Psychiatric diagnoses & bioessentialism will not liberate us
A review of Dr. Ayesha Khan's most recent, amazing article
It was my younger sister that first introduced Dr. Ayesha Khan’s substack to me. Dr. Khan’s most recent article had me jumping out of my chair shouting …. YES!!! THIS!!!
A key theme explored in Khan’s piece is the tension between Western biomedical models of mental distress and more holistic frameworks from non-Western cultures. She takes aim at the underlying assumptions that prop up the notion of psychiatric diagnoses as innate biological categories. Khan argues this “born this way” view of conditions such as autism and ADHD promotes a form of bioessentialism that risks overlooking their social construction.
As she explains, “The concept of neurodiversity has been heavily co-opted in the global north, watered down, individualized, sanitized and DEPOLITICIZED. People often frame neurodivergence as atypical brain wiring which is the same biological essentialism that gave us race science.” Khan suggests this tendency to turn to reductive biological explanations is equally prevalent across movements dealing with gender, sexuality, and more in the Global North.
According to the author, the utility of clinical labels - whether reclaimed or not - is limited by their shaky foundations. “Categories and labels like autism/ADHD etc, whether they are reclaimed & redefined or not, are all social constructs, not biological realities with clear boundaries, definitions, and measurable criteria,” she argues.
Khan’s critique goes beyond questioning the empirical basis for “neurodivergent” and “neurotypical” categories. She suggests the uncritical exportation of these Western mental health models to the Global South should be viewed as an insidious form of modern colonialism. As her own connection deepened to her cultural roots, Khan believes she outgrew the need to understand herself through a diagnostic lens - however radical its redefinition. “The more I anchored into the collective, the less attached I was to even the redefined, radical derivates of these labels,” Khan reflects. “The diagnoses that were always foreign to my community, imposed on us by our colonizers, were again feeling foreign to me.”
Selected Quotes
A pivotal tension Khan explores is the friction between individualistic frameworks of mental distress prevalent in the West versus more collective orientations dominant in non-Western settings. She argues that the positioning of clinical diagnoses as immutable biological realities risks diminishing their social and cultural construction.
As Khan outlines, “Psychiatric diagnoses have become increasingly prominent individual identity labels, particularly in the global north (aka western societies). There are movements (born in the global north) to reclaim and redefine these labels which understandably can be a source of empowerment for some.”
However, she goes on to suggest, “I also believe the long-term utility of diagnostic labels is limited by the oppressive premise and colonial foundation that they were built on... especially when they are used as “real” biological categories.”
According to the author, whilst reclaiming medical labels can offer affirmation, their utility remains constrained. Khan attributes this to the colonial and individualistic assumptions baked into formal systems of categorising mental distress in the West.
Again, she argues, “If anything, I see the global north’s obsession with spreading colonial models of mental health, including psychiatric diagnoses, to the the global south as being one wing of modern day colonialism.”
Here Khan positions the active exportation of biomedical frameworks to non-Western contexts as a form of contemporary imperialism. This risks obscuring vital opportunities for cross-cultural learning as part of an interconnected, pluralistic global community.
Systemic problems vs the individual
Khan’s piercing critique of the foundations undergirding Western mental health models raises crucial questions. Her characterisation of exporting biomedical frameworks globally as modern colonialism demands examination. However uncomfortable for some, interrogating the potential for systemic harm perpetuated by neurodiversity movements demands urgent attention.
As Khan shares, the uncritical adoption of diagnostic categories rooted in Euro-American traditions risks crowding out indigenous modes of meaning-making. She centres the realities of communities in the Global South for whom neither “neurodivergent” nor “neurotypical” speak to their lived experience. Pushing back against the imperialistic assumption that Western approaches are inherently more “advanced,” Khan asks us to consider what could be gained by honouring the diversity of frameworks across cultures.
“Some clarifications off the bat. I am writing this from the perspective of communities in the global south who have always had alternative modalities to conceptualize human and planetary distress without pathologizing it. Our communities have been/ are being killed for our cultural traditions including medicine. Many of us in the diaspora are struggling to rediscover, reconnect with, practice, and preserve our traditions.
If terms under the umbrella of neurodivergence are important to you, then know that I’m not asking you to abandon them, nor am I framing them unilaterally as “bad”. I’m asking you to look beyond them, to be aware of how they can be leveraged for harm and to recognize that there are other ways for communities to make sense of their distress without these labels. I’m asking you to embrace complexity and create space for it. The rest of the world should not have to speak this precise language.”
Here she clarifies she isn’t asking people to abandon terms they find meaningful, but rather to be aware of limitations and leave space for other frameworks.
Ultimately, Khan’s piece underscores the importance of structural critique over individualistic conceptions of identity and distress. The conversation about psychiatric diagnosis and decolonisation is not about personal failings to become “more inclusive.” It is about reckoning with mental health movements and systems that, despite good intentions, may unintentionally marginalise whole communities. This demands embracing the plurality and complexity of human experience across cultural traditions globally.