2013-03-07

Towards a Philosophy of Autism: The Enactive Response to the Tendency to Pathologize

Joel Parthemore (Centre for Cognitive Semiotics, Lund University)

An increasing trend in recent years has seen the pathologizing of a wide range of mental phenomena under the headings of "disease", "disorder", or "disability". A recent school in philosophy of mind, enactivism, is inclined to oppose this trend as based upon philosophically dubious assumptions. In
particular, enactivism rejects mind-brain reductionism and emphasizes the continuity between agent and environment, co-created out of their interaction. Enactivism is inclined to view much if not most of autism spectrum "disorders" as instances of cognitive diversity, recasting the disabilities associated with autism as a problem, not of neurology, but of the relationship between autist and society. The result is a failure to address the full range of human needs and talents and the mislabeling of the presumed minority as "broken". This paper shows how a re-conceptualization of autism can be not only philosophically better justified but also beneficial to autists and public alike. The diagnosis of autism and autism spectrum disorders dates to the 1940s. Until relatively recently, they were considered extremely rare; but, as Newschaffer and colleagues (2007) write, “today, the prevalence of ASDs is understood to be many times greater, with the condition now thought to be second only to mental retardation among the most common developmental disabilities in the United States”. The growth in autism diagnoses is far from unique, if one considers other conditions falling under the broad heading of mental health. In 1988, there were 500,000 reported cases of attention deficit hyperactivity disorder in the States. By 2007, that number had risen to 4,000,000. Various reasons have been put forward for these trends: not least the possibility that these diseases or disorders are more prevalent than previously thought; or that they are, for less than fully understood reasons, becoming more prevalent. At the same time, various people have noted the financial incentive for the pharmaceutical companies to encourage the labeling of phenomena as diseases requiring medication, with all the more profit to be made from chronic diseases requiring long-term medication. Others would put the finger more broadly on the politics of healthcare funding: a definite diagnosis with a clear treatment plan comes with a much more predictable cost. What is most interesting for my purposes, however, are the often unstated philosophical – often, specifically metaphysical – assumptions that lie behind contemporary professional and public understanding of mental health issues. Modern science has taken a principled stand against supernatural explanations and against Cartesian divisions of mental thought from physical matter. All
phenomena, it is said, have a natural and physical explanation: positions known respectively as naturalism and physicalism. Such a position might or might not be valid. What is significant for my purposes is the particular way in which naturalism and physicalism are frequently if not generally cashed out -- not assisted by the common failure to define either term but rather take them as
understood. Naturalism is taken to mean something like “open to a complete and consistent account”, leaving out the possibility that some phenomena may be more amenable to naturalistic explanations than others. Meanwhile, the mental is either taken to reduce to the physical: mental explanations are
reducible to physical ones; or to emerge more-or-less straightforwardly from the physical. This raises two problems. Mental phenomena get reductively treated as just another form of physical phenomena, setting up what I claim as a false equivalence between physical disorders and mental ones. The very term “mental illness” implies this. Illnesses are physically localizable phenomena, whereas I argue that mental phenomena simply are not, in general, localizable in the
same way as physical ones. Illnesses come with a certain script: when one is ill, one goes to the doctor for treatment; one receives drugs or is given some specific treatment plan; one hopes for a cure or at least an amelioration of symptoms. If mental health issues are, indeed, a different order of things,
then they call for a different set of scripts. The muddled understanding of mind’s relationship to matter gives rise to further conceptual confusions: in particular, a frequent tendency to conflate things that legitimately are disorders (e.g., schizophrenia, bipolar disorder, and dissociative personality disorder: things that currently fall under the general heading of mental illness) from things that, I argue, are not. Autism is not considered an
illness, but it is commonly referred to as a disorder and treated as a disability (an even more vague and problematic term). All of these terms – disorder, illness, disability – are loaded with conceptual baggage. I argue that much of what is considered to fall within autism spectrum disorders – as well as
other phenomena that are not considered diseases but are considered disorders – should better be understood in more neutral terms, as expressions of cognitive diversity, where that diversity is ceteris paribus a potential benefit and not liability to society. Several caveats are in order. First, I am neither a psychologist nor psychiatrist, and nothing I say here should be taken to imply otherwise. I am a philosopher of mind with a particular interest in how people organize their conceptual understanding of the world, especially their ability to conceptualize the “same things” in multiple, equally valid but often mutually exclusive, ways. I ascribe to a school of philosophy known as enactivism that implies a different, albeit decidedly non-Cartesian, understanding of the relationship of cognitive and biological self: one that has been well explored in some domains but not when it comes to issues of mental health and cognitive dysfunction. Second, I am not claiming that autism does not exist nor that it is, as some radical constructivists might have it, a purely social construction. Finally, I am certainly not denying that autism, as with all mental phenomena, has a substantive physical basis, nor that there are not forms of autism that are legitimately understood as disorders. Rather, my concern is with how autism (broadly understood) is conceptualized – both professionally and publicly – as well as with how that conceptual structure then prejudices how people who are labeled with autism spectrum disorders get treated. I begin by introducing enactivism, a school of philosophy with roots in the work of Humberto Maturana and Francisco Varela from the 1970s onward, with its distinctive view of the relationship between agent and environment as co-creators. I then argue that enactivism is inclined to view mental “disorders” in general and autism spectrum disorders in particular quite differently from the prevailing views in American and European psychiatry. This leads me to consider the consequences of such a radical re-conceptualization. I close with some prescriptions for the way forward.