The Diagnosis Crisis: Reimagining Minds in a System That Misses the Point

 

There are hundreds of thousands of people currently on waiting lists for neurodivergent diagnosis in the UK. Every few months, this crisis reappears in the press—a headline, a wringing of hands, a vague promise to “do better.” But while the political and medical consensus treats this as a failure of capacity—a bottleneck in an otherwise functional system—I want to suggest something more radical: that diagnosis itself is part of the problem.

The question we’re avoiding isn’t how to fix diagnosis. It’s whether we should be relying on it at all.

A Short History of “Normal”

The very concept of diagnosis depends on the idea of deviation from a norm. But that norm has never been neutral. As disability theorists, historians, and critical medical scholars have shown, “normal” is a statistical fiction forged in the furnaces of colonialism, industrialism, and eugenics. It is a number derived from population averages, then moralised into a model of how people should behave, think, move, and learn.

Medicine, especially psychiatry, has long been complicit in enforcing this normality—classifying deviation not as difference but as disorder. Neurodivergence, in this framing, becomes a pathology to be managed, corrected, or compensated for.

This model is not only outdated; it is actively harmful. It flattens experience, narrows identity, and imposes a moral economy of functioning: who gets help, who gets believed, who gets to belong.

I say this as someone who has received a diagnosis—ADHD—which opened important doors for me. It gave me access to medication, which helped stabilise my capacity in moments where everything felt unmanageable. It gave me a framework for interpreting my own patterns, a way to begin constructing a narrative of self that wasn’t rooted in failure or shame.

But that framework came at a cost. Like many others, I found myself reshaping parts of my identity around the diagnostic label, internalising its logic even as I questioned its validity. The very act of naming something can be both liberatory and limiting. A diagnosis can be a tool—but it can also become a box.

This is especially dangerous when diagnostic categories are treated as the only valid way to access support. In a society structured around scarcity, diagnosis becomes a gatekeeping mechanism: a passport to resources that are otherwise withheld. If you can prove you are disordered enough, sick enough, impaired enough—you might be allowed help.

This is not just a medical problem. It’s an economic one.

The Price of Recognition

Diagnosis is currency in a bureaucratic system. Whether it’s time with a specialist, access to academic accommodations, eligibility for disability benefits, or even basic belief in your own account of your experience—diagnosis is often the required ticket.

This scarcity-driven logic feeds an entire ecosystem: private clinics charging eye-watering fees, NHS departments buckling under demand, and pharmaceutical markets profiting from neatly defined labels. The narrower the diagnosis, the easier it is to prescribe, package, and profit. Nowhere is this dynamic more visible than in education, where children often have to fail conspicuously—measured against narrow, normative standards—before they’re granted support. Classrooms become diagnostic arenas; parents, unwillingly, become case managers in a system built on exclusion.

The result is a deeply inequitable system in which the well-resourced and well-spoken can more easily secure recognition, while others are left to fall through the cracks. It’s also a system that creates perverse incentives—encouraging people to identify with dysfunction in order to be heard.

The Guardians of Normal

The diagnosis system doesn’t just gatekeep access to resources based on economic status—it also operates as a vector for deeper, more insidious inequalities related to race, gender, and class. Neurodivergence is not a monolithic experience, and the ways in which people navigate the diagnostic system are shaped by their social locations. Understanding how neurodivergence intersects with other axes of identity helps reveal why some individuals are far more likely to receive the diagnosis they need, while others remain overlooked or misdiagnosed.

Class and Neurodivergence: The Economic Divide

For many, accessing a neurodivergent diagnosis is a financial burden that may be out of reach. Private assessments, especially for conditions like ADHD and autism, often come with a high price tag that many families simply cannot afford. Those with lower socioeconomic status face long waiting times for public assessments, and without the financial resources to navigate these barriers, many are left without the support they need. This economic divide results in a system where individuals from wealthier families are more likely to receive timely diagnoses and access to necessary services, such as therapy, educational accommodations, and medical treatments.

However, the impact of class doesn’t just stop at access to resources—it shapes how neurodivergence is perceived and treated. For those from working-class backgrounds, being labelled with a diagnosis may be seen as an undesirable stigma, potentially reinforcing stereotypes of being "problematic" or "difficult." In this context, diagnosis becomes not a tool for support, but a mark of social disadvantage, deepening the divide between the already privileged and those who are systemically disadvantaged.

Race and Neurodivergence: Cultural Bias and Misdiagnosis

The diagnostic system is also influenced by racial biases that shape how neurodivergence is understood and classified. Studies have shown that children of colour, particularly Black and Indigenous children, are more likely to be misdiagnosed or underdiagnosed, and may experience delays in receiving appropriate services. Racial disparities in access to healthcare also contribute to this inequality, with racial minorities less likely to have access to timely, high-quality assessments.

