Autism

This document is a lengthy handout providing brief summaries of a number of objections I have made to Simon Baron-Cohen, and some related points. The objections are scattered across multiple databases and are in numerous contributions.

This paper presents an example of a topic inviting amateur psychology in response and introduces some characters: some who try to shut down the topic and some who will allow for it but with greatly reduced amateur psychology. It raises the question of why these characters hate amateur psychology so. Also it introduces a rational actor model in relation to the topic: a model which explains why people in a field look similar. People in a job want to be regarded (...) as competent, so it is rational for them to develop a distinctive look. (shrink)

What does it take to see how autistic people participate in social interactions? And what does it take to support and invite more participation? Western medicine and cognitive science tend to think of autism mainly in terms of social and communicative deficits. But research shows that autistic people can interact with a skill and sophistication that are hard to see when starting from a deficit idea. Research also shows that not only autistic people, but also their non-autistic interaction partners can (...) have difficulties interacting with each other. To do justice to these findings, we need a different approach to autistic interactions—one that helps everyone see, invite, and support better participation. I introduce such an approach, based on the enactive theory of participatory sense-making and supported by insights from indigenous epistemologies. This approach helps counteract the homogenising tendencies of the “global mental health” movement, which attempts to erase rather than recognise difference, and often precludes respectful engagements. Based in the lived experiences of people in their socio-cultural-material and interactive contexts, I put forward an engaged—even engaging—epistemology for understanding how we interact across difference. From this perspective, we see participatory sense-making at work across the scientific, diagnostic, therapeutic, and everyday interactions of autistic and non-autistic people, and how everyone can invite and support more of it. (shrink)

Music therapy for autism has historically been guided by a “pathology paradigm” that aims to normalize autistic people in line with neuronormativity. The neurodiversity movement has initiated a paradigm shift towards more neuro-affirming practices. However, music therapy would benefit from a more robust theoretical grounding to guide this neuro-affirming transition. We address this gap by putting forward an enactive account of autistic musical engagement—grounded in the neurodiversity paradigm—that avoids pathological framing. Drawing on first-person reports from recent qualitative studies, we discuss (...) how autistic people use music in everyday life for emotional regulation, identity construction, and social connection, while also noting how music can sometimes clash with autistic sensory sensitivities and agency. From this enactive perspective, autistic styles of musical engagement are revealed not as a set of symptoms to be managed but as vital dimensions of sense-making. We conclude by deriving some core principles to guide the development of neuro-affirming music therapies and inclusive live music events, creating spaces for autistic flourishing. (shrink)

Autism spectrum disorder is usually understood through deficits in social interaction and communication, repetitive patterns of behavior, and hyper- or hyporeactivity to sensory input. Affordance-based Skilled Intentionality that combines ecological-enactive views of cognition with Free Energy and Predictive Processing was proposed as the framework from which to view autism integrally. Skilled Intentionality distinguishes between a landscape of affordances and a field of affordances. Under the integrative Skilled Intentionality Framework, it can be shown that autistic differences in the field of affordances (...) stem from aberrant precision estimation. Autistics over-rely on the precision afforded by the environment—a stable econiche they build. According to this approach, autism is understood as characterized by an atypical field of affordances. I will build on the ecological-enactive account of autism to suggest that one way to shape the neurotypical landscape of affordances in accordance with autistic needs is through the use of Ambient Smart Environments (ASEs). Taking the cue from autistic lived experience, ASEs could help minimize environmental uncertainty and afford affective scaffolding by supporting dynamic and flexible niche construction in accordance with individual autistic styles. (shrink)

Redefining mental health is not interpretive gloss or an attempt to rescue our vocabulary by reifying its assumptions in new terms. It is a statement of minimal commitments about the least one must assume in order to speak coherently about minds, meaning, and breakdown without covertly reintroducing metaphysics whenever explanation runs thin. The following axioms are intentionally sparse because surplus premises do not remain surplus; they calcify into foundations, and foundations tend to be defended long after their use has expired. (...) Each axiom is therefore not a preference but a constraint on what may legitimately be posited in subsequent analysis, and they are arranged so that later claims are disciplined by earlier ones rather than floating free as optional rhetoric. (shrink)

I am nonverbal autistic, so language has never been neutral for me. It has functioned less as a bridge and more as a demand, test, and most often a threat. In our hyperverbal world, silence is treated as absence, an absence of thought, of feeling, of intelligence, and of intent. That mistake causes real harm. I learned at an early age that if I could not translate myself quickly, fluently, and on cue, my inner state would be ignored and overwritten. (...) Speech was never optional. It was required as proof that I was present in a way others were willing to recognize. (shrink)

