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Expanding DEI to Disability: Opportunities for Biological Psychiatry

Open AccessPublished:August 26, 2022DOI:https://doi.org/10.1016/j.bpsc.2022.08.008

      Abstract

      Given its subject matter, biological psychiatry is uniquely poised to lead STEM DEI initiatives related to disability. Drawing on literatures in science, philosophy, psychiatry, and disability studies, we outline how that leadership might be undertaken. We first review existing opportunities for the advancement of DEI in biological psychiatry around axes of gender and race. We then explore the expansion of biological psychiatry’s DEI efforts to disability, especially along the lines of representation and access, community accountability, first person testimony, and revised theoretical frameworks for pathology. We close with concrete recommendations for scholarship and practice going forward. By tackling head-on the challenge of disability inclusion, biological psychiatry has the opportunity to be a force of transformation in the biological sciences and beyond.

      Keywords

      Working to make an academic field more diverse, equitable, and inclusive is a physical and conceptual task. It involves rearranging habits, as well as reimagining the core of scholarly and creative activity. Increasingly, STEM (Science, Technology, Engineering, and Mathematics) and related fields, are recognizing the ways in which women, people of color, disabled people,* and LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer+) people (among others) are underrepresented and disadvantaged within their ranks. Studies repeatedly document the challenges underrepresented scholars face in entering STEM fields, starting with the bias about what a scientist looks like and continuing through leaky pipelines, weak mentorship networks, and full-fledged obstacle courses (

      Asmeret Asefaw Berhe, Rebecca T. Barnes, Meredith G. Hastings, Allison Mattheis, Blair Schneider, Billy M. Williams, and Erika Marin-Spiotta, “Scientists from Historically Excluded Groups Face a Hostile Obstacle Course,” Nature Geoscience 15 (2022): 2-4.

      ). Once in the field, underrepresented scientists continue to face workplace microaggressions and harassment (

      Gabriella Gitierrez y Muhs, Yolanda Flores, Carmen G. Gonzalez, and Angela P. Harris, eds., Presumed Incompetent: The Intersections of Race and Women in Academia (Logan: Utah State University Press, 2012).

      ,

      Yolanda Flores, Gabriella Gitierrez y Muhs, Carmen G. Gonzalez, Presumed Incompetent II: Race, Class, Power and Resistance of Women in Academia (Logan: Utah State University Press, 2020).

      ); inequities in grant funding (
      • Reshma J.
      Sex Differences in Attainment of Independent Funding by Career Development Awardees.
      ,
      • van der Lee R.
      • Elemers N.
      Gender Contributes to Personal research Funding Success in the Netherlands.
      ,

      Donna K Ginther, Walter T. Schaffer, Joshua Schnell, Beth Masimore, Faye Liu, Laurel L. Haak, and Raynard Kington, “Race, Ethnicity, and NIH Research Awards,” Science 333.6045 (2011): 1015-1019.

      ,
      • Hoppe Travis A.
      • Litovitz Aviva
      • Willis Kristine A.
      • Meseroll Rebecca A.
      • Perkins Matthew J.
      • Ian Hutchins B.
      • Davis Alison F.
      • Lauer Michael S.
      • Valentine Hannah A.
      • Anderson James M.
      • Santangelo George M.
      Topic Choice Contributes to the Lower Rate of NIH Awards to African-American/Black Scientists.
      ), hiring and promotion (
      • Nielson M.W.
      Limits to Meritocracy? Gender in Academic Recruitment and Promotion Processes.
      ,
      • DePaola M.
      • Scoppa V.
      Gender Discrimination a evaluators Gender: Evidence from Italian Academia.
      ,

      Joanna R. Jackson, Ann M. Holmes, Elizabeth Gloembiewski, Brittany L. Brown-Podgorski, and Nir Menachemi, “Graduation and Academic Placement of Underrepresented Racial/Ethnic Minority Doctoral Recipients in Public Health Disciplines, United States, 2003-2015,” Public Health Rep, 134.1 (2017): 63-71.

      ,
      • Fang Di
      • Moy Ernest
      • Colburn Louis
      • Hurley Jeanne
      Racial and Ethnic Disparities in Faculty Promotion in Academic Medicine.
      ), speaking invitations, and teaching evaluations (
      • Mengel F.
      • Sauermann J.
      • Zolitz U.
      Gender Bias in Teaching Evaluations.
      ,
      • Boring A.
      Gender Biases in Student Evaluations of Teaching.
      ,

      Dana A. Williams, “Examining the Relation between Race and Student Evaluations of Faculty Members: A Literature Review,” Profession (2007): 168-173.

      ); and biases in publishing and citations (
      • West J.D.
      • Jacquet J.
      • King M.M.
      • Correll S.J.
      • Bergstrom C.T.
      The Role of Gender in Scholarly Authorship.
      ,

      J. Huang, A. J. Gates, R. Sinatra, and A.-L. Barabasi, “Historical Comparison of Gender Inequality in Scientific Careers Across Countries and Disciplines,” PNAS 117 (2020): 4609-4616.

      ,
      • Caplar N.
      • Tacchella S.
      • Birrer S.
      Quantitative Evaluation of Gender Bias in Astronomical Publications from Citation Counts.
      ,

      P. Chakravartty, R. Kuo, V. Grubbs, and C. McIlwain “#CommunicationSoWhite,” Journal of Communication 68.2 (2018): 254–266; Cite Black Women, Home, available at: https://www.citeblackwomencollective.org/ (Accessed: January 29, 2022).

      ). These biases and inequities contribute to large scale issues in retention and promotion, and compromise sense of belonging and wellbeing. Ultimately, however, science pays the highest price. Its history and its future are weaker without the contributions of marginalized scientists.
      Overwhelmingly, attention to diversity and inclusion in STEM has focused on addressing disparities across gender and race. These efforts, however, have been limited in significant respects. Endeavours to increase gender diversity have worked to improve the representation of women, but left unaddressed other gender minorities (e.g., trans and non-binary people). Similarly, efforts to increase racial and ethnic diversity have typically emphasized Black and Latinx representation, to the exclusion of Asian and Indigenous people. Perhaps even more saliently, few STEM diversification initiatives have addressed disparities in disability.
      While biological psychiatry can contribute to diversity on several fronts, the field is uniquely poised to lead STEM integration around disability. Insofar as biological psychiatry deals directly with psychiatric disabilities and disorders—and therefore directly with related disability communities, it is well-positioned to lead in advancing disability inclusion in STEM. In this essay, and drawing on literatures in psychiatry, science, philosophy, and disability studies, we first review existing opportunities for the advancement of diversity, equity, and inclusion (DEI) in biological psychiatry around issues of gender and race. We then explore the expansion of biological psychiatry’s DEI efforts to disability, especially along the lines of representation, access, community accountability, first person testimony, and revised theoretical frameworks for pathology. We close with concrete recommendations for research and practice going forward. By tackling the challenge of disability inclusion head-on, biological psychiatry has the opportunity not only to itself be transformed, but also to be a force of transformation in the biological sciences and beyond.

      I. DEI in Biological Psychiatry

      A Primer Efforts to enhance DEI in psychiatry, and biological psychiatry specifically, have emphasized organizational and editorial commitments. These recommendations are critical if the field is to make steady and sustainable advances on these fronts. Important, too, are individual efforts to diversify the field. New emphases on citation ethics (

      Neha Kumar, and Naveena Karusala, “Braving Citational Justice within Human-Computer Interaction,” (November 11, 2020), https://nehakumar.medium.com/braving-citational-justice-within-hci-5b43c1436fbc.

      ) and narrative CVs (

      Athene Donald, “Getting Universities’ People and Culture Right,” (August 27, 2021), http://occamstypewriter.org/athenedonald/2021/08/27/getting-universities-people-and-culture-right/.

      ), as well as general calls to self-education, offer widely accessible outlets for DEI activity. Moving forward, a blend of recommendations for professional associations, journals and other publications, as well as individual laboratories and scientists, is important.
      Scientific bodies such as the Organization of Human Brain Mapping (
      • Tzovara Athina
      • Amarreh Ishmael
      • Borghesani Valentina
      • Maller Chakravarty M.
      • DuPre Elizabeth
      • Grefkes Christian
      • Amelie Haugg
      • Lee Jollans
      • Lee Hyang Woon
      • Newman Sharlene D.
      • Olsen Rosanna K.
      • Tilak Ratnanather J.
      • Gina Rippon
      • Uddin Lucina Q.
      • Maria L.
      • Vega Bringas
      • Veldsman Michele
      • White Tonya
      • Badhwar AmanPreet
      Embracing Diversity and Inclusivity in an Academic Setting: Insights from the Organization for Human Brain Mapping.
      ) and National Institutes of Health (
      • Valantine Hannah A.
      • Collins Francis S.
      National Institutes of Health Addresses the Science of Diversity.
      ) are leading efforts to integrate DEI into the institutional fabric of science. They have proposed a range of inclusive practices that include revising mission and values statements and codes of conduct; enhancing recruitment, retention, and mentorship; diversifying curricula; expanding community outreach; forming DEI committees; rebalancing speaking invitations, conference panels, and Q&A airtime; developing inclusivity training for hiring, promotion, and grant review committees; creating diversity awards; demographic data collection; instituting all-gender restrooms and inclusive signage; improving education and implementation of legally-mandated accommodations as well as best practices for accessibility (
      • Tzovara Athina
      • Amarreh Ishmael
      • Borghesani Valentina
      • Maller Chakravarty M.
      • DuPre Elizabeth
      • Grefkes Christian
      • Amelie Haugg
      • Lee Jollans
      • Lee Hyang Woon
      • Newman Sharlene D.
      • Olsen Rosanna K.
      • Tilak Ratnanather J.
      • Gina Rippon
      • Uddin Lucina Q.
      • Maria L.
      • Vega Bringas
      • Veldsman Michele
      • White Tonya
      • Badhwar AmanPreet
      Embracing Diversity and Inclusivity in an Academic Setting: Insights from the Organization for Human Brain Mapping.
      ,
      • Valantine Hannah A.
      • Collins Francis S.
      National Institutes of Health Addresses the Science of Diversity.
      ). In psychiatry, calls for greater diversity have addressed both the pool of psychiatric practitioners (
      • Lokko Hermioni N.
      • Chen Justin A.
      • Parekh Ranna I.
      • Stern Theodore A.
      Racial and Ethnic Diversity in the US Psychiatric Workforce: A Perspective and Recommendations.
      ) and the structure of psychiatry departments (

      Hermioni L. Amonoo, Nomi C Levy-Carrick, Ashwini Nadkarni, Samara J Grossman, David Green, Regina M. Longley, David Silbersweig, Christopher AhnAllen, “Diversity, Equity, and Inclusion Committee: An Instrument to Champion Diversity Efforts Within a Large Academic Psychiatry Department,” Psychiatric Services 73.2 (2022): 223-226.

