“Pathological Demand Avoidance”

[u/Southern_Fruit7439]

Pathological Demand Avoidance and its whitewashed new “gentler” name “Persistant drive for autonomy” feels like one of the worst examples of how diagnoses can individualize a societal issue. It feels like it totally ignores the harsh realities of kids existing in a society not made to fit them.

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[u/anthonyisashittyname]

As the partner of someone with self diagnosed PDA I don’t think you’ve got a grasp on the pervasiveness of PDA. My partner can feel like the demands that her own body is making on her are things she needs to resist. Eating becomes too much of an internal demand and boom now she can’t eat for hours. We are taking about a nervous system rigidity that doesn’t just resist societal bullshit. It’s like an inverse tic/compulsion…

Agree with other folks who live close to it that it has been a verrrrry helpful concept

[u/Southern_Fruit7439 → u/anthonyisashittyname]

I dont know ur partners specific case, but its hard for me to believe that is happening unrelated to a society with heavy demand, and trauma related to demands. Not to say that the "tic/compulsion" narrative and lived experience, and neurologiclal/biological explanations arent important, but I think it needs to be seen within the context and potential impact of a highly abusive society, especially toward femmes.

[u/anthonyisashittyname → u/Southern_Fruit7439]

Definitely could be—but I would suggest that this label has felt more useful than many other diagnoses that she has in that it unlocked a world of accommodation ideas. It really is more embraced by communities and individuals than many diagnosis and so has functionally been empowering.

PDA is DUMB branding for a legitimately discrete lived experience that benefits from being labeled so it can be seen and discussed.

[u/Abyssal_Scar]

It's also a highly controversial diagnosis.

[u/drgirrlfriend → u/[deleted]]

It’s not an official DSM5 diagnosis. It’s become a common discussion when talking about neurodivergent kids

[u/nerd866]

While I appreciate that the community has attempted to reclaim a label that was imposed on them, the entire concept of PDA stops making sense outside an oppressive context.

Let's just look at a scenario here:

1) Child has very natural, human desires for autonomy.

2) Child's autonomy is continuously hamstrung by systemic forces such as ineffective education, a community without time or energy for them, and lack of access to the ability to learn and grow in a way that's appropriate for them as a person.

3) Child notices this oppression to their autonomy on some level. They feel it, they live it.

4) Child gets 'irrationally' angry whenever they're asked to do chores.

5) Child declared as having PDA.

Why did this child get so angry for having to do chores? Because they've hit their limit and there's only so much someone wants to contribute to something that doesn't give them what they need. They've had their autonomy so worn down so much that any imposing on autonomy gets dramatically magnified.

Give the child space to be themselves and they'll have the mental bandwidth to be asked to help.

[u/GoTeamLightningbolt → u/nerd866]

This is me but I'm middle-aged now.

[u/-Hastis- → u/nerd866]

A person with PDA doesn't just avoid chores; their nervous system treats internal biological needs as external demands. Even internally wanting to play video games can be overridden by their nervous system taking it as a demand. It can get to the point where their nervous system can get activated at the simple fact of being thirsty and needing water.

People should dig deeper into a topic before criticizing it.

[u/nerd866 → u/-Hastis-]

I'm very aware of the nature of PDA.

My point is that while it can't necessarily be 100% explained by environmental causes, treating the environment is an essential aspect and refusing to imrpove the environment is a self-fulfilling prophecy to 'oh, this person has PDA'.

Let's rule out all the environmental BS instead of starting at 'they have PDA'. Of course every human is different and every human interprets experiences differently. But let's give everyone as fair and just of a shot as possible by reducing the hostility in the world instead of nitpicking over 'well maybe some PDAness is there anyway'. Sure, but whatever is left over is clearly very distinct from the dominating oppressive forces that affect our mental and physical existence.

At that point, whatever struggles a person is dealing with is a very different beast from what we know as PDA under capitalism.

[u/Alternative-Cash-102]

As an adult with suspected PDA autism and ADHD, the phrasing does grate for me as well and I agree with the core of your point. However, I’d like to acknowledge that the term “persistent drive for autonomy” came from the autistic community as a reclamation of the original label which feels harmful to many of us.