Television has entered a golden age, or so we are told. Premium cable and streaming platforms have gifted us with countless programs described in breathless detail as “unflinching,” “provocative,” or “darkly relevant.” These shows gesture toward systemic critique the way a debutante gestures toward the punch bowl, with practiced elegance and no intention of actually drinking. They deploy anti-capitalist aesthetics as set dressing with corrupt executives, soulless corporations, and montages of urban decay scored to melancholy indie rock. One watches and (...) feels appropriately concerned, so we subscribe to another streaming service. The circuit completes itself, and no one is harmed. (shrink)

Once upon a time, when a child behaved strangely, stared too long, spoke to no one in particular, or failed to respond to the ordinary rituals of social life, an explanation arrived quickly and with confidence. Something had possessed the child. Some demon, spirit, or malign influence that did not belong. This diagnosis was not subtle, but it was reassuring. The world was still intact. Normality existed. The problem was an intruder. Remove the intruder, and order would return. That story (...) has never really gone away. It has only learned new words. Modernity congratulates itself on having banished demons, but it has not abandoned demonology. We have simply traded incense for instrumentation and exorcists for experts. Where possession once explained deviation, we now speak of toxins. Where curses once crept through bloodlines, we now trace exposure pathways. Where corruption once entered through sin, it now enters through plastics, preservatives, pesticides, vaccines, microplastics, endocrine disruptors, heavy metals, and any other unnamed residue detected at parts-per-billion levels by machines whose sensitivity outpaces our interpretive restraint. The form has changed. The function has not. (shrink)

The word hallucination arrives with unusual authority. It sounds finished, clinical, as though it refers to something isolated, named, and understood. To say that someone is hallucinating feels like saying that a machine has malfunctioned; it is a discrete error occurring inside an otherwise reliable system. However, the moment one pauses over the term, it begins to wobble. What, precisely, is being named? An experience? A perception? A belief? A failure to meet a standard that is rarely examined but always (...) assumed? The apparent solidity of the word conceals its surprising vagueness. It feels concrete, but it collapses under scrutiny, revealing less a thing in the world than a verdict rendered upon certain kinds of experience. This is not because the experiences themselves are unreal, trivial, or invented. People see, hear, feel, and sense things that are intense, meaningful, and sometimes frightening. Any honest inquiry must begin by taking those experiences seriously. The problem lies not in the phenomena of experience, but in the confidence with which we name them. “Hallucination” does not simply describe what someone reports; it quietly judges how that report relates to an external frame of reference. It tells us, without saying so, that the experience has failed to line up with what is collectively recognized as real. In this sense, the term functions less as a neutral description and more as a marker of misalignment. It signals that something has gone out of bounds, not necessarily in the mind, but in the relationship between an individual’s account of reality and the symbolic order that governs shared life. (shrink)

The neurodiversity movement grew out of the autism community but is now being applied to many neurological types, from dyslexia to schizophrenia. The resulting neurodiversity paradigm maintains that these neurological differences are normal variations in the human species, like race and sexual orientation, which should be valued and accommodated, not “fixed” or eliminated. Yet some clear-eyed individuals view their brain differences as deficits and would continue to seek treatment in the absence of discrimination or lack of accommodation. I argue that (...) fully appreciating cognitive diversity requires more nuanced normative claims that respect individual differences and fluid circumstances. Although analogies to minority statuses can be useful, variations in personality traits provide a more flexible and inclusive model for neurodivergence. Despite ultimately rejecting the biodiversity metaphor, a more nuanced neurodiversity paradigm emphasizing our shared humanity can promote compassion, respect, and support for all. (shrink)

This chapter canvases a number of ways that issues surrounding disability intersect with social epistemology. We begin with a discussion of how social epistemology as a field and debates concerning epistemic injustice in particular would benefit from further (a) engaging the fields of disability studies and philosophy of disability and (b) more directly addressing the problem of ableism. In section two, we turn to issues of testimony, “intuitive horribleness,” and their relationship to debates concerning disability and well-being. We address how (...) the regular lack of uptake of disabled people’s testimony can lead to a number of structural rather than merely individual epistemic injustices, and we also consider how the very nature of some disabilities make testimonial issues more complicated. We conclude by discussing various norms of social interaction and how they can systematically disadvantage Autistic people in particular with respect to all the issues discussed herein. (shrink)

In this paper, I argue that basic forms of collective intentionality such as those involved in atttending, acting and feeling with others essentially involve experiencing and understanding others as co-subjects, that their content is nonconceptual, and that they represent co-subjects and their positions at a level that is prior to the mind-body differentiation.

