Divergent Mind

Thriving in a World That Wasn't Designed for You

Jenara Nerenberg

• Publisher: HarperOne
• Year: 2020
• ISBN:
  9780062876812
• Topic: Psychologie
• Subtopic: Psychopathologie

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A paradigm-shifting study of neurodivergent women—those with ADHD, autism, synesthesia, high sensitivity, and sensory processing disorder—exploring why these traits are overlooked in women and how society benefits from allowing their unique strengths to flourish.

As a successful Harvard and Berkeley-educated writer, entrepreneur, and devoted mother, Jenara Nerenberg was shocked to discover that her "symptoms"--only ever labeled as anxiety-- were considered autistic and ADHD. Being a journalist, she dove into the research and uncovered neurodiversity—a framework that moves away from pathologizing "abnormal" versus "normal" brains and instead recognizes the vast diversity of our mental makeups.

When it comes to women, sensory processing differences are often overlooked, masked, or mistaken for something else entirely. Between a flawed system that focuses on diagnosing younger, male populations, and the fact that girls are conditioned from a young age to blend in and conform to gender expectations, women often don't learn about their neurological differences until they are adults, if at all. As a result, potentially millions live with undiagnosed or misdiagnosed neurodivergences, and the misidentification leads to depression, anxiety, low self-esteem, and shame. Meanwhile, we all miss out on the gifts their neurodivergent minds have to offer.

Divergent Mind is a long-overdue, much-needed answer for women who have a deep sense that they are "different." Sharing real stories from women with high sensitivity, ADHD, autism, misophonia, dyslexia, SPD and more, Nerenberg explores how these brain variances present differently in women and dispels widely-held misconceptions (for example, it's not that autistic people lack sensitivity and empathy, they have an overwhelming excess of it).

Nerenberg also offers us a path forward, describing practical changes in how we communicate, how we design our surroundings, and how we can better support divergent minds. When we allow our wide variety of brain makeups to flourish, we create a better tomorrow for us all.

Part I

Inner Worlds

Chapter 1

The Female Mind Throughout History

Words, language, definitions, and framing all act as power conductors—they let in meaning, set boundaries, keep unwanted implications out, and generally empower or disempower. When we think about our choice and use of the phrase mental illness, for example, we have to stop ourselves and ask some questions. Who came up with this term and when? Was it a man? A scientist, pastor, plumber, farmer? What else was happening at the time the words were being employed? Was there slavery? Child marriage? Lobotomies?

I urge you to take questions of language seriously—not because you need to become a historical or linguistic expert, but because seriously exploring and answering such questions helps generate broader societal shifts. If your definition of your mind has been “locked” in an outdated viewpoint, or if how doctors or researchers view the mind is stunted, then increased questioning will begin to chisel at and loosen the very critical and often private world of the emotional interior.

The worlds of medicine and psychiatry have been “plagued” with words of weight that greatly affect the lives of women. We take the words and definitions for granted, unaware of their histories and unaware of the meanings in which we swim, until at some point in our lives we begin to pull (or push) back.

What women are subjected to—both in practice and in viewpoints—always reflects the broader sociocultural dynamics at play. During slavery in the United States, for instance, people began naming “slave diseases”—when slaves showed signs of unhappiness and wanting their freedom. In other eras, as women began working outside the home and gaining more freedom, doctors advised them to stay home for fear of injuring their reproductive organs. Homosexuality was deemed a mental disease until 1973. There is an interplay, an ontological dynamic between self-perception and societal structure.

In the 1400s, for example, the common notion of madness was that the devil and evil spirits had taken possession of the human mind. This belief contributed to many women being viewed as “witches” and then killed, especially if they were considered to be countercultural or irreligious, as Denise Russell notes in her book Women, Madness, and Medicine (1995). By the 1700s madness became a notion of human weakness rather than spirit possession, and into the nineteenth century female “hysteria” started to become a common reference instead.

Medicine and psychiatry have always toggled between being viewed as a “divine” or a “scientific” practice; in fact, psychiatry partially originated in the disciplines of obstetrics and gynecology, where it was seen as “rightly” housed within the study of women’s issues. In the late 1800s many male doctors asserted that in some cases the female clitoris should be removed because hysteria was caused by masturbation.

Hysteria was described as a “disease” of “uncontrollable emotion” that predominantly affected women, and “sexual emotions” encouraged it. Others described hysteria as a physical disorder that caused women to be morally perverted or to suffer from “paralysis of the will.” Whatever feelings and bodily complaints women described at the time were generally not believed by doctors, who discarded the complaints as lies and caused by laziness. The common cure for hysteria was thought to be marriage. Henry Maudsley, a prominent British physician in the 1800s, claimed that menstruation could lead to mental instability and mania. In 1875, another British physician, Andrew Wynter, believed that insanity was passed down to children from the mother.

