The Fascist Echo in Labour's "Over-diagnosis" Inquiry

The below is the transcript of a talk titled “Neurodiversity, over-diagnosis, and late fascism” that I gave twice this year, first at the Festival of the Oppressed and more recently at Historical Materialism. It overlaps with some things I’ve published here but makes the more specific case that the current popularity of “over-diagnosis” discourse should be understood less as a renewed neoliberal push for austerity and more as part of the mainstreaming of the ideology of the far right. I’ve decided to publish it now given the announcement this week that Wes Streeting has ordered an inquiry into overdiagnosis.

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In 1762 the Genevan philosopher Jean Jacques Rousseau declared a national emergency. This regarded how doctors diagnosing more health problems were facilitating moral decline, in particular one that impacted masculinity. “What matter” he wrote, if doctors “make the dead walk, we have no need of corpses; they fail to give us men, and it is men we need”. For Rousseau, any increased framing of suffering as a medical matter, and any ensuing easing of suffering, was itself thus driving this moral decline. Men, he thought, needed to suffer to become real men.

Like all reactionary declinist myths, as I’ve written about previously, versions of this seem to reappear in every generation, despite a lack of evidence that our morality is in fact in continual decline. In the 1970s, for instance, it was the Catholic priest Ivan Illich who claimed in Medical Nemesis that the medicine of his day was making people sicker, since he saw reliance on technical fixes as accelerating cultural and moral regression. For Illich as for Rousseau, we need to suffer more again, and to suffer better, to regain our traditional (Christian) virtues.

Today the focus is most centrally on neurodivergence and mental health diagnoses. One dominant discourse is that we live in an age of ‘overdiagnosis’. And as Rhiannon Lucy Cosslett recently detailed in the Guardian, ‘overdiagnosis’ discourse with a particular focus on autism, ADHD, anxiety and depression is the new culture war—the main function of which so far, as the U.K. has seen recently, is to justify cruel cuts to welfare. Health Secretary Wes Streeting has claimed for instance that over-diagnosis is an issue for any attempt to make a sustainable benefits system. Similar remarks have often been made by Nigel Farage and far right influencers in recent years.

In many ways this might seem to be a re-enactment of when (often legitimate) critiques of psychiatry were used by the Thatcher government in the 1980s to justify decimating services. As the Marxist writer Peter Sedgwick detailed in his classic 1982 book Psycho-Politics, this effectively led to many more people with mental health problems becoming homeless or ending up in prison.

Yet what we see today is not mere opportunistic co-optation of valid concerns about diagnosis. And neither is it merely a justification for more neoliberal austerity, although it is that too. What we are seeing is, I want to argue, a new development of health fascism.

The context here regards years of campaigning by disabled activists, and ensuing disability rights wins. Because of this it has become possible to reclaim diagnoses such as autism or ADHD to increasingly used them to recognise forms of workplace discrimination, harm, and exclusion that are caused by inaccessible institutions and in turn the productivist norms of capitalist society. As such, these diagnoses are increasingly used by students and workers for organising to push back against oppressive systems and institutions of exploitation. The backlash against the expansion of these diagnoses is thus, in significant part, a ruling class backlash against a demand for change by those who are disabled and positioned as (potential) wage-labourers.

It is of the utmost importance to understand how intertwined this is with the ideology of a newly empowered far right. Marxists have often understood fascism as a process that arises in response to capitalist crisis. Lowering living standards, rising unemployment, and increased inequality breeds mass discontent. And in this context, such as in Europe in the early 20th century, space emerges for charismatic populist leaders to begin promising national or racial rebirth. That is, a return to a golden age, not just of prosperity but of health and moral virtue.

In Late Capitalist Fascism Mikkel Bolt Rasmussen details how the golden age of the likes of Trump or Farage is not the actual age of fascist power in Italy and Germany, but rather the 1950s in capitalist democracies. This is idealised as a time not just when work paid and was more stable, but also when white men specifically were more empowered, there was greater racial segregation, and binary gender roles seemed fixed and clearer. Hence, contemporary fascists frame this as the ‘natural’ order they need to return to. Political subjects who challenge this myth—Muslims, migrants, trans people, antifa, etc.—are seen as in need to expelling or eradicating, in one way or another.

