Tuesday, 5 December 2017

Is Autism a Disease?

This post is by Christopher Mole, Chair of the programme in Cognitive Systems at the University of British Columbia. He is the author of Attention is Cognitive Unison (OUP, 2010), and The Unexplained Intellect (Routledge, 2016). This post outlines the argument of his recent article, “Autism and ‘disease’: The semantics of an ill-posed question” (Philosophical Psychology, 8(3): 557-571).

Discussions of autism are often euphemistic: We speak of ‘service users’ rather than patients; and ‘atypicality’ rather than illness. By avoiding the rhetoric of disease we avoid the implication that the autistic point of view is a defective one, which would be gone from a world in which everything was operating correctly.

Those who do use the vocabulary of disease might reject such motivations, while congratulating themselves on their straight-talking, no-nonsense approach. This would, I think, be a mistake. According to one tradition, the mistake would be that of applying a ‘medical model’. Autism, on this view, is something other than a disease.

This too is an unappealing position. Autism has several effects, some disrupting the gastrointestinal system, others disrupting the processes of immune response and inflammation. It seems arbitrary to deny that those consequences that affect psychological functioning might also be understood medically. And to deny this would leave us without a full account of the autistic person’s entitlement to help.

Autistic people can seem inconsiderate. They are, as a result, prone to suffer from loneliness, unless allowances are made. Such suffering can be profound. It is appropriate that these allowances be made (and appropriate that healthcare budgets provide funding for them). Autism therefore differs from such non-medical conditions as the condition of being an arsehole. That condition is also prone to produce the suffering of loneliness, but — not being a disease — there is no reason why healthcare resources should be directed to its mitigation.

On these grounds (and others) we find ourselves wanting to avoid saying that autism is a disease, and also wanting to avoid saying that it is not one. We might try to have it both ways, by saying that the question is vague, or that the answer varies from case to case. I claim that we should instead reject both answers.

Michael Dummett’s theory of pejoratives opens up the logical space for this. Pejoratives (such as racist terms for ethnic groups) should be rejected whether their use is affirmative or negative. Such terms should even be rejected in contexts that are non-assertoric, as in the asking of questions.

Similarly, I claim, we should reject the vocabulary of disease in connection with autism, not because we should deny that autism is a disease, but because we should refuse even to ask the question.

It is a strength of Dummett’s theory that it applies to vocabulary whether or not that vocabulary is insulting, and so explains why vocabulary that applauds piety, machismo, or class loyalty, is no better than vocabulary that deplores racial diversity, effeminacy, or free-thinking. The problem with pejorative vocabulary is not the insult. The problem is that such vocabulary allows normative consequences to be inferred from the wrong descriptive basis.

The vocabulary of disease enables us to infer certain normative consequences on the basis of there being a condition that impairs human flourishing: from the presence of such a condition it allows us to infer that cure-seeking would be appropriate (and perhaps obligatory for those with a duty of care); and it allows us to infer that shortcomings attributable to this condition are mitigated.

The problem is not that cure-seeking and mitigations are inappropriate. They usually aren’t. The problem is, instead, that these normative consequences are bundled together, and are made to be inferable from this particular descriptive basis. The main argumentative burden of my paper is to show that this gives the wrong account of when cure-seeking is appropriate, and the wrong account of why mitigation is.

If this is right then we should regard the question of whether autism is a disease in something like the way that we regard the question of whether chastity is becoming to a lady. We don’t want to say that is, nor that it isn’t, and we certainly don’t want to say that it depends which lady is in question. 

Because the question embodies a misbegotten set of values, even before we start to answer it, we instead want to reject the whole enquiry. In the question of whether autism is a disease the values are misbegotten in a different way, but again it is the whole enquiry that needs to be rejected, with neither a positive nor a negative answer being given.

Something similar may apply when the disease question is raised in connection with addiction, post-traumatic stress, and reactive depression.

1 comment:

  1. I'm not so sure what 'vocabulary of disease' might be. Is it an empty signifier? My response.



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