Neurodiversity: Beyond Eliminative Interventionism in Psychological Practice

A philosophical critique of psychological interventions for neurodivergent people

1. Introduction

Current (traditional, longstanding) psychological approaches to neurodivergence (i.e., outside the realm of “neuro-affirming”) suffer from two interconnected problems which create systemic injustice for neurodivergent people in mental health settings. These approaches are characterised by inadequate understanding and harmful treatment by mental health clinicians (psychologists, psychiatrists, social workers, counsellors, medical professionals in mental health roles, and so on - herein, “clinicians”).

While these issues probably extend to educational, medical, and broader social contexts, this analysis focuses specifically on psychological interventions and mental health practice. Various explanations for this problem exist, including those focusing on capitalism or broad power structures. I argue instead that what I term “neurodivergent systemic injustice (NSI)” stems from two specific, interconnected philosophical errors within psychological practice that can be addressed without dismantling entire institutional frameworks.

My central thesis is that NSI results from the interaction between (1) an epistemological error: attempting to reduce phenomenological experiences in ways that are fundamentally inadequate or impossible, particularly for distinctively neurodivergent experiences, for the purposes of identifying individual “units of pathology”; and (2) a moral error: clinicians assuming authority to impose eliminative interventions that prioritise social conformity over neurodivergent wellbeing. I call this “Eliminative Interventionism.”

This concept comprises two interconnected elements that must both be present to create the systematic harm observed:

Reducing to pathology: The epistemological practice of breaking down complex neurodivergent phenomenological experiences into discrete, separable deficits or symptoms that can be individually targeted for intervention. This entails adopting the faulty assumption that neurodivergent phenomenology can be reduced and constitutes a form of epistemic injustice.

Eliminative Interventionism: The clinical practice of implementing interventions designed to eliminate or suppress distinctively neurodivergent ways of being based on external standards of normalcy rather than client-determined goals. This extends beyond diagnostic categorisation to encompass the systematic deployment of therapeutic approaches that prioritise social conformity over neurodivergent wellbeing and self-determination.

These elements are mutually dependent and reinforcing; both must be present and both must be addressed to prevent the systematic harm ofEliminative Interventionism. Crucially, these errors feed each other: the reductive analysis provides false clinical justification for Eliminative Interventionism, while the commitment to eliminative goals creates professional pressure to maintain reductive frameworks that support these interventions.

I argue for a paradigm shift toward accommodative interventions that respect both the complexity of neurodivergent experience and neurodivergent autonomy.

What follows discusses how this error is applied to neurodivergent lived experience specifically - that is, relating to their “way of being” or the phenomenological aspects of neurodivergent experiencing, which is influenced by but not comprised solely of specific neurological, developmental, or biological differences or impairments.

This is a philosophical exposition, not an academic paper.

2. The epistemological error: Reductive approaches to neurodivergent phenomenology

2.1 The general problem with reducing subjective experience (irreducibility)

Longstanding psychological approaches to neurodivergence rely heavily on reductive methodologies that attempt to break down complex phenomenological experiences into discrete, measurable components. This approach faces a fundamental limitation as subjective experiences resist meaningful reduction because their essential character emerges from their holistic, integrated nature rather than from separable parts.

The categories imposed by reductive analysis inevitably fail to capture lived experience. For instance, what clinicians categorise as “social deficits” might be experienced by neurodivergent people as an endless multitude of experiences, from selective social engagement based on different values and preferences to sensory overwhelm. What appears as “attention problems” in someone diagnosed with ADHD might represent interest-driven focus that operates according to different patterns of attention, or emotional shut-down due to being perceived as a failure for not being able to process instructions fast enough.

You may contest that we have indeed identified useful categories from reductionist approaches such as executive dysfunction, rejection sensitivity, regression, and the like. An important distinction should be made here between usefulness and reality. The categories that emerge from reductive analysis are constructs created for the convenience of clinical intervention and research rather than actual features of neurodivergent experience. These categories exist primarily to enable therapeutic formulation and ongoing research. They are not natural kinds and should not be confused with having successfully reduced phenomenology.

