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I’m grateful to Shelley Tremain for organizing this symposium. I’m also grateful to Mich Ciurria, Jane Dryden, Johnathan Flowers, and Sofia Jeppsson – all scholars that I have long admired – for their careful engagements with Empire of Normality. I’m glad that each commentator found much to agree with and augment in their insightful readings of the book. That said, it would be boring for me to reiterate all our agreements in my response to their commentaries. So, while this discussion takes place against a broader backdrop of both my gratitude and much agreement, for now I will focus mainly on points of disagreement and the questions that each author raises.
The Question of Mental Illness
Mich Ciurria’s essay defends the value of my book and raises many interesting and pertinent points that both cohere with and go beyond my own analysis, focusing especially on eugenic ideology in academia and philosophy, among much else. I’m grateful to Ciurria for their many insights in these regards. Ciurria then ends by raising the following challenge:
do you think that the language we use to describe neurodivergence is immaterial? I noticed that you use neurodivergence, madness, and mental illness seemingly interchangeably. This is somewhat surprising, since “mental illness” is associated with the pathology paradigm that you reject. Perhaps as a neuroMarxist, you believe that the language we use is less important than the material conditions that structure our lives and relationships, so we shouldn’t argue over language. Could you clarify?
I recognize that my use of the term mental illness may be controversial, so appreciate the chance to clarify how I use the term. In fact, I do not think that words are immaterial, nor do I use mental illness interchangeably with madness and neurodivergence. Rather, I use illness as a subset of madness and neurodivergence. I use it this way precisely because I recognize the material significance of words. More specifically, it refers to forms of neurodivergence whereby people who experience tend to see it as illness (or disorder) and want access to things like treatment or cure in the hope of recovery. At least for my own experiences of such ailments, I’m happy to call these illnesses (or disorders), albeit in a specific sense and with important caveats to which I’ll return.
First, though, it’s important to clarify that, for me, the “pathology paradigm” is not (despite the name) defined by its acknowledgement of neurological or mental pathology. Rather, it is defined by its conflation of mental or neurological health with so-called normal functioning within, and functioning to naturalize, capitalist neuro-social relations. After all, as I detail in the book, constructs of mental or neurological illness or pathology existed long before the pathology paradigm or the concept of normal functioning; versions of these were recognized in many traditional medical approaches around the world. However, as I also note, traditionally, health tended to be understood more as a matter of harmony than normality, so the distinction between health and pathology has varied throughout history.
As to using the term mental illness, I chose to do so as part of a strategy relevant for the current historical moment. There are several key factors driving this decision. First, I wanted to resist a common assumption I find both in liberal neurodiversity and other liberal movements organized against psychiatric pathologization and control. This assumption holds pathologization to be primarily linguistic or discursive in character. To pathologize, on this view, is to name something as an illness, disease, disability, or pathology. Understood this way, liberation most centrally requires that we change words, freeing us from linguistic pathologization.
I think this approach is misguided, certainly; but in saying that, I do not downplay the significance of the discursive. To the contrary, as I show in my critique of Szaszian anti-psychiatry and its offshoots in bourgeoise critical psychiatry, this approach is at best a form of idealism. At worst, this approach discursively and, in turn, materially, tends to play into the hands of neoliberal governments looking for excuses to cut funding for supports, often leading to the incarceration of neurodivergent people in prisons in greater numbers.
In fact, in many cases (but not always) the issue with pathologization is not the linguistic aspects of pathologization itself, but rather things that pathologization often stands as proxy for: individualization, depoliticization, and so on. This distinction is important to note because these problems often remain regardless of whether one is linguistically pathologized or not. As I show with the example of Ivar Lovaas, who rejected the concept of mental illness yet controlled and abused his patients nonetheless, clinicians who reject linguistic pathologization are just as likely to abuse or harm patients as are those who accept the concept. Psychiatric survivors have detailed experiences of similar issues with regard to contemporary “critical psychiatry” clinicians, who also focus on linguistic depathologizing but who nonetheless retain the oppressive practices, structures, and institutions of psychiatric control. I wanted to distinguish linguistic (de)pathologization from the forms of domination and oppression with which it is often associated in order to resist the reification of mental health liberation as something primarily discursive in character.
