So I’m starting a new two-year research project on neurodiversity theory at the University of Bristol, and as part of this I’ll be running a new blog. My first post can be found here: https://www.psychologytoday.com/gb/blog/neurodiverse-age/201907/mental-disorder-within-the-neurodiversity-paradigm

Of course, I’ll still have this blog too, although it may be less active for a while.

A new study by the historian Czech Herwig – the culmination of eight years of research – has decisively shown that Hans Asperger, who first developed the concept of autism as we know it today, was highly complicit in the Nazi eugenics programme. Amongst other things, he sent many cognitively disabled children to be euthanised, suggesting, in line with Nazi ideology, that they were ‘burdens’ to their parents. At the same time, a new book by researcher Edith Sheffer titled Asperger’s Children, coming out this May, argues that the term ‘Asperger’s syndrome’ should be totally given up. In her words ‘We should stop saying “Asperger.” It’s one way to honor the children killed in his name as well as those still labeled with it’. Regardless of whether we agree with this, it seems clear that Asperger was a very bad man.

The combination of these publications has been a shock for many in the autistic community. Until now, Asperger had widely taken to have been working in subtle resistance to Nazi eugenics. Most notably, Steve Silberman’s best-selling 2015 book Neurotribes held Asperger up as a sort of prototype neurodiversity advocates: a brave resister of Nazi eugenic ideology who baptised the category of autism more as a move of political solidarity than a medical advance. Also, his insights into autism were decades ahead of his time, and indeed, in many ways, very much in line with contemporary thinking.

As both an autistic person and researcher working on the ethics of autism, I am not so much interested here in simply condemning Asperger (although, this is now, quite rightly, being done, and needless to say I am glad that this new research has been published so we can do so). Rather, I am concerned with more practical and pressing concerns that arise in light of these new revelations. First: I want to reassess what went so very wrong with Asperger’s otherwise, as it hitherto seemed, sound reasoning in regards to autism (by which I mean his political philosophy rather than his scientific research).  And second, I am also interested in asking how much we have actually changed from his views today.

Why Asperger Seemed Good

Beyond his vital contributions to autism research, Asperger was until now widely thought of as a good person, and it is initially worth considering why. The key reason for this regards his initial 1938 paper on autism, in which Asperger argued against the popular eugenicist notion that undesirable traits could simply be erased from the human population.

In short, according to eugenicist theory, humans could exhibit desirable traits and undesirable traits, and the goal was to slowly erase undesirable traits from humanity through selective breeding. Against this notion, Asperger presented the case of autism. His argument came in two parts. First, he noted how autism came with important benefits, such as strong logical thinking and creativity, rather than just limitations. Second, he argued that the strengths and limitations he associated with the category were inextricably intertwined.

Given the combination of these points, Asperger concluded that autistic people were not just potentially useful members of society, but also that there should be no attempt to alter them – since the negative were so intimately linked with the positives. This seemingly allowed him to save at least some of his patients (i.e. those without further intersecting disabilities) from being killed.

According to Steve Silverman’s influential analysis, then, Hans Asperger’s aims and thoughts in the 1930s were a prototype for contemporary neurodiversity ideology, which – quite rightly – is fiercely pro-autism rights and staunchly anti-eugenics. In short, Asperger and neurodiversity proponents seemed allied in sharing a humanitarian response to what each takes to be as totalitarian ideology and its correlating drive to normalise and homogenise human life. In light of this, for Silberman, there seemed good reason to think of Asperger as a kind of patron saint of the neurodiversity movement.

What Went Wrong With Asperger’s Reasoning?

Asperger seemed to have some good ideas – those we have just mentioned – but clearly went deeply wrong in his thinking (and thus acting) somewhere else. The important thing, given his apparent overlap with much contemporary thinking, including with some neurodiversity proponents, is to ask precisely where he went wrong – lest we repeat the same mistakes.

Clearly, as Herwig covers, many factors were involved. Nonetheless, my suggestion is that the core error in Dr. Asperger’s thinking regards a certain way of thinking about both society and the value of human life. As the sociologist Zigmunt Bauman stressed in his book Modernity and the Holocaust, many atrocious Nazi policies arose in light of a ‘bureaucratic culture which prompts us to view society as an object of administration, as a collection of so many `problems’ to be solved, as `nature’ to be `controlled’, `mastered’ and `improved’ or `remade’, as a legitimate target for `social engineering’’. When combined with the Social Darwinist ideology of Nazi Germany in relation to the perceived ‘race hygiene’ needs of the Third Reich, this way of thinking led to an instrumental way of viewing human life. That is, humans were seen as valuable in relation to their perceived needs of the society, rather than simply being inherently valued as human beings.

In short,  then, while Asperger (rightly) resisted the notion that single traits could simply be erased from humanity, what is significant is that he (wrongly) still held on to this more general instrumental manner of framing and valuing human life. For his argument was not that autistic life should be valued as such, due to something like a deep love or care for autistic people. Rather, he only argued that his autistic patients should not be killed or altered as they could be instrumentally useful (for instance, he once suggested that they could become effective code breakers for the Nazi party). 

The upshot of this was that, while this allowed him to save some autistic patients from being steralised or euthanised, he fully endorsed the killing of more seemingly heavily disabled patients. For on his manner of reasoning, they were not useful to society, and so were mere burdens to be killed.

A Problem with Neurodiversity?

Skip forward forty years or so and to the English-speaking world. Autism was by then widely established as a medical category, diagnoses were rising rapidly, and its dark history was at that time widely forgotten. The concept of the autism “spectrum” had recently been developed, and the autistic conditions were increasingly represented as hereditary developmental disorders associated with unique cognitive profiles. Huge amounts of research were being carried out with the aim of treating or “curing” the condition, and journalists were starting to write of the terrible autism “epidemic” that was unfolding across the world.