Autism Spectrum Disorder is a diagnosis applicable to a vast range of presentations. However, there are disadvantages to theorizing and communicating about autism as a single spectrum. This paper suggests an alternative or supplementary multi-dimensional approach for diagnosticians and educators – an approach that more accurately reflects our understanding of autism.

Affordances are action-possibilities, ways of relating to and acting on things in our world. They help us understand how these things mean what they do and how we have bodily access to our world more generally. But what happens when this access is ruptured or impeded? I consider this question in the context of psychopathology and reports that describe this experience. I argue that thinking about the bodily consequences of losing access to everyday affordances can help us better understand these (...) reports. An affordance-based approach to psychopathology can illuminate some of the causes, as well as the experiential character and consequences, of affective disorders and diminished spatial agency in self-world disturbances. It also highlights some under-explored ethical and political dimensions of these issues that need further attention. (shrink)

Fictionalist theories of metaphor hold that metaphorical utterances aim at fictionality. Fictionalism successfully explains speaker judgments about the truth and aptness of metaphorical utterances, and it also accurately predicts the data around metaphor and autistic individuals (who have deficits in both imaginative play and metaphor comprehension). But fictionalism is not a viable theory of metaphor, despite these merits, because of (what I call) the problem of semantic entailment: semantic entailments that are normally valid fail under metaphorical interpretation, but fictionalism predicts (...) otherwise. I argue this to ultimately show that theorists of metaphor should reject the linguistic side of the fictionalist story; but this leaves open the possibility of accepting psychological fictionalism, i.e., the hypothesis that fiction/make-believe is central to the cognitive processing of metaphor. Coupling psychological fictionalism with a different theory of metaphorical meaning and content (such as contextualism) promises to keep the explanatory upsides of traditional fictionalism while avoiding the problem of semantic entailment. (shrink)

The aim of this paper is to discuss monastic paideia in the context of providing shelter for ASD individuals in the High Middle Ages. Firstly, we will canvas the historical and conceptual shift from Ancient Greek paideitic ideas to their Christian counterparts. Then, by drawing on the recent literature in the history of medicine that traces the signs and symptoms of autism spectrum disorder (ASD) in Hildegard of Bingen, a German abbess in the 12th century, we will turn to her (...) invented language Lingua Ignota as a source of both her diagnosis and a manner of dealing with her disability. This, in turn, could be further advanced by identifying monasteries as therapeutic loci for neuroatypical individuals who had trouble finding their place within the arid and somewhat monochromatic medieval society. (shrink)

We present results from a single case study based on semi-structured interviews with a student (a boy in school year 3) diagnosed with autism spectrum disorder and his school staff after participating in a short and small-scale intervention carried out in a socio-economically disadvantaged Swedish elementary school in 2019. The student participated in a seven week long intervention with a total of 12 philosophical dialogues (ranging from 45 to 60 minutes). Two facilitators, both with years of facilitation experience and teacher (...) degree and at least BA in philosophy, facilitated the majority of the dialogues and mainly followed a ”routine” procedure. The student was interviewed in direct connection to the end of the intervention about his experiences from the dialogues and his perceptions about whether and how the dialogues had influenced him. The student’s two teachers, who had participated in the dialogues as participants, were interviewed as a pair, also in direct connection to the end of the intervention, while the school principal was interviewed two years after the study. These staff interviews concerned the staff’s experiences of the influence of the dialogues on the students within the intervention as well as transfer effects to other contexts in school. The data from the study include detailed elaborations from a student perspective of different effects on the student’s communicative and cognitive development, which are in several respects supported also by staff reports. The results show that the student was able, interested, and willing to participate in philosophical dialogues, and our data point to several positive outcomes for the student in the communicative and cognitive domains. (shrink)

En 1959, la revue Scientific American publie l’une des premières études consacrées à des œuvres d’art réalisées par une personne explicitement décrite comme « autiste » : un dénommé Joey[1]. L’auteur de cette étude de cas, Bruno Bettelheim, s’est avéré par la suite être un charlatan, sa pratique a été discréditée et aujourd’hui, ses méthodes sont généralement – et à juste titre – considérées comme abusives. Néanmoins, son travail a joué un rôle important dans la création du débat autour de (...) l’autisme aux États-Unis au lendemain de la Seconde Guerre mondiale.[2] Ses recherches psychanalytiques concernant l’autisme ont été par la suite rassemblées dans son livre, La forteresse vide (1967). Si celui-ci est dorénavant un texte discrédité, il s’agit cependant d’une archive essentielle concernant la situation difficile des personnes autistes et la manière dont la vie et le travail de Joey ont perturbé les compréhensions dominantes de la différence humaine. (shrink)

