#pathologization

Abstract

Here is a non-exhaustive list of reasons this concept makes no sense and you should stop saying it:

A. Autistic people are more likely than non-autistic people to be trans, nonbinary, or otherwise gender-non-conforming, so any attempt to group autistic people by binary, birth-assigned gender is even less likely to be accurate than the gender binary already is in the general population.

2. There is absolutely no evidence supporting the "presents differently" theory that could not be better explained by clinician bias.

iii. The alleged "presentation differences" between autistic "girls" and "boys" are just bog-standard gender stereotypes with "autism" plugged in somewhere. "Boys are better at math and science and logic and not having feelings and their dominant emotion is Anger, but girls are better at socializing and caretaking and brushing hair and their dominant emotion is Approval-Seeking." "Huh, that sounds like reactionary sexist hogwash." "No, I mean, autistic boys are better at math and science and logic and not having feelings and their dominant emotion is Anger, but but autistic girls are better at socializing and caretaking and brushing hair and their dominant emotion is Approval-Seeking." "Oh, okay, now it's Objective Science."

four. Sexist bias, including among clinicians, tends to frame "male" neurodivergence as essentially cognitive and "female" neurodivergence as essentially emotional, because, as we all know, Men Think, Women Feel. Psychology is obsessed with the idea that "girls" are universally and inherently self-loathing and self-destructive -- anything a "girl" has trouble with cannot possible be a skill she hasn't learned or an ability she doesn't have, let alone merely a different way of being; she must simply be self-abnegatingly denying herself the thing she cannot do. So a "girl" with the same traits as an "autistic boy" will have those traits attributed to something emotional, like depression, anxiety, bipolar disorder, borderline personality disorder, or eating disorders. "Autistic girls" aren't being "missed" (read as neurotypical); they're having their exact same autistic traits as "autistic boys" being framed as mood disorders instead of neurodevelopmental disabilities.

cinco. Fundamentally, this premise gets completely backward what diagnosis means and why pathologization happens. People are pathologized and diagnosed, with any kind of disability, when they have traits that fall outside the range of traits considered "acceptable" for their position. "It's more acceptable for boys to have meltdowns, so autistic boys have more meltdowns than autistic girls, so the boys get diagnosed with autism" -- No, this doesn't make sense. That's not how diagnosis works. If it were more acceptable for boys to have meltdowns, then boys who have meltdowns would not be getting diagnosed with anything. Their behavior would not be seen as pathological. If "It's more acceptable for boys to have meltdowns" were to explain any kind of diagnosis differential, it would be "Therefore girls who have meltdowns are diagnosed, while boys who have meltdowns are just considered normal boys." And, to be clear, that kind of thing is absolutely a factor in gender differences in diagnosis, but in the opposite direction from how people mean it. Like, as a "girl," I wasn't really expected or pressured to be athletic, so my absolutely abysmal gross motor skills were just shrugged at and not seen as a sign of disability. Can't run or throw? Well, I was a girl, and a nerd to boot. What do you expect? A "boy" with my level of gross motor skills would draw a lot more Concern.

ζ. "Girls are pressured to mimic/mask more than boys are," even if true (debatable), elides over the fact that many autistic "girls" can't "mimic/mask," because they are disabled. They have a disability. Because some of the things their society expects them to be able to do are things that they cannot, in fact, do. "Girls don't have meltdowns because they're not allowed to. Girls don't forget to do essential tasks because they're not allowed to. Girls don't --" Okay but they do. Girls do in fact very much do those things. Because they are disabled. Because they have disabilities. Because there are things they are expected to be able to do, which they cannot, in fact, do. And it's weirdly disability-erasing (ableist) to claim that people simply develop the ability to do things they can't do just because they're expected to.

heptad. Circling back to point A., while I can't prove it, I really think a lot of this "gendered autism" stuff is a way to pathologize and also explain away queerness/transness/gender-non-conformity in diagnosed-autistic kids. "Oh, no, don't worry, the reason your son consistently Fails At Masculinity isn't because he's some kind of sissy; it's actually because he has this Masculine Male Boy Disorder where he just doesn't understand how boys are supposed to behave. Lots of boys have it. No, no, the reason your 12 year old son is kissing his male friend on the mouth isn't because he's gay; he just has a social skills disorder and doesn't know that boys don't kiss their platonic guy mate dude friends. It's a very masculine disability. Elon Musk has it." I know somebody who was told by an Autism Mom that all autistic people are bisexual because "They don't know the difference." Sure, keep telling yourself that.

just finished reading this very comprehensive FAQ. i really appreciated the clarity and thoroughness of all of it, but especially this section:

If psychiatric diagnoses aren’t “real”, then you’re saying that fibromyalgia, chronic fatigue syndrome, etc. aren’t real.

It is true that they function in similar ways and serve similar purposes. A diagnosis of fibromyalgia does not actually tell you anything about what is going on in your body or why you are experiencing this immense physical pain and fatigue. The treatment is often referred to as “symptomatic”: it helps with the symptoms you are experiencing but does nothing against the underlying issue (except sometimes in combination with other more specific diagnoses). Of course, people who say that those illnesses are “not real” often mean that those who suffer those clusters of symptoms should shut up, pull themselves up by the bootstraps and go back to physical work, since the disease is “all in their head”. So it is understandable that people’s reaction to encountering this claim is to retort to medical arguments: my pain is real, it’s not psychological! This assumes that the only two possibilities are: 1. that it is a medically recognized disease, has (at least partly) a biological cause, it is real, and you are justified in struggling or 2. that it is not a medically recognized disease, doesn’t have any biological cause, it is fake, you are making it up for attention, you are lazy, you are simply not trying enough. This is however a false dichotomy. A useful parallel is with the system of gender: the classification of humans between “biologically male” and “biologically female” is socially constructed and serves the purpose of structures of power. This classification being constructed, however, does not mean that 1. people do not have real, existing organs between their legs (chronic pain) or that 2. the effects of the gender system on people’s lives is not real, and devastating (ableism).

As like, a bad thing? And I’m not saying it isn’t! But I’m curious as to why. Because like, I’ve seen the thought parroted around before, and I couldn’t see anything wrong with it myself. But I could definitely be wrong!

of course if you’re too tired to answer this you don’t have to, have a good day, go drink water, etc etc this ask was sent in good faith

i think "intrinsically" is the operative word here - the idea that both gender- and other forms of bodymind noncompliance are innate, pathological, and fixed reek of bioessentialism, even if they're presented in a progressive way (e.g. 'born this way' lgbtq arguments that justify tolerance based on the idea that we can't help it).

ultimately, these ideologies are dangerous not only because they offer a veneer of tolerance for reactionary, essentialistic ideas, but they also provide the architecture for eugenic practices (autism cure, "gay gene, etc.) + shared forms of corrective abuse (ABA/conversion abuse).

it isn't bad that there's a lot of overlap between autism and trans identity (it's only bad if you have a problem with one or both of these things) but we should be framing it as "hmmm these relationships to sociality that are disruptive, noncompliant, and/or boundary-breaking share a lot in common, and social conditions hostile to trans people seem especially hostile to autistic people too, and vice-versa so it's no wonder why they tend to co-occur." not "autism and Gender Identity Disorder™ are comorbid"

like whoa, child is hostile and uncooperative to corrupt authority figures who don't explain anything and offer arbitrary demands with little reward or reason why, and who may or may not have either abused them or aided and abetted their abusers: "they have a disorder". like even the name makes me want to punch whoever came up with this. questioning unexplained, unjustified authority is not a disorder but smthn we should all do.