      ). The Society of Biological Psychiatry established an Inclusivity Task Force focused on ameliorating disparities around gender and race (

      Society of Biological Psychiatry, “Diversity and Inclusion” (Accessed February 2022), https://sobp.org/diversity-and-inclusion/.

      ). And efforts are underway to improve DEI in publishing in biological psychiatry journals (
      • Hart Kamber L.
      Sophia Frangou, and Roy H. Perlis, “Gender Trends in Authorship in Psychiatry Journals from 2008 to 2018.
      ,
      • Carrie E.
      Bearden, “Accelerating the Bending Arc Toward Equality: A Commentary on Gender Trends in Authorship in Psychiatry Journals.
      ,
      • Jordan Chloe J.
      • Carlezon Jr., William A.
      Neuropsychopharmacology (NPP): Gender Balance in Journal Function.
      ) and in Biological Psychiatry specifically (
      • Leibenluft Ellen
      Increasing Diversity in Science: It Begins with All of Us.
      ). These efforts include diversifying journal editors, editorial boards, reviewers, and authors by actively increasing the number of women and/or people of color editing, reviewing, and publishing.
      Individuals, too, can play a part in the project of diversifying science, especially scientific publishing. Recent work has identified the marked undercitation of women and people of color in the fields of neuroscience (34-35), communications (

      Xinyi Wang, Jordan Dworkin, Dale Zhou, Jenny Stiso, Danielle S. Bassett, Perry Zurn, and David Lydon-Staley, “Gendered Citation Practices in Communication Research,” Annals of the International Communication Association (2021).

      ), cognitive science (
      • Fulvio Jacqueline M.
      • Akinnola Ileri
      • Postle Bradley R.
      Gender (Im)Balance in Citation Practices in Cognitive Neuroscience.
      ), medicine (
      • Chatterjee Paula
      • Werner Rachel M.
      Gender Disparity in Citations in High-Impact Journal Articles.
      ), and physics (

      Erin G. Teich, Jason Z. Kim, Christopher Lynn, Samantha C. Simon, Andrei Klishin, Karol Szymula, Pragya Srivastava, Lee Bassett, Perry Zurn, Jordan Dworkin, and Dani S. Bassett, “Citation Inequity and Gender Citation Practices in Contemporary Physics,” arXiv.

      ) (among others). This overall undercitation holds when controlling for the journal, publication year, author seniority, number of authors, and whether the paper was a review or empirical article. The effect is shown to be largely driven by the reference lists of papers first- and last-authored by men. Importantly, authorial discretion affords authors the opportunity to rebalance their reference lists to reflect existing demographics in the field (or go beyond them). The Citation Diversity Statement (CDS) is one helpful tactic to raise awareness and calculate (and in some cases recalibrate) the balance of one’s reference lists. The CDS is a short statement, appended to the paper much like acknowledgments, which offers an account of the citation diversity in that paper’s reference list (40-41). The CDS has now appeared in over 30 separate journals, with the biological sciences leading the social sciences in their endorsement (

      Perry Zurn, Erin G. Teich, Samantha C. Simon, Jason Z. Kim, and Dani S. Bassett, “Supporting Academic Equity in Physics through Citation Diversity,” Nature Communications Physics (under review).

      ). Cell Press, which publishes over 50 journals in the biological sciences, now has the option to include a CDS and Journal of Cognitive Neuroscience invites a CDS in its submission guidelines (
      • Sweet Deborah
      New at Cell Press: The Inclusion and Diversity Statement.
      ). Citation diversity is a quickly growing area in STEM DEI initiatives and allows individuals to contribute to the process in meaningful ways.
      Overwhelmingly, the STEM DEI efforts listed above have focused on ameliorating disparities along the lines of gender and race or ethnicity. While disability is an acknowledged vector of discrimination in academia, concrete advancements and initiatives have been few and far between. The NIH identifies disabled people as one of the largest sectors lacking in the biomedical research workforce (

      Hannah A. Valantine and Francis S. Collins, “National Institutes of Health Addresses the Science of Diversity,” PNAS 112.40 (2015): 12240-12242; https://direct.mit.edu/jocn/pages/submission-guidelines.

      ). And the Organization of Human Brain Mapping explicitly identifies “accessibility for visible and invisible disabilities” as among the next frontiers of DEI efforts in science (
      • Tzovara Athina
      • Amarreh Ishmael
      • Borghesani Valentina
      • Maller Chakravarty M.
      • DuPre Elizabeth
      • Grefkes Christian
      • Amelie Haugg
      • Lee Jollans
      • Lee Hyang Woon
      • Newman Sharlene D.
      • Olsen Rosanna K.
      • Tilak Ratnanather J.
      • Gina Rippon
      • Uddin Lucina Q.
      • Maria L.
      • Vega Bringas
      • Veldsman Michele
      • White Tonya
      • Badhwar AmanPreet
      Embracing Diversity and Inclusivity in an Academic Setting: Insights from the Organization for Human Brain Mapping.
      ). Biological Psychiatry recently added a statement to its editorial policies indicating it aims to “increase participation among individuals of underrepresented racial, ethnic or gender identities; from underrepresented countries or disadvantaged backgrounds; and those with disabilities” (

      Biological Psychiatry, “Editorial Policies” (Accessed February 2022), https://www.biologicalpsychiatryjournal.com/article/S0006-3223(21)01808-4/fulltext#sec3.6.3.

      ). Given the paucity of concrete proposals and practices, however, disability inclusion poses a significant opportunity for initiative and innovation in science.

      II. Disability in Biological Psychiatry

      An OpportunityBiological psychiatry, while similar to other STEM fields in many respects, is also unique. Insofar as the field focuses on elucidating the nature and causal mechanisms of psychiatric disability, mood disorders, and other neuroatypicalities, it intersects directly—as a matter of necessity—with disability communities. Biological psychiatry utilizes neuroimaging, psychopharmacology, and neuroimmunochemistry, among other tools, not only to understand psychiatric disabilities and disorders but also, in many cases, to treat them, with a range of cognitive, behavioral, drug, and neuromodulation therapies. As such, where most STEM DEI initiatives merely mention including disabled people, biological psychiatry has the unique opportunity to become a thought-leader in actionable disability inclusion. Here we address four main vectors of that opportunity.

      a. Access and Representation

      Across academia, discussions of disability inclusion typically focus on enhancing accessibility in classrooms and conferences. The demands of disability justice, however, are more expansive. Research shows that disabled students with an interest in STEM, faced with systemic barriers in the sciences, often choose not to pursue undergraduate or graduate degrees in STEM fields (
      • Thurston Linda P.
      • Cindy Shuman B.
      Jan Middendorf, Cassandra Johnson, “Postsecondary STEM Education for Students with Disabilities: Lessons Learned from a Decade of NSF Funding.
      ). Those systemic barriers include elements common to underrepresented groups (e.g., lack of mentorship, recruitment, retention, etc.) but also unique to the disability community (e.g., ableist ignorance [48-49] and discrimination, inaccessible buildings and communicative materials, lack of accommodations and adaptive aids) (
      • Tzovara Athina
      • Amarreh Ishmael
      • Borghesani Valentina
      • Maller Chakravarty M.
      • DuPre Elizabeth
      • Grefkes Christian
      • Amelie Haugg
      • Lee Jollans
      • Lee Hyang Woon
      • Newman Sharlene D.
      • Olsen Rosanna K.
      • Tilak Ratnanather J.
      • Gina Rippon
      • Uddin Lucina Q.
      • Maria L.
      • Vega Bringas
      • Veldsman Michele
      • White Tonya
      • Badhwar AmanPreet
      Embracing Diversity and Inclusivity in an Academic Setting: Insights from the Organization for Human Brain Mapping.
      ,
      • Thurston Linda P.
      • Cindy Shuman B.
      Jan Middendorf, Cassandra Johnson, “Postsecondary STEM Education for Students with Disabilities: Lessons Learned from a Decade of NSF Funding.
      ,
      • Scott Bellman
      • Burgstahler Sheryl
      • Chudler Eric H.
      Broadening Participation by Including More Individuals with Disabilities in STEM: Promising Practices from an Engineering Research Center.
      ). In an April 2021 report, the National Center for Science and Engineering Statistics found that 8.89 percent of PhD awardees in the biological and biomedical sciences reported having one or more disabilities (51). The report also found that disabled scientists and engineers experienced higher unemployment rates and received fewer research assistantships, traineeships, internships, fellowships, scholarships, and grants than those without disabilities. Munoz and Meeks show, furthermore, that grant funding awarded to disabled researchers has significantly declined over the last decade (

      Beatriz Munoz and Lisa M. Meeks, “A Decade of Decline: Grant Funding for Researchers with Disabilities 2008 to 2018,” PLoS ONE (2020): 0228686.

      ). In response to data like these, the NIH formed the Working Group on Diversity’s Subgroup on Individuals with Disabilities to produce a white paper and recommendations, which are projected to include data collection schematics, evidence-based practices and programs, and, most importantly, “perspectives of individuals with disabilities” (53).
      Addressing the underrepresentation of disabled scientists and the systemic barriers they face requires a multi-pronged approach (
      • Tzovara Athina
      • Amarreh Ishmael
      • Borghesani Valentina
      • Maller Chakravarty M.
      • DuPre Elizabeth
      • Grefkes Christian
      • Amelie Haugg
      • Lee Jollans
      • Lee Hyang Woon
      • Newman Sharlene D.
      • Olsen Rosanna K.
      • Tilak Ratnanather J.
      • Gina Rippon
      • Uddin Lucina Q.
      • Maria L.
      • Vega Bringas
      • Veldsman Michele
      • White Tonya
      • Badhwar AmanPreet
      Embracing Diversity and Inclusivity in an Academic Setting: Insights from the Organization for Human Brain Mapping.
      ,
      • Thurston Linda P.
      • Cindy Shuman B.
      Jan Middendorf, Cassandra Johnson, “Postsecondary STEM Education for Students with Disabilities: Lessons Learned from a Decade of NSF Funding.
      ,
      • Scott Bellman
      • Burgstahler Sheryl
      • Chudler Eric H.
      Broadening Participation by Including More Individuals with Disabilities in STEM: Promising Practices from an Engineering Research Center.
      ). Just as some of the barriers (and solutions) are shared across marginalized groups, so too are some of the barriers (and their solutions) unique to disability communities. First, it is critical to develop mentoring networks, hiring and recruitment protocols, and retention practices that focus on supporting disabled scientists and students. We recommend psychiatry departments and biological psychiatry laboratories hire and retain disabled graduate students, postdocs, and faculty, and learn about the unique challenges to creating disability-supportive employment environments (
      • Sumner K.E.
      • Brown T.J.
      Neurodiversity and Human Resource Management: Employer Challenges for Applicants and Employees with Learning Disabilities.
      ,
      • Anna Krzeminska
      • Austin Robert D.
      • Bruyère Susanne M.
      • Hedley Darren
      The Advantages and Challenges of Neurodiversity Employment in Organizations.
      ,
      • Saleh Matt
      Susanne Marie Bruyère, “Leveraging Employer Practices in Global Regulatory Frameworks to Improve Employment Outcomes for People with Disabilities.
      ). National psychiatry and biological psychiatry organizations should form committees to monitor the status of disabled scientists, build mentorship pipelines, and highlight disabled scientists’ contributions to the field. They should also implement protocols to counteract discrimination against disabled scientists in grant funding, as well as institute grant funding for disabled scholar-led research. Second, it is critical to improve access and accommodations across campus: in classrooms, laboratories, and other collaborative spaces. We recommend psychiatry departments and biological psychiatry laboratories, as well as national organizations, enhance universal design in conferences, journals, laboratory protocols, etc. Universal design adapts curricula and learning environments to increase access for the widest range of learners, including those with mobility or sensory impairments, chronic pain, or neuroatypicalities (
      • Wilson Jan Doolittle
      Reimagining Disability and Inclusive Education Through Universal Design for Learning.
      ,
      • Griffin Edward
      • Pollak David
      Student Experiences of Neurodiversity in Higher Education: Insights from the BRAINHE Project.
      ,
      • Chapman Robert
      Neurodiversity and the Social Ecology of Mental Functions.
      ,

