In fact, I overdosed on my medication at only 11 years old because I thought if I took all my medication (anti-psychotics and stimulants) at once, I would "get better" quicker.

It wasn't a gift of understanding as many experience these days because the lens I was taught to view Autism and ADHD was through the pathology paradigm - as a disease, illness and disorder. That's why this lens is so important because we deserve to have access to an alternative understanding of our differences, traits and altered states instead of relying on the single narrative that they’re a deficit, disorder or sign of an illness.

Even though our understanding of Autism and ADHD isn't taught as a disease or illness as much these days, other human differences are still seen and taught as a disease, illness and disorder. And obviously, people deserve an alternative narrative, people deserve to not see their differences or altered states as an illness or disorder, to see it in a different way than how it's taught by psychiatry and psychology.

That's why understanding neurodiversity outside of diagnostic labels is important. Not just for Autism or ADHD but for those who experience altered states like mania or dissociation, those who hear voices or experience psychosis, those who are Plurals and Systems and so many more.

I wouldn't have the level of acceptance or understanding of myself that I do now if I wasn't introduced to neurodiversity or the socio-political term, neurodivergent or madness or even, Indigenous understandings of altered states and hearing voices.

I would be stuck if I only listened to the narrative of psychiatry and the DSM.

If you’re wondering why I picked a smorgasbord of all things, it was inspired by the relationship smorgasbord; a concept that explains how every relationship is unique and made up of different aspects, roles and goals. Instead of defining a relationship as strictly platonic or strictly romantic, it allows individuals to move away from labels and be specific. I believe this applies to neurodiversity. Instead of defining individuals by diagnostic labels, we want to be specific and acknowledge each person’s unique differences and traits.

If we’re rolling with the analogy of a smorgasbord, there are a lot of different ingredients that make up the diversity of our minds. You could say each individual is a plate of various ingredients and tasty treats. Each of us are our own unique combination of ingredients and there are infinite combinations of ingredients. There are so many variations of ingredients too. For example, imagine cheese as communication differences - there are many ways to communicate as there are many cheeses. Some of us might have Parmesan on our plate, some of us might have tripe Brie, some of us might have cheddar and many of us might even have a cheese board, a combination of cheeses. In other words, a combination of communication differences. Many of us might have an ingredient or five that’s common with a lot of people while some of us have ingredients that are less common. Some of us might have ingredients in common but perhaps prepared a different way. And some of us have ingredients that people look down upon, that they judge, like pineapple on pizza.

I would like to share five reasons why The Neurodiversity Smorgasbord may be helpful and beneficial for everyone and especially, our fight for neuroinclusion:

We deserve to understand ourselves and each other beyond the DSM.

We deserve to understand neurodiversity as well as our differences without relying on the DSM and diagnostic labels. We deserve to name and assign our own meanings to our differences, traits and altered states instead of relying on the single narrative that they’re a deficit, disorder or sign of an illness.

“Psychiatric diagnoses are not neutral, objective or inevitable ways of viewing ourselves and making sense of our experiences and suffering. They’re one specific way and they’re often applied in ways that maintain existing power structures.”

— Candice Alaska

For too long, individuals have been denied the ability to define their own experiences, limited by a paradigm that only offers meaning rooted in pathology and disease. Western psychiatry has controlled the language we use to describe our differences, altered states and experiences - only offering us any chance of understanding through diagnoses. In fact, our differences, our altered states, our experiences are often only validated or seen as real if we have a diagnosis. As if our experiences or differences don’t exist unless they fit into a made up box. For example, experiences of voice hearing or plurality or being a System can’t be described, captured or defined by a diagnosis. As someone who hears voices, diagnoses like psychosis or schizophrenia don’t describe my experiences yet my experiences still exist.

It is crucial that we have the opportunity to learn about our individual differences without relying on socially constructed diagnostic labels that may or may not describe someone’s experiences completely or accurately.

We need to understand altered states as a part of the rich tapestry of being human.

Instead of pathologising altered states or defaulting to viewing altered states as a pathology or illness, we should recognise altered states as a part of the human experience. Recognising altered states as a human experience allows each person to define their altered states and make their own meaning out of their altered states. Psychosis, for example, is an altered state and while psychosis can be scary and distressing for some, it doesn’t match the lived experience of every individual who experiences psychosis. Dissociation, again, is a spectrum from everyday experiences like day dreaming to experiences that are more distressing or disabling upon an individual.

There are other cultures who hold different meanings surrounding these altered states but Western psychiatry provides a single, limited meaning of altered states - mental illness. If we seek to only understand altered states within the context of the DSM and mental illness, we are assigning a single meaning to these states.

“While psychiatry only perceives conditions of madness like extreme states as symptoms of sickness, the Mad community, and many cultures across the globe, can understand them as enlightening, transformative, and transcendental experiences.”

— Derrick Quevedo

We need to understand how hearing voices is a human experience and response.