It was in this context that the neurodiversity movement arose. In the early 1990s, autistic self-advocates such as Jim Sinclair began to argue that autism was not a disorder that required awareness, but a difference that required acceptance and accommodation. They challenged the narrative that it was inherently tragic, and instead argued that autistic suffering was a product of unjust social conditions.

Building on early autism rights self-advocacy, in 1998 the term ‘neurodiversity’ was first used by the journalist Harvey Bloom an article in the Atlantic. He used this to indicate how different neurological types ‘may be every bit as crucial for the human race as biodiversity is for life in general […] Cybernetics and computer culture, for example, may favor a somewhat autistic cast of mind’. As a counter to the medical paradigm’s notion of autism as a disorder, proponents of neurodiversity began to argue that ‘neurological difference’ or ‘neurodivergence’ should be accepted and celebrated for the value it can bring to society.

Today, to be clear, the neurodiversity movement is utterly vital, given how terribly autistic people are pathologised, marginalised, and treated in a neurotypical society. In short, when it comes to the question of cognitive disability, neurodiversity proponents make up the vanguard of the world’s anti-fascists.

Nonetheless, in Blume’s framing – and indeed in the very analogy with biodiversity that the concept of neurodiversity is built upon – the implicit use of instrumental rationality remains. For he does not argue that neurodivergent life is simply valuable in and of itself; rather, he argues that we should value it because we have no idea when those who currently fall outside perceived economic needs will again become more useful for society. The key difference between this and Asperger’s take was that Asperger judged neurodiversity’s value in relation to the Third Reich, while Blume does in relation to human society more broadly.

Although not all neurodiversity  proponents do this, a good deal, at least, precisely rely on stressing how instrumentally useful autistic and other neurodivergent persons can be. For instance, it is not uncommon to see lists of (alive or dead) “geniuses” who were or are purportedly autistic to be shared among neurodiversity advocates, used in order to justify our worth. In turn, capitalists who have long excluded autistic people have recently started to look into finally giving autistic people jobs, due to increasingly seeing us as a potential instrumental resource to be drawn upon.

What Needs to Be Done?

It is important to again emphasise that the neurodiversity movement (from autistic self-advocates to allies such as Silberman) provides an utterly vital challenge to the default exclusion and medicalisation of cognitive difference. Indeed: it is the critics of neurodiversity, who seek to eradicate autism, that are much closer to the apparent fascist and eugenicist sympathies of Asperger. And it is also true that neurodivergent people can, indeed, be useful for society in a huge variety of ways, so I certainly do not think people are wrong to correct stigma in this regard.

Nonetheless, it seems to me, to actually cultivate genuine emancipation would require learning to value autistic people intrinsically rather than instrumentally. This is what I think Nick Walker, who I take to be one of the most nuanced neurodiversity proponents and a staunch anti-fascist, means in claiming that a fundamental tenant of the neurodiversity paradigm regards how ‘diversity, when embraced, acts as a source of creative potential within a group or society’. While it is understandable why, by contrast, some other neurodiversity proponents have often resorted to emphasising our instrumental potential (since it has long been unduly denied), focusing so centrally on this – i.e. making it a central tenant of the ideology – leaves those considered to be less valuable behind. Moreover, even if we all were deemed to have positive net instrumental value, this line of argument nonetheless actively takes the focus away the focus from finding non-instrumental, intrinsic value in autistic modes of being. Our value and power, as Walker indicates, must be built into the very basis of the paradigm, not understood as merely instrumental.

In short – while it is terrible that we have to justify our continued existence at all – for those of us who want to effectively resist eugenicist ideology today, the worry here is that any reliance on instrumental rather than intrinsic value to justify autistic being will, although it may seem to help us justify our existence in the short term, actually reinforce a devaluation of autistic life over a longer period. Given this, something more radical will be needed for the neurodiversity movement to realise its emancipatory aims.

The Scream, 1893, Edvard Munch.

In recent years the narrative has shifted from saying that autistic people feel too little – usually due to a purported empathy deficit – to saying we feel too much. This move has been widely celebrated: seen by many in the autistic community both as vindicating autistic self-advocates, and as a step forward for the neurodiversity conception of autism as a difference rather than a deficit.

To give a bit of initial  context, this shift began largely in light of decades of autistic self-advocates stressing that many characteristically autistic social problems are more the product of an overwhelming sensory world, rather than due to an innate inability to empathise. In light of this, neurotypical researchers eventually began to propose new cognitive theories of autism, and in turn to carry out studies to test various related hypotheses.

The most notable example of this is the intense world theory, initially proposed by Henry Makram and his co-authors in 2007. This theory claims that autism is a product of ‘hyper’ sensitivity rather than ‘hypo’ sensitivity as had been previously thought. In the words of Makram et al:

‘because a subset of cues are overly intense, compulsively attended to, excessively processed and remembered with frightening clarity and intensity. Autistic people may, therefore, neither at all be mind-blind nor lack empathy for others, but be hyper-aware of selected fragments of the mind, which may be so intense that they avoid eye contact, withdraw from social interactions and stop communicating.’

For them, this includes not just cognitive-perceptual differences, but also ‘hyper-emotionality’, leading autistic people to become, in their words, ‘trapped in a limited […] internal world’. In turn, subsequent research has seemingly supported this theory, such as a recent study which found precisely that autistic people don’t look others in the eyes, not due to social disinterestedness as previously thought, but rather due to sensory-overload – just as autistic people, and in turn Makram, suggested.

