Typically, although it’s notoriously hard to define, autism has been represented as a biologically-based mental disorder that can be usefully investigated by biomedical science. In recent years, ho...

This article outlines the emergence of ABA (Applied Behaviour Analysis) in the mid-20th century, and the current popularity of ABA in the anglophone world. I draw on the work of earlier historians to highlight the role of Ole Ivar Lovaas, the most influential practitioner of ABA. I argue that reception of his initial work was mainly positive, despite concerns regarding its efficacy and use of physical aversives. Lovaas’ work, however, was only cautiously accepted by medical practitioners until he published results (...) in 1987. Many accepted the results as validation of Lovaas’ research, though both his methods and broader understanding of autism had shifted considerably since his early work in the 1960s. The article analyses the controversies surrounding ABA since the early 1990s, considering in particular criticisms made by autistic people in the ‘neurodiversity movement’. As with earlier critics, some condemn the use of painful aversives, exemplified in the campaign against the use of shock therapy at the Judge Rotenberg Center. Unlike earlier, non-autistic critics, however, many in this movement reject the ideological goals of ABA, considering autism a harmless neurological difference rather than a pathology. They argue that eliminating benign autistic behaviour through ABA is impermissible, owing to the individual psychological harm and the wider societal impact. Finally, I compare the claims made by the neurodiversity movement with those made by similar 20th- and 21st-century social movements. (shrink)

In recent decades, attempts to explain autism have been frustrated by the heterogeneous nature of its behavioral symptoms and the underlying genetic, neural, and cognitive mechanisms that produce them. This has led some to propose eliminating the category altogether. The eliminativist inference relies on a conception of psychiatric categories as kinds defined by their underlying mechanistic structure. I review the evidence for eliminativism and propose an alternative model of the family of autisms. On this account, autism is a network category (...) defined by a set of idealized exemplars linked by multiple levels of theoretically significant properties. I argue that this network model better captures the empirical phenomena, the historical growth of the category, and the ways the category has been shaped by social norms and interests. Finally, I defend a realist interpretation of network categories against the challenge from eliminativists. (shrink)

Jean Ayres invented Sensory Integration for children experiencing learning and social difficulties because, according to Ayres, they could not adequately integrate information from multiple sensory modalities. She established a scientific basis for her identification of children with sensory integrative difficulties, using statistical techniques to identify symptoms and neuroscience to determine a cause. She was an unusually reflective practitioner who catalyzed a community of practice around SI without becoming a guru—indeed, she encouraged her students to come up with their own ideas (...) and test them empirically. She felt isolated from the growing field of Occupational Therapy yet is viewed as one of its greatest pioneers. After her death in 1988, the SI community gradually began to argue about fundamental issues like what should constitute an appropriate diagnosis and set of tests for SI. At present, the network is fragmented to the point where some of the opposing positions may be incommensurable with each other, which would require a trading zone. (shrink)

A caring approach to knowledge production has been portrayed as epistemologically radical, ethically vital and as fostering continuous responsibility between researchers and research-subjects. This article examines these arguments through focusing on the ambivalent role of care within the first large-scale experimental beagle colony, a self-professed ‘beagle utopia’ at the University of California, Davis (1951–86). We argue that care was at the core of the beagle colony; the lived environment was re-shaped in response to animals ‘speaking back’ to researchers, and ‘love’ (...) and ‘kindness’ were important considerations during staff recruitment. Ultimately, however, we show that care relations were used to manufacture compliancy, preventing the predetermined ends of the experiment from being troubled. Rather than suggesting Davis would have been less ethically troubling, or more epistemologically radical, with ‘better’ care, however, we suggest the case troubles existing care theory and argue that greater attention needs to be paid to histories, contexts, and exclusions. (shrink)

ArgumentResearch into the biological markers of pathology has long been a feature of British psychiatry. Such somatic indicators and associated features of mental disorder often intertwine with discourse on psychological and behavioral correlates and causes of mental ill-health. Disorders of sociality – particularly psychopathy and antisocial personality disorder – are important instances where the search for markers of pathology has a long history; research in this area has played an important role in shaping how mental health professionals understand the conditions. (...) Here, I characterize the multiplicity of psychiatric praxis that has sought to define the mark of antisociality as a form of “ontological anarchy.” I regard this as an essential feature of the search for biological and other markers of an unstable referent, positing that uncertainties endure – in part – precisely because of attempts to build consensus regarding the ontology of antisociality through biomedical means. Such an account is suggestive of the co-production of biomarkers, mental disorder, and psychiatric institutions. (shrink)