In 1895 Sigmund Freud published Studies on Hysteria, which concluded that early sexual trauma was responsible for adult female hysteria. Just two years later he switched his viewpoint because widespread reports of childhood sexual abuse led him to believe that his theory must not be entirely accurate. The pressure to pathologize and medicalize, using the language of disease, put weight on Freud to conform, or he would lose his stature in the medical community. No one could imagine that hysteria wasn’t a disease—no one saw the connection between the way women were treated and their emotional lives.

In her 1985 book The Female Malady: Women, Madness, and English Culture, 1830–1980, Elaine Showalter traces the history of psychiatry from its association with gynecology to the pervasive overrepresentation of women in mental hospitals, and onward to the 1960s when studies concluded that mental illness was found more often in women than men. Showalter points to the “dual images of female insanity—madness as one of the wrongs of woman; madness as the essential feminine nature unveiling itself before scientific male rationality.” Calling to mind the writers Sylvia Plath, Virginia Woolf, and Anne Sexton, Showalter continues, “Biographies and letters of gifted women who suffered mental breakdowns have suggested that madness is the price women artists have had to pay for the exercise of their creativity in a male-dominated culture.”

Psychology and psychiatry as we know them today had to fight hard to become respected disciplines, and they didn’t become so until they were firmly accepted and entrenched within the practice of medicine and science more broadly. As ideas regarding madness, insanity, and disorder were slowly evolving, many practitioners were viewed as “quacks.” Scientists from other fields developed tools to examine body parts and physical disease, and the same approaches were attempted with the brain and human behavior. The development of psychology and psychiatry thus evolved as science as a whole evolved.

But human behavior, desires, beliefs, and thoughts are harder to probe, so the two fields took longer to develop. North America’s first medical college was established in 1765 in Philadelphia, signaling the arrival of medicine and medical studies as “scientific.” But doctors were still treating “insane” patients through “bleeding,” a way of purging and fixing so-called irregular blood circulation. “Drowning therapy” was also popular at the time, as was making patients extremely dizzy by spinning them around and around.

The increased medicalization of challenges affecting the brain and behavior meant that less and less attention was being given to how broader sociological and historical contexts would affect people’s emotions and mental states. During the late 1700s there had been a short-lived wave of what was called “moral treatment,” where people who were deemed insane were treated slightly better and lived in quarters with gardens and areas devoted to the practice of art. A man by the name of Philippe Pinel in France was the primary force behind this approach, and soon after the Quakers in North America were experimenting with similar approaches.

But when these centers started to be influenced by medical professionals, the focus on moral treatment lessened, and a hybrid approach combining medicine and moral treatment began to take hold. Physicians began to manage these centers and in turn medicalize interactions with patients as opposed to relying on more gentle, human dynamics that brought out “balance” in the individual. As Robert Whitaker writes in Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill:

As physicians gained control of the asylums, they also constructed a new explanation for the success of moral treatment—one that put it back into the realm of a physical disorder. Pinel’s “non-organic” theory would not do. If it were not a physical ailment, then doctors would not have a special claim for treating the insane. Organizing activities, treating people with kindness, drawing warm baths for the ill—these were not tasks that required the special skills of a physician.

Beyond the influence of medicine, larger contextual forces were underestimated as well. Much of what became known as “madness,” especially in women, cemented around the time of the acceleration of capitalism in Western Europe. If context determines “normal” and “abnormal,” then it makes sense to give greater attention to broader historical, economic, and societal forces at work. Showalter notes that since the eighteenth century, there were often literary references to a kind of “English malady”: “The English have long regarded their country, with a mixture of complacency and sorrow, as the global headquarters of insanity.” And as England’s influence on the cultural development of the United States is vast, it’s worth noting how notions of madness came about in contemporary US history.

Between the early 1800s and early 1900s, “The everyday psychopathology of the masses was a burgeoning and protean market, especially among the swelling ranks of the affluent; and doctors, armed with the authority of the microscope and the pharmacy, had seized it,” explains Gary Greenberg in The Book of Woe: The DSM and the Unmaking of Psychiatry. At the same time, the idea that the transition to modernity was creating a rising incidence of “mental disorder” or “insanity” would occasionally crop up. Edward Jarvis, a physician in Massachusetts in 1872, began to speak and write on this, but it never gained much ground.

