________________________________________________
In Robert Chapman’s Empire of Normality, they lay out a Marxist theory of psychiatric and neuropsychiatric disabilities. Industrialization and modern capitalism made a huge difference for society’s view on disability.
This is not to say that disability, or equivalent concepts, did not exist before industrialization. Sweden was late to the industrialization game, lagging behind the UK by a century or so. Yet, the Swedish government began collecting disability statistics in the 1860s, in what was still a highly agrarian society. But in line with Chapman’s narrative, people had very different ideas about what counted as a disability back then (Wisselgren and Vikström 2023).
The government gave the task of collecting statistics to priests, who knew everyone in their parish. Nowadays, wheelchair users are the go-to example of disabled people, but back then, mobility disabilities weren’t even on the radar. The category “cripple” – roughly, any physical disability other than blindness or deafness – was not added to Swedish disability statistics until well into the twentieth century, when more people worked in factories and became “crippled” in workplace accidents. Instead, the 1860 statistics recorded how many people were (completely) blind or deaf, or mentally disabled. Now, the government did complain that priests across the country used different terms for the latter and might be reporting slightly different things, and the priests (reasonably) complained back that diagnosing people wasn’t supposed to be their job in the first place. Nevertheless, it is interesting that mentally disabled people were supposed to be so different from the rest of the population that you could distinguish this category without any special tests or training.
In 1860, after Swedish priests had counted, recorded, and done their best to diagnose every person in the country, statistics showed that less than two in a thousand people had a mental disability (Wisselgren and Vikström 2023). In the early twentieth century, mental disabilities had become several times as common in official statistics, but still a far cry from present-day prevalence. At present, around 10% of the Swedish population are assumed to have one or several neuropsychiatric diagnoses, and the number will, of course, be even higher for all mental disabilities taken together (Bölte 2016). Getting diagnosed often takes a long time; we no longer believe that anyone can spot who’s disabled or not.
In popular debates, in newspapers, magazines, and above all social media, it is often claimed that people get diagnosed for no reason these days. Instead of getting diagnoses like ADHD, autism, chronic depression or anxiety disorder, claim a “sick role” and demand special accommodations, people should just toughen up and get a grip on themselves. Those who resist this narrative often insist that the number of people who fit these diagnoses have remained the same throughout history, it’s just that their suffering and struggles used to go unrecognized. In the bad old days, the same people who get diagnosed and help now would just have been locked up in institutions, driven out of the village with pitchforks by ignorant peasants branding them as witches or changelings, or they would have committed suicide.
The extent to which changeling myths are connected to real cases of mental disability is clearly outside my expertise, though I know that it is not some generally accepted fact among historians. Goodey and Stainton (2001), for instance, cites many historical descriptions of changelings that don’t mention mental differences at all, focusing, instead, on strange and supernatural physical abilities. But even if some mentally disabled people in the past were labelled changelings or witches, such explanations can’t account for the numbers we see. I mentioned Swedish statistics above. Moreover, the WHO estimates that about one in eight people worldwide have one or more mental health conditions (WHO 2022), and according to the Johns Hopkins Institute, as much as 26% percent of all American adults suffer from one or more mental disorders in any given year (Johns Hopkins Medicine 2024). There may have been past eras where some people who, today, would have gotten a medical diagnosis and help, instead were labelled changelings or witches, or cast out or killed themselves, but not as many as 12,5-26 % of the population!
Nevertheless, it is also false that people get diagnosed on the flimsiest grounds these days, at least as a general statement. People often struggle for a long time to get their diagnosis and may still be denied any special accommodations and support afterwards. However, the idea that either there is rampant over-diagnosis and people are diagnosed and treated on the flimsiest grounds, or else the number of people with (neuro)psychiatric disabilities remain constant through time whether they get helped or not, is a false dichotomy. Chapman argues, in Empire of Normality, for a third option: present-day capitalist society keeps raising the bar for how productive, efficient, socially competent, focused, and overall how normal you gotta be to keep up. As the bar goes higher and higher, more and more people fall below it, which results in actual, serious suffering and struggles.
In a capitalist society obsessed with productivity and making more and more money, Chapman writes, there is an inherent tension: On the one hand, the bar for how socially competent, cheery, stress-resilient, flexible, fast-thinking, hard-working, etc., etc. employees must be keeps rising. This means that over time, fewer and fewer people manage to reach the bar, and thus fewer and fewer people are considered normal/neurotypical. More and more people are diagnosed with a neuropsychiatric disability because they fail to live up to society’s demands, and/or diagnosed with a mental illness as the ever-increasing demands causes them to break down. On the other hand, a fiercely competitive capitalist society can only afford a certain number of sick and disabled people, can only afford to let a certain number of people live on welfare, can only afford a certain number of employees to get special accommodations and a certain number of students extra help in school.
