Reflections of Diversity: How Gender Identity and Neurodivergence Mirror the Natural World

The following is my capstone presentation from my graduation at Naropa University in May 2023

By Everett Dietzler

Rising Tides

Establishing Roots

During one of the monthly trainings at the clinic where I completed my internship, a colleague presented a statistic that struck me in a profound way. Up to 25% of transgender clients may also be autistic. I had some concept for how rare this number must be and wanted to learn more about what it means to work with Neurodivergent clients. The path led me to examine more deeply my own Neurodivergence and to find more supportive ways of working with the co-occurrences in my transgender clients. Of my caseload at the time, 17 out of 20 clients were transgender or non-binary and nearly a third were diagnosed, presented with traits of or questioned whether or not they might be Autistic.

Neurodiversity Paradigm

Neurodiverse is a relatively new term, coined by sociologist Judy Singer in 1999. She was searching for a word that would define the experiences of three generations of women in her family (including herself) who were not neurotypical. As you can see, Neurodiverse encompasses a wide range of disabilities.

The Gender Tree

Conversations about gender, sex and sexuality can often be conflated which is why I personally like the gender tree. It helps to break down the different facets that make up our gender. One of the most important pieces to note on the tree is societal influence. Most of what we associate with gender is actually just a social construction. At a certain point it became the cultural norm that boys played with fire trucks and girls played with Barbies. Many of the norms that have been associated with particular genders are not based in, or observable in objective reality. This means that qualities we associate with being a particular gender are learned and not inherent.

Statistical Improbability

When I heard the statistic about potentially how many of my clients might also be Autistic, the number seemed astounding. Given that both populations represent relatively low percentages of the population, how could this number be so high? Some theorize that it could be due to Autistic folks being less concerned with social norms and in turn having less internalized transphobia. Another theory is the gatekeeping associated with gender affirming care. Many trans folks need to see a therapist in order to gain access to hormone replacement therapy or gender affirming surgery, so they might be evaluated more often than undiagnosed cisgender folks are. Minority stress can also be a contributing factor, making Autistic traits more prevalent and diagnosis easier.

The Human Need to Classify

Homosexuality was added to the DSM in 1952, seen by psychologists as something disordered, to be cured. Activists worked to pressure the APA to remove homosexuality, citing that its inclusion in the DSM resulted in social stigma. Once homosexuality was considered a natural variant in the human population, questions shifted from what causes homosexuality and how to cure it, to focusing on the actual health care needs of the population.

In 2013, advocates saw the shift from gender identity disorder which pathologized transgender folks to Gender Dysphoria which denotes the stress experienced as a result of the incongruence between sex assigned at birth and gender identity. While this is certainly a step in the right direction to reducing stigma for transgender communities, it still fails to accurately describe the experience of dysphoria. While dysphoria can certainly show up as different aspects of the body not aligning with one’s gender identity, I also see it quite frequently in clients who are not perceived in the way they would like to be by others. This points to social components contributing to gender dysphoria as well.

Similarly, Autism has undergone several revisions in the DSM. Asperger’s syndrome was removed because of its similarity to the presenting traits of Autism. It is also important to note the role that Hans Asperger played in differentiating “high and low functioning” Autistics in Nazi Vienna to distinguish who should or shouldn’t be exterminated. Today we refer to support needs, rather than functionality. Many advocate for the removal of Autism Spectrum Disorder from the DSM as those in the Autistic community are attempting to shift the narrative to the Neurodiversity paradigm. There is nothing wrong or disordered about autism, it is a natural variant in the human population, just like homosexuality and gender identity.

Diverse by Design

Joan Roughgarden paints a picture of a natural world that is ripe with diversity in her book Evolution’s Rainbow. She highlights that the purpose of sex is not necessarily reproduction since asexual species are able to reproduce. Sex can be viewed as a method of maintaining diversity, which allows species to thrive. Biological categories of sex should not be made to coincide with social categories. Male and female are biological categories, man and woman are social categories. We also see six commonly recognized sexes represented in the human species. Babies that are born intersex may be subjected to nonconsensual surgeries to force them to align with one of these social categories. Social-inclusionary traits allow certain animals to interact with other members of their species. Take hyenas for example. Female hyenas often fight one another for dominance and the first one to back down does so by displaying an erect penis.