In fact, I tried to draw attention to the ways in which the grip of idealism has become so deep that we are, in many ways, entering an era of what we might call “neoliberal depathologization,” where linguistic depathologization is reified and commodified to be sold as a new framework, framing, and lens that helps us see that we are really just “different,” or “distressed” rather than ill or disabled. You can buy these new forms of self-understanding by paying an appropriate therapist or by buying their books – all of which leave the world and its oppressive structures intact while rejecting the concept of mental illness itself and specific diagnoses.
In the past, I was more opposed to the concept of mental illness than I am now. But I have in recent years become increasingly interested in reclaiming the concept of mental illness. Part of the motivation to do so is material: in many countries, recognition of illness comes with recognition of rights for healthcare, whereas, by contrast, we have no right to, say, not be distressed. Many people do consider themselves ill (and did so long before the emergence of capitalism) – largely because this fits how they feel ill. Telling them they have been tricked or duped into thinking this―as often happens in critical psychiatry and so on―is an oversimplification that is almost always unhelpful and, in many cases, harmful.
From a materialist perspective, if recognition of illness comes with access to healthcare, and if people by and large want to get access to treatment for a given ailment, and finally if they themselves see it as a medical condition, then denying that their ailment is an illness mainly expresses a failure of solidarity with them. To be clear, I am also supportive of any individual or group that decides to not use this framing, as I make clear when I discuss the significance of de-colonial approaches that emphasize the need to recognize the legitimacy of different framings. I think that such openness requires that we leave space for various conceptions of illness.
But what conception of mental illness? A conception that is both social and historicized, much as my conceptions of disability and impairment are. Here I also follow Fanon―who saw mental illness as intimately related to alienation and oppression―and the Socialist Patients Collective―who sought to “turn illness into a weapon” around which to organize. Thus, for me, to describe some of my experiences as forms of illness does not imply that there is an underlying natural “disease” and avoids any essentialism or reduction of illness to the individual. Instead, the historicized conception that I recommend sees illness as a social concept that, while it can be used by mental health professionals or governments in harmful or oppressive ways, can also be used both to make demands on the state (not to mention insurance companies, and so on) and to organize given our various shared interests, including resistance to the social mechanisms that cause us to become unwell.
My view, then, is that – while space for alternative perspectives must also be made – reclaiming illness in such a way that recognizes it as a tool for making demands for rights and support is necessary, in the current historical moment, for a strategically effective mass politics of mental health.
The Centrality of Racial Capitalism
Johnathan Flowers provides a careful and insightful reading of some of the key arguments and themes of Empire of Normality. Like Ciurria, Flowers agrees with me on much. He also makes several interesting observations about the situatedness, necessity, and utility of my intervention for which I am grateful, including the way that he situates my book within specific subfields of academic philosophy and concludes that the book is a work of “political philosophy of disability” (a point to which I will return).
Nonetheless, Flowers pushes back against what he sees as my failure to engage deeply enough with Black scholarship relating to race, which he associates in part to my minimalist citational style. Because of this failure, he worries that my work may collapse back into “class-first” Marxism and towards default whiteness. To make the case for this critique, Flowers gives several brief examples, but the fullest regards Cedric J. Robinson’s framework of racial capitalism, developed in his seminal book Black Marxism: The Making of the Black Radical Tradition. I’ll thus likewise focus on the same example in my response to Flowers’s criticisms.
