Why Approaches That Focus On The “Present” May Not Be Neurodiversity Affirming

Author: Shira Collings, MS, NCC (she/they) 

Many contemporary therapy modalities place a high degree of emphasis on staying in the present. Trauma treatment models often focus on separating the past from the present, and teaching the body and brain that the symptoms one is experiencing are a result of past traumatic events, not the present. Somatic and mindfulness based approaches encourage people to pay attention to physical sensations happening in this moment rather than thoughts about the past or future. Some models utilize physical exercises or visualizations to help people release the tension stored in the body from past trauma.

I want to start out by clarifying that I do very much see value in these approaches. There are times when thought patterns and coping strategies we have internalized from past trauma no longer serve us or apply to our present circumstances, and it can be powerful and healing to separate the past from the present. And being attuned to one’s physical sensations and engaging in practices to relax the nervous system can have significant benefits for physical and mental health. I regularly incorporate these practices into my clinical work and have benefited personally.

But I wonder about the relevance of these approaches for people who face ongoing harm. The implication of so many trauma modalities is that if someone feels unsafe and hypervigilant, this is due to frightening past experiences but does not match current circumstances. This is not applicable to those who are not actually safe in the present. 

For many neurodivergent people, the world is not a safe place. Neurodivergent folks have a high likelihood of experiencing educational and workplace discrimination, medical gaslighting, and frequent microaggressions. Neurodivergent people of color have a significantly increased risk of experiencing police brutality. Since there is a high degree of overlap between neurodivergent and LGBTQ+ identities, neurodivergent folks often face both ableism and cisheterosexism. Trans neurodivergent individuals in particular are facing ongoing harm in our current sociopolitical climate.

For this reason, I’m not sure whether mainstream trauma approaches are always applicable to neurodivergent people or people with other marginalized identities. I’m not even sure if the word “trauma” applies. For so many of us, there is no discrete event or period of time that was harmful, and there has not been and there is not a foreseeable end to the harm we experience. Telling someone who is experiencing ongoing harm that they are actually safe in the present and that their anxiety, hypervigilance, and hopelessness come from painful past experiences is incredibly invalidating.

Not only is so much harm ongoing, but many people’s identities and sense of community develop in relation to shared past experiences. Neurodivergent identity is not just about sharing a set of traits or a particular diagnosis; rather, neurodivergent people can often relate to one another and feel a sense of solidarity and connection due to shared past experiences of oppression and being misunderstood. This can fuel neurodivergent folks to come together and to support one another. In this sense, the past is an important part of who we are and those we feel connected to. 

I imagine this is true for other cultural identities as well. For me personally, an important part of my Jewish identity and values is that our teachings instruct us to remember our people’s past as if it were our own personal past, so that we feel a sense of connection to our collective memory. A core Jewish value is to use our identification with our collective past experiences of oppression to have empathy and solidarity with anyone else experiencing oppression. In fact, some of our traditions involve reliving and re-experiencing key moments from our collective past so we can use this memory to inform our future actions. I know many other cultures have these kinds of traditions too. 

For neurodivergent people and people with other cultural identities that involve a sense of connection with past personal or collective memories, the past is not really “the past.” It is not a discrete unit of time that is separate from us but rather an ongoing part of us. An emphasis on staying focused on the present may feel alienating for people who value living in and being shaped by the past.

How does this show up in the eating disorder field?

In the eating disorder field, there is increasing awareness of the role that trauma often plays in the development of eating disorders. In a lot of ways, this is a positive change! People deserve to have their trauma recognized and to have access to any trauma treatment modalities that are helpful to them. 

But I have also noticed that at times, there can be an overt or implied narrative that an individual needs to heal from their trauma so that they can recover from their eating disorder, or vice versa, that an individual needs to eat enough and be nutritionally stable enough so that they can move on to trauma treatment. The idea is that once people release the trauma that has been stored in their bodies, it will no longer affect their eating and they will eat in a way that is considered to be in line with recovery, which often translates to not too much, not too little, and a wide variety of unprocessed/cooked foods. The field’s definition of recovery also often involves mindful eating, further enforcing the focus on staying in the present and not letting thoughts about the past influence current behavior.