Evidence for this artificial nature includes persistent failure to identify consistent, reliable patterns within these supposed categories. For example, despite executive functioning impairments being widely believed to constitute a core issue in ADHD, there are no consistently impaired executive functions that reliably characterise people with ADHD. These categories consistently dissolve under empirical scrutiny. While researchers often interpret these failures as indicating the need for “more sophisticated research methods”, there comes a point where the absence of reliable patterns suggests the categories themselves may be artefacts of the research process rather than genuine natural kinds.

Each reductive category relies on underlying phenomenological assumptions that are themselves reducible. This creates an infinite regress problem. There is no clear stopping point where we can confidently say the reduction has adequately captured the reality of lived experience. Therefore, reduction of phenomenology is untenable - a quality of phenomenology is that it is irreducible. Despite this, this practice continues for the purpose of not only reducing experiences that cannot be reduced, but doing so for the purpose of identifying units of pathology to be intervened with.

3. The moral error: pathologisation > eliminative interventions

3.1 Professional assumption of moral authority

The second major error starts with clinicians assuming moral authority to pathologise particular people on the basis of their reductive analysis, that is by evaluating their reductionistic method to find what aspects of neurodivergent experience they believe constitute “problems” requiring intervention, and implementing such interventions. This authority is typically exercised to impose standards of social cohesion with the assumption that this constitutes the great good for both society and the individual. Importantly this does not centralise the aim of supporting neurodivergent people in achieving their own goals, or supporting their wellbeing more generally.

As such we can make a fundamental distinction between two types of interventions¹:

1. Eliminative interventions: Approaches that aim to eliminate or suppress distinctively neurodivergent ways of being, usually to achieve social conformity. Examples include training eye contact to make others comfortable, suppressing stimming behaviours, or teaching social conformity regardless of the neurodivergent person’s preferences.

2. Accommodative and supportive interventions: Approaches that work with neurodivergent differences to support genuine wellbeing. Examples include teaching self-advocacy skills, providing sensory accommodations, or addressing sources of suffering identified by neurodivergent people themselves (or their advocates).

3.2 The violation of professional obligations

Clinicians have a moral obligation² to help their clients (benevolence), including neurodivergent clients. When they implement eliminative interventions based on flawed and misused epistemological foundations, they violate this fundamental obligation.

Systematic implementation of interventions that prioritise conformity over wellbeing, based on inadequate understanding of what they claim to treat, is unethical.

4. How reductive analysis enables Eliminative Intervention

The epistemological and moral errors constitute a systematic pipeline from flawed understanding to harmful clinical practice.

When clinicians believe they have successfully analysed neurodivergent phenomenology into discrete units of pathology (or read studies or attended professional development seminars that make such claims), they feel clinically justified in targeting these supposed “deficits” for elimination. The reductive analysis provides the theoretical foundation that makes Eliminative Interventions appear scientifically and clinically legitimate.

Then, when clinicians are committed to making neurodivergent clients conform on the basis of their pre-defined goals³, goals which also define clinical success, they have professional (and arguably, economic, see 5.2) incentives to maintain reductive frameworks that support these goals. As such, institutional commitment to Eliminative Interventions creates pressure to preserve analytical approaches that justify such interventions. This interaction creates a self-reinforcing cycle whereby unjustified understanding justifies harmful interventions, and commitment to supposedly helpful interventions prevents reflection on practice.

While both errors must be addressed, the epistemological foundation appears to be the driving force that enables and sustains eliminative approaches. If clinicians continued to reduce neurodivergent phenomenology but nonetheless intervene by respecting client preferences about (non-conformist) therapeutic goals, immediate harm would be reduced. However, for as long as flawed epistemological foundations remain, institutional pressure to follow eliminative approaches will be sustained and regenerate.