      Lawrence K. Fung, ed., Neurodiversity: From Phenomenology to Neurobiology and Enhancing Technologies (Washington, DC: American Psychiatric Association Publishing, 2021).

      ).
      Advances in access and accommodation have historically privileged physical disability; however, psychiatric disability, mental health disorders, and neurodivergence (and their imbrications with physical impairments) are increasingly a focus of disability theory and activism (

      Brenda A LeFrancois, Geoffrey Reaumea, and Robert J. Menzies, Mad Matters: A Critical Reader in Canadian Mad Studies (Ontario: Canadian Scholars’ Press Incorporated, 2013). \

      ). In its efforts toward disability inclusion, biological psychiatry should therefore be informed not only by ADA standards but also disability community recommendations that go beyond them (

      Leah Lakshi Piepzna-Samarasinha, Care Work: Dreaming Disability Justice (Vancouver: Arsenal Pulp Press, 2018).

      ). This involves cultivating a robust relationship with disability communities. Indeed, while ableist stigma around physical and psychiatric disabilities compromises the workplace, and disabled scientists should have the right not to disclose their disability in all non-relevant contexts, building a culture of access with and for disabled people goes a long way toward ensuring a creative work environment (

      Eli Clare, “Body Shame, Body Pride: Lessons from the Disability Rights Movement,” in The Transgender Studies Reader 2 (New York: Routledge, 2013), 261-265.

      ,

      Mia Mingus, “Forced Intimacy: An Ableist Norm,” Leaving Evidence blog (August 6, 2017), https://leavingevidence.wordpress.com/2017/08/06/forced-intimacy-an-ableist-norm/.

      ,

      Monique A. M. Gignac, Julie Bowring, Arif Jetha, Dorcas E. Beaton, F. Curtis Breslin, Renee-Louise Franche, Emma Irvin, Joy C. Macdermid, William S. Shaw, Peter M. Smith, Aaron Thompson, Emile Tompa, Dwayne Van Eerd, and Ron Saunders, “Disclosure, Privacy, and Workplace Accommodation of Episode Disabilities: Organizational Perspectives on Disability Communication-Support Processes to Sustain Employment,” Journal of Occupational Rehabilitation 31 (2021): 153-165.

      ).

      b. Community Accountability

      For decades, the disability movement has had the mantra “Nothing About Us, Without Us” (

      James Charlton, Nothing About Us, Without Us: Disability Oppression and Empowerment (Oakland: University of California Press, 2000).

      ). While this slogan has primarily been a political call to action, it is also an epistemic intervention. For biological psychiatry, the “nothing” should be understood as the core values that guide the development of treatments for psychiatric disease and disability. Ultimately, these values are a kind of moral knowledge generated by the perception and reasoning of specific individuals with a particular point of view (

      Jackie Leach Scully, Disability Bioethics: Moral Bodies, Moral Difference (Lanham: Rowman and Littlefield, 2008).

      ,

      Mary Mahowald, “A Feminist Standpoint,” in Disability, Difference, Discrimination: Perspectives on Justice in Bioethics and Public Policy, eds. Anita Silvers, David Wasserman, and Mary B Mahowald (Lanham: Rowman & Littlefield, 1998), 211-252.

      ). Insofar as disabled people are excluded from conversations shaping the basic goals of biological psychiatry, the values generated by their point of view will be excluded from deliberations (

      Jackie Leach Scully, “Moral Bodies: Epistemologies of Embodiment,” in Naturalized Bioethics: Toward Responsible Knowing and Practice, eds. Hilde Lindemann, Marian Verkerk & Margaret Urban Walker (Cambridge: Cambridge University Press, 2009), 23-41.

      ) about the kinds of treatments or therapies the field should use and pursue.
      A commitment to this disability moral standpoint can underwrite arguments like that of Sara Goering and Eran Klein, who maintain that “recognition justice” demands engineers, physicians, and scientists “gather and take seriously the input of potential end users throughout the design process” of emerging neurotechnologies, such as brain-computer interface devices (

      Sara Goering and Eran Klein, “Neurotechnologies and Justice by, with, and for Disabled People,” in The Oxford Handbook of Philosophy and Disability, eds. David Wasserman and Adam Cureton (New York, NY: Oxford University Press, 2020), 616-632.

      ). More specifically, recognition justice requires “participatory parity, such that groups have equal opportunities to enter dialogue regarding matters of justice, and to be heard.” They argue that participatory parity ought to apply to deliberations about the purpose and goals of developing neurotechnologies. As such, the standpoint of disabled people who will be the end users of such technology ought to be valued throughout the design process and not just as a way to market a final product that will be more acceptable to a patient population and maximize sales. In our view, biological psychiatry could lead STEM DEI efforts by adopting this approach and recognizing the viewpoints of disabled people when framing the basic goals of the discipline and doing so as a matter of justice.
      Disability inclusion in psychiatric research makes for better science and greater social justice. It allows science not only to calibrate more finely its knowledge and increase impact across diverse populations, but also to redress longstanding patterns of treating disability on a deficit model, as simply a problem to be solved. In the first national study of disabled people’s views on precision medicine research, Sabatello et al. show that while there is widespread willingness to participate, important barriers (especially re: physical access, communication, and information) to disability inclusion need to be removed (
      • Sabatello Maya
      • Chen Ying
      • Zhang Yuan
      • Paul S.
      Appelbaum, “Disability Inclusion in Precision Medicine Research: A First National Survey.
      ). Beyond involving disabled people in the research, study results should also be returned to the community in accessible ways (
      • Sabatello Maya
      • Zhang Yuan
      • Chen Ying
      • Paul S.
      Appelbaum, “In Different Voices: The Views of People with Disability about Return of Results from Precision Medicine Research.
      ). Non-disabled researchers, need to be trained (and train themselves) in disability cultural competency, and become more aware of disability experiences, rights, and histories (
      • Sabatello Maya
      • Inclusivity Cultivating
      Precision Medicine Research
      Disability, Diversity, and Cultural Competence.
      ,
      • Garland-Thomson Rosemarie
      • Iezzoni Lisa I.
      Disability Cultural Competence for All as a Model.
      ). In biological psychiatry, some scholars also recommend the inclusion of disabled people among psychiatric researchers and service providers. Participatory approaches to mental health services research emphasize the value of research led by those with lived experience of psychiatric disabilities, as well as the importance of both self-directed care and peer specialists (
      • Jones Nev
      • Atterbury Kendall
      • Byrne Louise
      • Carras Michelle
      • Brown Marie
      • Phalen Peter
      Lived Experience, Research Leadership and the Transformation of Mental Health Services: Building a Pipeline.
      ,
      • Jones Nev
      • Niu Grace
      • Thomas Marilyn
      • Riano Nichoals S.
      • Hinshaw Stephen P.
      • Mangurian Christina
      Peer Specialists in Community Mental Health: Ongoing Challenges of Real-World Inclusion.
      ,

      Sarah Kamens, Larry Davidson, Emily Hyun, Nev Jones, Jill Morawski, Matthew Kurtz, Jessica Pollard, Nev Jones, “Taking Issue: Rethinking Consumer Empowerment (and Systems Change) through the Lessons of Self-Directed Care,” Psychiatric Services (2019).

      ). In each of these cases, the impetus is to validate individual autonomy, but also to support disability community-led and community-accountable research (
      • Kalathil Jayasree
      • Jones Nev
      Unsettling Disciplines: Madness, Identity, Research, Knowledge.
      ).

      c. Testimony from Disabled People

      One concrete form of inclusion is listening to disabled people themselves. First-person testimony from disabled people should not only inform disability inclusion in STEM but it should also inform psychiatric research and practice.
      Data rooted in biology, chemistry, neuroscience, among other sciences, are essential for psychiatric researchers and clinicians. It is easy to foreground or otherwise prioritize this data over patient testimony, and disciplines such as psychology or sociology that incorporate it, as the former appear more “objective” than the latter. Yet, this tendency, understandable as it is, is fraught when it comes to appreciating past and present disparities in the equity of care and treatment for disabled people (

      Henri-Jacques Stiker, A History Of Disability (Ann Arbor: University of Michigan Press, 1999); Kim E. Nielsen, A Disability History of The United States (Boston: Beacon Press, 2012).

      ,

      Michael Rembis, Kim Nielsen, and Catherine Kudlick, eds., The Oxford Handbook of Disability History (Oxford, New York: Oxford University Press, 2018).

      ). Historically, medical practitioners did not simply disregard the first-person accounts and testimonies of disabled people; they actively undermined them, especially in the domains of psychology and psychiatry and often along racialized lines; and this legacy resulted in numerous harms (

      Harriet A. Washington, Medical Apartheid: The Dark History Of Medical Experimentation On Black Americans From Colonial Times To The Present (New York: Anchor Books, 2008).

      ,

      Nancy Ordover, American Eugenics: Race, Queer Anatomy, and the Science of Nationalism (Minneapolis: University of Minnesota Press, 2003).

      ,

      Robert A. Wilson, The Eugenic Mind Project (Cambridge, MA, USA: MIT Press, 2017).