If neurodiversity refers to the different ways that we interact with and experience the world around us, hearing voices surely counts as a unique way of experiencing the world. While Western psychiatry frames voice hearing as a symptom of an illness, this doesn’t accurately represent the experience of voice hearing across history and cultures.

In many cultures, voice hearing has spiritual, cultural and ancestral significance. As a result, they see their voices as helpful, positive, calming, or simply the norm. For some Indigenous people here in so-called Australia, hearing voices is seen as a normal cultural experience in certain contexts. In New Zealand, some voice hearing experiences are explained by Kaitiaki; a spiritual guardian.

There are many other cultures where individuals have different relationships with their voices. Even within Western society, individuals have different relationships with their voices where the voices aren’t negative, scary or distressing. We continue to assume hearing voices is a sign of an illness or disorder but that just isn’t the case for everyone.

“There is nothing inherently, ontologically, transhistorically pathological about hearing voices.”

— La Marr Jurelle Bruce in How To Go Mad Without Losing Your Mind: Madness and Black Radical Creativity

In fact, voice hearing is a more common human experience than we realise. The Hearing Voices Movement has continuously advocated for us to understand voices as a human response instead of an illness. As Understanding Voices explains, we all have the capacity for hearing voices but how, when, where and why we may experience voices differs.

If we can recognise voice hearing as a human experience, we are giving each individual the autonomy to make sense and meaning of their own experience.

We need to recognise plurality as a human experience and spectrum.

I would like to propose that plurality, the experience of being many within one bodymind, is another unique way of interacting with and experiencing the world. Plurality, which Meg John-Barker describes as “an umbrella term for any way in which people experience themselves as different selves, parts, or states at different times” is a part of neurodiversity.

It’s another way to exist in this world that is neither wrong or right, it just is.

“There’s a theory about the ‘self’ which states that who you are is not a fixed thing, like a rock or a plant. It’s a unique dynamic. That ‘self’ is what emerges in relationship with another. So each ‘self’ in each setting, each relationship, is slightly unique, and has aspects that may differ from all others.”

— Sarah K Reece

This is a part of the plurality spectrum that almost every one of us can relate to. If you ever feel like a different person, if you ever have to switch roles depending on the context, if you feel like there’s parts of you, if you believe there’s different aspects of yourself - all of these can be considered plural experiences. While not all of us will have permanent or continuous experiences of being many within one bodymind or identify as a System, many of us (singlets included) will have plural experiences throughout our lives.

If we can see plurality as a part of neurodiversity, another way of existing in this world, maybe we can start to see it as another difference to respect, affirm, support and accommodate - without question.

“Plurality challenges the dominant western societal conceptualization of personhood as single & autonomous - it queers how our bodies are seen as an extension of ourselves, how our bodies are used to express ourselves, how our bodies are seen as representative of ourselves.”

— The Ring System

Identifying and understanding someone’s unique profile of differences allows a more individual approach to support and accommodations.

I believe identifying a person’s unique profile (or plate) or differences, traits or altered states gives us a better opportunity at identifying specific accommodations and supports. This isn’t just helpful for therapists, allied health professionals or coaches but employers too. Instead of relying on an individual to disclose a diagnosis, we can simply acknowledge the existence of human differences and adapt, adjust and design our workplaces, classrooms and environments accordingly.

I genuinely believe that we can identify our supports, our differences, our needs and our challenges without relying on a diagnosis to communicate them. I can describe and name my altered states without using a diagnosis. I can discuss my plural experiences without using the terms, OSDD or DID, that don’t describe my experiences anyway. I can discuss the way I pay attention, the way I process information, the way I communicate or my sensory needs without relying on a diagnosis.

“I don’t need to rely on the DSM and diagnostic labels to justify or explain how I am human.”

- Sonny Jane Wise

After all, if you’ve met one Autistic person, you’ve met one Autistic person and this applies to every diagnosis, every form of neurodivergence and really, every individual. Sure, we can understand a diagnosis but I don’t believe a diagnosis allows us to really understand an individual.

Yes, we currently rely on the DSM and the language of psychiatry to get our needs met, to receive support and to access accommodations. While I don’t see that changing any time soon, I want to imagine an alternative way of understanding neurodiversity outside of the DSM. I have to imagine a future where we don’t need to disclose a diagnosis in order for people to take our needs and differences seriously. I need to imagine a future where we can just explain the way we function and it was understood and respected because hey, that’s neurodiversity.

Can you see the potential of The Neurodiversity Smorgasbord yet?

Even if you don’t see the potential of this particular framework, I hope you can see the desperate need for understanding neurodiversity beyond the DSM. At the very least, I hope you can see a future where we have access to language that describe our differences outside of diagnostic labels. If I could wish for one thing though? I wish for The Neurodiversity Smorgasbord to be an opportunity for people to move away from viewing plurality, hearing voices and altered states as mental illnesses and instead, as human differences and experiences. If the neurodiversity space can recognise these as a part of neurodiversity and include them within our fight for neuroinclusion, I’ll consider it a win.

I just don’t want anyone to be left behind, I guess.

So… welcome to The Neurodiversity Smorgasbord.