Quite understandably, such theories and the re-framing associated with them have been celebrated by autistic people as emancipatory and ‘ground-breaking’. Especially given how damaging the empathy-deficit myth is for the autistic population, and also given how this new framing seems to better fit with autistic lived experience, it is easy to see why so many embrace this new framing. Hence one recent article that is intended to support autistic self-advocacy, for instance, states: ‘As it turns out, the issue isn’t so much that autistic people are insensitive to the feelings of others. It’s more that their brains are oversensitive’

Nonetheless, there is reason to be wary. As feminists have long argued, part of the relationship dynamic between the oppressed and the oppressor regards how the oppressor tends to systematically appropriate the vocabularies and claims of the oppressed under the guise of friendship. An yet the this is actually done in order to reinforce – albeit more subtly – existing power-relations. In the case of autism, this would mean neurotypicals in positions of power adopting some of the vocabularies or insights of autistic neurodiversity proponents in order to seem like supporters; yet to in fact use this process to produce a more subtle, and thus harder to spot and combat, pathologisation of autistic being.

In this regard, the first thing to note is that the intense world theory is still a pathology paradigm theory through and through. For on the one hand, how the theory is presented by Makram uses all the same unduly negative descriptions (‘compulsive’, ’impairments’ and so forth) and metaphors (the ‘trapped’ child, who needs ‘unlocking’ etc.) we see in all the other medical accounts.  On the other hand, it seems to have been widely overlooked how, within psychiatric theory, it does not matter whether a psychological difference is considered ‘hyper’ or ‘hypo’: either way, it is taken to be a matter of pathologically falling outside the norm. ‘Too much’ may be different to ‘too little’, but it is still considered just as inherently bad. Hence, although this challenges one pathology paradigm framing of autism, it only replaces it with another.

But perhaps the most worrying thing here regards how this new framing leads to autistic suffering being blamed on autistic oversensitivity. In this regard it is worth drawing attention to a form of psychological domestic abuse sometimes called ‘gaslighting’. What this refers to is the systematic undermining of the victim’s sense of reality in order to make them think the abuse is their fault rather than the fault of the abuser.

Very significantly, one of the core ways to do this is for the abuser to convince the victim that they are just too sensitive, meaning that any hurt they feel is not down to their abusive environment but rather due to their own inability to cope with the world. Hence, if the abuser, say, cheats on their spouse, the abuser can argue that it wasn’t a big deal, and that the spouse is just oversensitive, perhaps even overly jealous, thus dismissing the hurt and instead framing the victim as being the problematic one. In other words, subtle manipulation techniques are used to not just to victim-blame, but also to make the victim internalise and thus believe this – to the point where they finally lose their sense of reality and can be totally controlled by the abuser.

With this in mind, I am wary of all accounts that frame autistic suffering and disablement stemming from us being hyper-sensitive. Far from reversing it, all this does is make the pathologisation of autism more subtle, more hegemonic. In fact, the issue is that the sensory world is designed for the neurotypical, and so has by and large failed to accommodate the autistic sensory-style. That is, whilst it is true that we suffer from ‘too much information’, this stems from the neurotypical-centric way in which the world is organised  – not due to how we process the world as such.

As readers of this blog will be familiar with, neurodiversity proponents argue that autism is a neuro-minority rather than a mental disorder. In short, they deny neither that categories such as autism indicate disabilities, nor indeed the various forms of distress associated with being disabled. Rather, it is that they locate this disablement and distress in society instead of framing it as stemming from a medical pathology in the individual. So an autistic person may, for example, have heightened sensory sensitivity; but they only become disabled in relation to the senses in a world that is not designed to accommodate for this different way of processing, thus leading them, say, to experience sensory overload.

Nonetheless, critics of the neurodiversity movement like to point to examples of what they (misleadingly, as we shall see) call “severe” or “low-functioning” autism in order to either limit or even dismiss the validity of the movement. Sure, they argue, even if some so-called “high-functioning” individuals seem different rather than disordered, and even if a few people given the “severe” label do advocate for the neurodiversity movement, these are not representative of the many who need 24 hour care, and have (so far) unsuccessfully been able to communicate anything more than very basic needs to those around them. In short, what these critics claim is that the minds of at least some of those deemed “severe” are so deficient that they are not just undeniably bad, but inherently so.

I want to suggest here that these critics of neurodiversity base their view on an increasingly outdated, and indeed unjustified, theory of what a mind is as such. I will call this the ‘neuro-centric mind’ theory, and I take this (at least implicitly) to be the most widely held theory of the nature of the mind among the educated public today. In short, on this view, a mind stems from a brain, and is the psychological functioning that stems from that brain. Looked at this way, you might as well say that you are your brain. Or at the very least, the brain is the seat of the mind, and anything beyond the brain and its thoughts are not part of the mind as such.

This is a fairly widely held view of the nature of the mind, and one I am sure many readers of this blog will hold (including many neurodiversity proponents). But as the philosopher Andy Clark has long argued, this view is neither justified, nor able to accurately capture the phenomena of cognition. In short, he notes, many of our cognitive processes do not just take place within the broader world they are embedded in; rather, many forms of cognition actually wholly or partly rely on this outside world. As a recent commentator summarises, for example: ‘There [are] many kinds of thinking that weren’t possible without a pen and paper, or the digital equivalent—complex mathematical calculations, for instance. Writing prose [is] usually a matter of looping back and forth between screen or paper and mind: writing something down, reading it over, thinking again, writing again. The process of drawing a picture [is] similar.’

What Clark points out here is that, whilst the neuro-centric mind theory might frame these resources as mere external scaffolding for the mind, this vastly underestimates their importance. In fact, since the cognitive process that arise in light of them could not happen without this scaffolding, then this scaffolding is as integral to cognition as the scaffolding of the brain is.

