The Diagnostic Gaze: Who Gets Named, Who Gets Blamed, and Who Gets Erased
Bridgette Hamstead
The process of diagnosis is often framed as a neutral act of identification, a gateway to understanding, support, and access. In theory, receiving a diagnosis should open doors: to services, accommodations, treatment, and self-knowledge. But in reality, the diagnostic process is anything but neutral. It is shaped by a long and ongoing history of racism, sexism, classism, ableism, and settler colonial logic. The tools of diagnosis, the professionals who wield them, the criteria by which someone is evaluated, and the cultural assumptions embedded in every screening question, all of these are shaped by dominant norms and institutional biases. Diagnosis is not simply a matter of identifying what is already there; it is a process of meaning-making and boundary-drawing that determines whose needs are legible, whose behavior is pathologized, and whose suffering is believed. It decides who gets named, who gets blamed, and who gets erased.
Neurodivergent people do not have equal access to diagnosis. Race, gender, class, and language fluency shape not only who gets diagnosed, but when, how, and with what level of credibility. Autistic women and nonbinary people are often diagnosed late, if at all, because diagnostic criteria were developed based on studies of white, cisgender boys. Their presentation is still treated as the gold standard, despite overwhelming evidence that autism shows up differently across genders, cultures, and communities. As a result, many people who don’t fit the normative profile, especially those who mask, internalize, or express distress in ways that are not easily observed, are either overlooked or actively misdiagnosed. Instead of autism, they are labeled with anxiety, borderline personality disorder, or mood disorders, reinforcing a cycle of misunderstanding and misplaced treatment.
Race compounds this dynamic even further. Black and brown children are significantly more likely to be misdiagnosed or underdiagnosed when it comes to neurodevelopmental conditions, and far more likely to be labeled with behavioral or conduct disorders. Rather than being seen as children in distress, they are seen as defiant, oppositional, or dangerous. These misinterpretations follow them into adulthood, where Black and Indigenous neurodivergent adults are routinely denied access to supportive care and more likely to be subjected to coercive interventions, including institutionalization, incarceration, or psychiatric holds. These outcomes are not accidental. They reflect a deep bias in the way clinicians, teachers, and gatekeepers interpret behavior, biases that are often reinforced by standardized diagnostic tools created within narrow cultural frameworks. A screening tool that asks whether a child “maintains appropriate eye contact” or “answers questions directly” is not measuring objectivity. It is measuring proximity to white, Western, neurotypical norms.
Socioeconomic status is another major determinant in who gets diagnosed and when. Diagnosis often requires access to health insurance, time off work, transportation, culturally competent providers, and the ability to navigate complex and intimidating systems. Parents with resources are more likely to advocate for their child, push for second opinions, and hire private evaluators. Adults with financial privilege are more likely to be diagnosed later in life because they can afford the assessments, therapy, and community that help them put the puzzle pieces together. Meanwhile, low-income families, people navigating poverty, and those who’ve been targeted by the carceral or welfare systems may avoid seeking diagnosis altogether because of the real fear that it will result in greater surveillance, custody challenges, or institutional consequences. In these contexts, diagnosis is not experienced as access, it is experienced as exposure.
Even within neurodivergent communities, perceived intelligence plays a significant role in who is affirmed and who is questioned. Those labeled as “gifted” or “high-functioning” are more likely to be granted autonomy, platformed, and treated as credible advocates. Those with intellectual disabilities, limited verbal speech, or complex support needs are frequently spoken over, excluded from decision-making, and denied the right to define their own experience. The cultural preference for neurodivergent people who can “pass” as articulate, independent, and insightful reflects a deeper societal discomfort with disability that is perceived as inconvenient, unpredictable, or unsanitized. The same system that praises the “quirky genius” isolates and institutionalizes the person who cannot translate their distress into a format that clinicians and educators find digestible.
The diagnostic gaze is not only about who receives a label, it is also about who does not. Many late-diagnosed autistic, ADHD, and otherwise neurodivergent people describe living for decades with a sense of dislocation, overwhelm, and shame without ever having the language to understand why. They were not considered “disabled enough” to warrant attention, or they learned to mask so effectively that their distress went unnoticed until their bodies could no longer hold the cost. For others, diagnosis was actively denied or delayed by professionals who dismissed their self-awareness, attributed their concerns to anxiety, or assumed they were exaggerating. The psychological toll of not being believed, of knowing something is different, of knowing you are struggling, and of being told that your experience doesn’t count, is a form of epistemic violence rarely acknowledged in public discourse around disability.
Yet diagnosis is also a site of community reclamation. In recent years, peer-led and community-centered models of identification have begun to challenge the authority of clinical gatekeepers. Neurodivergent people are increasingly asserting the right to name themselves, build language that reflects their lived experience, and critique the tools that have historically excluded them. This shift is not about rejecting diagnosis altogether, but about reframing it. It is about recognizing that medical language is not the only valid framework, and that many of the most profound forms of self-understanding emerge not in the therapist’s office, but in conversation with others who have survived similar systems. Peer groups, online forums, storytelling spaces, and disability justice collectives are offering something clinical spaces often cannot: context, solidarity, and cultural fluency.
Still, the stakes remain high. Access to diagnosis continues to determine who gets accommodations, funding, and legal protection. It shapes how people are treated in schools, courts, hospitals, and public life. It influences who is taken seriously and who is dismissed. If diagnosis is to be truly liberatory, it must be disentangled from its history of categorization, control, and coercion. It must be made accessible without being weaponized. And it must be placed in the hands of those who have long been denied the right to name their own experience.
The diagnostic gaze is not just a question of science or policy, it is a question of power. Until we reckon with that, we will continue to replicate the very inequalities that so many of us are working to dismantle. Naming is never neutral. It is always shaped by the values, fears, and hierarchies of the culture in which it occurs. If we want to build a more just and liberatory future for neurodivergent people, we must begin by asking not only who gets named, but also who gets to do the naming.
Reflection Questions:
When you think of diagnosis, do you associate it more with access and support, or with stigma and control? Where did that association come from?
What assumptions do you hold, consciously or unconsciously, about who “looks” autistic, ADHD, or neurodivergent? Where did you learn those assumptions?
Have you ever been disbelieved when describing your own experience? What was the impact of that disbelief on your identity or sense of self?
Who in your community or workplace is most likely to be pathologized for behaviors rooted in trauma, sensory overload, or cultural difference?
Have you ever noticed a difference in how neurodivergent traits are treated depending on someone’s perceived intelligence, race, gender, or class?
When someone discloses a self-diagnosis, how do you respond? What do you believe gives a person legitimacy to name their own experience?
Can you think of a time when someone was denied a diagnosis they clearly needed, or when someone was diagnosed only after years of struggle? What systemic forces delayed that recognition?
How are diagnostic tools and criteria influenced by white, Western, cisnormative, and middle-class cultural standards? What are the consequences for those who don’t conform to those standards?
How has the diagnosis process been used to surveil or control people, especially Black, brown, Indigenous, and low-income communities? What role have schools, courts, or medical systems played in that?
What is the difference between naming and labeling? Who benefits from each?
Have you ever felt pressured to “prove” your diagnosis or to perform your neurodivergence in ways that make it more legible to others?
What does it mean for diagnosis to be trauma-informed, culturally grounded, and community-led? What would that look like in practice?
What alternative or peer-based ways of understanding neurodivergence have been meaningful to you? Where have you found language or resonance outside of clinical systems?
How does the expectation of early diagnosis erase those who come to understand their neurodivergence later in life, often after years of internalized harm?
If we believed people when they told us who they are, without demanding proof, what kind of access, care, and culture might become possible?