      ). Luckily, there is over fifty years of research in the multi-disciplinary and intradisciplinary field of disability studies (

      Lennard J. Davis, The Disability Studies Reader, 5th ed. (New York: Routledge, 2016).

      ), as well as decades of research in sub-fields such as philosophy of disability (
      Joel Michael Reynolds and Teresa Blankmeyer Burke
      Introducing The Journal of Philosophy of Disability.
      ), that not simply draws upon but centers the lived experiences and testimony of disabled communities. One fruitful nexus between that literature and psychiatry is phenomenological psychopathology, a mixed-methods approach that integrates first-person and third-person analysis and research of psychopathological states (
      • Messas Guilherme
      • Tamelini Melissa
      • Mancini Melina
      • Stanghellini Giovanni
      New Perspectives in Phenomenological Psychopathology: Its Use in Psychiatric Treatment.
      ,

      Giovanni Stanghellini, “Phenomenological Psychopathology and Psychotherapy,” The Oxford Handbook of Phenomenological Psychopathology, eds. Giovanni Stanghellini, Matthew Broome, Andrea Raballo, Anthony Vincent Fernandez, Paolo Fusar-Poli, Rene Rosfort (Oxford: Oxford University Press; 2019), 952-971.

      ,

      Anthony Vincent Fernandez, “Phenomenological Psychopathology and Psychiatric Classification,” in The Oxford Handbook of Phenomenological Psychopathology, eds. Giovanni Stanghellini, Matthew Broome, Andrea Raballo, Anthony Vincent Fernandez, Paolo Fusar-Poli, Rene Rosfort (Oxford: Oxford University Press; 2019), 1016-1030.

      ,
      • Gerrit Ian van Schalkwyk
      • Srihari Vinod
      The Duration of Untreated Psychosis: A Phenomenological Study.
      ,
      • Daley Tamara C.
      • Jones Nev
      • George Preethy
      • Rosenblatt Abram
      First Person Accounts of Change among 80. Young Adults with a First Episode of Psychosis.
      ).
      Ableist assumptions negatively impact patient-practitioner communication and can lead to increased medical error (

      Joel Michael Reynolds and David M. Peña-Guzmán, “The Harm of Ableism: Medical Error and Epistemic Injustice,” Kennedy Institute of Ethics Journal 29.3 (2019): 205–42.

      ). This is highly relevant in biological psychiatry’s service sector. In a recent survey, 82.4 percent of practicing US physicians report that people with significant disability have worse quality of life than nondisabled people (
      • Iezzoni Lisa I.
      • Rao Sowmya R.
      • Ressalam Julie
      • Bolcic-Jankovic Dragana
      • Agaronnik Nicole D.
      • Donelan Karen
      • Lagu Tara
      • Campbell Eric G.
      Physicians’ Perceptions of People with Disability and Their Health Care.
      ). This judgment conflicts with a large body of social scientific research suggesting that people with significant disability—as with non-significant disability—experience levels of quality of life similar to non-disabled people (
      • Albrecht Gary L.
      • Devlieger Patrick J.
      The Disability Paradox: High Quality Of Life Against All Odds.
      ,

      Ron Amundson, “Disability, Ideology, and Quality of Life: A Bias in Biomedical Ethics,” in Quality of Life and Human Difference: Genetic Testing, Health Care, and Disability, ed. David Wasserman, Jerome Bickenbach, and Robert Wachbroit, Cambridge Studies in Philosophy and Public Policy (Cambridge: Cambridge University Press, 2005), 101–124.

      ,
      • Wieseler Christine
      Objectivity as Neutrality, Nondisabled Ignorance, and Strong Objectivity in Biomedical Ethics in Advance.
      ). Tellingly, just 40.7 percent of physicians expressed confidence in their ability to provide the same quality of care to patients with significant disability as they do to non-disabled patients (
      • Iezzoni Lisa I.
      • Rao Sowmya R.
      • Ressalam Julie
      • Bolcic-Jankovic Dragana
      • Agaronnik Nicole D.
      • Donelan Karen
      • Lagu Tara
      • Campbell Eric G.
      Physicians’ Perceptions of People with Disability and Their Health Care.
      ). This is not just a matter of clinical judgment, but also of law. In a subsequent piece, more sobering details from the same study were released: 35.8 percent of physicians “reported knowing little or nothing about their legal responsibilities under the ADA, 71.2 percent answered incorrectly about who determines reasonable accommodations, 20.5 percent did not correctly identify who pays for these accommodations, and 68.4 felt that they were at risk for ADA lawsuits” (
      • Iezzoni Lisa I.
      • Rao Sowmya R.
      • Ressalam Julie
      • Bolcic-Jankovic Dragana
      • Agaronnik Nicole D.
      • Lagu Tara
      • Pendo Elizabeth
      • Campbell Eric G.
      US Physicians’ Knowledge About the Americans with Disabilities Act and Accommodation of Patients with Disability.
      ). This raises grave concerns regarding medical education and patient-practitioner communication (
      • Michael Reynolds Joel
      Three Things Clinicians Should Know About Disability.
      ,

      Rosemarie Garland-Thomson, “Human Biodiversity Conservation: A Consensual Ethical Principle,” The American Journal of Bioethics 15, no. 6 (June 3, 2015): 13–15.

      ,
      • Joseph A.
      Stramondo, “Why Bioethics Needs a Disability Moral Psychology.
      ,

      Lisa I. Iezzoni and Bonnie O’Day, More Than Ramps: A Guide To Improving Health Care Quality And Access For People With Disabilities (Oxford; New York: Oxford University Press, 2006).

      ,

      Lisa I. Iezzoni, “Eliminating Health and Health Care Disparities Among The Growing Population Of People With Disabilities,” Health Affairs 30, no. 10 (October 1, 2011): 1947–54.

      ).
      To take seriously the issue of disability inclusion, qualitative research rooted in the existing lives of disabled people must act as a touchstone. This is true even when such disability literature and activism is ambivalent with respect to biological psychiatry (e.g., the neurodiversity movement) or actively hostile to biological psychiatry (e.g., the C/S/X [consumer/survivor/ex-patient] movement) (

      Mohammed Abouelleil Rashed, Madness and the Demand for Recognition: A Philosophical Inquiry into Identity and Mental Health Activism, International Perspectives in Philosophy and Psychiatry (Oxford; New York: Oxford University Press, 2019).

      ,

      Curtis, T., R. Dellar, E. Leslie, and B. Watson, eds. 2000. Mad Pride: A Celebration of Mad Culture. Truro, United Kingdom: Chipmunkapublishing; "Disability and Madness," Special Issue of Disability Studies Quarterly, Vol 33, Issue 1, 2013, https://dsq-sds.org/issue/view/100.

      ). While community accountability and first-person testimony may not be easy to integrate, it is best practice for research and medical practice. While there are longstanding debates concerning how best to incorporate first-person testimony in ways that positively promote the interests of the patient or patient group in question, there is no lack of suggestions for actionable changes. Lisa I. Iezzoni et al. recommend that disability education be integrated into all levels of medical education; that curricula include an Implicit Association Test disability module; that training facilitate empathy through, for example, house calls; and that trainees learn to pay heightened attention to situations in which disabled patients are especially vulnerable (

      Iezzoni, Lisa I., Sowmya R. Rao, Julie Ressalam, Dragana Bolcic-Jankovic, Nicole D. Agaronnik, Karen Donelan, Tara Lagu, and Eric G. Campbell. 2021. “Physicians’ Perceptions Of People With Disability And Their Health Care.” Health Affairs 40 (2): 297–306. https://doi.org/10/ghzk3b.

      ,
      • Agaronnik N.
      • Campbell E.G.
      • Ressalam J.
      • Iezzoni L.I.
      Exploring issues relating to disability cultural competence among practicing physicians.
      ,
      • Lagu T.
      • Iezzoni L.I.
      • Lindenauer P.K.
      The axes of access—improving care for patients with disabilities.
      ,
      • Long-Bellil L.M.
      • Robey K.L.
      • Graham C.L.
      • Minihan P.M.
      • Smeltzer S.C.
      • Kahn P.
      • et al.
      Teaching medical students about disability: the use of stan- dardized patients.
      ,
      • Siebens H.
      • Cairns K.
      • Schalick 3rd, W.O.
      • Fondulis D.
      • Corcoran P.
      • Bartels E.
      PoWER program: people with disabilities educating residents.
      ,
      • Mello M.M.
      • Persad G.
      • White D.B.
      Respecting disability rights—toward improved crisis standards of care.
      ,
      • Crossley Mary
      Disability Cultural Competence In The Medical Profession.
      ,
      • Garland-Thomson Rosemarie
      • Iezzoni Lisa I.
      Disability Cultural Competence for All as a Model.
      ,

      Iezzoni, Lisa I., and Bonnie O’Day. 2006. More Than Ramps: A Guide To Improving Health Care Quality And Access For People With Disabilities. Oxford; New York: Oxford University Press.

      ,
      • Kirschner Kristi L.
      • Lou Breslin Mary
      • Iezzoni Lisa I.
      • Sandel Elizabeth
      Attending to Inclusion: People With Disabilities and Health-Care Reform.
      ,

      Reynolds, Joel Michael, and Christine Wieseler. Improving Accessibility and Quality of Care for Patients with Disabilities. Health Progress: Journal of the Catholic Health Association of the United States. March-April 2019. https://www.chausa.org/publications/health-progress/article/march-april-2019/improving-accessibility-and-quality-of-care-for-patients-with-disabilities.

      ). Turning to disability bioethics in particular, Reynolds and Wieseler recommend cultivating a critical comportment to ‘common sense’ claims about disability and instead embracing critical disability scholarship, which emphasizes testimony by and work from disabled people as well as participatory models of research and practice (

      Reynolds, Joel Michael, and Christine Wieseler. The Disability Bioethics Reader. London; New York: Routledge, 2022, 3.

      ).

      d. Reframing Pathology

      Perhaps the greatest challenge to disability inclusion for biological psychiatry is this: How can a field that deals with physical, neurological, and biochemical pathologies not contribute to but rather mitigate the widespread pathologization of disabled people? Today, ableist perceptions and stereotypes are rampant; many people implicitly or explicitly believe that there is something wrong with disabled people, that they need to be fixed, that they are less capable and have less to contribute (
      • Lewin Noa
      • Akhtar Nameera
      Neurodiversity and Deficit Perspectives in The Washington Post’s coverage of Autism.
      ). These biases are precisely what fuel academia’s tendencies not to include disabled people in higher education, provide access measures in classrooms and laboratories, engage disabled people in research, and give the first-person testimony of disabled people the weight it deserves.
      While there are numerous ways biological psychiatry (as well as STEM fields in general) can redress the harms of social pathologization, we briefly mention four here.
      • 1.
        These fields would do well to cultivate a humility about contemporary definitions of “normal function” and health (

        Quill (Rebecca) Kukla, “Medicalization, ‘Normal Function,’ and the Definition of Health,” in Routledge Companion to Bioethics, eds. Elizabeth Fenton, John D. Arras, and Rebecca Kukla (New York: Taylor & Francis, 2014), 515-530.