Hence the superior alternative to the neuro-centric mind theory is Clark’s (and Chalmer’s) ‘extended mind theory’, which holds that the mind is not situated in the brain, but rather widely embedded in relation to many various resources, from the neural to the technological (for example, even as I type this article, the many tabs open on my browser are constituting my memory as much as my brain is). By contrast, it is a mistake to think that ‘whatever matters about my mind must depend solely on what goes on inside my own biological skin-bag, inside the ancient fortress of skin and skull.’ This belief, although still widely held, rests on unfounded assumptions as to what constitutes cognition – one that unduly discriminates against environmental (and sometimes bodily) resources in favour of just the neural resources.

Return here to the example of the so-called “severely” autistic person who needs a lot of help. Perhaps they need special technology to communicate (we might not even have invented this technology yet), and various technological resources in place to help them organise and plan their day. Perhaps they also need other people there around the clock to help them do things in various respects. And so forth.

On the one hand, according to the neuro-centric mind view, we should judge mental deficiency in terms of having to rely on external supports more than whatever we consider normal at the given time, since the need for external supports indicates that the mind (and brain) must be lacking. (In turn, if we then look at the neurology and it does indeed seem different to the norm, then this is taken to confirm that the mind was deficient – thus giving the impression of justifying the initial hunch.) Hence, on this view, it is hard to conceive of someone who needs 24 hours support, and so forth, to be anything but mentally disordered, or indeed “low-functioning”.

By contrast, however, without unduly discriminating against the extended aspects of the mind, there is no good reason to think that any given mind is deficient merely for having to rely on the environmental aspect of the mind more than the neural. For if we withhold from such discrimination, then this seem like a matter of different distribution rather than inherent dysfunction. It is just that some minds rely on the neural aspect more heavily, whilst others rely on the environmental aspect more heavily. The case of the so-called “severely” autistic person who needs a lot of help is, then – at least when they do get the help they need – a case of widely distributed cognition, rather than deficient cognition.

Crucially too, then, whether they get this help or not is a matter of social justice, not of medicine. Just as it would be a case of social (in)justice rather than medical pathology if some group (for instance, all those with an IQ between 85 and 90) were needlessly excluded from being given calculators at school due to discrimination. The extended mind theory thus helps us understand how the disablement of the autistic extended mind is a matter of power-structures having excluded this mind in various ways, rather than a simple matter of impaired functioning.

This leaves me with the following two thoughts. On the one hand, for as long as there are autistic people whose extended minds cannot function, then despite initial appearances, it may not be the autistics who are sick. Rather, the sickness lies in the society that leads to the disablement of the extended minds of its minority members. On the other hand – and perhaps worse still – society’s need to project this pathology back onto the autistic person, rather than admitting its true societal nature, makes the sickness of that society seem much more insidious that it might initially appear.

Picture by Joan M. Mas

Autism is seen, in popular representations, largely as a social and communication disorder. Formerly framed as stemming from an autistic lack of a “social instinct”, the current dominant idea is that something is deficient or missing in autistic social cognition. Often referred to as a cognitive deficit in “empathy” or “theory of mind”, much research on autistic social issues has focused on trying to clarify and detect this inside autistic brains and minds. The search for an elusive broken “theory of mind module” or “empathy mechanism” in the brain, and its ensuing cognitive manifestations, however, has led to conflicting results – with some scientists even concluding that autistic people feel too much empathy rather than too little.

Another view is that this is not simply an individual neuro-cognitive issue, but rather a wider social problem. Against the idea that autistic people have too much or too little anything, autistic neurodiversity movement advocates have long argued that the empathy problem is actually a two-way issue between neurotypicals and autistics, which only emerges when the line is crossed. Dubbed the “double empathy problem” by autistic scholar Damian Milton, this framing emphasises how communication and social encounters are always things that happen between people – meaning that any breakdown in communication is always relational and down to both sides, not just an innate issue with one or the other.

Not much empirical research has been carried out in this regard (most funding is directed to and by pathology paradigm proponents, who have no interest in pursuing a neurodiversity paradigm reframing of autism). However, a new collection of studies, published in Nature has given clear weight to the notion that autistic problems in socialising stem as much from the neurotypical side as the autistic side.

The three studies, each of which drew on different samples and used a variety of methodologies, initially all found that

‘observers’ first impressions of individuals with ASD engaging in real-world social behavior were found to be robustly less favorable than those of matched TD [i.e. neurotypical] controls […] these impressions were associated with reduced intentions to socially engage by observers’

In other words, they found that an important contributor to social and communication problems stemmed not from the autistic individuals, but rather from the neurotypical reactions, based on (by definition) exclusionary social attitudes and first impressions, which led to a decreased drive to interact with autistic individuals. That is to say, neurotypicals tend to decide, within moments of meeting autistic people, that autistic people are less worth socialising with than neurotypicals.

Building on this, one of the studies further compared evaluations between written communication and speaking in person. What it found was that autistic people were not rated negatively by neurotypicals when only their writing was assessed. Rather, it was how autistic people look, rather than the substance of what was said, that was the key factor in determining the neurotypical drive to exclude autistic individuals. This was further confirmed, note the researchers, when

‘a static image was sufficient for generating negative first impressions of those with ASD […] In contrast, first impressions of TD controls improved with the addition of a visual information’

In other words, an accompanying photo of an autistic individual had a negative affect on neurotypical perception of the value of the writer, whilst an accompanying photo of a neurotypical tended to have a positive affect.