Furthermore, cultural understandings of neurodivergence often differ across communities, and the traditional medical framework for diagnosis is shaped by Western norms. For instance, what may be considered a "symptom" of ADHD in one cultural context may be seen as a normal variation in another. This cultural mismatch can lead to misdiagnosis or a lack of diagnosis altogether, leaving individuals without support.

The racialized experience of neurodivergence is not just a matter of medical treatment; it also plays out in how individuals are treated in society. Racial stereotypes about behaviour, discipline, and intelligence can often intersect with perceptions of neurodivergence, leading to harsher punishments in schools, stigmatization in the workplace, or general marginalization within healthcare settings.

Gender and Neurodivergence: The Hidden Struggles of Women and Non-Binary Individuals

Gendered assumptions about behaviour also complicate the experience of neurodivergence. For women, girls, and non-binary individuals, neurodivergent traits may be dismissed or misinterpreted, leading to underdiagnosis or late diagnosis. Women, in particular, are more likely to internalize symptoms of conditions like ADHD and autism, often developing coping mechanisms that mask their struggles. This can result in a lack of understanding from teachers, employers, and even healthcare professionals, leading to frustration and a sense of isolation.

Non-binary and gender-nonconforming individuals face even more challenges, as the medical system often fails to consider the complexities of gender identity in relation to neurodivergence. These individuals may find their experiences invalidated or misunderstood, both by society at large and by medical professionals who are ill-equipped to recognize the intersection of gender and neurodivergence.

Moving Beyond Intersectionality: A Call for a More Inclusive Approach

By acknowledging how race, class, and gender intersect with neurodivergence, we can begin to see that the diagnostic system is not just failing on a general level—it is failing more severely for those who are already most marginalized. A post-diagnostic society must be one that actively works to address these intersections, ensuring that all individuals, regardless of their social position, have equitable access to the support and care they need.

Boxed In

Diagnosis often provides more than just an explanation—it offers solidarity, protection, and political leverage. It’s a crucial tool for securing legal rights and access to resources, especially in advocacy movements that seek to redefine neurodivergence from a pathology to an identity. For example, in the UK, diagnoses like autism and ADHD entitle individuals to legal protections, such as safeguards against discrimination in education and the workplace. These legal frameworks are vital for ensuring the rights of neurodivergent people and driving systemic change.

However, while diagnosis is essential for securing rights, its over-reliance can be problematic. It risks limiting people to a fixed identity based solely on their condition, reinforcing societal assumptions about what it means to be neurodivergent. When a person defines themselves primarily through their diagnosis, it can restrict self-understanding and personal growth, as the label comes with predefined expectations and limitations. This is compounded by the fact that diagnostic criteria are often narrow and fail to capture the full complexity of lived experience.

In advocacy, diagnosis can empower movements by giving them a shared language and platform for change. But it also creates a paradox: while it provides solidarity, it can isolate individuals within a category defined by society’s own understanding of “difference.” The more rigidly one identifies with their diagnosis, the harder it becomes to engage with other forms of identity or challenge the assumptions underlying the label.

Ultimately, medicalised identity is a fragile kind of refuge. It depends on systems that can revoke recognition at any moment. It also risks essentialising complex, shifting ways of being into a set of checkboxes.

Not everyone wants—or needs—to identify with a diagnostic label. And we should not be building systems that require people to do so in order to be treated fairly.

Other Ways of Knowing

There are other models. The social model of disability, long a cornerstone of disability rights activism, shifts the focus from individual impairment to structural exclusion. But even this doesn’t go far enough for our purposes.

We need a model that transcends the disability discourse entirely—a model that starts not with disorder, but with divergence.

Indigenous Knowledge Systems: Relational and Ecological Understandings

Indigenous knowledge systems often emphasise a holistic, relational understanding of difference. In many Indigenous cultures, mental and cognitive diversity is seen not as pathology but as part of the rich tapestry of human experience. For example, in some First Nations communities in North America, what Western medicine labels as “autism” is often regarded as a form of heightened sensitivity, even a spiritual gift. Such individuals might be considered “shamanic” or “visionary” rather than being defined solely by deficits.

This approach contrasts with the pathologising tendencies of Western diagnostic frameworks, which isolate traits and view them through a deficit lens. In an Indigenous context, however, these differences are understood as valuable contributions to the community’s spiritual, cultural, and ecological understanding. Neurodivergent individuals might be recognised for their unique ways of seeing the world, contributing wisdom that is otherwise inaccessible to the majority.

In a post-diagnostic society, this model would encourage communities to view neurodivergence as a strength to be cultivated, not a burden to be fixed. Social and educational systems would therefore focus on fostering environments where diverse cognitive styles are celebrated, not suppressed. Teachers and caregivers would be trained to see every individual as part of a greater whole, where each person’s differences have something vital to offer.

Feminist Theory: Challenging the Binary of Normal and Abnormal

Feminist theory, particularly post-structural feminism, has long critiqued the binary logic that divides normal from abnormal. This binary is not only a way of categorising people; it is also a means of policing behaviour and reinforcing power structures. Feminist scholars such as Judith Butler argue that gender is performative and fluid, suggesting that identity is not a fixed essence but a social construct that evolves in response to societal pressures.