Notably, Flowers acknowledges that I cite Robinson in my introduction, where I indicated that I planned to build Robinson’s insights into the book’s synthesis along with other intersectional materialist texts. Flowers also acknowledges that I weave issues relating to race throughout my argument from this point on. Despite this, Flowers notes that I do not cite Robinson again and claims that Robinson’s analysis of racial capitalism – which emphasizes how racialized power dynamics and categorizing practices emerged prior to, and were part of the basis of capitalism – is therefore not actually incorporated into the text, making the citation merely “cursory”. Flowers also suggests that the text could have been improved (implying that his charges would be avoided) if Robinson’s analysis had been incorporated in a more than cursory way.
I’m grateful that Flowers gives me the opportunity to clarify my approach, which I think his reading severely misunderstands, effectively erasing my extensive incorporation of Robinson (and the other texts I cite). In fact, following my indicated commitment to do so in the introduction, I was careful to build Robinson’s analysis into my analysis throughout. Consider how in my initial chapter on the rise of capitalism, I emphasise how the rise of capitalist economic relations was:
driven by the way Europeans began to colonise parts of Africa from the twelfth century, and later the Americas. Having already developed early racialised notions about the Irish and Slavs, European colonisers adapted these notions to justify their subsequent genocide and enslavement of Black and Indigenous peoples. This brought a new slave trade that was, if anything, much more brutal than the slavery of the Roman era. Out of this a larger, global capitalist system began to grow… (27-8)
This passage precisely links back to Robinson’s analysis of racial capitalism, which emphasized how racialized power relations and categorisations were prior to, and thus built into, the origins of capitalism, in the exactways I describe – and which Flowers wrongly claims are absent from my analysis. Building on this passage, I further discuss disability in slave plantations and detail how much of the basis for the scientific management of people was initially developed in this context, stating that: “Because of how racism was built into the origins of capitalism, millions of enslaved labourers were thus doubly objectified in a way that was far worse than the already bad exploitation of white workers in Europe” (31, emphasis added). This remark precisely links back to Robinson’s analysis, much as I continue to do throughout the later history that I cover. This historical survey includes, for instance, my emphasis on Galton’s ranking of both individuals and the races―which I show was foundational for the pathology paradigm―and my emphasis on how the forms of domination that I detail in the Fordist era had their roots in “the kinds of scientific management that had been pioneered on slave plantations” (92). It was because of this Robinsonian thread, which I was careful to weave throughout the text, that I was able to conclude by the end of the book that “the ideals of normality and supernormality, as we have seen, grew together and are intimately intertwined with […] racial capitalism [and related systems] out of which the Empire of Normality arose” (164).
Having drawn attention to this thread, my consistent incorporation of Robinson’s analysis becomes clear: it is not absent, nor is my citation “cursory,” in the ways that Flowers claims. Yet the question of how such an insightful reader as Flowers missed this carefully woven thread – and others like it – is interesting. To be fair to Flowers, I suspect that this oversight relates to the minimalist style of writing and citation that I used in the book, and how this minimalist style clashes with Flowers’s understandable expectations as an academic. After all, in academic writing it is widely expected that authors will (re)cite very regularly and thoroughly, repeatedly (re)mentioning technical terms and scholars by name, sometimes even a dozen or more times per page. Thus, academics may look for such signs to help them understand the substance of a text. It feels to me like Flowers was looking for this kind of thing as he read the book: that is, name dropping and repeated citations of Robinson to show that I had indeed lived up to my claim to be building on his work. This expectation would also explain why Flowers mentions my citational style, which he seems to assume was carelessly employed rather than carefully designed.
Flowers certainly reads the book as if it were an academic book: his first consideration, after all, is to begin asking where it should sit in the various sub-fields of contemporary academic philosophy. Yet the issue for Flowers’s reading is that Empire of Normality is not an academic book and does not aspire to be an academic book, let alone a work of academic philosophy, nor does it aspire to adhere to the norms of academic writing.
