Neurodivergence is Not a Moral Defect – Nursing Clio

Neurodivergence is Not a Moral Defect

Mere hours after the Senate confirmed Robert F. Kennedy, Jr. as Secretary of Health and Human Services on February 13, the White House released an Executive Order entitled “Establishing the President’s Make America Healthy Again Commission.” The text is so full of disinformation it’s difficult to pick out a single issue (for example, it lists “electromagnetic radiation” as a potential cause of chronic illness), but, as an ethicist who works on neurodiversity, I was particularly disturbed that it called neurodivergence and mental illness “dire threats.” Such framing puts our lives and livelihoods in grave danger, while claiming that we are the problem. You see, I’m AuDHD myself, and I know firsthand how damaging moral panics about us, and the medications we need to function, are.

Kennedy’s infamous vaccine denialism and promotion of autism quackery have long been dangerous. But this executive order, which takes aim at the medications we use to manage and preserve our lives—particularly given Kennedy’s proposal to put people who need psychoactive medication in labor camps—reveals another dimension of the threat Kennedy’s worldview poses. The Executive Order declares that ADHD and autistic people, especially when we have appropriate medical support, pose “a dire threat to the American people and our way of life.” It also directs the MAHA commission to “assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs.”

Read that again. Neurodivergent people, according to this Executive Order, are a threat to the American people. We must reduce their numbers and confiscate their life-saving medications.

ADHDers and autistics, who are dismissed as lazy, immature, unempathetic, self-centered, and possibly fraudulent are, sadly, used to this. We were treated to a poignant reminder during Kennedy’s confirmation hearing, when Alabama Senator Tommy Tuberville averred that in his day, “attention deficit” was treated not with medication but with a belt. Nor is this the sole preserve of the far right. Timothy Snyder’s On Tyranny, for example, upholds eye contact and small talk—two things that are difficult or even painful for many autistic people—as pillars of resistance to fascism.^[1] Sigal Samuel, in Vox, similarly argues that diffuse patterns of attention make us less empathetic and corrode our politics. And in Stolen Focus—blurbed by such left luminaries as Naomi Klein—Johann Hari straightforwardly says that people who “can’t pay attention” prefer “simple, authoritarian solutions.”^[2]

Here, too, apparently, we are a threat to the American people and our way of life.

My neurodivergence does not represent a health crisis or a threat to the American people. My mind is not a problem—far from it. I love the ways I can make connections between apparently disconnected concepts and synthesize them into new and interesting arguments. I love the intense joy I get from a good sensory experience, or from talking about an interest that lights my mind ablaze. And, far from being a tool of tyranny, the fact that my attention isn’t easily forced to go where someone else tells it is incredibly valuable in a moment of terrifying authoritarian escalation. But there are particular challenges that come along with that wonder, and medication makes them manageable.

Put bluntly: stimulants make it possible for me to do my job. They make it possible for me to turn ideas into completed projects, and to manage all the administrative moving parts that make a college class work. Stimulants make it possible to brush my teeth and eat on a regular schedule, and help keep me from making boneheaded financial decisions. They help keep my emotions regulated, and they help me cultivate my personal relationships and think about my words for a moment before I blurt out the latest thing that’s crossed my mind.

I was diagnosed with ADHD when I was twenty-three, after it became clear that the coping mechanisms that got me through college were no longer sufficient for graduate school. Contrary to Senator Tuberville’s claim that stimulants are handed out “like candy,” I underwent a months-long diagnostic process involving three different providers before I was able to take Adderall. Because stimulants are controlled substances, I must jump through extra administrative hoops to get my medication each month—ironic, indeed, for a drug that treats my impaired executive function.

I’ll never forget the first time I tried to study while properly medicated. I was able to focus on what I wanted to focus on, meet my reading and note-taking goals, and do so without wasting time and energy fighting my brain. I couldn’t believe it didn’t have to be such a struggle to follow through with the things I wanted to do in the first place.