In some species, homosexuality can encourage sharing, can facilitate reconciliation in disputes, welcome new members to the group or build lasting bonds. In some cases, without these connections, an individual might not otherwise survive. Biologists have historically underreported diversity in animal and plant species for fear of it hurting their careers. The responsibility falls to scientists to highlight this diversity instead and refute claims that homosexuality is unnatural. As Roughgarden states, “Suppressing the full story of gender and sexuality denies diverse people their right to feel at one with nature and relegates conservation to a niche movement—the politics of a privileged identity.”

Queer Ecology

Queer ecology asks us to challenge heterosexist and cisnormative concepts of the natural world. We have been socialized to believe that humans should be separate from nature, that nature must be protected from us, that nature and culture must be split. These ideals have been built into our nature institutions as well. The national parks themselves represent the removal of indigenous people from the land.

Environmental justice movements fight against the inequities faced by communities of color and highlight that the impacts on our natural world have a direct impact on our bodies. This lens also asks us to observe, embrace and celebrate the diversity we see reflected in the natural world. Evolutionary theory is steeped in a heteronormative worldview that views the primary purpose of sex to be about reproduction. However, we see that homosexuality can serve a number of functions in the natural world.

Deconstructing Dualisms

Through a queer lens, we can conceptualize more affirming and radical ways of understanding gender, sexuality and neurodiversity.

Attachment vs. Authenticity

Attachment theory has become widespread through pop psychology and we often hear about the importance of developing secure attachment. But much of the research we see across Western psychology does not account for the experiences of gender and sexual minorities. One study from Seattle Pacific University found that lesbian, gay, bisexual and queer participants experienced higher rates of insecure attachment than their heterosexual counterparts. Studies also show that Autistic children have higher rates of insecure attachment than allistic children do. It is not uncommon for LGBTQ+ folks to be rejected by friends or family, in fact one poll from 2013 reported that 39% of participants were rejected by at least one person in their life. LGBTQ+ youth are particularly vulnerable to this rejection with up to 40% of homeless youth identifying as part of the community.

As Gabor Mate illustrates in The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture, humans cannot survive without attachments to others, it is mandatory. From the moment we are born, we are reliant on our caregivers to feed us, cloth us and protect us. Our necessity for attachment means giving up a piece of our authenticity so that we don’t push away our caregivers. For example, a young child might pick up on their caregiver’s distress when they cry, resulting in the child suppressing this behavior to meet the caregiver’s needs. Children can begin to internalize certain beliefs about their own value and cut themselves off from the most vulnerable parts of themselves, resulting in what some may refer to as small t trauma. And so, Mate names authenticity as our other core need. The dilemma then is, what happens when our need for attachment is put at risk by our need for authenticity? Mate states, “Authenticity’s only dictate is that we, not externally imposed expectations, be the true author of and authority on our own life.”

Disclosure

So how do LGBTQ+ and Neurodiverse folks choose between attachment and authenticity? In many cases, some folks will choose to be authentic with certain people in their lives and not others. Some might disclose to close friends but not to family. Some might hide their authenticity for fear of hurting their career. In Neurodivergent communities these terms are referred to as masking and unmasking. In TGNC communities they are often referred to as coming out/disclosing and stealth. Often times these decisions are survival strategies, yet hiding our authenticity comes at a price. Autistic folks who mask are at higher risk for autistic burnout, identity confusion, anxiety and depression. For TGNC folks there can be increased dysphoria and shame along with anxiety and depression. On the contrary, some studies have shown that avoiding the stigma that is associated with coming out can lead to decreased depression in some demographics. Throughout The Myth of Normal, Mate highlights study after study that illustrate how suppression, repression and minority stress are the underlying factors for many physical ailments including chronic illness.

Inclusivity vs. Pathology

In the next section we will explore ways that mental health practitioners can work toward reducing stigma by depathologizing Neurodivergence and gender identity through inclusive language and modalities. The DSM’s track record, as illustrated earlier has proven that Western psychology often takes some time to catch up to progressive and diverse cultural values. This has resulted in social stigma, negative medical attitudes, detrimental public policy decisions and maleficence toward clients. Treatments for homosexuality used to include electroshock therapy, chemical castration and conversion therapy.