        ). As psychiatrists well know, advances in scientific knowledge and shifts in cultural attunements have, over the centuries, dramatically changed the definitions and treatments of disease (
        Anna Bredström, “Culture and Context in Mental Health Diagnosing: Scrutinizing the DSM-5 Revision.
        ,
        • Drescher Jack
        Queer Diagnoses Revisited
        The Past and Future of Homosexuality and Gender Diagnoses in DSM and ICD.
        ,
        • Samuels Ellen
        My Body, My Closet: Invisible Disability and the Limits of Coming-Out Discourse.
        ). There is no reason to think changes to current biomedical theory and practice are not imminent and disability inclusion may be one factor in turning the next corner.
      • 2.
        These fields would do well to resist the logic of cure, which assumes that deviations from “normal function” must be fixed or rectified. Disability theorists repeatedly underscore that to have a disability is not to have a defective body, but to have a minority body (

        Elizabeth Barnes, The Minority Body: A Theory of Disability (Oxford: Oxford University Press, 2016).

        ) or a bodymind (
        • Price Margaret
        The Bodymind Problem and the Possibilities of Pain.
        ) representative of the vast diversity in human life forms (

        Eli Clare, Brilliant Imperfection: Grappling with Cure (Durham: Duke University Press, 2017).

        ,

        Eunjung Kim, Curative Violence: Rehabilitating Disability, Gender, and Sexuality in Modern Korea (Durham: Duke University Press, 2017).

        ). While many disabled people value psychiatric treatment and support services—and rightly advocate for more, there is no reason for cure (or the erasure of disability) to be the first or primary response to disability (

        Joseph Stramondo, “A Critique of the Curative Imperative,” Surgery (November 8, 2021).

        ).
      • 3.
        These fields would do well to more consistently and deeply embrace patient choice, whether in the mode of treatment or the selection of treatment at all (

        Nev Jones, “Embracing Patient Choice,” British Journal of Psychiatry 201.6 (2012): 492.

        ). Patients’ knowledge of their own bodies and their autonomy over their experience of embodiment deserve the utmost respect. Where certain forms of disability, moreover, create the grounds for greater community, patients’ choice to retain those disabilities even in the face of cure deserves validation.
      • 4.
        These fields would do well to contribute to a greater scientific understanding and celebration of the rich intellectual, emotional, and social capacities that mark disabled bodyminds and disability communities (

        Gabi Serrato Marks and Skylar Bayer, “Our Disabilities Have Made Us Better Scientists,” Scientific American (July 10, 2019).

        ,

        H-Dirksen L. Bauman and Joseph J. Murray, “Deaf Studies in the 21st Century: ‘Deaf-Gain’ and the Future of Human Diversity,” Disability Studies Reader (London: Routledge, 2013), 246-260.

        ,

        Rosemarie Garland-Thomson, “Welcoming the Unexpected,” in Human Flourishing in an Age of Gene Editing, eds. Erik Parens and Josephine Johnston (Oxford: Oxford University Press, 2019), 15-28.

        ). Biological psychiatry in particular has the opportunity to underscore and support the creativity and curiosity inherent to neurodiversity (
        • Holly A.
        White and Priti Shah, “Uninhibited Imaginations: Creativity in Adults with Attention-Deficit/Hyperactivity Disorder.
        ,
        • Best Catherine
        • Arora Shruti
        • Porter Fiona
        • Doherty Martin
        The Relationship between Subthreshold Autistic Traits, Ambiguous Figure Perception, and Divergent Thinking.
        ,

        Kristina T. Johnson, “Autism, Neurodiversity, and Curiosity,” in Curiosity Studies: A New Ecology of Knowledge, eds. Perry Zurn and Arjun Shankar (Minneapolis: University of Minnesota Press, 2020), 129-146.

        ,

        Perry Zurn, “Cripping Curiosity,” in Curiosity and Power: The Politics of Inquiry (Minneapolis: University of Minnesota Press, 2021), 149-171.

        ).
      While biological psychiatry may need to catch up to some STEM fields in its efforts to expand DEI along the lines of gender and race, the field itself is poised to become a thought-leader in the realm of disability inclusion precisely because it intersects on an everyday basis with disability communities. The four main vectors of that opportunity—access and representation, community accountability, first-person testimony, and reframing pathology—sketch a landscape within which biological psychiatry can begin to play that leadership role. Working with and through disabled scientists and disability communities, moreover, will be critical to that venture.

      III. Practical Recommendations

      Based on the literatures in science, psychiatry, philosophy, and disability studies we have reviewed, we offer the following practical recommendations for expanding DEI initiatives in biological psychiatry to disability inclusion.

      Access and Representation:

      • Hire and retain disabled scientists.
      • Build mentorship networks for student and junior disabled scientists.
      • Enhance accessibility and aids for disabled scientists in classrooms, in laboratories, and on campus.
      • Reimagine disability access and universal design at national and international conferences.
      • Include disabled scientists among journal editors, editorial boards, reviewers, and authors.
      • Include disabled scientists among invited speakers, collaborators, organization leaders, etc.
      • Cite disabled scholars, especially when discussing research about psychiatric disabilities.
      • Collect data about disabled scientists in local, national, and international psychiatry organizations.
      • Institute grants and fellowships for disabled-scholar-led research and disability community engaged research.

      Community Accountability:

      • Include disabled people in study cohorts by default where appropriate.
      • Involve disabled people in the development (not simply consumption) of neurotechnologies.
      • Train non-disabled researchers in disability cultural awareness.
      • Build a pipeline and support for disabled scientists with the lived experience of a psychiatric disability to be among researchers and practitioners addressing that disability.

      First-Person Testimony:

      • Acknowledge first-person testimony of disabled people as a touchstone for disability inclusion, psychiatric research, and psychiatric practice.
      • Solicit first-person testimony through participatory research and patient-centered care.
      • Train medical practitioners to listen more effectively to their patients.

      Reframing Pathology:

      • Cultivate humility about current psychiatric theory and practice.
      • Resist assuming that deviations from “normal function” must, necessarily, be “cured.”
      • Honor patient choice and autonomy with respect to psychiatric treatment.
      • Celebrate the intellectual and social contributions of disability communities and of people with psychiatric disabilities and diseases in particular.
      • Celebrate the scholarly contributions of disabled scientists through, for example, awards, fellowships, citations, and other forms of recognition in science.

      IV. Future Research and Directions

      Of necessity, meaningful disability inclusion in biological psychiatry will change what research looks like, reconfiguring both the lines of its inquiry and the methods by which that inquiry is conducted. First, research questions should continue to explore the understanding of existing diseases, disorders, and disabilities, and the development of affordable and effective treatment for those who want it. In addition, however, investigators should devote greater attention to questions that explore the enhanced capacities certain neurodivergences afford in comparison to control populations. Such research would be centered less in a deficit model and more in a disability gain framework. Second, making research protocols more disability inclusive remains a significant challenge for the field. Common neuroimaging studies employing fMRI typically require participants to lay supine for extended periods of time, which excludes people with chronic pain or claustrophobia. Selection tasks, moreover, that require color recognition, visual acumen, verbal processing, and/or fine motor skills exclude people with blindness, language-processing disorders, and reduction of fine motor function. The problem of co-morbidities or co-disabilities, moreover, complicates things further, often excluding disabled people from a study relevant to one of their disabilities because of another. However, we are hopeful that these challenges to full accessibility can be met in at least some contexts and believe there are good justifications for the field to put forth the effort. Namely, co-disabilities present not just a challenge, but a motivation for including disabled research participants in studies. For example, if certain acquired disabilities arising from traumatic brain injury or spinal cord injury increase the likelihood of co-occurring PTSD, depression, and so on, then failing to study these intersections creates a significant gap in knowledge the field cannot simply ignore.
      The story both of science and of DEI has yet to be fully written. Where science will go—through what new discoveries, via what methods, and on whose shoulders—has yet to be determined. Similarly, the best practices for cultivating DEI in scholarly endeavors (as in life) may well proceed through an infinite number of revisions and reconfigurations. How we think about psychiatric disorders and diseases—and how we think about disability, for that matter—is sure to change not only in our lifetimes but well beyond them. Committing to enhance disability inclusion in biological psychiatry, then, involves listening to the wisdom available to us here and now, recognizing its limitations but also valuing its contributions. Having drawn on literature in science, psychiatry, philosophy, and disability studies, we outlined a series of vectors along which disability inclusion in biological psychiatry might be pursued. We offer that outline with an open hand. In whatever direction this conversation develops, we hope it involves a richer interface between scientific and disability communities, in which the former, perhaps paradoxically, also learns to follow.

      Uncited reference

      Jordan D. Dworkin, Kristin A. Linn, Erin G. Teich, Perry Zurn, Russell T. Shinohara, and Danielle S. Bassett, “The Extent and Drivers of Gender Imbalance in Neuroscience Reference Lists,” Nature Neuroscience (June 19, 2020). doi: 10.1038/s41593-020-0658-y.

      ,

      Maxwell A. Bertolero, Jordan D. Dworkin, Sophia U. David, Claudia López Lloreda, Pragya Srivastava, Jennifer Stiso, Dale Zhou, Kafui Dzirasa, Damien A. Fair, Antonia N. Kaczkurkin, Bianca Jones Marlin, Daphna Shohamy, Lucina Q. Uddin, Perry Zurn, Danielle S. Bassett, “Racial and Ethnic Imbalance in Neuroscience Reference Lists and Intersections with Gender,” Biorxiv.

      ,

      Perry Zurn, Danielle S. Bassett, and Nicole Rust, “The Citation Diversity Statement: A Practice of Transparency, A Way of Life,” Trends in Cognitive Sciences (2020).

      ,

      Jordan D. Dworkin, Perry Zurn, and Danielle S. Bassett, “(In)citing Action to Realize an Equitable Future,” Neuron 106.6 (June 17, 2020): 890-894.

      ,

      Gaile Pohlhaus, “Varieties of Epistemic Ignorance,” in The Routledge Handbook of Epistemic Injustice, eds. Ian James Kidd, Jose Medina, and Gaile Pohlhaus, Jr. (New Brunswick: Routledge, 2017), 13-26.