Given this, it is no surprise that autistic people experience problems when it comes to social interaction. As the authors further clarify, their findings suggest that the issues autistic people face are in fact relational:

The reluctance of TD individuals to engage in social interactions with their ASD peers further limits the opportunities for individuals with ASD to practice their already fragile social skills. This can have a significant negative impact on the ability of socially aware and socially interested individuals with ASD to improve their social communication abilities and work toward more successful social integration

The practical implications of this, conclude the researchers, is that

If our goal is to improve social interactions for individuals with ASD, it may therefore be equally important to educate others to be more aware and accepting of social presentation differences, rather than trying to change the many interwoven factors of self-presentation that mark the expressions of individuals with ASD as atypical.

This fits precisely with the notion that the empathy problem goes both ways rather than from within autistic people, not to mention that this happens in the context of pervasive ableist norms and attitudes that seek to alter rather than accommodate autistic being. Given this, as many autistic individuals will surely testify, this important new research may, then, be vital in helping to show policy makers and the wider public that the key problem with regards to autism is not autism itself. Rather, as autistic self-advocates have long argued, it is neurotypical society and the ableism so deeply embedded throughout.

The term ‘schizophrenia’ stems from the from Greek words skhizein, which means ‘to split’, and phrēn, meaning ‘mind’. The initial thought was that the mind splits in some sense: not, as is sometimes thought, into multiple personalities; but rather into a fragmented and alienated personality, usually beginning in late adolescence or early adulthood. Beyond this, the condition is also most centrally characterised largely in light of psychosis, hearing voices, paranoia, a general sense of apathy, and flat or fluctuating moods and emotions. When all these characteristics emerge together in one person to what is deemed a ‘clinically significant’ level, that person is taken within mainstream psychiatry to have schizophrenia.

These traits are often represented as inherently harmful deviations from the norm, and together they are taken to somehow destroy or at least radically damage the previously existing person. Given this, schizophrenia (and related ‘schizophrenic spectrum’ conditions such as schizoaffective disorder) are taken within both psychiatry, and society more broadly, to be something terrible – tragic medical diseases to be combated with pharmaceutical drugs, institutionalisation, and perhaps, one day, genetic engineering.

But the rise of the neurodiversity movement, which until now has focused mostly on the autism spectrum and other developmental disabilities, gives reason to challenge this view of the schizophrenic spectrum. What neurodiversity movement proponents claim is that, even though the underlying neuro-cognitive differences captured by psychiatric labels indicate meaningful ways of being, the harm associated with these conditions is caused more by society and ideology than due to anything like innate medical pathology. In light of this, neurodiversity movement proponents argue that what they call ‘neurominorities’ – autism, dyslexia, and so on – are natural and legitimate, albeit oppressed or excluded, ways of being in the world.

In particular, neurodiversity proponents often stress the need to embrace one’s neuro-type as an inherent part of one’s identity, instead of seeing it as an external pathology that is separate from one’s essential selfhood.  Autistic neurodiversity proponents, for example, find the notion that you can have autism, rather than be autistic, highly problematic – much in the way that it is problematic to speak of gay people as ‘people with sexual orientation disturbance’, which was precisely how homosexuality was characterized within institutional psychiatry until the 1980s. In this regard, neurodiversity proponents stress the need to drop person-first language (e.g. ‘person with autism’) in favour of identity-first language (e.g. ‘autistic person’). Part of the thought behind this is that, in order to genuinely accept oneself, and in turn live a good flourishing life, seeing one’s neurocognitive style as an essential and valuable part of one’s selfhood, rather than an added pathology, seems vital.

Notably, many schizophrenic persons have resisted psychiatry in a variety of ways, for example by trying to demedicalise hallucinations. What the neurodiversity movement adds is calling into question whether schizophrenic selfhood too, might be re-conceptualised and reclaimed in this way. That is, it points towards the possibility of not just demedicalising schizophrenia’s associated traits, as the ‘hearing voices’ and ‘mad pride’ movements have already started to work towards, but rather towards a more radical and affirmative embrace of the categorization as part of the personal and political identities of schizophrenic persons.

Of course, on the face of it, it might seem strange to claim that schizophrenia could be seen as a neurominority rather than a disorder. After all, there is nothing good about hearing harsh and invasive voices, or thinking that people are out to get you. And many will be familiar with (misleading) tabloid stories of schizophrenic spectrum persons harming themselves or others. In short, then – as many schizophrenic spectrum persons testify – those who end up being given these diagnoses do indeed encounter terrible amounts of distress, and many would do anything to return to their pre-schizophrenic selves.

Nonetheless, all this does not, in and of itself, necessarily mean that being on the schizophrenic spectrum is always inherently harmful to the extent it may seem. It may still be both that the distress stems from cultural, material, and social as much as neurological factors, as proponents of the social model of disability already contest. And it may also be that we dismiss schizophrenic selfhood due to a particularly restricted conception of what it means to be a healthy person (or indeed have a self at all). If this is the case, then it may be that, for some, seeing schizophrenia as a natural part of human neurodiversity is preferable to seeing it as a medical disorder after all.

One recent scientific study which supports this view, for example, comes from the Stanford anthropologist Tanya Luhrmann and colleagues. By interviewing people who had experienced hearing voices (or auditory hallucinations) in different cultures, they found that the whether this was associated with distress varied hugely. More specifically, in North America, voices were experienced as harsh and invasive strangers, and so caused a huge amount of distress to those who heard them. By contrast, In Ghana and India, voices were much more likely to be experienced as playful and friendly.

Very significantly, the key factor in this difference, Luhrmann and her colleagues note, was actually the socially constructed ideal of the self that dominated in each society. In North America (as with the rest of the West), an atomized, individualistic conception of self dominates, meaning that hearing outside voices was conceptualized and experienced as an external threat to autonomy and selfhood. By contrast, given that more collectivist conceptions of selfhood dominate in Africa and India, it did not matter if some internal voices are not one’s own, since others are already part of the self anyway – and so the voices were much less likely to be harmful, and were sometimes even helpful.

