Ronan Scott reviews Empire of Normality: Neurodiversity and Capitalism, by Robert Chapman (Pluto Press, 2023).

Georges Canguilhem pointed out in 1988 that it is difficult to disentangle the ‘popular’ understanding of the body from the medical understanding, so influential has the medical profession been in defining and categorising us. ‘The diffusion of an ideology of medical specialisation’, he wrote, ‘often results in the body being lived as though it were a battery of organs.’ We are influenced by the social relations we are in: we don’t have free reign in our consciousness. As imaginative as we try to be, our ways of understanding the world are limited by our conditions, and those conditions can only be changed through struggle, which will at once change our consciousness.

If the communist theorist peers out at capitalism from the gutter, and looks for its traces in the depths of the self, they fall into all kinds of complexities. In the murky realms of experience, trauma lurks alongside soreness and social exclusion. You feel like you must escape your own skin, you cannot continue to bear the sensations it carries, but at once you are in pain from sitting too long at a laptop, and when you move you feel tiredness and fatigue and depression, simultaneously the body feels alien, perhaps this is some duality or break in the self, perhaps it is this body that is the problem, its sexual form (socially, biologically), or the scorn you believe it is held in due to its deviations or idiosyncracies.  Soon you might find yourself reaching for an idea of a quality of wellbeing, or a right to health, the grouping of symptoms into a disorder, the isolation of different experiences into different tracks of the brain, the psyche, the gut, the search for a cure to meet the disease, the hunt for a community of sufferers.  The capitalism that is identified through a mixture of introspection and theory is at once highly abstract and incredibly personal, terrifying to confront, too much part of the self to really fight. 

This self, if we might call it that without thinking too hard about what it means, was forged in particular social relations of production which gave it certain limitations. At some point, distinguishing between cause and effect becomes meaningless. Technology produces certain minds, but it works with matter already existing: tendencies of cognition and ranges of ways of thinking. Capitalism demands an intensity of work which inevitably allows its technologies to radically alter people, whether it causes their muscles to grow or weaken, their dexterity to increase or decrease, or their attention to contract or intensify. Because labour is the foundation of profit, work will both produce and be produced by the workers born into a system where technologies adapt to prompt the greatest productivity from the particular constellations of skills and tendencies that are thrown up by the last generation of society, technology, and work. Vygotsky, in The Socialist Alteration of Man, explained how such transformations in the psyche that take place under late capitalism – mass education, awareness of industrial processes, interaction with other workers of both sexes and all ages – laid the ground for new types of socialist minds in 1930s Russia, for “it is only the capitalist form of organisation of the industrial process which is responsible for the fact that all these forces exert a one-sided and crippling influence”. By the 60s, the tide had changed. Revolutionaries across Latin America and Africa, from Che Guevara to Paulo Friere, Amilcar Cabral to Samora Machel, were exploring types of consciousness and learning that were new to the Marxist-Leninist tradition, and were derived less from the pre-history of socialist psychological development under capitalism. 

Concepts of the self have shifted radically since the era of Jean-Paul Sartre and Frantz Fanon, whose influence lasted well into the 70s. Sartre and Fanon were concerned with a particular moment of struggle, with its pinnacle in  the Algerian War and the Front de Libération Nationale (FLN). In their old paradigms, the self nurses oppositions and dualities, and interacts unfathomably with the social world, existing at once as a metaphysical and material thing, a mystical and vital thing, a persona and a response to a set of relationships. These ways of speaking about the self are no longer second-nature in the way we talk about capitalism and the psyche. When it comes to questions of psychosocial disability, in the last 20 years a new set of writings has come to the fore, from authors like Leah Lakshmi Piepzna-Samarasinha, Kai Cheng Thom, and Ann Cvetkovich. And last year, in the wake of Health Communism: A Surplus Manifesto, twenty twenty three brought Micha Frazer-Carroll’s Mad World, and Chapman’s thesis on neurodiversity and capitalism, Empire of Normality. The self is getting a makeover. 

Chapman’s work is an important addition to existing Marxist accounts of disability and mental health. It challenges the reformism implicit in many movements around neurodivergence, and demonstrates how the demands of people with autism and ADHD may be coopted into a more efficient capitalist machine. Chapman’s sweeping history of the idea of neuro-normality aims to identify a moment in time when material conditions prompted bourgeois theorising about the ‘normal’ and the development of this idea in step with the needs of capitalism. Chapman draws together the advent of statistics, behaviourism, psychology and psychiatry, and associates them with the material need of capital to find ever more lucrative ways to increase the intensity of labour. 