True, I do see the book as scholarly insofar as it required research and makes points relevant to scholarly debates, and it does cover some philosophy here and there. But it is not published with an academic publisher and was not written for an academic audience. It also does not seek to be comprehensive, including every example and detail that I could gather. Rather, I published the book with a radical publisher; and it is purposely brief, providing a lightning tour across many centuries, ideas, thinkers, issues, and events in a mere 165 pages. In this, among other things, the book seeks to show how the logics of neuronormativity relate to racial capitalism in ways that (I hope) will help readers who are less familiar with the themes of the book identify examples on their own; it does not seek to cover every example of these logics.
The book was written for the general public – especially neurodivergent people on the radical left – with the need for accessibility driving the way I wrote it. (This is also why, in contrast to most academics, including many who work on disability, I would only agree to publish with a publisher who was explicitly committed to publishing an audiobook version–the production of which is underway). In terms of style, citation and jargon-heavy academic texts can hinder accessibility or put off people who have not had access to training in reading academic texts. I am all too aware of this form of exclusion, having experienced it firsthand given my atypical route into academia. Moreover, part of the argument of the book is that our work hours, especially for those of us who are multiply marginalized, are increasing while our cognitive and attentive focus is constantly diverted and stifled by the workings of capital. This exploitation means that even fewer of us have the time or energy to focus on lengthy (not to mention expensive) academic monographs than we had at any other time in living memory.
While I certainly did not shy away from covering technical theory – I assume competence – I thus attempted a different, more minimalist and accessible style than I am expected to use in my academic work. Among much else, I kept the book as brief as possible, shaving off many examples, lengthier discussions, passages, and even whole sections from denser earlier drafts. The presentation was also purposely much sparser with respect to the employment of technical terms, scholarly namedropping, and repeated citations, given the ways in which these practices can hinder accessibility as it relates to disability, class, access to education, and so on. My lightning tour across my key influences (such as Fanon) in the later chapters was also precisely designed to be brief, reflecting the same concerns – despite the fact that these influences impacted my broader analysis in ways that some may miss.
My citational style was developed with these concerns in mind. While I did make sure to cite all notable influences on my argument at key points, once I had introduced a text and committed to building on it, I assumed that the cited insights were ready to be built into my analysis from that point on. This aimed to make the text more accessible by avoiding the academic expectations of regularly namedropping and re-citing, when re-visiting, or linking back to, the same points (unless, for instance, I was quoting new sections of their texts). My example of Robinson in the above paragraph demonstrates this method, following my explicit commitment to building on his work expressed when I cited his book in the introduction. I equally used this method with other texts that I cite, including texts from Marxist-Feminists, disabled materialist scholars, and so on, my careful incorporations of which equally seem to be erased on Flowers’s reading. Marx himself, although the most central theorist for this work, is only cited several times over the course of Empire of Normality. (Poor Engels, like other more orthodox Marxists, is neither mentioned in the book nor cited in it at all.)
No method of writing or citational style is perfectly designed for all contexts. Each one, including the method and style that I used in the book, has its limitations. Indeed, while I have disagreed with Flowers’s argument, that the text struck him as it did is something I take seriously, as indicating a need to further update and refine the style I developed. And to be sure, I don’t dispute that my positionality brings epistemic limitations (as I acknowledge on the very first page of the book) or that more examples relating to various intersections might have helped strengthen the argument at various points, including some that Flowers notes. I’m therefore grateful for Flowers’s suggestions in these regards. If I ever publish a revised edition of Empire of Normality, I may even use some of the examples that he suggests.
Still, the main thrust of Flowers’s critique and his most critical conclusions seem based on a significant misunderstanding of both my style and approach, which leads him to position my book in an academic context (a context for which it was not written), while missing the many ways that I incorporate the various texts that I cite with respect to race, gender, disability, and other intersections. Perhaps I should have been more explicit in the book itself that the norms, expectations, and practices of academic publishing―which I see as insufficiently intersectional―were part of what I seeking to resist.