This wasn’t my first go-round. After two years of social and behavioral difficulties in school, I was evaluated the summer I turned seven. That report describes my performance on a battery of tests in ways that read almost like a list of diagnostic criteria for ADHD and autism. It then concludes that I didn’t display the “classic profile” for ADHD. Instead, it says my parents believed I was willfully misbehaving. Perhaps that conclusion was foregone anyway: my mother was adamant that she would never put her daughter on “those drugs.”

You might think— well, you turned out alright, and you were medicated once you reached an age where you could make your own healthcare decisions. Isn’t that all RFK Jr’s worried about—overmedicating children? And for me, perhaps it looked as though everything was fine. Even without treatment, I got good grades, and I attended a top college and graduate program. I have a PhD, and a tenure-track job at an excellent research university. All’s well that ends well, right?

Here’s what isn’t apparent: the generational wealth that insulated me from making disastrous financial decisions and gave me a cushion when I forgot to see the dentist for three years straight and needed several hundred dollars of dental work. I had the good fortune to meet my incredibly organized wife when I was nineteen, and have had her support for my entire adult life. Because I am white, cisgender, and middle class, and my apparent support needs are minimal, my symptoms were merely exasperating, rather than excuses to limit my medical care, curtail my freedom, deny my ability to communicate, or extrajudicially murder me. Not everyone has the structural support that has saved me many times over–and it’s important to understand that for this Executive Order, and everything that follows in its wake, the disproportionate harm it will cause neurodivergent people without those supports is precisely the point.

Here’s what else isn’t apparent: The struggle it took to learn things that didn’t come naturally to me. The anxiety of wondering when just being “super-smart” and quick wouldn’t be enough to compensate. The insidious belief that I was just lazy. And when I think about the years of wasted energy and self-flagellation and wonder what I could have done if I had gotten support when I first needed it, I get very, very angry.

I’m a scholar of Jewish ethics, and I’ve done plenty of public scholarship that showcases my expertise in that sphere. And, in either apt or horrifying timing, I’m currently writing a book about neurodivergent affinities in the Babylonian Talmud, and how they can counter the ongoing portrayal of neurodivergent traits as moral defects. If I were following the standard op-ed formula, now would be when I’d say, “here’s a passage of Talmud that, read creatively, can show us a better way!” And it’s true. I could tell you about a passage that seems to argue that, for certain prayers, waiting until the last possible moment to recite them isn’t just barely adequate, but ideal. I could tell you about how the rabbis make the dysregulated conduct of the biblical Hannah the exemplar for how all Jews should pray. I could tell you how the very structure of the Talmud, with its tangents, hyperfixations, and wild syntheses, is deeply resonant with neurodivergent thinking.

But, frankly? Screw that. I shouldn’t have to dredge up a passage from the Babylonian Talmud in order to prove that neurodivergent people are not moral defectives and that we deserve to have the support we need.

Because of Kennedy and all the voices who downplayed the extent of his dangerous beliefs, neurodivergent people now face imminent threats to our already threatened support needs. Not just from Kennedy: the administration’s illegal plan to dismantle the Department of Education would be catastrophic for the educational supports neurodivergent and other disabled students depend on. So would this lawsuit, joined by seventeen state attorneys general, seeking to end section 504 out of anti-trans spite. So would Congress’s plan to gut Medicaid. It’s incumbent upon all of us to push back as strongly and as loudly as we can.

Regardless of what the Talmud does or doesn’t say, or the disinformation and stigma we face, here’s what’s important: ADHD, autism, and other neurodivergences are not tragedies. Neurodivergence is not a public health crisis. It doesn’t require a cure. It isn’t a pharmaceutical conspiracy. It is not, for the gazillionth time, caused by vaccines. It is not a threat.

And it is not a moral defect.

Featured image caption: Courtesy Tara Winstead.

Rebecca J. Epstein-Levi is Assistant Professor of Jewish Studies and Gender & Sexuality Studies at Vanderbilt University. An expert on sexual ethics, she uses unconventional readings of classical rabbinic text to study the ethics of sex and sexuality, disability, and neurodiversity. In her copious free time, she enjoys cooking unnecessarily complicated meals and sharpening her overly large collection of kitchen knives. She lives with her wife, Sarah, her cats, Faintly Macabre and Chroma the Great, and a flock of wire dinosaurs and other beasties.