Conversion Therapy

Conversion therapy still exists in the United States today, despite evidence that it can cause long lasting harm to survivors. Some report anxiety, depression, suicidal ideation, low self-esteem, delayed acceptance of their identities and substance use. Much research still needs to be done on helping survivors recover, but one qualitative study points toward the necessity for affirming care. Conversion therapy is illegal in 20 states along with Washington D.C. and only six others partially support bans for minors (as of 2023). That leaves 24 states where conversion therapy can be practiced without repercussions on minors. These laws do not apply to religious providers. The American Psychological Association’s (APA) official position is that they recommend that ethical practitioners refrain from attempts to change individuals’ sexual orientation and respect the identities for those with diverse gender expressions. They also encourage legislation that bans these practices. As we can see, the historical pathologizing of homosexuality and gender identity has resulted in outdated, archaic and harmful practices that aim to change people at the core of who they are.

Applied Behavioral Analysis

Ole Ivar Lovaas, has close ties to the foundation of conversion therapy and is also credited for his research on applied behavioral analysis with autistic children. ABA was designed to make autistic children present more neurotypically by learning to make eye contact or suppress stimming behaviors. The successes of ABA have mostly been attributed to improving cognitive performance and language skills in some children. Some advocates against ABA argue that some of the modality’s techniques are abusive including punishing negative behaviors with electroshock therapy or sensory punishment. ABA essentially forces Autistic children to learn how to mask their behaviors. Autistic advocates for ABA would like to see the practice focus more on learning new skills than suppressing Autistic traits.

Gender Affirming Care Saves Lives

Access to care is another important factor to consider when discussing inclusivity vs. pathology. I am sure you all have seen at least one story in the news recently as state after state is attempting to ban access to gender affirming care for transgender youth. These bans threaten to sue practitioners, imprison caregivers and put children into foster care should families seek treatment for their kiddos. These bans are moving forward despite outcries from advocates and medical associations such as the American Academy of Pediatrics, the American Medical Association and the APA. There is overwhelming evidence that access to gender affirming care saves lives by reducing depression, anxiety and suicidal ideation.

I see some of this anxiety reflected in my clients who fear that who they are may someday be made illegal. The World Professional Association for Transgender Health (WPATH) currently sets the standards of care for medical and mental health professionals working with transgender clients. While this is crucial in maintaining up to date care, some criticize the amount of intervention on a mental health professionals’ part as gatekeeping. Often, those seeking gender affirming care must see a therapist before gaining access to hormone replacement therapy (HRT) or gender affirming surgeries. This creates an additional financial barrier that may be challenging for some folks to overcome.

In most cases, a diagnosis of gender dysphoria is required to receive care or get insurance providers to cover healthcare services. The informed consent model offers an alternative to this system, by allowing clients to legally consent to treatment by signing documentation stating they understand the risks associated with said treatment. This can make gender affirming care more accessible for those who cannot afford the additional costs of months of therapy. There is also the added task of finding a provider that is proficient in gender affirming care or running the risk of finding one that is not. Discrimination towards transgender folks in healthcare is alarmingly common. According to a survey conducted by the Center for American Progress, nearly half of respondents reported having negative or discriminatory experiences with healthcare providers.

Barriers to Care

For those seeking a diagnosis for Autism, again the costs can be quite high. Testing may or may not be covered by insurance and can cost up to $5000. Official diagnosis may be difficult to come by for those assigned female at birth and for BIPOC folks. Historically, autism research has focused primarily on the traits presented by cisgender white males. More research needs to be done to determine how different traits show up in marginalized demographics. Black children are often misdiagnosed with ADHD or adjustment disorder. And folks assigned female at birth are more likely to mask traits of Autism. And yet, some folks need the diagnosis in order to receive accommodations at school, work, home or in other areas of their life.

For some transgender Autistic folks, a diagnosis can mean being denied access to gender affirming care. One study found that 35% of respondents reported being denied transition related care because of their autism diagnosis. It is essential that as practitioners we listen to the needs of our clients. We must use the language they use, honor their autonomy and support them in embracing their strengths and diversity. For too long, Western psychology has excluded marginalized communities from primary research. Together we can make the field more inclusive through community-based participatory research, patient led and trauma informed care models, and advocacy.