Interestingly, the claims of this anthropological study chime with those of Rutgers psychologist Louis Sass, who has argued over the past three decades that post-modern Western societies hugely amplify the kinds of problems associated with the schizophrenic spectrum. For Sass, because postmodern times are, like the schizophrenic spectrum, characterized by a hyper self-reflexivity, fragmentation, alienation, and an ever increasingly individualistic yet decentered self, the two can accentuate each other in a way that makes the schizophrenic way of being manifest as more problematic than it otherwise would have. In other words, it may be pervasive aspects of our post-modern society, and the conception of selfhood that accompanies it, that amplifies the problems schizophrenic spectrum persons seem to be prone to, rather than these problems being most centrally biomedical in nature.

If the claims of researchers like Sass and Luhrmann are even partially right, then it seems that it is social rather than neurological factors that are key in explaining some of the distress and disablement experienced by those on the schizophrenic spectrum. And in particular, it seems that historically contingent conceptions of selfhood – that is, pre-scientific, normative, and ideologically laden notions regarding what it means to be a person – are an important factor in the harm associated with being schizophrenic. Given this, it may be that learning to see schizophrenia as a natural part of neurodiversity may actually be better for schizophrenic persons in terms of the possibility of self-acceptance and living good, thriving lives.

Indeed, as at least one study on first person narratives indicates, it is precisely the case that schizophrenic spectrum persons tend to flourish, like everyone else, when they come to accept and affirm themselves for who they are. As one schizophrenic man, Simon Champ, writes, it was precisely such an affirmative self-narration that

‘has given me the most precious thread, a thread that has linked my evolving sense of self, a thread of self- reclamation, a thread of movement toward a  whole and integrated sense of self, away from the early fragmentation and confusion I felt as I first experienced schizophrenia.’

In contrast to seeing schizophrenia as a pathological destruction of the self caused by an internal dysfunction, then, it may help to consider working towards a more inclusive and diverse understanding what it means to be and develop as a self. In particular, we may need to acknowledge that for some manifestations of human neurodiversity more than others, it is natural for selfhood to fragment and then resynthesize in new and creative ways (and to be more active in generating images and voices, perhaps especially in response to often harmful social environments).

In fact, many of us do this to some extent: situations that cause a rupture in our existence can sometimes cause selfhood to fragment, in some sense, and in turn to need some time before it can realign and grow. This can be seen as a natural reaction, and part of the human condition, that may be pathological but may not be. In line with this, instead of automatically seeing them as deviations from ordinary selfhood, more schizophrenic kinds of fragmentation and self-other relations might also one day be seen as a natural ways for selfhood to adapt and relate to (sometimes extreme) circumstances – part of the continual path of an ever changing self existing in an imperfect world, rather than the destruction of one self replaced by a broken self.

Of course, I am not denying that those on the schizophrenic spectrum currently suffer terribly, nor even that this way of being comes with its own unique set of challenges and limitations. Clearly, many do experience terrible disablement and distress, and it is also important to acknowledge that in many cases of, say, paranoid psychosis or severe depression, medication may be helpful or lifesaving (just as all humans need medication at some point in their lives). The point, rather, is that all human ways of being come with their own challenges and limitations: it is part of the human condition to suffer, to experience crises of selfhood, and to change as life happens to us. And in the case of the schizophrenic spectrum, there is at least some reason to at least entertain the possibility that the most terrible distress might actually caused by life-events, society, and ideology, rather than due to some inherent medical pathology.

Indeed, once we add to this that, as both survivors and anti-psychiatrists such as Thomas Szasz have long stressed, those given schizophrenic spectrum labels are routinely stigmatized, institutionalized, drugged without consent, and repeatedly told they are inherently sick and broken, it is no wonder that so many become increasingly paranoid, depressed, and apathetic following encounters with services. Just as with other oppressed or excluded minorities who are thereby more prone to experiencing mental distress, so too it should not be surprising that schizophrenic spectrum persons encounter similar issues in an equally routine and terrible way.

What I am denying, then, is that those given these labels are obviously inherently broken, sick, or pathological; and I am also denying, vehemently, that it always helpful to cast them as such. Rather than defaulting back to seeing the schizophrenic traits as something that destroys the self, we need to work towards understanding how, for some neurodivergent selves, these kinds of self-relation is a natural reaction to the various struggles encountered in the human condition more broadly, as well as to more specific oppressive social conditions that people with schizophrenia spectrum traits encounter. The schizophrenic spectrum, in other words, must be welcomed into the arms of the already blossoming neurodiversity movement – where it could be seen, as with autism, a reclaimed way of being rather than merely an imposed label to reject.

Theories regarding the “cause” of autism abound. In the 1960s much was made of the psychoanalytic notion that bad parents, especially “refrigerator mothers”, could “cause” autism in their children by disturbing them emotionally. This theory became dominant across the West – leading to children being cruelly ripped away from their guilt-ridden mothers – until the late 1970s, when the combined might of increasingly fierce parent advocacy groups, and growing scientific consensus, pushed it to the hazy fringes of psychiatric discourse.

Since the 1990s there has been increased talk of an “epidemic”, and blame has alternatively been scapegoated on vaccines. This theory was first espoused by British researcher Andrew Wakefield, and it caused quite a stir. Parents stopped vaccinating their children, leading to outbreaks of disease and sickness worldwide. Nonetheless, as with the refrigerator mother theory, a scientific consensus emerged that there was, despite incessant searching, no evidence whatsoever to support this hypothesis. In fact, and although the myth it is still periodically dredged up by uninformed celebrities such as Donald Trump, Wakefield has now been exposed as a fraud, and struck off the British Medical Council.