We might expect that Chapman would wish to reject the set of diagnoses at play, and the concept of neurotypicality altogether. If neurotypicality simply represents the highest realistic average of labour extraction attainable in a society with a cognitively dense workload, what particular utility does the concept have for our movement, beyond being something to fight against? But Chapman doesn’t take this step, despite their general critique of how these concepts were formed. Perhaps this is due to Chapman’s apparent jumpiness around anti-psychiatry, which in the 60s advanced many of the critiques of the categorisation and pathologisation of people that are still used today.

Inevitably, people have different personal experiences of diagnoses under capitalism. For one person, a diagnosis will give them access to medication under a liberal health system that makes life more bearable. For the next, the diagnosis leads to forms of incarceration and exclusion. Through having a usable search term, one person finds a community of people who seem similar to them, who can provide mentorship and friendship. The next finds depression and hopelessness and becomes stuck in the apparent immutability of the body and mind. The diversity of experiences at play makes theorisation tricky. The comrade who argues that the concept of autism is simplifying our understanding of people and reducing our capacity to resist capitalist ideas of behaviour must accept that some comrades feel a great sense of security and hope in organising within categories of neurodivergence. Similarly, the comrade who finds neurodiversity a useful paradigm from which to attack capitalism mustn’t simplify the perspective of another who is suspicious of such categorisations. The former should not present the latter as someone who believes that conditions of existence are ‘not real,’ but someone who is critical of our concepts and basis of organisation and action. Compared to Chapman, Frazer-Carroll, whose Mad World came out last year, is more critical of the concepts of diagnosis and mental illness, recognising a process of ‘bio-certification’ around diagnosis, alongside the determining force of diagnosis in setting expectations of how the diagnosed person will behave and live the rest of their life. Even more critical is the communist Anders Lee, who argues that the diagnostic process around autism is epistemologically unsound and has resulted in a simplification of people and personalities within the Left, which must be replaced by a broader politics of forgiveness, diversity, acceptance, and self-development. Instead of medicalised terminology, Lee says, we should talk about what we are actually experiencing, rather than discussing a vague label that was pinned to our symptoms. How we theorise each others’ behaviour and psyches on the Left has huge implications for what we expect of each other, the ways we trust each other, our strategy for building mass power, and our self-image. It’s an incredibly tricky thing to work out. We will come to understand it if we engage in struggle and become conscious of our actions. 

Ultimately, Chapman seems to fear the erasure of the concepts of mental illness and developmental disorders because the state relies upon these categories as a way to permit medical care and divide up the workforce. It’s a reasonable fear, when so many people’s survival relies on diagnosis. But an uncomfortable question remains. Are mental illness, autism, and ADHD concepts we must eventually let go of in order to find our own understanding of the different ways of ‘feeling bad’? How might we act collectively to transform them, rather than worrying that if we change the concepts people will become confused and start saying ‘mental illness is all a social construct – it’s not real!’ Ideas of both mental illness and neurotypicality rely on a dodgy idea of ‘wellness’, which works on the pretence that some in society have no significant problems in their minds, souls, or bodies. We may have to accept that ideas of illness or disability have outgrown their original basis as a counterpoint to wellness: almost everyone is struggling, a lot, all the time. The neurodivergence conversation in the Western left may be following a somewhat similar pattern to the one on transness. Where at one point it was seen as a necessary political line that gender was an immutable identity, hard-wired into the brain (that trans people are ‘born this way’), there is now room to breathe, and space for transness to have legitimacy without a story of biological wiring. Saketopolou and Pellegrini’s recent work, which rejects ‘core gender identity’ and instead examines how self-theorisation regarding gender is made through experience, culture, and trauma, may provide something of a roadmap for Neurodiversity Theory in the US and Europe in the coming years. 