Nature vs. culture

We have already seen how the human need to classify has resulted in the pathologizing of diversity. Now let’s take a look at some of the ways culture (particularly colonial Western culture) attempts to overwrite nature. Although the term two-spirit is only 33 years old, indigenous tribes have honored community members in those roles for tens of thousands of years. Those who lived with the land, rather than off of the land, readily embraced this diversity into their tribes. In many tribes, two-spirit people held spiritual roles as healers, shamans and ceremonial leaders. Colonization forced these practices underground as two-spirit people were targeted, often with violence. Tribal cultures across the globe have long understood that there are more than two genders. It wasn’t until the Age of Enlightenment in Europe that the gender binary was constructed.

Feminists and queer theorists have challenged this thinking for decades, none more notably than Judith Butler who espouses that gender is performative, “We act as if that being of a man or that being of a woman is actually internal reality or something that is simply true about us, a fact about us, but actually it’s a phenomenon that is being produced all the time and reproduced all the time, so to say gender is performative is to say that nobody really is a gender from the start.” Diversity is inherent in nature, binary constructions of gender or not.

Historical Advantages

Some archeologists theorize that autistic people were likely revered in their communities 100,000 years ago. Analysis of cave art shows signs of autistic traits that could have been used by hunters and gatherers to procure food. For years, the scientific community has theorized about how autism develops. Some theories claim autism can develop as a response to stress in the womb while others claim that development can be environmental. A recent study that spanned five countries and over 2 million participants found that autism is inheritable around 80% of the time. If autism is genetic, that must mean that there are evolutionary advantages to having this variation in the human gene pool.

Humans have long sought to categorize and classify, especially in the West. This naming of difference, and in many cases the invention of it, can have detrimental effects. The social expectations of performing gender, neurotypicalness and heterosexuality not only harm those on the margins, but they limit the possibilities of being for all humans. Biology in the natural world loves complexity, and so then we can reason biology loves complexity in the human species too.  

Mirroring Possibilities

The Ecological Self

Just as queer ecology asks us to consider how we are inseparable from nature; the ecological self asks us to understand nature as quintessential to our being. To say that we are all made of stardust, as romantic as it might sound, is an existential truth. The ecological self asks us to consider interdependence with one another and the planet to be in right relationship. To know the ecological self is to know true authenticity.

Your Own Reflection

As we close today, I would like to invite you all to join me in a visualization. You are welcome to close your eyes if that feels safe and think of a time when you saw yourself reflected in the natural world. If nothing comes to mind, maybe one of these images resonates with you. The tree that sits on Chapel Rock in Pictured Rocks National Lakeshore stretches its roots across a chasm to find nutrients on the other side. Or maybe you see yourself in the vibrant flowers that grow in an otherwise barren tundra. Perhaps you are the fern, who’s roots are buried so deeply into the soil that not even a forest fire can stifle your existence. Or maybe you connect with the tardigrade who is tough enough to survive the vacuum of space. Maybe you were grieving and saw your experience mirrored in a dense misty fog. Perhaps you connected with a fresh spring bloom after releasing some trauma from your body.

How does it feel to see yourself reflected in this natural environment? Notice where it might spark something in you and be curious about that sensation. Are there ways in which you feel connected to a deeper sense of yourself? Are there parts of you that feel safer to express themself here? The natural world offers you a nonjudgmental space to come as you are. The trees do not perceive your gender, the sun is not aware if you perform neurotypically, the birds sing to celebrate your authenticity. I believe the natural world has the power to offer marginalized folks a glimpse at their ecological selves, to know a part of themselves unscarred by social norms and bigotry. One does not need to look very far to see that diversity is everywhere, diversity is thriving.

New Pathways

Earlier we discussed some of the ways that we can push the edges of inclusivity and treatment with transgender and neurodiverse clients. Including these communities in every step of the research process is critical to dismantling how Western psychology continues to pathologize natural diversity. You can also become an advocate! Condemn bills that deny gender affirming care and work to replace politicians who support those efforts. Support Autistic led organizations and immerse yourself in the stories of folks whose lives are different from your own. Through embracing diversity, we open up limitless possibilities of being and connecting with one another and the natural world. By connecting with the natural world, we see reflected infinite possibilities of who we can be, our authenticity. Getting back to our authenticity illuminates new pathways for healing and expression that allow us to harness our true power. How will you harness your power to make a difference in the world?