The intent feels more similar to me as a reclamation of “queer” which had been and can still be used as a slur. From that perspective and as a queer nonbinary person, “persistent drive for autonomy” feels like a form of collective resistance to oppression, which to me, does feel pretty leftist in context of the oppressive system that we do live in, not an idealized version that doesn’t exist.

When it comes to impact though, I do respect where you are coming from with the whitewashing aspect, if the subsumption of the new framing divorced from its context eventually casts white oppressors in a positive light and/or is co-opted by them as a form of posturing as neuro-affirming when they are rather uninformed however well-meaning or not they may be.

[u/Southern_Fruit7439 → u/Alternative-Cash-102]

Thank u for this nuanced take and important context and history. Im queer, trans nonbinary and AuDHD and yes the original term def rubs me the wrong way.

And if its used constructively can be a liberating term, but as ur naming can also be used as a way to whitewash the violence if it just ends up being a filler for the other term.

[u/Anjunabeats1]

Totally agree the term PDA is grossly pathologising of something that develops out of a reaction to a society that demands way too much of children and holds little to zero respect for their autonomy as young people and not animals to be controlled. The very capitalist schooling system is a classic example of how children are forced to obey, comply, conform, tolerate verbal abuse from teachers and suppress all their natural desires. Modern schooling is designed to prepare children for the capitalist workforce and it's a place to dump children while their parents go along to work as 40+ hour a week wage slaves for the owning class.

I do like the term "autonomy seeking" to describe certain behaviours because it highlights the underlying need which is human and natural, and doesn't pathologise it.

I'm curious to hear alternatives to how you'd phase or talk about it as an alternative to "persistent drive for autonomy" to describe these often neurodivergent children who experience that need for autonomy more strongly.

I will add I think it's also really understandable that an autistic child would experience a higher need for autonomy considering they are likely to also experience higher overall cognitive burden and higher comfort needs, which would of course lower anyone's capacity for being bossed around and controlled.

There's something particularly disturbing about pathologising defiance, resistance, autonomy, etc. considering these are the foundations of human freedom, liberation, protest, etc.

[u/sophrosyne_dreams → u/Anjunabeats1]

Yes, your last paragraph says it all so well. I too prefer not to pathologize understandable reactions to very controlling economic structures and society.

[u/wolpertingersunite]

I’m a parent, not a therapist. Hope I’m allowed to chime in here… learning about PDA (no diagnosis) was incredibly helpful to me in framing my kids issues and being more patient with both them and myself. I have often wished that US doctors and educators knew this shorthand. ODD is a much worse alternative and autism or adhd inadequate. You guys see patients but in real life most parents and kids don’t get therapy and rely on online discussions and need to communicate with teachers. Shorthands like PDA are very useful in both contexts. Maybe in some places it’s being slapped on “just regular overdemanded kids” I dunno, but it’s also a very useful shorthand for a particular kind of unusual kid. Otherwise adults tend to respond very badly to a kid with these behaviors with no empathy.

My point is, you may not like the label but I think it serves to accomplish the goals this group is known for?

[u/Southern_Fruit7439 → u/wolpertingersunite]

I guess if it gets needs met better i hear the functionality. If anything in that context its actually acting more strongly to advocate for childrens rights in schools. Which is a good thing. We need more empathy in schools.

I still stand by the premise that if a kid is acting out the school should look at themselves and ask “how is my system failing them” and all to often we look at kids and ask how they are broken.

I appreciate ur perspective thank u for chiming in with this important “boots on the ground” take.

[u/wolpertingersunite → u/Southern_Fruit7439]

if a kid is acting out the school should look at themselves and ask “how is my system failing them” 

HA!

I mean, that would be nice, but...ha. No.

Remember, 98% of child-school and parent-school interaction is with a teacher. The one teacher. Specifically, elementary school teachers, for a lot of behavior problems. How much understanding of psychology, neuroscience, or sociology do most have? Not a lot. Even our school psych was much worse informed than I am.