This thinking can be applied to neurodivergence as well. Instead of viewing neurodivergent traits as “abnormal” or “deviant,” we could understand them as just another variation within the spectrum of human experience. Feminist theory provides a useful lens for challenging the medicalised model that views difference as something to be corrected, focusing instead on empowerment and choice. Feminists have long argued for bodily autonomy and the right to self-define, and this ethos could be expanded to neurodivergence: people should have the right to define their own cognitive experiences and needs, free from the constraints of diagnostic labels.

A post-diagnostic approach informed by feminist theory would create systems that support people in expressing their full identities without forcing them into rigid categories. Educational spaces could embrace multiple learning styles, recognising that there is no one “right” way to think or learn. Healthcare could focus on listening to individuals and responding to their lived experiences, rather than imposing a diagnostic framework upon them.

Queer Theory: Embracing Fluidity and Rejecting Fixed Categories

Queer theory, too, offers important insights for a post-diagnostic society. Queer theorists such as Eve Kosofsky Sedgwick and Jack Halberstam challenge the normative categories that structure our understanding of identity and experience, arguing that these categories—whether of gender, sexuality, or cognition—are social constructs rather than inherent truths.

In relation to neurodivergence, queer theory offers a powerful challenge to the rigid categorisation imposed by medical diagnosis. Just as queer theory resists the imposition of fixed gender or sexual identities, it can also resist the imposition of rigid cognitive identities. The focus is on embracing fluidity, recognising that identity is not static and that people’s experiences of their minds and bodies can change over time.

For example, a queer-informed model of neurodivergence might support people in exploring their cognitive diversity without labelling them as “ADHD” or “autistic.” Instead of imposing a diagnosis, it would create space for individuals to navigate their cognitive experiences, experiment with different approaches, and change their self-concept as they grow. This would involve creating inclusive spaces that value diverse expressions of being, without confining people to diagnostic labels or predetermined categories of difference.

Breaking the Frame

Incorporating elements from these alternative models would allow us to move away from a system that views neurodivergence as pathology and towards one that embraces cognitive diversity as a form of human richness. A post-diagnostic society would see people not as defined by their conditions but as complex individuals whose identities and needs shift over time. It would provide structures of support that are flexible, needs-based, and centred on human dignity and self-determination.
By embracing the fluidity and diversity of human experience, these alternative frameworks can help us imagine a world where neurodivergence is not a label to be feared or resisted, but an aspect of life to be acknowledged, understood, and celebrated.

Expanding the Vision: Post-Diagnostic Systems

A post-diagnostic society is not just an abstract ideal, but a feasible and necessary shift. To move from a system that relies on diagnosis as the primary gateway to care, we need to focus on creating a needs-based, rather than deficit-based, system of support. This would prioritize understanding individual experiences and responding with flexibility, rather than fitting people into predefined categories.

Concrete Steps Toward a Post-Diagnostic World 

Shift from Diagnosis to Needs-Based Support: Rather than requiring individuals to obtain a formal diagnosis before receiving support, we could create systems that allow people to access services based on their self-identified needs. This would mean rethinking eligibility for education, healthcare, and social services—ensuring that help is available without bureaucratic or diagnostic hurdles. For example, individuals could engage in a needs assessment that takes their lived experience into account, rather than focusing on whether they meet specific diagnostic criteria. 

Empowering Self-Identification: A major step in this shift is empowering individuals to describe their own experiences and needs. This could involve training professionals in active listening, allowing for a more nuanced understanding of a person’s challenges. Instead of relying on the diagnostic label as the entry point, a system based on self-identification would trust individuals to articulate what kind of support they need. This would also reduce the risk of misdiagnosis or over-pathologisation, which is often a problem in current diagnostic practices. 

Flexible and Holistic Support Models: Support structures should be flexible enough to accommodate a wide range of neurodivergent experiences. For instance, instead of a one-size-fits-all educational or healthcare approach, schools and healthcare providers could offer a variety of interventions tailored to diverse needs. This might include collaborative, community-led models of education that allow for more personalised, responsive care. These models should focus on fostering strengths rather than "curing" deficits. 

Building Community and Peer Support: One way to bypass over-reliance on diagnosis is by strengthening peer support networks. These networks, which may exist informally or within more formalised structures, provide a space for individuals to share their experiences and solutions without having to identify primarily by a medical label. The emphasis here is on solidarity, not sameness. Such networks often exist in disability rights movements, where people come together not just because they share a diagnosis, but because they share a need for social change.

 

No Way Back to Normal

We cannot treat the diagnosis crisis simply as a backlog problem. That would be like patching the gates of a collapsing dam. The deeper question is: why do we need gates at all?

Diagnosis may have helped me—but it should not be the only way to be heard, helped, or held. The true crisis is not in the waiting lists. It’s in the logic that built them.

Let’s start again.