Beyond the Diagnosis: Navigating Internalized Pathology After Labels

Bridgette Hamstead

For many late-diagnosed autistic and otherwise neurodivergent adults, receiving a diagnosis can be a deeply validating and life-changing moment. It provides an explanation for a lifetime of feeling different, struggling in ways that others seemed not to, and never quite understanding why the world felt harder than it should. A diagnosis can offer relief, clarity, and even joy. But after the initial wave of affirmation, another quieter process begins. The path forward involves not only understanding the diagnosis but also reckoning with the years of internalized pathology and shame that came long before it. Being told, finally, that you are autistic or ADHD does not erase the damage of a lifetime spent thinking you were broken.

Many of us grew up believing that our struggles were personal failings. We internalized the belief that we were lazy, overly sensitive, socially inept, unreliable, or simply not trying hard enough. We were often punished, rejected, or dismissed for behaviors that we now understand as natural neurodivergent traits. Even in adulthood, we carried those messages with us into workplaces, relationships, parenting, and everyday interactions. The diagnosis might have named our neurotype, but it did not automatically dismantle the deeply embedded narratives that told us our way of being was wrong. Instead, many of us find ourselves caught in a strange liminal space where we intellectually understand that we are neurodivergent, but we continue to judge ourselves through a neurotypical lens.

This tension is especially intense for those who masked effectively for years. Masking becomes a way of life, a survival strategy so ingrained that it feels automatic. Even after diagnosis, many continue to mask without realizing it. We suppress our stims, force ourselves to maintain eye contact, push through sensory overwhelm, and speak in socially acceptable tones even when we are in pain. We do it because the alternative has always been rejection, ridicule, or punishment. It takes time and intentional effort to unlearn the belief that masking is required for safety. Even more challenging is unlearning the idea that our unmasked selves are inherently less worthy, lovable, or competent.

Pathologization does not disappear with diagnosis. In fact, diagnosis often comes from within systems that continue to frame neurodivergence through a medicalized, deficit-based lens. Most diagnostic criteria for autism and ADHD are written to identify what we lack rather than to understand how we function. The language used is clinical, dehumanizing, and often disconnected from lived experience. Traits like intense focus, sensory sensitivity, pattern recognition, or emotional depth are framed as dysfunctions instead of variations. This framing reinforces the idea that we are fundamentally disordered and in need of correction. Even when we find the diagnosis validating, we absorb the language of pathology in ways that can deepen our shame.

For those of us who were diagnosed later in life, there is often grief woven into this process. We grieve the years we lost to misunderstanding ourselves. We grieve the relationships damaged by our inability to explain what we were experiencing. We grieve the career paths we abandoned, the classrooms that failed us, the friendships that faded, and the moments we masked through until we shut down. Alongside that grief is the painful awareness that many of the systems we now seek support from are still not safe or affirming. Many clinicians, educators, and even support groups continue to operate from a framework that views neurodivergent people as impaired rather than simply different. When we turn to these systems for help, we often encounter the same ableist assumptions that harmed us in the first place.

Navigating internalized pathology requires not only unlearning but rebuilding. It is not enough to reject the messages we were given. We must actively construct a new narrative that affirms our neurodivergence and honors our lived experience. This often happens most powerfully in community. When we are in spaces with other neurodivergent people, we begin to see ourselves reflected with compassion and complexity. We realize that what we thought were personal failings are shared experiences. We learn new language that reframes our behaviors, needs, and patterns in more affirming ways. We stop calling ourselves lazy and start recognizing executive dysfunction. We stop apologizing for needing quiet and start naming sensory regulation as a valid need. We stop forcing eye contact and start noticing how much better we feel when we don’t.

This is not a quick process. It is layered, nonlinear, and often painful. Internalized ableism is sneaky. It can show up even in spaces that claim to be neurodivergent-affirming. It can sound like self-doubt, perfectionism, harsh inner criticism, or fear of being too much. Sometimes it sounds like silence, like holding back in conversation because we are afraid our words will be misunderstood. Sometimes it sounds like exhaustion, like pushing ourselves to meet standards that were never meant for us. Sometimes it looks like overachievement, a relentless effort to prove that we are not the stereotypes others have assigned to us. These patterns take time to notice and even longer to unravel.

And yet, there is hope. The more we connect with others who share our neurotype, the more we realize we were never broken. We were reacting exactly as anyone would in environments that did not understand or support us. Our burnout, our shutdowns, our meltdowns, our self-doubt, our perfectionism, our need to control things just to feel okay—these were all responses to chronic misattunement, not flaws in our character. Diagnosis may name our neurodivergence, but liberation begins when we stop viewing our traits through the lens of pathology and start seeing them as part of who we are.

We deserve to move beyond the diagnosis. We deserve a life that is not built around damage control, but around authenticity and access. We deserve systems that affirm our strengths, accommodate our needs, and celebrate our complexity. And most of all, we deserve to believe that we are already enough, just as we are. The work of undoing internalized pathology is lifelong, but it is also life-giving. It is how we begin to come home to ourselves.