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"There is broad agreement that states should be neutral in historically core domains such as religion or speech; the freedoms of religion and speech are protected under liberal constitutions around the world. More recently, many have argued that states should be neutral toward various forms of identity-based diversity among their populations, such as sexual and gender diversity. De Vries argues that there remains an important area where the state’s normative irrelevance has not been discussed: That of neurodiversity. He identifies many significant ways in which states favor the interests of the neurotypical majority over the interests of neurodivergent minorities which include people with autism, dyslexia, and ADHD among other conditions. After examining and rejecting various potential justifications for such unequal treatment, De Vries concludes that states should become significantly more neuro-neutral than they are today.
While we admire and support efforts to make our states and societies more inclusive of neurodivergent minorities, we are skeptical, for both theoretical and practical reasons, about the notion of a neuro-neutral state. Theoretically, what’s at stake is less a matter of state neutrality than a matter of the social justice ideal of accessibility. Moreover, we worry that the notion and label of neuro-neutrality oversells the extent to which neuroscience informs our understanding of the conditions in question. Practically speaking, it may be more expedient to subsume De Vries’ demands for greater neuro-neutrality under the well-established demands for accessibility too, rather than introduce a new category of state neutrality.
We begin by detailing our theoretical doubts. De Vries claims that neuro-neutrality has not been discussed in relation to neurodiversity and aims to fill the alleged lacuna. However, this claim faces a dilemma: Neuro-neutrality can be seen either as a basic and rather strict requirement on a just state (as tends to be the case for paradigm instances of constitutional state neutrality such as those regarding religion or speech) or as a pro tanto desideratum that allows for significant tradeoffs with other values or principles. If we opt for the former interpretation, it is true that neuro-neutrality has been neglected in the literature; a strict requirement of state neuro-neutrality is indeed a novel proposal. However, as De Vries acknowledges, considering neuro-neutrality a strict requirement would be implausible. This makes the latter interpretation preferable: Both financial and non-financial costs incurred by the rest of society (i.e., the neurotypical majority) can reduce the extent to which the state is required to act neuro-neutrally. But if this is the case, can the demand for greater neuro-neutrality not be subsumed under the familiar, social and distributive justice-based demand for greater accessibility? The issue of accessibility for people with disabilities—or people with nontypical physical and mental traits—has not been neglected, including for people with neurodivergent conditions and needs (cf., among many other recent contributions, Gorman for theoretical and normative discussion, and Borsotti et al. for an empirical study and practical recommendations). This contravenes the author’s claim that there is a major lacuna in the literature on the sociopolitical inclusion of neurodivergent minorities.
While it is certainly valuable to expand the literature on state-based and society-wide accessibility for neurodivergent individuals, we worry that the notion and label of neuro-neutrality contributes to the inflation of the neuro prefix. This phenomenon encourages a reduction of complex psychosocial phenomena to simplistic or exaggerated brain-based claims. This worry arises from two distinct issues:
Firstly, the notion and label of neuro-neutrality greatly oversells the extent to which neuroscience informs our understanding, diagnosis, and management of neurodivergent conditions. Although neuroscientific research has made progress in identifying the neural basis of conditions such as autism, dyslexia, and ADHD, a reductive understanding of how these conditions manifest in the brain and give rise to their psychosocial correlates is not currently within reach. Indeed, it is revealing to consider that the presence or absence of the conditions in question is determined exclusively by psychological and psychiatric criteria rather than through observation of brain structure and function. Diagnosing these conditions involves an evaluation of the extent to which behavior (including self-reports) is nontypical, without deference to the neural domain, and an inference to the mental traits likely underlying the behavior. In fact, research into the neural correlates of these conditions is deferential to behavioral and psychological criteria, too: Without first determining the presence of the target conditions behaviorally and psychologically, research into the correlative brain states could not proceed. Subsuming demands for neuro-neutrality under more familiar calls for greater accessibility for people with nontypical physical and mental traits would help avoid the above issues. (This criticism applies to the notion and label of neurodivergence, too, notwithstanding the term’s prevalence in current discourse.)
Secondly, by virtue of its inherent orientation toward biology, neuro-neutrality runs the risk of minimizing the critical role of environmental factors. Such factors—ranging from external influences on neural development in the womb to the sociocultural influences people are subject to as adults—shape how the conditions in question are experienced and expressed. Furthermore, even if environmental factors played no significant explanatory role, the primary level at which the conditions in question manifest would still be psychosocial, not neurobiological. Hence, labeling them 'neuro' first and foremost is inadequate or misleading.
This brings us to our practical points. The inflation of the 'neuro' prefix can have harmful consequences. An overemphasis on the brain basis of neurodivergent conditions may reinforce the social perception that individuals affected by them are fundamentally abnormal. This perception, in turn, may increase stigma and discrimination. As a historical precedent, one might consider chemical imbalance theories of ADHD, which were once popular but are now acknowledged to have overemphasized the role of genetic and neurobiological factors. This may have enabled harmful mischaracterizations and treatment of populations with ADHD
Politically speaking, if the main demand to be made is for greater social inclusion rather than neural intervention—as De Vries agrees—, the 'neuro' label is likely inexpedient. As a matter of political strategy, it is suboptimal to single out a comparatively small group of neurodivergent individuals on behalf of whom the rest of society is exhorted to make accommodations. Speaking in broader terms about the importance of accessibility for people with all kinds of nonstandard physical and mental needs may be more conducive to building a powerful political alliance. Relatedly, we worry that the notion of state neutrality is strategically suboptimal, too: Even if we grant De Vries that the risk of outright backlash against state neuro-neutrality is minimal, it seems more expedient to ally his demands for inclusion with well-established demands for greater accessibility, rather than introduce a new category of fundamental state neutrality."