      ,

      Nancy Tuana and Shannon Sullivan, eds., Race and Epistemologies of Ignorance (New York: SUNY Press, 2007).

      ,

      “Women, Minorities, and Persons with Disabilities in Science and Engineering,” National Science Foundation (April 2021), https://ncses.nsf.gov/pubs/nsf21321/.

      ,

      ACD Working Group on Diversity, Subgroup on Individuals with Disabilities, National Institutes of Health (Accessed February 11, 2022), https://www.acd.od.nih.gov/working-groups/disabilitiessubgroup.html.

      .

      Acknowledgments

      From the revision stage of this article forward, JMR received funding from The Greenwall Foundation as part of the project “Addressing the Roots of Disability Health Disparities.” This work was not otherwise funded by grants or other forms of financial support.

      References

        • Dunn Dana S.
        • Andrews Erin E.
        Person-First and Identity-First Language: Developing Psychologists’ Cultural Competence Using Disability Language.
        American Psychologist. 2015; 70: 255-263
        • Halmari Helena
        • Correctness Political
        Euphemism, and Language Change: The Case of ‘People First.
        Journal of Pragmatics. 2011; 43: 828-840
        • Morton Ann Gernsbacher
        The Use of Person-First Language in Scholarly Writing May Accentuate Stigma.
        Journal of Child Psychology and Psychiatry. 2017; 58: 859-861
        • Botha Monique
        • Hanlon Jacqueline
        • Williams Gemma Louise
        Does Language Matter? Identity-First Versus Person-First Language Use in Autism Research: A Response to Vivanti.
        Journal of Autism and Developmental Disorders. 2021; : 1-9
      1. Asmeret Asefaw Berhe, Rebecca T. Barnes, Meredith G. Hastings, Allison Mattheis, Blair Schneider, Billy M. Williams, and Erika Marin-Spiotta, “Scientists from Historically Excluded Groups Face a Hostile Obstacle Course,” Nature Geoscience 15 (2022): 2-4.

      2. Gabriella Gitierrez y Muhs, Yolanda Flores, Carmen G. Gonzalez, and Angela P. Harris, eds., Presumed Incompetent: The Intersections of Race and Women in Academia (Logan: Utah State University Press, 2012).

      3. Yolanda Flores, Gabriella Gitierrez y Muhs, Carmen G. Gonzalez, Presumed Incompetent II: Race, Class, Power and Resistance of Women in Academia (Logan: Utah State University Press, 2020).

        • Reshma J.
        Sex Differences in Attainment of Independent Funding by Career Development Awardees.
        Annals of Internal Medicine. 2009; 151: 804-811
        • van der Lee R.
        • Elemers N.
        Gender Contributes to Personal research Funding Success in the Netherlands.
        PNAS. 2015; 112: 12349-12353
      4. Donna K Ginther, Walter T. Schaffer, Joshua Schnell, Beth Masimore, Faye Liu, Laurel L. Haak, and Raynard Kington, “Race, Ethnicity, and NIH Research Awards,” Science 333.6045 (2011): 1015-1019.

        • Hoppe Travis A.
        • Litovitz Aviva
        • Willis Kristine A.
        • Meseroll Rebecca A.
        • Perkins Matthew J.
        • Ian Hutchins B.
        • Davis Alison F.
        • Lauer Michael S.
        • Valentine Hannah A.
        • Anderson James M.
        • Santangelo George M.
        Topic Choice Contributes to the Lower Rate of NIH Awards to African-American/Black Scientists.
        Science Advances. 2019; 5eaaw7238
        • Nielson M.W.
        Limits to Meritocracy? Gender in Academic Recruitment and Promotion Processes.
        Science and Public Policy. 2016; 43: 386-399
        • DePaola M.
        • Scoppa V.
        Gender Discrimination a evaluators Gender: Evidence from Italian Academia.
        Economica. 2015; 82: 162-188
      5. Joanna R. Jackson, Ann M. Holmes, Elizabeth Gloembiewski, Brittany L. Brown-Podgorski, and Nir Menachemi, “Graduation and Academic Placement of Underrepresented Racial/Ethnic Minority Doctoral Recipients in Public Health Disciplines, United States, 2003-2015,” Public Health Rep, 134.1 (2017): 63-71.

        • Fang Di
        • Moy Ernest
        • Colburn Louis
        • Hurley Jeanne
        Racial and Ethnic Disparities in Faculty Promotion in Academic Medicine.
        JAMA. 2000; 284: 1085-1092
        • Mengel F.
        • Sauermann J.
        • Zolitz U.
        Gender Bias in Teaching Evaluations.
        Journal of European Economic Association. 2019; 17: 535-566
        • Boring A.
        Gender Biases in Student Evaluations of Teaching.
        Journal of Public Economics. 2017; 145: 24-41
      6. Dana A. Williams, “Examining the Relation between Race and Student Evaluations of Faculty Members: A Literature Review,” Profession (2007): 168-173.

        • West J.D.
        • Jacquet J.
        • King M.M.
        • Correll S.J.
        • Bergstrom C.T.
        The Role of Gender in Scholarly Authorship.
        PLoS ONE. 2013; 8e66212
      7. J. Huang, A. J. Gates, R. Sinatra, and A.-L. Barabasi, “Historical Comparison of Gender Inequality in Scientific Careers Across Countries and Disciplines,” PNAS 117 (2020): 4609-4616.

        • Caplar N.
        • Tacchella S.
        • Birrer S.
        Quantitative Evaluation of Gender Bias in Astronomical Publications from Citation Counts.
        Nature Astronomy. 2017; 10141
      8. P. Chakravartty, R. Kuo, V. Grubbs, and C. McIlwain “#CommunicationSoWhite,” Journal of Communication 68.2 (2018): 254–266; Cite Black Women, Home, available at: https://www.citeblackwomencollective.org/ (Accessed: January 29, 2022).

      9. Neha Kumar, and Naveena Karusala, “Braving Citational Justice within Human-Computer Interaction,” (November 11, 2020), https://nehakumar.medium.com/braving-citational-justice-within-hci-5b43c1436fbc.

      10. Athene Donald, “Getting Universities’ People and Culture Right,” (August 27, 2021), http://occamstypewriter.org/athenedonald/2021/08/27/getting-universities-people-and-culture-right/.

        • Tzovara Athina
        • Amarreh Ishmael
        • Borghesani Valentina
        • Maller Chakravarty M.
        • DuPre Elizabeth
        • Grefkes Christian
        • Amelie Haugg
        • Lee Jollans
        • Lee Hyang Woon
        • Newman Sharlene D.
        • Olsen Rosanna K.
        • Tilak Ratnanather J.
        • Gina Rippon
        • Uddin Lucina Q.
        • Maria L.
        • Vega Bringas
        • Veldsman Michele
        • White Tonya
        • Badhwar AmanPreet
        Embracing Diversity and Inclusivity in an Academic Setting: Insights from the Organization for Human Brain Mapping.
        Neuroimage. 2021; 229117742
        • Valantine Hannah A.
        • Collins Francis S.
        National Institutes of Health Addresses the Science of Diversity.
        PNAS. 2015; 112: 12240-12242
        • Lokko Hermioni N.
        • Chen Justin A.
        • Parekh Ranna I.
        • Stern Theodore A.
        Racial and Ethnic Diversity in the US Psychiatric Workforce: A Perspective and Recommendations.
        Academic Psychiatry. 2016; 40: 898-904
      11. Hermioni L. Amonoo, Nomi C Levy-Carrick, Ashwini Nadkarni, Samara J Grossman, David Green, Regina M. Longley, David Silbersweig, Christopher AhnAllen, “Diversity, Equity, and Inclusion Committee: An Instrument to Champion Diversity Efforts Within a Large Academic Psychiatry Department,” Psychiatric Services 73.2 (2022): 223-226.

      12. Society of Biological Psychiatry, “Diversity and Inclusion” (Accessed February 2022), https://sobp.org/diversity-and-inclusion/.

        • Hart Kamber L.
        Sophia Frangou, and Roy H. Perlis, “Gender Trends in Authorship in Psychiatry Journals from 2008 to 2018.
        Biological Psychiatry. 2019; 86: 639-646
        • Carrie E.
        Bearden, “Accelerating the Bending Arc Toward Equality: A Commentary on Gender Trends in Authorship in Psychiatry Journals.
        Biological Psychiatry. 2019; 86: 575-576
        • Jordan Chloe J.
        • Carlezon Jr., William A.
        Neuropsychopharmacology (NPP): Gender Balance in Journal Function.
        Neuropsychopharmacology. 2019; 44: 4-8
        • Leibenluft Ellen
        Increasing Diversity in Science: It Begins with All of Us.
        Biological Psychiatry. 2020; 87: 379-381
      13. Jordan D. Dworkin, Kristin A. Linn, Erin G. Teich, Perry Zurn, Russell T. Shinohara, and Danielle S. Bassett, “The Extent and Drivers of Gender Imbalance in Neuroscience Reference Lists,” Nature Neuroscience (June 19, 2020). doi: 10.1038/s41593-020-0658-y.

      14. Maxwell A. Bertolero, Jordan D. Dworkin, Sophia U. David, Claudia López Lloreda, Pragya Srivastava, Jennifer Stiso, Dale Zhou, Kafui Dzirasa, Damien A. Fair, Antonia N. Kaczkurkin, Bianca Jones Marlin, Daphna Shohamy, Lucina Q. Uddin, Perry Zurn, Danielle S. Bassett, “Racial and Ethnic Imbalance in Neuroscience Reference Lists and Intersections with Gender,” Biorxiv.

      15. Xinyi Wang, Jordan Dworkin, Dale Zhou, Jenny Stiso, Danielle S. Bassett, Perry Zurn, and David Lydon-Staley, “Gendered Citation Practices in Communication Research,” Annals of the International Communication Association (2021).

        • Fulvio Jacqueline M.
        • Akinnola Ileri
        • Postle Bradley R.
        Gender (Im)Balance in Citation Practices in Cognitive Neuroscience.
        Journal of Cognitive Neuroscience. 2021; 33: 3-7
        • Chatterjee Paula
        • Werner Rachel M.
        Gender Disparity in Citations in High-Impact Journal Articles.
        JAMA Network Open. 2021; 4e2114509
      16. Erin G. Teich, Jason Z. Kim, Christopher Lynn, Samantha C. Simon, Andrei Klishin, Karol Szymula, Pragya Srivastava, Lee Bassett, Perry Zurn, Jordan Dworkin, and Dani S. Bassett, “Citation Inequity and Gender Citation Practices in Contemporary Physics,” arXiv.

      17. Perry Zurn, Danielle S. Bassett, and Nicole Rust, “The Citation Diversity Statement: A Practice of Transparency, A Way of Life,” Trends in Cognitive Sciences (2020).