So far, the neurodiversity movement has operated largely within a liberal, rights-based framework, and for some time, people made progress by insisting that neurodivergent people should be seen as a marginalized group that require equal rights. But nowadays, this progress seems to have, by and large, come to a standstill. More and more parents of neurodivergent children as well as adults with (neuro)psychiatric diagnoses find that it gets increasingly difficult to get the special help and accommodations that you’re legally entitled to on paper. Now, many people seem downright puzzled by this development. They seem to think it’s just some large accident that this happens, and that it should be possible to correct without any large-scale changes to society.
Chapman explains that this tension is built into our present-day capitalist system. It’s built in that more and more people qualify for diagnoses because they can’tmanage the normal school system or normal job market without all kinds of extra help. At the same time, it’s built in that this extra help will often be denied them, because there’s a limit to how many ill or disabled people the system can afford.
Chapman, unfortunately but understandably, doesn’t give us a recipe for revolution towards the end. Readers might agree with everything they say in the book, and still have different ideas of how to best change society.
Bloody revolution, guns in hand? Bloodless revolution by having all workers in all fields doing a simultaneous strike and seizing the means of production? Old-fashioned social democratic reforms, update old plans from back in the day when social democrats planned to phase out capitalism? Somewhat less old-fashioned, but still twentieth century-style, social democracy, where you don’t plan on phasing out capitalism, but still want a much heftier welfare state and a more mixed economy than is currently the case in most western-European countries? Market socialism plus welfare state? Should Universal Basic Income be part of any of the above plans?
What Chapman definitely argues against is the idea that neurodivergent people primarily suffer from prejudice, restrictive social norms, and/or a lack of knowledge among other people, and that we can achieve equality between disabled people and normates simply by promoting tolerance and spreading information.
Or, one might add, by philosophical arguments that aim to show that neurodivergent people aren’t to blame.
Moral responsibility sceptics like Bruce Waller argue that the belief in moral responsibility is the root of, well, perhaps not all, but still a lot of evil (Waller 2014). People’s belief in moral responsibility leads them to blame the poor for their poverty and praise the rich for their alleged super hard work. People’s belief in moral responsibility presumably leads them to be demanding and unforgiving in general.
Not long ago, I was invited to discuss free will on a radio show. Another guest, a neuroscientist, talked about how learning more and more about the brain will make us more forgiving and relax our demands. He repeated the myth of how everyone nowadays diagnosed with ADHD or other neuropsychiatric disability would have been burnt at the stake or beaten up or thrown out of the village in the bad old days, but now we know better. Now, thanks to modern science, we know that it’s not the ADHDers’ fault that they fail in school, fail at work, and often can’t behave as they should.
I have published on this matter myself.
I’m a compatibilist, and in any case, I doubt that trying to get everyone to embrace moral responsibility skepticism is the best way to go. Nevertheless, I have published a paper where I accept the premise that it’s important to realize that people often have little to no moral responsibility for their troubles (Jeppsson 2023). However, reading Chapman’s book should give everyone involved in this particular debate pause.
Let’s picture Sisyphus with his boulder. The boulder represents attitudes to mentally disabled people. Sisyphus represents everyone who tries to improve these attitudes via argument: personal testimony, spreading scientific research results, and all kinds of philosophical arguments about moral responsibility intended to show that mentally disabled people who don’t live up to society’s demands aren’t to blame for their failure. When the rock is pushed higher and higher up, it means that general attitudes are improving. But the enormous gravity of neoliberal capitalism keeps dragging it back down. This needn’t imply that Sisyphus makes no difference at all (and at this point, I slightly depart from the original myth); perhaps, without his efforts, the boulder would continue to roll downwards, further and further down into an impossibly deep valley below. The boulder is sometimes higher up and sometimes lower down but thanks to Sisyphus’ relentless pushing, it stays on the hillside instead of going all the way down in the valley. If we want the boulder to stay up, we have to … well, change the metaphorical gravity in the scenario. Fortunately, economic systems, however hard to change, aren’t as inevitable as gravity itself.
Perhaps philosophers tend to overestimate the importance of philosophical ideas. There are many reasons to believe that moral responsibility beliefs tend to be ad hoc, something people come up with to morally justify what powerful economic interests dictate. As a compatibilist, I do believe that there are aspects of holding ourselves responsible, and responsibility-holding in personal relationships, that goes deeper than that (e.g., Jeppsson 2022). I also believe that Mich Ciurria (2020) makes important points about holding oppressors responsible. Nevertheless, claims about how poor people deserve to be poor because clearly, they have not worked hard enough, or contrary claims to the effect that rich people clearly deserve to be rich, seems thoroughly ad hoc.