By contrast, more reputable researchers have tended to focus on twins, genetics, epigenetics, and other various environmental factors. From the 1970s onward, for example, twin studies indicated that autism was probably inborn and hereditary. Since then, there has been an incessant search for so-called “risk” genes, as well as research on genomic imprinting and environmental factors, in order to explain the “cause” of autism – which itself is now seen more as a neurocognitive style, accompanied by varying levels of disability, rather than as an emotional disturbance.

In line with this, much has also been made of the fact that most of those diagnosed have been boys, which scientists now often take to indicate some kind of inherent link between autism and the male sex. Professor Simon Baron-Cohen, for example, characterises autism in terms of the “extreme male brain”. This is something he associates with rational, systematic thinking coupled with a lack of social understanding, which he hypothesises to stem from an overload of “male” hormones in the womb during pregnancy. Similarly, Dr Christopher Badcock suggests that autism may be a “hyper-mechanistic” kind of mind that stems from paternal genomic imprinting, again linking autism to the male sex.

Nonetheless, these biologised and sexed ways of understanding autism are, ultimately, unconvincing as well. On the one hand, there are multiple problems with the purported association between autism biological maleness. First, it seems to conflate sex (more biological) with gender (more cultural) in a dogmatic and problematic way, without taking into account the highly complex way in which the two interact. Second, even though people on the autism spectrum do tend to have these purportedly “masculine” traits, they also tend to lack many other traits associated with masculinity, for example, being good at sport and banter. Third, even though autism has, historically, been diagnosed mostly in buys and men, there is now growing awareness that many girls and women also share the cognitive traits associated with the condition, further problematising the assumed association between autism and men in a neurobiological sense.

In turn, beyond these gender troubles, when we review the scientific literature as a whole, things begin to seem a lot more complicated in regards to the purported biological essence of the condition as such. In fact, what the research findings have shown is that over a thousand genes, alongside a huge range of environmental factors – ranging from one’s proximity to busy roads to the age of the mother during pregnancy – seem to increase the chance of tending towards the separate cognitive and behavioural traits associated with the condition. But, crucially, the condition as a whole has no single cause, or even a range of combined causes. Similarly too, there is no neurological essence of the condition: despite systematically misleading reporting by enthusiastic science journalists, the differences seem be unique in each case, and studies reporting to find some neurological unity are rarely replicated.

What this indicates, as Professor Lynn Waterhouse argues in her 2013 book Re-thinking Autism, it that the fundamental error guiding our understanding of autism is that it really is one biological thing, or even “spectrum” of things. ‘Autism’, she writes, ‘is not one disorder or many “Autisms” but is a set of symptoms. The heterogeneity and associated disorders suggest that autism symptoms, like fever, […] signal a wide range of underlying disorders’. Given this (and putting aside her problematically pathologising vocabulary) talk regarding the “cause” of autism as such, when thought of in terms of a physical cause, doesn’t really make much sense (and this is so even though each single case might have its own disparate physical cause). The question, in other words, is driven by a fundamental unsupported assumption: that autism is a natural category, like “gold” or “mammal”, rather than social category, like “black” or “female”.

In contrast to these dominant biologised approaches, then, my own concern with the autism epidemic’s “cause” lies elsewhere – beyond the biomedical, and towards the normative. In fact, we should really be more interested in the social causes of our categorisation of autism (including those which have since caused that category to broaden and change), rather than the biological underpinnings of the traits we associate with autism in any given single case. For, once we accept that autism has no unified physical essence, this seems to be to be the most valid way of taking about what “caused” autism to come into being as a distinct human kind, and then to expand into a broad “spectrum” – or, indeed, “epidemic”.

When looked at from this angle, the first thing to note is that psychiatrists don’t just go around medicalising people at random. Rather, as the pioneering psychiatrist Karl Jaspers noted in his 1913 book General Psychopathology: ‘What is “ill” depends less on the judgement of the doctor than on the judgement of the patient and on the dominant views in any given cultural circle’. In other words, psychiatrists end up medicalising whoever happens to come to, or is sent to, them for “help” at any given time. But, in turn, whoever does end up being implicated as pathological, and in need of help, will already have been delineated by the wider norms of society – and, more specifically, whom these norms exclude.

Consider, for example, how homosexuality was wrongly medicalised as a mental disorder in the mid-20^th Century. Initially, homosexuality ended up being medicalised, in part, because homosexuals (to use the lingo of the time) began going to, or being sent to, their doctors to seek for “help” with their homosexual urges in large numbers. But the reason they were sent, was because society was already homophobic; that is, society had already pathologised being gay as somehow sick, and beyond hegemonic hetero-normativity. Thus, in its medicalisation of homosexuality, institutional psychiatry acted more as a catalyst for these more general social norms, than as its cause – and the same is the case for many other psychiatric classifications.

Bearing the relationship between social norms and psychiatric medicalisation in mind, we might, then, similarly ask which norms led to autism, when disentangled from intellectual disability, being categorised as a distinct kind of human, in need of medical attention, in the first place. In other words, to locate the “cause” of autism arising as a distinct human kind, we need to ask not what its biological underpinnings are, but rather which social norms changed, and in what way, for those we now labelled as being “mildly” autistic or as having “Asperger’s syndrome” beginning to emerge as problematic – something that first happened briefly in Austria in the 1930s, and then again Britain, before the rest of the West, in the 1980s.

Turn, first, to 1930s Austria, where Dr Hans Asperger and colleagues began noticing a newly distinctive kind of person. Notably, it had long been the case for a long time that those autistic persons with more notable disabilities, for example profound intellectual disability, emerged as being problematic – it was just that they were thought of as, say, “feeble-minded” or “schizophrenic” rather than “autistic”. But around this time, and for the first time in history, various boys (they were always boys, back then) began being sent to clinics in the German-speaking world who we might now class as having “Asperger’s syndrome” or “high-functioning autism”. 