      18. Jordan D. Dworkin, Perry Zurn, and Danielle S. Bassett, “(In)citing Action to Realize an Equitable Future,” Neuron 106.6 (June 17, 2020): 890-894.

      19. Perry Zurn, Erin G. Teich, Samantha C. Simon, Jason Z. Kim, and Dani S. Bassett, “Supporting Academic Equity in Physics through Citation Diversity,” Nature Communications Physics (under review).

        • Sweet Deborah
        New at Cell Press: The Inclusion and Diversity Statement.
        Cell. 2021; 184: 1-2
      20. Hannah A. Valantine and Francis S. Collins, “National Institutes of Health Addresses the Science of Diversity,” PNAS 112.40 (2015): 12240-12242; https://direct.mit.edu/jocn/pages/submission-guidelines.

        • Tzovara Athina
        • Amarreh Ishmael
        • Borghesani Valentina
        • Maller Chakravarty M.
        • DuPre Elizabeth
        • Grefkes Christian
        • Amelie Haugg
        • Lee Jollans
        • Lee Hyang Woon
        • Newman Sharlene D.
        • Olsen Rosanna K.
        • Tilak Ratnanather J.
        • Gina Rippon
        • Uddin Lucina Q.
        • Maria L.
        • Vega Bringas
        • Veldsman Michele
        • White Tonya
        • Badhwar AmanPreet
        Embracing Diversity and Inclusivity in an Academic Setting: Insights from the Organization for Human Brain Mapping.
        Neuroimage. 2021; 229117742
      21. Biological Psychiatry, “Editorial Policies” (Accessed February 2022), https://www.biologicalpsychiatryjournal.com/article/S0006-3223(21)01808-4/fulltext#sec3.6.3.

        • Thurston Linda P.
        • Cindy Shuman B.
        Jan Middendorf, Cassandra Johnson, “Postsecondary STEM Education for Students with Disabilities: Lessons Learned from a Decade of NSF Funding.
        Journal of Postsecondary Education and Disability. 2017; 30: 49-60
      22. Gaile Pohlhaus, “Varieties of Epistemic Ignorance,” in The Routledge Handbook of Epistemic Injustice, eds. Ian James Kidd, Jose Medina, and Gaile Pohlhaus, Jr. (New Brunswick: Routledge, 2017), 13-26.

      23. Nancy Tuana and Shannon Sullivan, eds., Race and Epistemologies of Ignorance (New York: SUNY Press, 2007).

        • Scott Bellman
        • Burgstahler Sheryl
        • Chudler Eric H.
        Broadening Participation by Including More Individuals with Disabilities in STEM: Promising Practices from an Engineering Research Center.
        American Behavioral Sciences. 2018; 62: 645-656
      24. “Women, Minorities, and Persons with Disabilities in Science and Engineering,” National Science Foundation (April 2021), https://ncses.nsf.gov/pubs/nsf21321/.

      25. Beatriz Munoz and Lisa M. Meeks, “A Decade of Decline: Grant Funding for Researchers with Disabilities 2008 to 2018,” PLoS ONE (2020): 0228686.

      26. ACD Working Group on Diversity, Subgroup on Individuals with Disabilities, National Institutes of Health (Accessed February 11, 2022), https://www.acd.od.nih.gov/working-groups/disabilitiessubgroup.html.

        • Wilson Jan Doolittle
        Reimagining Disability and Inclusive Education Through Universal Design for Learning.
        Disability Studies Quarterly. 2017; 371041578
      27. James Charlton, Nothing About Us, Without Us: Disability Oppression and Empowerment (Oakland: University of California Press, 2000).

      28. Jackie Leach Scully, Disability Bioethics: Moral Bodies, Moral Difference (Lanham: Rowman and Littlefield, 2008).

      29. Mary Mahowald, “A Feminist Standpoint,” in Disability, Difference, Discrimination: Perspectives on Justice in Bioethics and Public Policy, eds. Anita Silvers, David Wasserman, and Mary B Mahowald (Lanham: Rowman & Littlefield, 1998), 211-252.

      30. Jackie Leach Scully, “Moral Bodies: Epistemologies of Embodiment,” in Naturalized Bioethics: Toward Responsible Knowing and Practice, eds. Hilde Lindemann, Marian Verkerk & Margaret Urban Walker (Cambridge: Cambridge University Press, 2009), 23-41.

      31. Sara Goering and Eran Klein, “Neurotechnologies and Justice by, with, and for Disabled People,” in The Oxford Handbook of Philosophy and Disability, eds. David Wasserman and Adam Cureton (New York, NY: Oxford University Press, 2020), 616-632.

        • Sabatello Maya
        • Chen Ying
        • Zhang Yuan
        • Paul S.
        Appelbaum, “Disability Inclusion in Precision Medicine Research: A First National Survey.
        Genetics in Medicine. 2019; 21: 2319-2327
        • Sabatello Maya
        • Zhang Yuan
        • Chen Ying
        • Paul S.
        Appelbaum, “In Different Voices: The Views of People with Disability about Return of Results from Precision Medicine Research.
        Public Health Genomics. 2020; 23: 42-53
        • Sabatello Maya
        • Inclusivity Cultivating
        • Precision Medicine Research
        Disability, Diversity, and Cultural Competence.
        Journal of Community Genetics. 2019; 10: 363-373
        • Garland-Thomson Rosemarie
        • Iezzoni Lisa I.
        Disability Cultural Competence for All as a Model.
        The American Journal of Bioethics. 2021; 21: 26-28
        • Jones Nev
        • Atterbury Kendall
        • Byrne Louise
        • Carras Michelle
        • Brown Marie
        • Phalen Peter
        Lived Experience, Research Leadership and the Transformation of Mental Health Services: Building a Pipeline.
        Psychiatric Services. 2021; 72: 591-593
        • Jones Nev
        • Niu Grace
        • Thomas Marilyn
        • Riano Nichoals S.
        • Hinshaw Stephen P.
        • Mangurian Christina
        Peer Specialists in Community Mental Health: Ongoing Challenges of Real-World Inclusion.
        Psychiatric Services. 2019; 70: 1172-1175
      32. Sarah Kamens, Larry Davidson, Emily Hyun, Nev Jones, Jill Morawski, Matthew Kurtz, Jessica Pollard, Nev Jones, “Taking Issue: Rethinking Consumer Empowerment (and Systems Change) through the Lessons of Self-Directed Care,” Psychiatric Services (2019).

        • Kalathil Jayasree
        • Jones Nev
        Unsettling Disciplines: Madness, Identity, Research, Knowledge.
        Philosophy, Psychiatry & Psychology. 2016; 23: 183-188
      33. Henri-Jacques Stiker, A History Of Disability (Ann Arbor: University of Michigan Press, 1999); Kim E. Nielsen, A Disability History of The United States (Boston: Beacon Press, 2012).

      34. Michael Rembis, Kim Nielsen, and Catherine Kudlick, eds., The Oxford Handbook of Disability History (Oxford, New York: Oxford University Press, 2018).

      35. Harriet A. Washington, Medical Apartheid: The Dark History Of Medical Experimentation On Black Americans From Colonial Times To The Present (New York: Anchor Books, 2008).

      36. Nancy Ordover, American Eugenics: Race, Queer Anatomy, and the Science of Nationalism (Minneapolis: University of Minnesota Press, 2003).

      37. Robert A. Wilson, The Eugenic Mind Project (Cambridge, MA, USA: MIT Press, 2017).

      38. Lennard J. Davis, The Disability Studies Reader, 5th ed. (New York: Routledge, 2016).

        • Joel Michael Reynolds and Teresa Blankmeyer Burke
        Introducing The Journal of Philosophy of Disability.
        Journal of Philosophy of Disability. 2021; 1: 3-10
        • Messas Guilherme
        • Tamelini Melissa
        • Mancini Melina
        • Stanghellini Giovanni
        New Perspectives in Phenomenological Psychopathology: Its Use in Psychiatric Treatment.
        Front Psychiatry. 2018; 9: 466
      39. Giovanni Stanghellini, “Phenomenological Psychopathology and Psychotherapy,” The Oxford Handbook of Phenomenological Psychopathology, eds. Giovanni Stanghellini, Matthew Broome, Andrea Raballo, Anthony Vincent Fernandez, Paolo Fusar-Poli, Rene Rosfort (Oxford: Oxford University Press; 2019), 952-971.

      40. Anthony Vincent Fernandez, “Phenomenological Psychopathology and Psychiatric Classification,” in The Oxford Handbook of Phenomenological Psychopathology, eds. Giovanni Stanghellini, Matthew Broome, Andrea Raballo, Anthony Vincent Fernandez, Paolo Fusar-Poli, Rene Rosfort (Oxford: Oxford University Press; 2019), 1016-1030.

        • Gerrit Ian van Schalkwyk
        • Srihari Vinod
        The Duration of Untreated Psychosis: A Phenomenological Study.
        Psychosis. 2018; 10: 307-318
        • Daley Tamara C.
        • Jones Nev
        • George Preethy
        • Rosenblatt Abram
        First Person Accounts of Change among 80. Young Adults with a First Episode of Psychosis.
        Psychiatric Services. 2020; 71: 1277-1284
      41. Mohammed Abouelleil Rashed, Madness and the Demand for Recognition: A Philosophical Inquiry into Identity and Mental Health Activism, International Perspectives in Philosophy and Psychiatry (Oxford; New York: Oxford University Press, 2019).

      42. Curtis, T., R. Dellar, E. Leslie, and B. Watson, eds. 2000. Mad Pride: A Celebration of Mad Culture. Truro, United Kingdom: Chipmunkapublishing; "Disability and Madness," Special Issue of Disability Studies Quarterly, Vol 33, Issue 1, 2013, https://dsq-sds.org/issue/view/100.

      43. Joel Michael Reynolds and David M. Peña-Guzmán, “The Harm of Ableism: Medical Error and Epistemic Injustice,” Kennedy Institute of Ethics Journal 29.3 (2019): 205–42.

        • Iezzoni Lisa I.
        • Rao Sowmya R.
        • Ressalam Julie
        • Bolcic-Jankovic Dragana
        • Agaronnik Nicole D.
        • Donelan Karen
        • Lagu Tara
        • Campbell Eric G.
        Physicians’ Perceptions of People with Disability and Their Health Care.
        Health Affairs. February 1, 2021; 40: 297-306
        • Albrecht Gary L.
        • Devlieger Patrick J.
        The Disability Paradox: High Quality Of Life Against All Odds.
        Social Science & Medicine. 1999; 48: 977-988
      44. Ron Amundson, “Disability, Ideology, and Quality of Life: A Bias in Biomedical Ethics,” in Quality of Life and Human Difference: Genetic Testing, Health Care, and Disability, ed. David Wasserman, Jerome Bickenbach, and Robert Wachbroit, Cambridge Studies in Philosophy and Public Policy (Cambridge: Cambridge University Press, 2005), 101–124.