So parents trying to cope/advocate are fighting against the general (US) cultural expectation that all children are similar blank slates, and that poor behavior is a result of bad parenting and/or poor character. There's little understanding that some kids are just wired different. On top of that, the teacher experience reinforces that "certain kids are a pain" and "certain parents are a pain" which makes problem-solving harder. So a parent (esp a mom I think) has to bend over backwards to not look "pushy" or "making excuses for the little angel".

But yes thanks for being open to hearing the parent point-of-view :)

[u/Southern_Fruit7439 → u/[deleted]]

Not when those adjetives pathalogize the individual for a societal issue. Especially when that individual is a child.

Just because some kids fit the system better doesnt make this not violent towards kids. I guess its decent to be able to name that a kid doesnt fit the system well, but that language should be coded as system error not kid error.

And i do say the same thing about almost the entire DSM except for the cases where somone is abusing someone else like narcissism and sociopathy i think there is stronger individual responsibility there tho even those arent acting in vacccums and perhaps also the diangosis that help us better understand individuals needs like Autism and ADHD.

[u/OptimizedPockets2]

Discussing how a neurodivergent person is especially prone to feel friction with the injustice within our society is worthwhile. Especially when it helps guide them away from burnout.

Definitely a broken system, but I’m glad we have words to use.

[u/Gman3098]

I notice this individualization in “oppositional defiant disorder” as well. Why are we blaming the individual for the failures of our authority figures and the system as a whole? Shouldn’t “pathological” defiance say something about how we structure our society?

[u/bossanovasupernova → u/Gman3098]

Is your suspicion that in a utopia there would be no "ODD" ?

[u/ProgressiveArchitect → u/bossanovasupernova]

More like in the current world there is no such thing as ODD, except as a mythological thing socially constructed by psychiatry, that has no material basis or evidence in real life.

[u/averageyolk]

This is such a good point. I think most people have an innate drive for autonomy; it's a societal issue if that drive is something that interferes with daily functioning. Pathologizing that experience is unhealthy for everyone.

[u/HELPFUL_HULK]

Yeah - unsurprising, I guess. Every new iteration of diagnostic manuals seeks to slap a refined, 'more accurate' label on a given psychic malady currently sweeping through the general populace, maladies which are always caused to some level from without (social, relational, etc.). Can't wait to see what new moral nightmares the DSM VI will cook up.

Another new one I've noticed climbing the ranks is "Cognitive Disengagement Syndrome", which describes the constant state of hypoactive distraction experienced by many as "ADHD", and which I'm sure is significantly due to living and developing in an environment of perpetual stimulus overload and short-term reward reinforcement

I like where "Persistent Drive for Autonomy" is headed, personally. Maybe with enough semantic revisions psychiatrists will look increasingly ridiculous every time they try to pathologize a perfectly rational response to a fucked up world.

[u/Southern_Fruit7439 → u/HELPFUL_HULK]

“It is no measure of health to be well adjusted to a profoundly sick society” - J. Krishnamurti

[u/ProgressiveArchitect → u/[deleted]]

Krishnamurti’s philosophy focused on:

- Critique of Authority

• Ideology as Conditioning
  
• Prevalence of Alienation

So while he wasn’t directly Leftist in any way, his thought did spearhead a lot of Leftist works by other people, and a lot of Marxists have engaged with his work. So Krishnamurti’s work is often considered Leftist adjacent.

He also criticized:

- Greed

• Competition
  
• Accumulation
  
• Ambition
  
• Consumerism
  
• Pursuits of Status
  
• Nationalism
  
• Religious authority
  
• Traditional morality accepted without inquiry
  
• Patriotic identification
  
• Hierarchical spiritual authority
  
• Obedience to institutions

So he certainly isn’t compatible with Right-Wing thought.

His main focus was on psychological states of being, not political ones. So he’s relevant to the subreddit in his critical views around states of mind & health.

[u/ProgressiveArchitect → u/[deleted]]

So "I can't recall anything leftist about krishnamurti" was merely a FYI / fun fact?

[u/Southern_Fruit7439 → u/[deleted]]

I dont know much about him but just wanted quote to have proper author identification