It is noticeable how rarely current theories of disability, mental illness, and neurodivergence draw from theorists who were around before the 90s. Chapman is particularly suspicious of anti-psychiatry, though it is unclear whether their doubts are mostly because of anti-psychiatry’s theoretical correctness or its practical use. Chapman judges a theory’s utility partly based on how easily it can be co-opted, or muddled together with neoliberal, libertarian or fascist ideologies. But all theories can be co-opted if their terms are not made clear enough, and if there is not an army of people to fight for their true utility to the movement. Take the Scottish mental patients’ movements in the 80s and 90s, which argued that mental patients had the capacity to make decisions about their lives, treatment, actions. That same capacity argument is used now to incarcerate and punish patients who are ‘abusive’ when deeply distressed. In Chapman’s eyes, the whole intellectual and practical tendency of anti-psychiatry is functionally synonymous with the work and thought of the Hungarian libertarian theorist Thomas Szatsz. It’s a reductive view, and Chapman seems to almost acknowledge this at points, while defending the idea that anti-psychiatry in its battle against state and pharmaceutical psychiatric control looked indistinguishable from a libertarian movement. The latter critique is not uncommon, though normally levelled more gently – Barbara Taylor, for example, in her study on institutional mental healthcare in the UK, acknowledges that the struggle for reform waged by the anti-psychiatry movement was ‘pushing at an open door’ given the preference for a cheaper, more light-footed state coming from the political elites through the latter half of the 20th century. 

Our way of life determines the possibilities and limits of our psyche, and at the same time the psyche places limitations on our way of life. But in the cage of capitalism, we don’t get cleverer, we just respond to slightly new conditions. Every generation of the Left looks at the previous one with at least some degree of incomprehension and disgust. Why was so little progress made? What hindered the old guard from learning something more? Favourite uncles like Frantz Fanon exist in the millennial Left’s imagination as lonely wanderers, many of their Third Worldist comrades and mentees lost to history. We are happy with great men of the past, but not ordinary movements. What an embarrassment that alternative communities like Kingsley Hall existed, anti-establishment from its repurposed Indian spiritualities to its loose attitude to acid. Wasn’t R.D. Laing a drunk, wasn’t it all a bit swinging sixties but without the glamour of the USA? It might be worth remembering that in these desperate attempts to cure schizophrenia through philosophy and community, somebody was cleaning up the shit, somebody was sitting up all night with those in unbearable pain, someone else taking over the shift early in the morning wondering whether this was a revolutionary life. Do we have any claim to greater enlightenment or are we just terrified of making the same mistakes? We must look at them, the people of the past, and say ‘what was their struggle, and how did they theorise their practice?’ They ask back ‘what is the struggle you are theorising now?’

As unfashionable as the anti-psychiatry movement has become, it would do the Left some good to engage with its theories once in a while. At the Dialectics of Liberation conference in 1967, the central concern of the speakers was not the asylums, but the Vietnam War. What kind of collective consciousness, asked the attendees, created a population in the West that felt guilty for refusing the draft or refusing to manufacture napalm? It was, to them, impossible to see normality or wellness in such a consciousness. Nowadays, when we are explaining how state media operates to make people unsympathetic to the Palestinian cause, we describe how the media dehumanises Arabs. The media, we tell ourselves, makes someone believe that another person is not worthy of love because it convinces us that they are not human. This was an insufficient explanation in the 60s. To this argument, they would have responded with a deeper question of consciousness. Why could anyone be brought to believe that someone else was not human? What can we say about the psychology of such people? Back then, the dehumanisation argument itself was too simple. Instead, 60s theorists argued that the mechanism to get people to fight in Vietnam was to associate the Vietnamese with all the dark, frightening and repressed parts of the self, and then to give people the licence to externalise that part of the self into the other and attack it. To these theorists, psychological disturbance was deeply ingrained through society. Kwame Ture urged the conference attendees not to focus on problems of the individual, but to figure out how to correct Western consciousness so that white radicals would directly (violently) attack the powerful – the only sane thing to do when you witness oppression – rather than standing at the side wringing their hands. The focus at Dialectics of Liberation on consciousness was standard for the time. It was the key question for all of these thinkers, and particularly for Ture who lectured extensively on how to convert unconsciousness into consciousness in the people, which can only be done through struggle. 

The question of struggle at this moment was ‘violence, or non-violence’ (a very 60s question, we might think, but have we resolved it in our own movements?) The type of psychological theory they settled on had real, meaningful implications for both the question of violence and the question of strategy for consciousness. Your approach to the struggle against the white Westerner is rather different depending on whether you believe that they consider the enemy to be unhuman or to be evil. Your approach to struggle as a whole is different depending on whether you believe that people are already engaged in the struggle unconsciously, and how you believe they might be brought to conscious struggle. It is to this question of consciousness that I believe the disability movement, the psychiatric survivors movement, and the neurodiversity movement must turn.