The development of the fifth edition of the American Psychiatric Association9s _Diagnostic and Statistical Manual of Mental Disorders_—the DSM-5—has reenergised and driven further forward critical discourse about the place and role of diagnosis in mental health. The DSM-5 has attracted considerable criticism, not least about its role in processes of medicalisation. This paper suggests the need for a sociology of psychiatric critique. Sociological analysis can help map fields of contention, and cast fresh light on the assumptions and nuances of debate (...) around the DSM-5; it underscores the importance of diagnosis to the governance of social and clinical life, as well as the wider discourses critical commentaries connect with and are activated by. More normatively, a sociology of critique can indicate which interests and values are structuring the dialogues being articulated, and just how diverse clinical opinion regarding the DSM can actually be. This has implications for the considerations of health services and policy decision-makers who might look to such debates for guidance. (shrink)

In this article, I argue that the history and philosophy of autism need to account for two kinds of autism. Contemporary autism research and practice is structured, directed and connected by an ‘ontological understanding of disease’. This implies that autism is understood as a disease like any other medical disease, existing independently of its particular manifestations in individual patients. In contrast, autism in the 1950s and 1960s was structured by a psychoanalytical framework and an ‘individual understanding of disease’. This implied (...) that autism was not a distinct disease but an idiosyncratic and meaningful response of the child to a disturbed development of the ego. These two kinds of autism are embedded in and reveal two very different ‘styles of psychiatric thought’. (shrink)

In the decades since the Science Wars of the 1990s, climate science has become a crucible for the negotiation of claims about reality and expertise. This negotiation, which has drawn explicitly on the ideas and techniques of science and technology studies, has taken place in genres of fiction as well as non-fiction, which intersect in surprising ways. In this case study, I focus on two interwoven strands of this history. One follows Michael Crichton’s best-selling 2004 novel, State of Fear and (...) its reception by neo-conservatives as a commentary on the mis-uses of facts to stoke fear about anthropogenic climate change. The other considers Naomi Oreskes and Erik M. Conway’s 2010 publishing success Merchants of Doubt as the inverse, a demonstration of the forms of disinformation that have been used to undermine scientific consensus around climate change. I show that both Crichton’s as well as Oreskes and Conway’s approaches were critiqued by academic STS even as their accounts constituted the most high-profile performances of its stakes and the politics of knowledge since the Science Wars. In highlighting the STS practices deployed by each, as well as how those practices were differently linked to accusations of fear-mongering and a perversion of the purity of STS, I demonstrate the need for a reflexive history of STS. Such an approach, I argue, can better consider the social life of STS ideas and practices amidst calls for more politically-engaged approaches to knowledge production. (shrink)

This article examines three key aetiological theories of autism (meta-representations, executive dysfunction and weak central coherence), which emerged within cognitive psychology in the latter half of the 1980s. Drawing upon Foucault’s notion of ‘forms of possible knowledge’, and in particular his concept of savoir or depth knowledge, two key claims are made. First, it is argued that a particular production of autism became available to questions of truth and falsity following a radical reconstruction of ‘the social’ in which human sociality (...) was taken both to exclusively concern interpersonal interaction and to be continuous with non-social cognition. Second, it is suggested that this reconstruction of the social has affected the contemporary cultural experience of autism, shifting attention towards previously unacknowledged cognitive aspects of the condition. The article concludes by situating these claims in relation to other historical accounts of the emergence of autism and ongoing debates surrounding changing articulations of social action in the psy disciplines. (shrink)

In 1943, a distinguished child psychiatrist at Johns Hopkins University, Leo Kanner, published what would become a landmark article: a description of 11 children who suffered from a distinct disorder he called ‘infantile autism’. While initially quite obscure, in the early 1950s Kanner’s report garnered much attention, as clinicians and researchers interpreted these case studies as exemplifying the ill-effects of maternal deprivation, a new theory that rapidly gained currency in the United States. Sensory deprivation experiments, performed in the mid-1950s, further (...) complicated the picture, as experts debated whether maternal deprivation was unique or simply a form of environmental stimulation. As experts strove to make sense of this new disorder, they relied on concepts of maternal and sensory deprivation, both to promote their own theories and to critique or refute those of their colleagues. This interplay between the two theories also informed new forms of intervention, including ‘rage reduction therapy’, which served as a precursor for controversial forms of therapy today termed as the ‘attachment therapies’. This article sheds light on a little-known aspect of the history of autism, and examines the far-reaching effect popular etiological theories have in shaping debates over emerging medical concerns. (shrink)