The Significance of Galton
Jane Dryden also offers a careful and insightful reading and expansion of various themes from the book, especially in relation to ADHD, a reading and expansion for which I am especially grateful. Interestingly, like Flowers, Dryden considers how I depart from the norms of an academic monograph, also noting my minimalist citational style. But she is more conscious that my book was not intended for an academic audience. She thus recognizes that the book does not seek to provide a comprehensive history or review of the academic literature. Her reflections on this observation lead her to acknowledge that my approach fits my expressed aim of neurodivergent consciousness raising. In turn, Dryden correctly observes that:
Reflecting on the book as a whole, I think it makes sense to think of it primarily in terms of a call for political solidarity. The historical analysis is in service of this political call, in order to highlight the contingency of our current arrangements and conceptions, rather than to explore the history’s twists and turns for its own sake.
Following her reflections on the style and themes of the book, Dryden’s main critical point regards my use of Galton as a key figure for re-interpreting the history of psychiatry and related fields. She writes:
Given the book’s overall purpose, a focus on Galton helps emphasize the message that we are where we are because of particular work at a particular time – which can help make clear that we could do things differently. However, it stands out a bit oddly for a Marxian historical analysis to focus so repeatedly on one specific historical figure.
Moreover, she suggests that Galton is “discussed in ways that seem to stand out from his context” when compared to the other figures I discuss, such as Szasz and Descartes. Finally, she also notes that there are other figures I could have included that would have helped expand on the history I seek to detail. I appreciate that Dryden has raised these issues and that I can take this opportunity to defend my approach.
In fact, it is not odd for Marxists to focus on important historical figures. One favourite book that comes to mind is the classic God’s Englishman: Oliver Cromwell and the English Revolution by Marxist historian Christopher Hill. There are many other examples of Marxist biographies, including from Marx himself. In any case, I explain this part of my method in the introduction, where I wrote:
For my alternative telling, rather than attempting to provide a comprehensive history, I focus on carefully chosen key thinkers positioned in their broader material context. My aim with this is not to resurrect them as ‘great’ (or not so great) men, but rather to show how the progression of pathology paradigm thinking, especially at key moments, has been significantly determined by material factors in ways that are both guided by and reify capitalist power relations and hierarchies. This allows us to see how the material and the ideological continually interact and mutually reinforce each other even, perhaps especially, through the work of those usually positioned as having helped science progress. (15-16)
With this in mind, it is unclear to me why Dryden claims that I do not emphasize context when it comes to Galton. With Galton, the context that I sought to emphasize was the rise of capitalism, nationalism, colonialism, slavery and so on, as well as the various developments in medicine, philosophy and science, detailed in the chapters directly prior to my introduction of Galton. I regard Galton as a product of these broader historical forces and processes. Thus, I also emphasize the specific positionality of Galton as a white, wealthy man from a family rich from banking and gun-manufacturing in the British Empire at the height of its power.
The context that I sought to emphasize, in other words, was that Galton was born into the elite of a growing world system that required the ever-increased individualization, comparison, and ranking of both individuals and races, in terms of purported ability, productivity, and worth. What Galton did was synthesize not just a metaphysics, but also the accompanying set of methods for psychometric testing and bio-certification that formed the basis of a new paradigm. This paradigm functioned to reflect and in turn naturalized these contingent capitalist social relations, while also legitimizing the rankings he found himself born at the top of.
But more than this, Galton is important because of how influential his paradigm remains today. In this, my thinking has long been heavily influenced by some of the texts I cite, such as Lennard Davis’s classic work Enforcing Normalcy: Disability, Deafness, and the Body, which emphasised his significance in the history of normality and disability. While this influence has been recognized in disability studies, and with regard to intelligence testing, until now it had not (so far as I know) been connected to the rise of the dominant paradigm in psychiatry in the way I suggest it should be. At present, it is neither recognized nor acknowledged that we remain in a Galtonian paradigm in psychiatry and related fields as they pertain to both research and the clinic. Yet to effectively resist psychiatric power – for those of us who want to do so – we need to understand its genesis and workings. As I show, looking at psychiatry this way, provides us with a very different analysis and implications to existing analyses (such as from the Szaszian traditions) with which I contrast my analysis. As such, I focused on Galton since I sought to correct an error found in existing work on the history of psychiatry and its related fields, which in many ways overlook what I see as the underlying themes and problems that I identify.