While Rasmussen’s analysis—like most analyses of contemporary fascism—does not cover neurodivergence, this helps us see, I think, precisely why contemporary reactionaries, including fascists, also now focus so much on diagnoses such as autism or ADHD. There were far fewer disability rights and there was much more segregation in the 1950s. And in that time disability was almost wholly understood as an individual medical problem.

Today, by contrast, decades of activism have helped frame disablement as a socio-political relation. And it is precisely things like accommodations for school exams, or medications that help disabled people to compete in the job market, that upset the myth of the ‘natural’ order when it comes to mental ability. What the materiality of accommodations unveils in day to day life is that ability is not simply innate and individual but rather something relational, social, and political. Thus more people seeking diagnosis to access accommodations—and thereby undermining the myth that disability is individual and natural—means that undermining access to neurodivergent rights and welfare is a core part of the late fascist project.

To achieve this, the easiest method for the fascists and their allies is to promote denial of the reality and construct validity of these disabilities—and thus recognition of the need for rights or supports. Here culture war warriors (most recently Sami Timimi) basically follow the same method ‘gender criticals’ have with trans people: first relentlessly deny the validity of the identities in articles and interviews with the right wing press, and then enable journalists and politicians to use this to justify cutting off access to rights and vital medical support. Just as this method allows the reinforcement of traditional gender binaries and the undermining of trans rights, so too does it allow the reinforcement of what the fascist imaginary sees as natural hierarchies of ability, productivity, and worthiness. This is done through a denial of the reality neurodivergent and psycho-social disablement, including through overdiagnosis discourse, and is then used by governments to justify cutting supports.

But this undermining of the right is not the end point. In the U.S., the health secretary RFK Jr. recently suggested sending people who use ADHD meds to labour camps. In the UK, Nigel Farage recently attacked mental ill-health diagnoses on the grounds that he believes they increase victimhood culture. Each sees their related projects as a matter of returning not just to a natural order of hierarchy but also to a rebirth of national virtue and traditional forms of masculinity. All of this is intertwined and should, I urge, be understood not simply as a continuation of neoliberal austerity politics, but rather as something new—as part of the logics of late fascism as it pertains to health.

To put all this in a different way, the shift from early to late fascism when it comes to disability is as follows. Early fascists had focused their efforts on eliminating disabled people, first through mass sterilisation and then mass murder. Yet they only saw disabled people as posing a hereditary threat to the health of the race. They did not see disabled people as a serial collective with political agency and the power to challenge them. But since then disabled people have organised, raised consciousness, gained rights, and developed collective political agency as disabled people. Hence the fascists of today are less worried about disabled people corrupting the gene pool and are more worried about us corrupting culture and morality. That is why disabled people remain key targets of the fascist project yet in a way that differs from that understandings of Hitler or Himmler.

To resist late health fascism we need a mass politics of solidarity that centres people who are disabled or with mental ill-health alongside race, class, and gender. And we need a politics that recognises that many of our increasingly dominant health discourses—from those about overdiagnosis of ADHD to long COVID denialism—are a core part of the contemporary fascist and ruling class offensive.

In response to their tactics of denial, part of what we need, a small part, is to unite in a defence of the recognition of those conditions that are being dragged into culture wars, such as ADHD and depression, to undermine their recongition. Hopefully it goes without saying that the same time, we must also resist going too far the other way, with essentialised and reified conceptions of diagnostic or disabled identity —since that merely reflects the logic of capitalism in a slightly different form.

Instead, our task partly consists in developing an understanding of how shifts in population health and disablement—from long COVID to ADHD—relate to the development and intensification of capitalism, and of how the interests of the neurodivergent intersect with the interests of the working class internationally. Organising on this basis and getting this balance right, I want to propose, is not the end point. But it will be a necessary starting point for a politics that shifts away from reaction and towards revolutionary change in our current moment. To miss the health element of the current fascist global offensive is to miss a core part of that offensive—we ignore late health fascism at our peril.