When considering the social causes of the emergence of autism in 1930s Vienna, it is initially significant that it coincided with the rise of Hitler, the Nazi Party, and the German the occupation of Austria. On the one hand, as I have written about previously, the Nazi Party subscribed to a Social-Darwinist ideology that drove them to categorise and attempt to eliminate what they considered abnormal behaviours. This goes part way to explaining why divergent persons were increasingly pathologised. However, this alone doesn’t explain why those specific behaviours we now call autistic ended up being deemed abnormal, and only in boys, whilst other “male” behaviours – gambling, womanising, or lying – were not then seen as problematic.

As it turns, out, though, this may be explained by gender norms in Nazi Germany, which were intertwined with the drive to sterilise and exterminate the cognitively disabled. On the one hand, in Nazi ideology, the key role of men was to contribute to the state, and the key role of women was to reproduce. Thus, for those who were profoundly cognitively disabled, neither men nor women would be seen as fit to fulfil their gender roles, meaning they were exterminated. In turn, though, at a more subtle yet equally pervasive level, Nazi ideology also promoted a hyper-masculinity, whereby manliness was specifically associated with heroic group activities. The ideal traits associated with the “new man” were thus to develop a “soldier mentality”, join brotherly male dominated organisations such as the SS, and fight together in battles. Aside from this, there was also a huge patriarchal pressure for men to marry “hereditary fit” Aryan women, reproduce, and instil Nazi values into their children. Without exhibiting all these traits, males would not be considered “real” men, and would have fallen outside the realms of normality.

This, more than anything else, may account for why those boys who were previously considered “normal” were suddenly showing up everywhere as problematic. Given that those we now label as having “Asperger’s syndrome” are more in line with what we now think of as “geek” culture – solitary, lacking social attunement, and interested in mechanistic or philosophical pursuits – they would have fallen well outside the Nazi ideal of the “new man”. That is to say, they would neither have seemed particularly good at marrying, due to their purported problems in socialising, or falling in with this “solider mentality”, since they tend to be isolated, original thinkers, unlikely to be swept up in crowd madness. In short, as Dr Asperger noted in 1944, his autistic patients tended to ‘follow only their own wishes, interests and spontaneous impulses, without considering restrictions or prescriptions imposed from outside’ – traits which would have made them highly problematic from the inside viewpoint of the Nazi drive towards homogenous, hyper-masculine group mentality.

If this suggestion seems unreasonable, consider how long it took for Asperger’s syndrome to end up being deemed an issue in the UK and the rest of the West. Whilst it was deemed problematic in the German-speaking world, briefly, in the 1930s and 1940s, it didn’t systematically appear as an issue in the rest of the West until the 1980s. Although biologised approaches to autism cannot easily account for this huge gap, one clear social explanation regards how, during the first half of the 20^th Century, gender norms in the liberal West were very different from those in Nazi Germany. In fact, the modernist male ideal in the rest of the West was much more in line with those traits we now associated with Asperger’s: being rational, clear, fixed in focus, and lacking empathetic attunement were celebrated in the modernist masculine ideal.

Consider, as Patrick McDonagh has argued, how many heroes and anti-heroes produced by modernist writers (ranging from Beckett to Kafka) can retrospectively be seen to exhibit remarkable similarities to those bodies now labelled as having Asperger’s syndrome. One example is Albert Camus’ “outsider” Meursault, who has been described as a ‘striking depiction of a high-functioning autistic’. This is not just in light of his intense sensory overload under the blazing Algerian sun, but also, as Camus himself described him, his being ‘an outsider to the society in which he lives, wandering on the fringe, on the outskirts of life, solitary, and sensual’. In stark contrast to the hyper-masculinity of Nazi-Germany, these traits were, wrongly or rightly, positively fetishized in men throughout the first half of the 20^th Century in much of the modernist West, meaning that they would not have been deemed pathological and in need of medicalisation.

Whilst these traits were celebrated in the modernist era, they increasingly began to show up as problems in the Britain during the 1980s – meaning that something had changed in British social normativity. Interestingly, according to critical psychiatrist Sam Timimi and colleagues, this largely happened in light of the rise of the neo-liberal market system, and in particular the services economy. In particular, this economic shift began to alter the notion of the ideal male: rather than being fixed in focus and obsessive, men increasingly now had to forever shift into new roles and to constantly sell one’s “self” in order to fit in. Members of the workforce, in other words, now had to become increasingly agile, flexed, narcissistic, and hyper-social in order to succeed and be valued – and this economic drive became reflected in social normativity at all levels of society.

Thus, whereas modernist conceptions of masculinity tended to celebrate autistic traits, neoliberal economic ideology began to alter idealised conceptions of masculinity in such a way that takes them to be pathological. Boys who fell outside these norms began showing up at clinics, and suddenly a renewed interest in Hans Asperger’s previously overlooked publications from the 1940s, led by British psychiatrist Lorna Wing, emerged in order to account for this. By the mid-1990s, Asperger syndrome had been added to all the major diagnostic manuals, the “spectrum” had radically broadened, and diagnoses of the condition had skyrocketed.

In both times and places where Asperger’s syndrome came to be seen as a distinctively problematic condition – first, briefly, in Nazi-occupied territory during the 1930s and 1940s, and then again in neo-liberal Britain, Europe, and the United States, from the late 1980s onward – shifting gender norms help account for why the condition began to show up as problematic, and that too in more and more subtle cases. Gender norms, in other words, can account for the “cause” of autism, and the autism “epidemic”, in the only way that notion makes any sense: not as something physical, but rather as something that came into being, and grew, as a distinct social grouping at some point in history.