If Autism Isn’t a Mental Illness, What Is?

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My name is Elliot. I’m an autistic psychologist with bipolar 1 disorder (and ADHD). I’ve been mentioned in passing [1] [2] in news articles about autistic autism researchers, but I prefer to keep on the science side of things. I usually only use Twitter for personal entertainment, sometimes biting my tongue as I weigh the pros and cons of engaging in autism discourse. I don’t entangle myself too deeply in advocacy work. For the most part, I keep my opinions on controversial things low-key no matter which side I am on. This post is a divergence from that tendency.

I have not uncommonly heard people object to classifying autism as a mental illness. It’s almost taken for granted that autism doesn’t fall under that umbrella. You may be surprised to know how people try to justify it if you actually ask them “Why isn’t it a mental illness?” Indeed, when pressed the most common responses are along the lines of:

  • “Autism is a neurodevelopmental disability” / “You’re born with autism”
  • “Autism isn’t an illness” / “Autism doesn’t need to be treated”
  • “Autistic people aren’t like *those* people”

The common element in all of these responses is a lack of understanding of what mental illness is and what mentally ill people experience. The question I want to ask back is this: If autism isn’t a mental illness, what is?

I’m not unsympathetic to the cause of not labeling people as having an “illness” because they’re neurodivergent, but why is it okay to do it to schizophrenic folks and not to autistic folks? There are plenty of mad people who don’t exactly view their diagnosis as an illness, although opinions in the psychiatric community are varied on this topic. Some consider diagnostic labels to be a prison, and others a gift. We sure live with plenty of labels.

Pharmaceutical drug labels.

Mental illness takes many forms. Some of them are quite properly classified as “neurodevelopmental disabilities” (including schizo spec, bipolar disorder, and ADHD — among possibly many others). The disorders I just mentioned are predominantly caused by genetics, and are therefore present at birth. The expression does change over time — but don’t autistic people have qualities that change as they grow and learn?

People refuse to acknowledge the close similarities between autism and schizophrenia (and other severe mental illness).

I’m going to flat-out recognize this: I think a lot of our community is biased. There are a lot of autistic people that are sanist, and they’ve been permitted to perpetuate misunderstanding.

My own therapist once tried to convince me after I admitted to experiencing delusions earlier in the week that I was merely referencing thoughts that were “overly rigid” as a result of my autism. My psychotic symptoms were being falsely attributed to my autism, and a lack of care was being given where care was needed.

And in the real world autistic people are at high risk of being mistaken for schizophrenic and taken to an ER for psych evaluation when they’re in distress. People can be treated horribly. But instead of stepping back and saying “Why do we treat mentally ill people horribly?” we’ve decided that allyship is not for us and we double down on “Autism isn’t a mental illness.” We cast non-autistic (and some autistic!) neurodivergent people as the Other.

To be quite honest, I think some autistic people are scared of crazy.

Perhaps they’re scared of people who may be erratic, hard to predict, or have dramatic emotional reactions.

A person wearing black Converse and a blue hoodie.

Are there reasons to set autism apart from conditions we consider “mental illness”? I just don’t see the justification for viewing autism as so singularly unique from other conditions. It’s possible that, in the future, we could redefine and do away with the label of “mental illness” altogether. I’ll be interested to see how language evolves for neurodivergent folks. I hope even moreso that people in the autistic community approach the psychiatric community with an open mind, and not with fear or prejudice. I see hope for a future of cross-disability solidarity.

One thought on “If Autism Isn’t a Mental Illness, What Is?”

  1. Kim

    While I’ll agree with you that I’ve always found it odd that autism has suddenly in recent years become it’s own category of disability, somehow magically separate from any other form of mental disability, I have to say it is very important that people recognize that autism is not a mental illness. That previous psychological theories of autism were extremely harmful to everyone involved with autistic people. The recognition that autistic people are “whole” people, and that it is possible to be both autistic, and mentally healthy is esssential. That we have emotions just like everyone else, and that we are, in fact, not immune to mental health struggles, but actually more susceptible to them, as much due to ableism and discrimination as anything has been a huge, but recent development in the history of autism! (As in less than a decade ago). That we are entited to personhood, and therefore humane treatment is something many of our kind are still fighting for, and all too often denied!

    It wasn’t too long ago the “experts”, (including parents who thought they knew better than actual autistic people what it’s like to be autistic) were adamant that we were incapable of having any insight into our own experiences, our own lives, and were therefore, by the very nature of our autism, not entitled to the protections other disabled populations had long been granted, (including personhood, and a say in our own lives). This because we were considered to be “pathological” versions of NTs, inherently broken, and “in our own worlds”, having “turned our backs” on the world aroudn us as a result of trauma, or some other bunk.

    Recognizing autism as a neurodevelopmental condition has allowed us many protections we’ve been historically denied, and the ability to participate in society in ways we’ve never been allowed before.

    Right now it does seem as if the terminology is in transition, as people understand more and more about autism, and as science progresses in understanding so many other conditions as well. Eventually, I hope we’ll come to something less confusing, as a society, but until we do, I think it does society good to start considering diversity of all kinds more of a ‘normal’ concept, and embracing the idea of neurodiversity helps that.

    That said, I’m not okay with any kind of discrimination or oppression, and I do think that today’s neurodiversity movement suffers from far too much divisiveness and lack of openness towards and connectedness with the wider disability rights community, perhaps even the wider human community. We should be supporting each other, not fighting with each other. Alienating NTs isn’t an effective strategy either. Even if it can be an easy thing to feel hatred and anger, even rage towards the majority group that is responsible for any minority’s oppression.

    Anyways, in my opinion, it’s never okay to discriminate against someone because they have a mental illness, or other neurological or psychological, or physical difference, or to treat someone as if they are somehow “less human” or “less worthy of respect”, or any of that garbage.

    Saying autism isn’t a mental illness isn’t inherently trying to do this, it is just trying to climb our way out of the depths of the pit history has put us in; the one where autism was considered “a fate worse than death”, and where autistics were seen as undeserving of even the rights nonautistic mentally ill people were accorded long ago. Of our very membership in the human race.

    Maybe someday we will find a better term than “mental illness” to describe people who experience depression, or anxiety, delusions, and whatever other differences that are usually subsumed under the mental illness “umbrella”. Hopefully someday we, as a society, will see mental illness on par with physical illness. Hopefully, someday the sciences (both “hard” and “soft”) will develop a much better understanding of the various forms of diversity that are out there, and be much more accepting of those who are disabled by their differences, and those who are able to make them work for them, without having to demonize, or idolize either one.

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