It’s important to distinguish between desert in the moral responsibility sense and legal and other entitlements. My parents may be billionaires and leave me a fortune when they die, even if I’ve spent my whole life just sitting on my arse. I’m still legally entitled to these billions. Moreover, some philosophers and economists defend the view that if people have a right to their property in the first place, they also have a right to do with this property as they please, including leaving it to their lazy child when they die (e.g., Nozick 1974; Hayek 1944). Thus, people may argue that I am not just legally entitled to inherit this fortune according to the laws of my country, but also argue that these laws are just and that I am morally entitled as well. Nevertheless, it does not follow that I am morally responsible for having acquired all this money and deserve to be rich in the moral responsibility sense.
To be clear, I disagree with Nozick’s theory of justice, and I disagree that this theory could justify the world we live in even if we accept it as a premise (history has been thoroughly shaped by transactions that are unjust according to the theory, like blatant conquest, theft, and enslavement). I disagree with Hayek’s ideas that attempts to rein in capitalism must lead to authoritarianism. But it is interesting that thinkers that feature so prominently in neoliberal tradition do not argue that all rich people deserve their money because they all worked hard for it. The claim that riches and destitutions are always or even mostly deserved in the moral responsibility sense is just too preposterous for most scholars and researchers; we merely have to point out the phenomenon of large inheritances and generational wealth to prove the claim wrong. Nevertheless, the claim keeps popping up in popular debates, fueled by powerful economic interests.
Proving that people with neuropsychiatric disabilities cannot help their problems is not and will never be quite as easy. Presently, we have far less data than many people think on the correlations or causal relations between neurological phenomena on the one hand and psychological and behavioural difficulties on the other, and we diagnose people based on talk, not neurological examinations. But even if we managed to pin down precise brain differences between, say, people with ADHD and the rest of the population, we won’t find a neurological blameworthiness marker; it will always be possible to argue that the neurological differences we have found code for, say, laziness and bad character rather than blameworthiness-undermining problems. The only way we can find out whether someone truly struggles and does their best but fails anyway is by talking to them and trust what they say.
Thus, the same economic forces that fuel the ridiculous claim that all rich people deserve their money because they work so hard, will have no problem fueling arguments about how people with various neuropsychiatric and psychiatric diagnoses should simply get their shit together, stop demanding special accommodations like little snowflakes, and stop mooching off the welfare state instead of making an earnest living.
We can and should continue to argue against those who say that everyone who is poor, sick, or otherwise struggling have themselves to blame. But we should also work for material changes. Arguments may push back and defend, but arguments alone aren’t enough to truly improve things and move forward.
References
Bölte, S. 2016. 10% av befolkningen har neuropsykiatriska svårigheter. [10% of the population have neuropsychiatric difficulties.] Hjärnfonden. https://www.hjarnfonden.se/2016/06/10-av-befolkningen-har-neuropsykiatriska-svarigheter/ Accessed 2024-05-10.
Ciurria, M. 2020. An Intersectional Feminist Theory of Moral Responsibility. New York: Routledge.
Goodey, C.F., and Stainton. 2001. Intellectual Disability and the Myth of the Changeling Myth. Journal of the History of the Behavioral Sciences. 37(3): 223-319.
Jeppsson, S. 2022. Exemption, Self-exemption and Compassionate Self-excuse. International Mad Studies Journal 1(1): e1-21. Republished in The Bloomsbury Guide to the Philosophy of Disability, edited by Shelley Lynn Tremain, 339-359, London: Bloomsbury Academic.
Jeppsson, S. 2023. Agency and Responsibility: The Personal and the Political. Philosophical Issues. 33(1): 70-82.
John Hopkins Medicine. 2024. Mental Health Disorder Statistics. https://www.hopkinsmedicine.org/health/wellness-and-prevention/mental-health-disorder-statistics Accessed 2024-05-10.
Hayek, F. 1944. The Road to Serfdom. Oxford: Routledge.
Nozick, R. 1974. Anarchy, State and Utopia. New York: Basic Books.
Waller, B. 2014. The Stubborn System of Moral Responsibility. Cambridge, Massachusetts: The MIT Press.
Wisselgren, M. J., and Vikström, L. 2023. Behind the Numbers: Authorities’ Approach to Measuring Disability in Swedish Populations from 1860 to 1930. Historical Methods: A Journal of Quantitative and Interdisciplinary History. 56(2): 63-76.
World Health Organization. 2022. Mental Disorders. https://www.who.int/news-room/fact-sheets/detail/mental-disorders Accessed 2024-05-10.
_______________________________________________
*In a show of solidarity with this symposium, Pluto Press will take 30% off the purchase of paperback copies of the book and ebooks until the end of the calendar year. To get this discount on Empire of Normality, use the discount code BIOPHIL30 at plutobooks.com — the Pluto Press website.
BIOPOLITICAL PHILOSOPHY 