        • Wieseler Christine
        Objectivity as Neutrality, Nondisabled Ignorance, and Strong Objectivity in Biomedical Ethics in Advance.
        Social Philosophy Today. 2016; 32: 85-106
        • Iezzoni Lisa I.
        • Rao Sowmya R.
        • Ressalam Julie
        • Bolcic-Jankovic Dragana
        • Agaronnik Nicole D.
        • Lagu Tara
        • Pendo Elizabeth
        • Campbell Eric G.
        US Physicians’ Knowledge About the Americans with Disabilities Act and Accommodation of Patients with Disability.
        Health Affairs. January 2022; 41: 96-104
        • Michael Reynolds Joel
        Three Things Clinicians Should Know About Disability.
        AMA Journal of Ethics. 2018; 20 (E1181–87)
      45. Rosemarie Garland-Thomson, “Human Biodiversity Conservation: A Consensual Ethical Principle,” The American Journal of Bioethics 15, no. 6 (June 3, 2015): 13–15.

        • Joseph A.
        Stramondo, “Why Bioethics Needs a Disability Moral Psychology.
        Hastings Center Report. 2016; 46: 22-30
      46. Lisa I. Iezzoni and Bonnie O’Day, More Than Ramps: A Guide To Improving Health Care Quality And Access For People With Disabilities (Oxford; New York: Oxford University Press, 2006).

      47. Lisa I. Iezzoni, “Eliminating Health and Health Care Disparities Among The Growing Population Of People With Disabilities,” Health Affairs 30, no. 10 (October 1, 2011): 1947–54.

        • Lewin Noa
        • Akhtar Nameera
        Neurodiversity and Deficit Perspectives in The Washington Post’s coverage of Autism.
        Disability & Society. 2021; 36: 812-833
      48. Quill (Rebecca) Kukla, “Medicalization, ‘Normal Function,’ and the Definition of Health,” in Routledge Companion to Bioethics, eds. Elizabeth Fenton, John D. Arras, and Rebecca Kukla (New York: Taylor & Francis, 2014), 515-530.

      49. Elizabeth Barnes, The Minority Body: A Theory of Disability (Oxford: Oxford University Press, 2016).

        • Price Margaret
        The Bodymind Problem and the Possibilities of Pain.
        Hypatia. 2015; 30: 268-284
      50. Eli Clare, Brilliant Imperfection: Grappling with Cure (Durham: Duke University Press, 2017).

      51. Eunjung Kim, Curative Violence: Rehabilitating Disability, Gender, and Sexuality in Modern Korea (Durham: Duke University Press, 2017).

      52. Joseph Stramondo, “A Critique of the Curative Imperative,” Surgery (November 8, 2021).

      53. Nev Jones, “Embracing Patient Choice,” British Journal of Psychiatry 201.6 (2012): 492.

      54. Gabi Serrato Marks and Skylar Bayer, “Our Disabilities Have Made Us Better Scientists,” Scientific American (July 10, 2019).

      55. H-Dirksen L. Bauman and Joseph J. Murray, “Deaf Studies in the 21st Century: ‘Deaf-Gain’ and the Future of Human Diversity,” Disability Studies Reader (London: Routledge, 2013), 246-260.

      56. Rosemarie Garland-Thomson, “Welcoming the Unexpected,” in Human Flourishing in an Age of Gene Editing, eds. Erik Parens and Josephine Johnston (Oxford: Oxford University Press, 2019), 15-28.

        • Holly A.
        White and Priti Shah, “Uninhibited Imaginations: Creativity in Adults with Attention-Deficit/Hyperactivity Disorder.
        Personality and Individual Differences. 2006; 40: 1121-1131
        • Best Catherine
        • Arora Shruti
        • Porter Fiona
        • Doherty Martin
        The Relationship between Subthreshold Autistic Traits, Ambiguous Figure Perception, and Divergent Thinking.
        Journal of Autism and Developmental Disorders. 2015; 45: 4064-4073
      57. Kristina T. Johnson, “Autism, Neurodiversity, and Curiosity,” in Curiosity Studies: A New Ecology of Knowledge, eds. Perry Zurn and Arjun Shankar (Minneapolis: University of Minnesota Press, 2020), 129-146.

      58. Perry Zurn, “Cripping Curiosity,” in Curiosity and Power: The Politics of Inquiry (Minneapolis: University of Minnesota Press, 2021), 149-171.

      59. Leah Lakshi Piepzna-Samarasinha, Care Work: Dreaming Disability Justice (Vancouver: Arsenal Pulp Press, 2018).

      60. Anna Bredström, “Culture and Context in Mental Health Diagnosing: Scrutinizing the DSM-5 Revision.
        Journal of Medical Humanities. 2019; 40: 347-363
        • Drescher Jack
        • Queer Diagnoses Revisited
        The Past and Future of Homosexuality and Gender Diagnoses in DSM and ICD.
        International Review of Psychiatry. 2015; 27: 386-395
        • Griffin Edward
        • Pollak David
        Student Experiences of Neurodiversity in Higher Education: Insights from the BRAINHE Project.
        Dyslexia. 2009; 15: 23-41
        • Chapman Robert
        Neurodiversity and the Social Ecology of Mental Functions.
        Perspectives in Psychological Science. 2021; 16: 1360-1372
      61. Lawrence K. Fung, ed., Neurodiversity: From Phenomenology to Neurobiology and Enhancing Technologies (Washington, DC: American Psychiatric Association Publishing, 2021).

        • Sumner K.E.
        • Brown T.J.
        Neurodiversity and Human Resource Management: Employer Challenges for Applicants and Employees with Learning Disabilities.
        The Psychologist-Manager Journal 18. 2015; 2: 77-85
        • Anna Krzeminska
        • Austin Robert D.
        • Bruyère Susanne M.
        • Hedley Darren
        The Advantages and Challenges of Neurodiversity Employment in Organizations.
        Journal of Management & Organization. 2019; 25: 453-463
        • Saleh Matt
        Susanne Marie Bruyère, “Leveraging Employer Practices in Global Regulatory Frameworks to Improve Employment Outcomes for People with Disabilities.
        Journal of Social Inclusion. 2018; 6
      62. Eli Clare, “Body Shame, Body Pride: Lessons from the Disability Rights Movement,” in The Transgender Studies Reader 2 (New York: Routledge, 2013), 261-265.

      63. Mia Mingus, “Forced Intimacy: An Ableist Norm,” Leaving Evidence blog (August 6, 2017), https://leavingevidence.wordpress.com/2017/08/06/forced-intimacy-an-ableist-norm/.

      64. Monique A. M. Gignac, Julie Bowring, Arif Jetha, Dorcas E. Beaton, F. Curtis Breslin, Renee-Louise Franche, Emma Irvin, Joy C. Macdermid, William S. Shaw, Peter M. Smith, Aaron Thompson, Emile Tompa, Dwayne Van Eerd, and Ron Saunders, “Disclosure, Privacy, and Workplace Accommodation of Episode Disabilities: Organizational Perspectives on Disability Communication-Support Processes to Sustain Employment,” Journal of Occupational Rehabilitation 31 (2021): 153-165.

      65. Brenda A LeFrancois, Geoffrey Reaumea, and Robert J. Menzies, Mad Matters: A Critical Reader in Canadian Mad Studies (Ontario: Canadian Scholars’ Press Incorporated, 2013). \

      66. Iezzoni, Lisa I., Sowmya R. Rao, Julie Ressalam, Dragana Bolcic-Jankovic, Nicole D. Agaronnik, Karen Donelan, Tara Lagu, and Eric G. Campbell. 2021. “Physicians’ Perceptions Of People With Disability And Their Health Care.” Health Affairs 40 (2): 297–306. https://doi.org/10/ghzk3b.

        • Agaronnik N.
        • Campbell E.G.
        • Ressalam J.
        • Iezzoni L.I.
        Exploring issues relating to disability cultural competence among practicing physicians.
        Disabil Health J. 2019; 12: 403-410
        • Lagu T.
        • Iezzoni L.I.
        • Lindenauer P.K.
        The axes of access—improving care for patients with disabilities.
        N Engl J Med. 2014; 370: 1847-1851
        • Long-Bellil L.M.
        • Robey K.L.
        • Graham C.L.
        • Minihan P.M.
        • Smeltzer S.C.
        • Kahn P.
        • et al.
        Teaching medical students about disability: the use of stan- dardized patients.
        Acad Med. 2011; 86: 1163-1170
        • Siebens H.
        • Cairns K.
        • Schalick 3rd, W.O.
        • Fondulis D.
        • Corcoran P.
        • Bartels E.
        PoWER program: people with disabilities educating residents.
        Am J Phys Med Rehabil. 2004; 83: 203-209
        • Mello M.M.
        • Persad G.
        • White D.B.
        Respecting disability rights—toward improved crisis standards of care.
        N Engl J Med. 2020; 383: e26
        • Crossley Mary
        Disability Cultural Competence In The Medical Profession.
        Saint Louis University Journal of Health Law & Policy. 2015; 9: 89-109
        • Garland-Thomson Rosemarie
        • Iezzoni Lisa I.
        Disability Cultural Competence for All as a Model.
        The American Journal of Bioethics. 2021; 21: 26-28https://doi.org/10.1080/15265161.2021.1958652
      67. Iezzoni, Lisa I., and Bonnie O’Day. 2006. More Than Ramps: A Guide To Improving Health Care Quality And Access For People With Disabilities. Oxford; New York: Oxford University Press.

        • Kirschner Kristi L.
        • Lou Breslin Mary
        • Iezzoni Lisa I.
        • Sandel Elizabeth
        Attending to Inclusion: People With Disabilities and Health-Care Reform.
        PM&R. 2009; 1: 957-963https://doi.org/10.1016/j.pmrj.2009.09.001
      68. Reynolds, Joel Michael, and Christine Wieseler. Improving Accessibility and Quality of Care for Patients with Disabilities. Health Progress: Journal of the Catholic Health Association of the United States. March-April 2019. https://www.chausa.org/publications/health-progress/article/march-april-2019/improving-accessibility-and-quality-of-care-for-patients-with-disabilities.

      69. Reynolds, Joel Michael, and Christine Wieseler. The Disability Bioethics Reader. London; New York: Routledge, 2022, 3.

        • Samuels Ellen
        My Body, My Closet: Invisible Disability and the Limits of Coming-Out Discourse.
        GLQ: A Journal of Lesbian and Gay Studies. 2003; 9: 233-255