To be sure, I can see why Dryden, might wish for a longer, more detailed book, with more examples, a more comprehensive history, and so on, as she suggests. I agree with her that such a book would be welcome – I’d like to read such a book myself! But again, the desire seems to be for an academic monograph. As genuinely grateful as I am that academics are fruitfully engaging with my work, I did not write the book with an academic audience in mind and did not seek to write that book.
Responsibility
Sofia Jeppsson likewise adds interesting observations that augment what I cover in the book. This is especially so regarding the history of disability in Sweden, which she shows is different to, but nonetheless coheres with, the history that I detail with more of a focus on Britain. She then moves on to an interesting discussion that mainly focuses on moral responsibility and potential implications of the arguments that Empire of Normality comprises for debates about mental disability and moral responsibility.
In particular, Jeppsson draws attention to how debates about morality responsibility and just desert are often “fueled by powerful economic interests,” detailing how
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.
Against this, Jeppsson emphasizes how
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.
This seems right to me. Indeed, in a neoliberal era, we are precisely seeing a return of a moral model of disability more strongly than ever, since neoliberalism emphasizes the centrality of the individual and individual responsibility. Narratives about “snowflakes” relate closely to narratives about over-diagnosis, which in turn are used in right-wing papers to justify cutting disability benefits, accessibility measures, and so on. This form of ideology also relates to the rise in focus on things like “resilience” in clinical psychological practice, leading to a blend of moral and medical models utilized to enforce the improvement of individual virtue.
I would only add that when it comes to ascriptions of agency, moral responsibility, and just desert, neurodivergent people often find ourselves caught in a double bind, only one half of which is described by Jeppsson. For it is not just that we are often wrongly blamed for being disabled, or for the effects of disability; in other words, it is not simply that responsibility is ascribed to us when it should not be. It is rather also that our agency and capacity for moral responsibility is routinely denied on account of our neurodivergence when it should be recognized. This denial is most obvious when it comes to how the agency of people with intellectual disability is often wrongly assumed to be absent. Or consider how conservatorships often in fact undermine our agency and capacity for decision making, despite purporting to be premised on these characteristics. In other cases, for those of us who are both autistic and trans, our transness is often dismissed as a symptom of our autism rather than accepted as part of who we are. The double bind to which I draw attention thus regards how our agency is routinely both emphasized where it is irrelevant, and yet denied when it is present.
Notably too, such denials of neurodivergent agency and capacity for decision making are often at least implicitly legitimized by philosophers who write about moral responsibility. For instance, in her 2008 book The Ethics of Autism: Among them, but Not of Them, Deborah Barnbaum wrongly argued that all autistic people lack moral agency and are therefore outside the moral community of humanity. While she does not mention concrete practices such as conservatorships, it is not hard to see how such philosophical views could be used to legitimize harmful uses of this practice. Too often, then, philosophers have been complicit in these forms of oppression.
I welcome Jeppsson’s move towards a materialist analysis of moral responsibility, which seems to me to augment feminist work on relational conceptions of autonomy and other related attempts to move agency away from individual notions of autonomy or agency. I would like to see this materialist analysis combined with Marxist critiques of the concept of agency itself, as well as with more work on the specific ways in which capitalist social relations and ideology leads to the imposition or denial of capacity for responsibility when it comes to disabled people. Such a project, properly developed, may – in line with related recent works – help us move philosophy towards being a force that aids neurodivergent liberation rather than undermines it.
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*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 