Background: Biomedical research is influenced by many factors, including the involvement of stakeholder groups invested in research outcomes. Stakeholder involvement in research efforts raises questions of justice as stakeholders’ specific interests and motivations play a role in directing research resources that ultimately produce knowledge, shaping how different conditions (and affected individuals) are understood and treated by society. This issue is highly relevant to child psychiatry research where diagnostic criteria and treatment strategies are often controversial. Biological similarities and stakeholder differences between (...) attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) provide an opportunity to explore this issue by comparing research foci and stakeholder involvement in these conditions. Methods: A subset of ADHD and ASD research articles published between 1970 and 2010 were randomly selected from the PubMed database and coded for research focus, funding source(s), and author-reported conflicts of interest (COIs). Chi-squared analyses were performed to identify differences between and within ADHD and ASD research across time. Results: The proportion of ADHD research dedicated to basic, description, and treatment research was roughly similar and remained stable over time, while ASD research showed a significant increase in basic research over the past decade. Government was the primary research funder for both conditions, but for-profit funders were a notable presence in ADHD research, while joint funding efforts between nonprofit and government funders were a notable presence in ASD research. Lastly, COIs were noted more frequently in ADHD than in ASD research. Conclusions: Our study shows significant differences in research foci and funding sources between the conditions, and identifies the specific involvement of for-profit and nonprofit groups in ADHD and ASD, respectively. Our findings highlight the relationship between stakeholders outside the research community and research trajectories and suggest that examinations of these relationships must be included in broader considerations of biomedical research ethics. (shrink)

This paper explores ethologist Niko Tinbergen’s path from animal to human studies in the 1960s and 1970s and his views about human nature. It argues, first, that the confluence of several factors explains why Tinbergen decided to cross the animal/human divide in the mid 1960s: his concern about what he called “the human predicament,” his relations with British child psychiatrist John Bowlby, the success of ethological explanations of human behavior, and his professional and personal situation. It also argues that Tinbergen (...) transferred his general adaptationist view of animal behavior to the realm of human biology; here, his concern about disadaptation led him to a view of human behavior that was strongly determined by the species’ evolutionary past, a position that I call evolutionary determinism. These ideas can be seen in the work he carried out with his wife, Elisabeth Tinbergen, on autism. The paper concludes that Tinbergen’s vision of human nature constitutes another version of what anthropologist Clifford Geertz called in 1966 the “stratigraphic” conception of the human: a view of human nature as a composite of levels in which a universal ancestral biological core is superimposed by psychological and cultural layers that represent accidental variation at best and pathological deviation at worst. (shrink)

Neoliberal cultural frames of individual choice inform mothers’ accounts of why they refuse state-mandated vaccines for their children. Using interviews with 25 mothers who reject recommended vaccines, this article examines the gendered discourse of vaccine refusal. First, I show how mothers, seeing themselves as experts on their children, weigh perceived risks of infection against those of vaccines and dismiss claims that vaccines are necessary. Second, I explicate how mothers see their own intensive mothering practices—particularly around feeding, nutrition, and natural living—as (...) an alternate and superior means of supporting their children’s immunity. Third, I show how they attempt to control risk through management of social exposure, as they envision disease risk to lie in “foreign” bodies outside their networks, and, therefore, individually manageable. Finally, I examine how these mothers focus solely on their own children by evaluating—and often rejecting—assertions that their choices undermine community health, while ignoring how their children benefit from the immunity of others. By analyzing the gendered discourse of vaccines, this article identifies how women’s insistence on individual maternal choice as evidence of commitment to their children draws on and replicates structural inequality in ways that remain invisible, but affect others. (shrink)

This article provides empirical evidence of the social context and moral reasoning embedded within a parents’ decision to participate in autism genetics research. Based on in-depth interviews of parents who donated their family’s blood and medical information to an autism genetic database, three narratives of participation are analyzed, including the altruistic parent, the obligated parent, and the diagnostic parent. Although parents in this study were not generally concerned with bioethical principles such as autonomy and the issues of informed consent and/or (...) privacy and confidentiality of genetic information, a critical analysis reveals contextual bioethics embedded within these different narratives. These include the negotiations of responsibility that parents confront in biomedical research, the misguided hope and expectations parents place in genomic science, and the structural barriers of obtaining an autism diagnosis and educational services. Based on these findings, this article demonstrates the limits of a principle-based approach to bioethics and the emergent forms of biological citizenship that takes into account the social situations of people’s lives and the moral reasoning they negotiate when participating in autism genetic research. (shrink)