5. Objections and responses

5.1 Objection: This is already covered by epistemic injustice

Potential objection: This analysis simply restates what Miranda Fricker has already identified as epistemic injustice - the systematic wronging of neurodivergent people in their capacity as knowers, either through testimonial injustice (not being believed about their experiences) or hermeneutical injustice (lacking adequate conceptual frameworks to articulate their experiences).

While my analysis shares some concerns with Fricker’s epistemic injustice framework, it identifies fundamentally different problems requiring distinct solutions.

Fricker’s work, situated primarily within social epistemology and ethics, focuses on how marginalised groups are wronged as knowers, either through credibility or gaps in resources. The proposed solutions involve such solutions as reducing prejudice, developing better concepts, and improving practices to ensure marginalised voices are heard and validated.

In contrast, my analysis operates within philosophy of psychology and identifies methodological problems that persist regardless of whether neurodivergent people are believed or whether adequate concepts exist. The core issue is not credibility deficits or conceptual gaps, but the fundamental inadequacy of reductive approaches to phenomenological experience. Even if clinicians fully believed neurodivergent self-reports and possessed perfect conceptual frameworks, the attempt to reduce irreducible phenomenological experiences into discrete, treatable components would remain epistemologically flawed.

Furthermore, my framework identifies a specific moral violation that occurs within helping professions that extends beyond epistemic concerns, that is, clinicians assuming authority to impose eliminative interventions based on external standards rather than self-determined neurodivergent preferences. This represents a critique of professional moral authority that diverges from Fricker’s focus on epistemic credibility.

5.2 Objection: Ignorance of power structures

Potential objection: This analysis underestimates how institutional power dynamics create and maintain the problems identified. The “ignorance rather than malice” framing lets harmful systems off too easily, and authority figures consciously or unconsciously oppress neurodivergent people to maintain their institutional power.

This objection raises legitimate concerns but misidentifies both the mechanisms and solutions for NSI.

First, while power imbalances may exacerbate NSI, they do not adequately explain the specific epistemological and moral failures I have identified. The reductive pathologisation of experience and imposition of eliminative interventions stem from particular conceptual errors rather than from power-seeking behaviour per se. These errors can occur regardless of whether authority figures have malicious intent.

Second, I distinguish my position from anti-psychiatry approaches that seek to dismantle professional authority entirely. Professional expertise and institutional frameworks can serve legitimate helping functions when properly oriented. The problem lies not in the existence of professional authority but in how it is exercised.

Third, the power structure explanation, while containing some valid points as well as points of interest, does not provide targeted mechanisms for reform. My framework identifies specific epistemological and moral errors that can be addressed through concrete actionable changes⁴. This includes enhanced training, accountability mechanisms, and requiring clinicians to respect neurodivergent self-determination. Even if malicious clinicians are operating or power differential are fuelling NSI, these reforms would certainly constrain harmful uses of power whilst also bolstering beneficial ones (not all power is necessarily malicious).

Finally, the moral status of harmful actions does not depend on their underlying motivations. Whether NSI stems from ignorance, institutional pressures, or conscious oppression, clinicians can and ought to be held accountable for systematic failures. A focus on epistemological and moral errors provides sufficient grounds for the targeted reforms needed and whilst interesting, does not depend on properly identifying sociological origins of those errors (if this were possible).

I acknowledge that power imbalances worsen the problems I identify, and am open to comment on how they may in fact contribute to them. However, the epistemological and moral errors I identify are a more precise and actionable than broad critiques of institutional power/oppressive mechanisms.

5.3 Objection: Capitalism

Potential objection: This analysis ignores how capitalism creates the fundamental conditions for NSI. Under capitalism, there are economic incentives to “fix” neurodivergent people to make them productive workers, and the reductive approaches you critique may themselves reflect capitalist logic that reduces people to manageable, economically useful components.

To be clear: this essay neither defends nor critiques capitalism as an economic system. My argument is limited to demonstrating that capitalist explanations, while potentially relevant, do not adequately account for the particular epistemological and moral errors that constitute NSI.

