first chapter, entitled ‘the spread of diagnostic culture’, starts with the provocative statement that each year in Western countries, around a quarter of the population will suffer with a mental disorder. Should we interpret this as evidence for the progress of psychiatry in identifying and treating mental illnesses that have always existed? Alternatively, might it be the case that modern life somehow creates new conditions, or social pathologies? Brinkmann argues that a third, more fundamental explanation is needed: the development over recent years of what he calls ‘diagnostic cultures’. Increasingly, psychiatric diagnoses have become the lens through which people in Western societies understand ourselves and our suffering. They have substantially displaced religious and moral conceptions, and have also come to play an important role in our bureaucracies and our broader social arrangements. Partly, Brinkmann argues, this has been driven from above by those with a vested interest in these explanations, for example psychiatrists and drug companies. However, he also contends that citizens themselves are increasingly pushing for ‘pathologisation from below’, seeking diagnostic explanations for the various problems that we encounter in our lives.
We believe that, as long as autism – which is not a mental ill-health condition – remains in the psychiatric diagnostic manuals, there will continue to be those who use this to justify their attempts to find a cure. We believe it would be far more difficult to justify manipulating the human genome to remove autism, if it were not considered a psychiatric disorder and listed as such, alongside conditions such as schizophrenia, bi-polar disorder and psychosis. Currently autism must be categorised as either a mental health issue, or an intellectual learning disability, in order for autistic individuals to qualify for and access services, and yet although these can occur alongside autism, autism in itself is neither. One way to protect autistic individuals from any loss of access to support services, following the removal of their diagnostic label from the psychiatric manuals, would be to award autism its own separate status, as the cognitive difference many of us believe it to be. We therefore advocate that autism be removed from the existing psychiatric manuals and instead be included in a separate non-psychiatric identification (diagnostic) manual of neurodivergent needs.An open letter to Professor David Mandell Editor-in-Chief, Autism in response to the article “A new era in Autism”