This dissertation explores philosophical issues in autism and defends a new version of the enactive approach to autism and social cognition. The discussion in this dissertation centres around the question “why do autistics encounter social interaction problems?”, addressing this question in ways that raise broader philosophical issues. Within the philosophy of mind, these include the problem of other minds, the nature of emotions, and narratives and their role in understanding the self. Beyond cognition, such issues are intertwined with questions in (...) metaphysics, philosophy of science, sociopolitical and moral philosophy, and disability studies. In responding to the question “why do autistics encounter social interaction problems?”, I argue that autistic social interaction problems result from the sensorimotor differences between autistics and non-autistics. This contrasts with the response to this question given by widely-endorsed views that emphasize instead the cognitive deficits that autistic people have. Such cognitivist views, such as the theory theory and simulation theory, are the focus of my first two critical chapters. I go on to offer a critique of two approaches that go beyond the focus on mindreading in appealing to sensorimotor problems as lying at the heart of the problem. These views, interaction theory and the original enactive approach, are the focus of the next two chapters. I then turn to defend a novel form of the enactive approach in the last part of the dissertation by emphasizing the role of emotions as the capacity for us to make sense of the world and to construct the sense of self from narratives. My new approach shifts the explanatory focus from perception and motion to emotion. This maintains the advantage of the original enactive approach, while avoiding its behaviouristically limited descriptions. My account thus expands the theory’s capacity to describe and explain internal states important to self-understanding and self-expression. This allows one to approach autistic social difficulties by attending to the first-person perspective, cohering with my reliance on first-person autistic narratives as a major source of evidence that supplements traditional scientific research on autism. (shrink)

Historians and sociologists of psychiatry often claim that psychiatric diagnoses are discontinuous. That is, a particular diagnoses will be described in one way in one era and described quite differently in a different era. Historians and sociologists often draw epistemic consequences from such discontinuities, claiming that truth is pluralistic, provisional and historicised. These arguments do not readily fit in with how analytical philosophers of science approach scientific realism. I show how the pessimistic meta induction does not capture the point which (...) historians and sociologists are making but scientific perspectivism seems to capture their point much better. I then highlight conceptual innovations which scientific perspectivists add. They demarcate between truth and objective reality, they specify which type of truth they endorse and they put down constraints on possible truths. This blocks an anything goes relativism which historians and sociologists can be in danger of falling into. I highlight my argument by discussing a discontinuous episode in the history of autism. I discuss three aspects of this discontinuity and show how scientific perspectivism can portray each aspect as non-trivially true. My argument shows that we can be scientific realists about autism even if we can formulate notions of autism in quite different ways. (shrink)

Critics who are concerned over the epistemological status of psychiatric diagnoses often describe them as being constructed. In contrast, those critics usually see symptoms as relatively epistemologically unproblematic. In this paper I show that symptoms are also constructed. To do this I draw upon the demarcation between data and phenomena. I relate this distinction to psychiatry by portraying behaviour of individuals as data and symptoms as phenomena. I then draw upon philosophers who consider phenomena to be constructed to argue that (...) symptoms are also constructed. Rather than being ready made in the world I show how symptoms are constructs we apply to the world. I highlight this with a historical example and describe methodological constraints on symptom construction. I show the epistemic problems with psychiatric diagnoses are also applicable to symptoms. Following this, I suggest that critics of psychiatric diagnoses should extend their criticism to symptoms or, if they still believe symptoms are relatively epistemologically unproblematic, should rethink their concerns over psychiatric diagnoses. (shrink)

Comment le système associatif contribue-t-il à façonner les représentations et les politiques publiques en matière d’autisme? Cette question renvoie au rôle plus général des mouvements sociaux. Dans le domaine de la santé, ces mouvements participent de plus en plus à l’action publique et acquièrent une influence grandissante. Les associations de parents d’enfants autistes ont contribué à la prise de conscience du public et ont joué un rôle croissant dans les changements des représentations et des politiques publiques en matière d’autisme mais (...) un fossé s’est creusé entre les positions adoptées par des « experts associatifs » qui pèsent sur les décisions politiques et les situations que vivent au quotidien de nombreux parents. Cet article sur le rôle des associations de parents d’enfants autistes aux États-Unis et en France vise à analyser la montée en puissance d’un lobbying associatif qui influence les autorités politiques afin d’établir de nouvelles normes en matière d’autisme. (shrink)