Chapman hopes that the neurodiversity paradigm will be taken up and advanced by those in the global south, since ‘global capital produces similar forms of debility, disability and illness everywhere’. The latter statement certainly seems untrue: global capital does not create similar conditions everywhere, nor is consciousness similar everywhere, so there is no obvious progression of the psychosocial illnesses which come about through the intertwining of consciousness and conditions.  But even if conditions were similar in global majority countries, there is no necessary progression from their prevalent technological and social forms of control to the theory of neurodiversity which is but one among many that the Left is capable of generating. In fact, the anti-psychiatry paradigm that Chapman is so suspicious of is an important part of the pan-African psychiatric survivors’ movement, and anti-colonial critiques of the current mental illness and disability paradigms are becoming more common as those involved in the struggle against colonialism challenge individualising ideas of trauma and how to heal from it (see for example Jasbir K. Puar’s Right to Maim, and Fursan Sahawneh’s recent article, ‘In Gaza, Focus on Symptoms of “Mental Illness” Obscures Structural Violence and Oppression’). Neurodiversity Theory is a historically-specific epistemological paradigm, a quite modern, Western phenomenon. It’s a distinct body of thought, which emerged at a certain time, in certain places, and under certain conditions. 

The rest of the world does not live back in time from us. It is not the case that capitalist development will at some point create in Kenya conditions similar to the ones we live in now, at which point Kenyans will adopt the more ‘advanced’ Western theory. Instead, as Paul Sweezy argued at the Dialectics of Liberation conference all the way back in the 60s, capitalism in the advanced countries ‘exists as what is in many respects a minority part of the total world society and economy’ and is entirely premised on the exploitation, subjugation and plundering of labour and resources from the global majority. Neurodiversity Theory should be informed by theory and practice from countries that suffer most from capitalist exploitation. It should take its cues from the entire world of experience, because our struggle is a world struggle, and the Western struggle can get nowhere without guidance from those countries that are most advanced in the struggle. But we shouldn’t presume that Neurodiversity Theory will be any use to those struggles, especially given its likely imminent co-option as a form of neo-colonial control. Even in its Leftist form it is a response to forms of treatment and diagnosis that have been far more violent, carceral and catastrophic when applied to populations in the Global South, as we see in the psychiatric writings of Frantz Fanon.

I have quibbles with some of Chapman’s statements, such as the idea that social class has been replaced by ‘cognitive hierarchies’. It seems more plausible that contemporary hierarchies are built (domestically) around immigration status and (cross-continentally) the global location of labour. Chapman wants to stress the development of an ‘able-bodied ideal’ in capitalist ideology rather than working from the basis that capitalism desired to exploit labour to the maximum intensity, and could extract more profit from those who could tolerate more intensity. That is to say, sometimes the story reads like the thinkers who Chapman investigates changed the game – the account is less materialist than it could be. A more complex history of the comparison of man and machine would be welcome, perhaps with a critique of Cartesian dualism that builds upon Marx and Engels’ differentiation between strains of materialist and anti-materialist philosophies in The Holy Family and that avoids conflating Cartesian thought and Enlightenment ideas. 

Canguilhem once shared the understanding he’d arrived at of what it was to be ‘well’. Though he was not a Marxist, the words don’t seem a million miles from the self-understanding we might hope to achieve as communists. 

Je me porte bien, dans la mesure où je me sens capable de porter la responsabilité de mes actes, de porter des choses à l’existence et de créer entre les choses des rapports qui ne leur viendraient pas sans moi, mais qui ne seraient pas ce qu’ils sont sans elles.

“I am well, if I feel capable of bearing responsibility for my actions, of bringing things into existence and of making relationships between things which would not come to them without me, but which would not be what they are without them.”

The real implications of Neurodiversity Theory for the movement are huge, and change the way that we organise, struggle together, and live a collective life in struggle, first on a small scale and then on a mass scale. Wellness is not something we find within but in our relationship to the world and our ability to act and create in it. We must make sure that the things we find out there inform who we are in here, and that we keep changing the world as it keeps changing us.

Ronan Scott is from Leith and is interested in history.