The capitalism explanation, whilst interesting, remains overgeneralised. It does not explain why these particular harms occur to neurodivergent people specifically, nor does it provide targeted mechanisms for reform.

Even if capitalism contributes to (or even explains the mechanisms driving) NSI, clinicians can still be redirected to fulfill their helping obligations within existing economic structures and the incentive to help people with their goals rather than merely make them economically productive can be cultivated through the reforms I propose. This reformist approach follows logically from my diagnosis of the root causes and offers actionable solutions rather than requiring an economic revolution.

5.4 Objection: implementation

Potential objection: The distinction between eliminative and accommodative interventions may be too difficult to operationalise in practice.

While precise criteria require further development, the general distinction remains philosophically important and practically relevant. Many current interventions can be clearly classified as eliminative (e.g., teaching eye contact solely to make others comfortable) or accommodative (e.g., teaching self-advocacy skills). The existence of borderline cases does not invalidate their fundamental distinction.

5.5 Scope limitation (clinical practice)

Potential objection: This analysis seems to focus too narrowly on psychology/helping professions and ignores broader structural issues.

This analysis focuses specifically on psychological interventions rather than broader educational or medical approaches to neurodivergence.

This limitation is intentional. By focusing on specific epistemological and moral errors, the analysis identifies actionable problems that can be addressed without requiring wholesale social transformation. This does not deny that broader structural issues matter, but comes with the assumption that significant progress can be made through targeted reforms within this field. The centrality to the helping professions in serving a key role in perpetuating NSI is an area of interest and potential expansion.

6. Conclusion

I argue neurodivergent systemic injustice results from the interaction between epistemological errors (attempting to reduce irreducible phenomenological experiences) and moral errors (assuming authority to impose eliminative interventions). These errors mutually reinforce each other, creating systematic harm that exceeds what either would produce independently.

A philosophically adequate solution requires addressing both errors simultaneously. This means acknowledging the limitations of reductive approaches to neurodivergent (or all) phenomenology while ensuring neurodivergent self-determination about their own needs and goals. This does not require dismantling professional authority or relying on economic revolution. It does entail enhanced accountability mechanisms, because clinicians and the field have clearly failed in this regard.

Acknowledgments: This paper builds on insights from neurodivergent communities and critics of current approaches, while attempting to provide a targeted philosophical framework for understanding and addressing identified problems.

Conflicts of interest: The author identifies as neurodivergent and is a Clinical Psychologist.

¹ I am aware that precise criteria for distinguishing eliminative from accommodative interventions require further development, though the general distinction remains philosophically important. I hope it is somewhat evident on a common-sense basis that these interventions carry distinctive intentions.

² Or at the very least, contracted ethical duty

³ Usually neurotypical standards or norms, but I argue the intention is not in fact to make someone into a neurotypical (if that could even be defined). This usually seems to be guided by the unchecked moral-realist assumption of wellbeing is equated to social cohesion. This disregards other reasonable candidates for enhancing wellbeing, such as freedom.

It is worth mentioning that any psychological intervention is predicated on assumptions about objective wellbeing. This raises separate but fundamental questions within philosophy of psychology about whether wellbeing can be objectively defined or whether it is inherently subjective. If wellbeing is indeed subjective rather than objective, this calls the entire practice of clinical authority into question. Such a position would actually provide philosophical justification for dismantling current psychological frameworks or somehow reorganising them around forms of subjectively-guided intervention whose structure remains to be determined as it represents a significant divergence from current practice assumptions.

Currently, all psychological practice implicitly relies on objective wellbeing assumptions, even when practitioners think they’re being “neutral” or “client-led”. So which brand of wellbeing should we adopt?

⁴I advocate for Hanlon’s Razor in our approach to understanding NSI. I argue that NSI is exacerbated by, but cannot be wholly explained by power differentials, such as those produced by “capitalism”, or intentional attempts by authority figures to maintain power. In this way, this analysis expands upon my prior post “conspiratorial thinking in the neurodiversity space” by also addressing the “systemic oppression” angle and specifies my alternative diagnosis more in more detail.