But for those of us facing ongoing harm, this may never not impact the way we eat. For those of us who consider our personal or collective past to be an important part of our identity, this is going to affect the way we move through the world in general, which includes our relationship to food and body. The idea that it’s possible for everyone to be completely separate from any past influence seems like a myth. 

I believe that in some ways, our field’s emphasis on healing from the past and separating ourselves from the past reflects white supremacist ideology. White supremacist narratives often portray individuals in marginalized groups as living in the past, and as playing the victim due to past and ongoing oppression rather than overcoming their past obstacles. In contrast, those who benefit from white privilege and do not want to give this up are not portrayed as “clinging to the past.” Whiteness and the privileges that come with it are seen as the default and ideal, rather than an identity and culture that has been shaped by centuries of history. In upholding the myth that there can ever be a present moment or self that is completely separate from the past, this may be a collusion with white supremacy. 

Ironically, this emphasis on healing from the past can sometimes keep people from experiencing the present or future that they want to. I think it can become a way that we as clinicians view our clients as incomplete. The notion that someone needs to heal from their trauma in order to be whole and live a good life implies that if their trauma still affects them and is part of them, who they are now is broken. It implies that our clients who continue to feel traumatized are past versions of the person that we need to help them become. This can send a message that people do not deserve to live full lives until they recover from their trauma. It can prevent people from envisioning a future for themselves as they are now, and instead to feel as if their life is on hold until they recover enough.

What could we do differently?

To me, neurodiversity affirming care is much less about any specific diagnosis or neurotype and much more about time. When we view our clients as in need of being fixed or cured in order to live a good life, we are basically viewing them as past versions of themselves, as a preamble to a story that hasn’t yet started. And in believing that we are in a position to fix or cure our clients, we are declaring ourselves as the experts of their timeline, of what needs to change so that they can have the future they want. The pathology model of disability leaves little room for the notion that someone can live a meaningful and full life right here and now as a disabled person. 

I believe neurodiversity affirming care is about accepting those we work with as complete and whole, and as having the capacity to move toward the future they want, in the present moment, as they are now. This ironically means accepting that parts of the people we work with may always be living in or fused with the past, and that maybe this isn’t something to be fixed or changed. It also means accepting that people facing ongoing harm are likely going to be affected by this in an ongoing way.

I don’t believe that there is any clearcut answer as to what this looks like. As stated previously, the intention of this post is not to say we should never practice EMDR, mindfulness based approaches, somatic therapy, or other ways of releasing trauma from the body. To me, neurodiversity affirming care means deferring to the client as the expert on what they need and what support looks like, and exploring this with them if they do not know. Some people may benefit tremendously from trauma specific modalities and we should provide access to this. But I also think we as clinicians could leave space for clients to explore what it might be like to view trauma as part of them, and for the goal to be living meaningfully with this rather than freeing themselves from it.

I also believe there is so much value in acknowledging and bearing witness to the pain of ongoing and past harm rather than trying to change it. I think this can scare many clinicians because it feels like we are not offering hope. So many of us have been taught that it is our job to carry out specific techniques to alleviate pain and therefore help them to heal and be whole again. We may feel that not doing so is the same as giving up on a client or telling them their life will never get any better. From my perspective, bearing witness to pain without fixing or changing it is quite the opposite. It is recognition of the client’s wholeness, completeness, and capacity to keep finding ways to put one foot in front of the other, even when there is pain and harm. For a lot of neurodivergent folks, in particular those of us with people pleasing tendencies and demand anxiety, this can relieve quite a bit of pressure, as it can relieve the obligation to achieve anything or make any specific form of progress in treatment. Instead it can send a strong message that so many of us desperately need to hear: that our presence - even if this means being present with our past hurts - is enough.

Author: Shira Collings, MS, NCC (she/they) 

Shira is a pre-licensed counselor in the Philadelphia. She primarily works with people with eating disorders, disordered eating, body image distress, and those breaking free from diet culture. As a neurodivergent diet culture dropout themself, they are especially passionate about supporting neurodivergent folx in finding freedom with food. Click here to learn more about their services.