The demise of moral treatment also coincided with a wave of new immigrants leaving Europe for the United States. The switch from moral treatment to what people were swayed to believe was “hard science” was led by William Hammond, the Surgeon General during the US Civil War, who claimed that insanity was definitely a brain disease. By the 1930s it became illegal for the “insane” to marry in order to prevent their procreation. About four thousand mentally ill patients were sterilized in the 1950s, a number similar to that of the 1920s. And as late as the early 1950s, around the same time as the first Diagnostic and Statistical Manual of Mental Disorders (the DSM) debuted, about ten thousand patients were still undergoing lobotomies for the treatment of mental illness.

The medicalization of “abnormal” behavior, which became the field we now know as psychiatry, is thus a history laced with layers and layers of distant players. The pursuit of medicine as a career was not always prestigious. Only as the study of medicine became accepted and entrenched in the scientific fields did its prestige rise. So to begin to discuss human behavior, abnormalities, and so-called disorders within a medical framework was a bit like colonists arriving on new land to make their mark—and a hefty profit. Academics, scientists, government officials, and business professionals got involved to essentially grab a piece of the market share. Greenberg writes:

Surely the doctors who insisted that homosexuality was a disease were not all bigots or prudes. Nor are the doctors who today diagnose with Hoarding Disorder people who fill their homes with newspapers and empty pickle jars, but leave undiagnosed those who amass billions of dollars while other people starve, merely toadying to the wealthy. They don’t mean to turn the suffering inflicted by our own peculiar institutions, the depression and anxiety spawned by the displacements of late capitalism and postmodernity, into markets for a criminally avaricious pharmaceutical industry.

The history of the DSM thus reflects the history of politics and sociocultural dynamics. By the 1960s, the language of neurotransmitters, dopamine, and serotonin took hold. But, as Greenberg notes, “What seemed never to be in doubt as the doctors rushed from theory to theory was the idea that one brain chemical or another was the cause of mental suffering, just as one bacterium or another must be the cause of infection.” There thus arose the pressure to further categorize and itemize every possible “disorder” and its criteria. As Greenberg notes, the third iteration of the DSM (DSM-III), which came out in 1980, “nearly [doubled] the number of mental disorders” and “vastly expanded the manual’s scope, turning it into an entirely new psychopathology of everyday life.” It was actually a bestseller and garnered the American Psychiatric Association an extensive amount of money. Its success was largely due to seemingly highly scientific categorizations of so-called mental disorders. But those categorizations are fluid and changeable: from slave drapetomania in the 1850s (the “mental illness” that caused slaves to try to escape slavery) to homosexuality in the 1950s to today’s “internet use disorder.” The DSM is more like a catalogue of current social ailments than scientific hardwired “diseases.”

In Women and Madness, Phyllis Chesler writes of what she calls “psychiatric imperialism,” whereby normal responses to trauma are methodically pathologized in science and medicine. At the time of the book’s publication in 1972, few women were coming forward about gender biases in the study and practice of psychology. Chesler felt compelled to bring forward a conversation around gender, race, class, and medical ethics because “modern female psychology reflects a relatively powerless and deprived condition.” Of sensitivity she writes: “Many intrinsically valuable female traits, such as intuitiveness or compassion, have probably been developed through default or patriarchal-imposed necessity, rather than through either biological predisposition or free choice. Female emotional ‘talents’ must be viewed in terms of the overall price exacted by sexism.” Regardless of causation, of note here is that women’s internal lives were barely acknowledged or considered.

A 1984 questionnaire from the National Institute of Mental Health indicated that close to one-third of Americans would experience “mental illness” during their lifetimes. And more than 20 percent of Americans reported symptoms that would land them a “diagnosis” based on the DSM. Given such numbers, Greenberg notes that “our inner lives are too important to leave in the hands of doctors: because they don’t know as much about us as they claim, because a full account of human nature is beyond their ken.”

In the later half of the 1980s, for example, ADHD became a hot topic and popular diagnosis, and a strand of kids caught the attention of a doctor named Joseph Biederman at Massachusetts General Hospital. These kids were precocious and prone to tantrums and extreme sadness. Biederman sensed that perhaps the onset of bipolar disorder was much earlier than previously thought and that these kids might be showing early warning signs of it. Features of ADHD and bipolar disorder in the DSM overlapped, but these kids didn’t have the manic episodes characteristic of bipolar. The layers of criteria and nuanced symptoms listed in the DSM that are designed to differentiate one diagnosis from the next are fluid and relative, contributing to what Greenberg calls “ad-hoc diagnosing.”

Throughout the early 2000s Biederman’s newfound focus on childhood bipolar disorder resulted in a surge of medications being prescribed to children. According to Greenberg, the diagnosis of bipolar disorder among children in 2003 had increased by fortyfold over the previous decade. By 2005, antipsychotic drug use in kids increased 73 percent in just four years. In 2007, five hundred thousand children were on drugs that previously had been reserved for extreme cases.

This is an example of the consequ...