There is growing philosophical interest in “affective injustice”: injustice faced by individuals specifically in their capacity as affective beings. Current debates tend to focus on affective injustice at the psychological level. In this paper, I argue that the built environment can be a vehicle for affective injustice — specifically, what Wildman et al. (2022) term “affective powerlessness”. I use resources from ecological psychology to develop this claim. I consider two cases where certain kinds of bodies are, either intentionally or unintentionally, (...) deprived of access to goods affording the development and maintenance of their subjective well-being: hostile architecture and masking practices in autism. This deprivation, I argue further, leads to a significant weakening and diminishment of their spatial agency, hinders their well-being, and in so doing gives rise to a pervasive experience of affective powerlessness. By drawing attention to these themes, I show that an ecological approach helpfully supplements existing approaches. It highlights how affective injustice can emerge via the way bodies are positioned in space, and the central role that built environments play in determining this positioning. (shrink)

Autism is a psychopathological condition around which there is still much prejudice and stigma. The discrepancy between third-person and first-person accounts of autistic behavior creates a chasm between autistic and neurotypical (non-autistic) people. Epistemic injustice suffered by these individuals is great, and a fruitful strategy out of this predicament is much needed. I will propose that through the appropriation and implementation of methods and concepts from phenomenology and ecological-enactive cognitive science, we can acquire powerful tools to work towards greater epistemic (...) justice for autistic individuals. I will use the resources found in the skilled intentionality framework, integrated with various phenomenological theories. From these approaches, we can view autistic impairments and disability relationally and how epistemic enablement and disablement form. Phenomenology and its methods help us learn more about the perceptual and social experiences of autistic individuals. The voices of the autistics themselves will be of the greatest importance here. I will show that, through restructuring our landscape of affordances and with a greater phenomenological understanding of the autistic inner world, we can devise new strategies that afford greater epistemic enablement and epistemic justice. (shrink)

In this paper, we examine some basic linguistic abilities in a small sample of adults with minimal receptive vocabulary, whose receptive mental verbal age ranges from 1;2 to 3;10. In particular, we examine whether the participants in our study understand noun phrases consisting of a noun modified by an adjective. We use stimuli that they can recognise by name. Except for one participant, we find that, while all of them understand the noun and adjective in isolation, none seems to understand (...) these noun phrases, which means that they seem to not do linguistic composition. In order to test whether the difficulty is linguistic or conceptual, we ran two other studies, one on concept composition, and the other on iconic symbolic composition (composition of pictograms). Results suggest that linguistic composition is particularly difficult in this population, and that vocabulary breadth may not predict compositional abilities. (shrink)

This paper investigates, from a philosophical perspective, whether high functioning autists are legally responsible for the crimes they may commit. We do this from the perspective of the Croatian legal system. According to Croatian Criminal Law, but also criminal laws adopted in many other countries, the legal responsibility of the person is undermined due to insanity when two conditions are satisfied. The first may be called the incapacity requirement. It states that a person, when committing the crime, suffers cognitive or (...) volitional incapacities or limited capacities that are relevant for exculpation. The second, we may call the mental disorder requirement, which states that these exculpatory incapacities are due to the presence of a mental disorder. In this paper we focus on the incapacity requirement. The review of the studies on executive functions deficits associated with high-functioning autism suggests that many autists should not be held categorically responsible for the crimes they may commit. Nonetheless, we argue that these impairments in executive functions generally do not provide an unqualified excuse. (shrink)

The proliferation of work by autistic writers continues apace, defying a long and multidisciplinary tradition of constructing autistic people as lacking the capacity for narration. To study neurodivergent literature, then, is to witness the refusal of these exclusionary narrative conventions, and to register the ideological presuppositions that underpin pathologization. In this article, I engage with recent insights from Neurodiversity Studies to explore the connections between narrative neuronormativity and other discourses of oppression, especially those that have generated racialized, gendered, and colonial (...) narratives of desubjectification. Focusing on the neuroqueer movement—an emergent practice of disidentification that refuses the interpellations of neuronormativity, ableism, heteronormativity, and cisnormativity—I discuss the concept of allism, arguing that this satirical critique of pathologization harbors a deconstructive force that denaturalizes the dialectic of recognition. Pursuing the discursive context and theoretical implications of this critique, I provide a short genealogy of narrative neuronormativity, connecting the operation of the dialectic in the early novel to the clinical texts of child psychology. To demonstrate the neuroqueer subversion of this tradition, I then read An Unkindness of Ghosts, by Rivers Solomon, a text that stages a disidentification with storytelling. Protagonist Aster’s neuroqueer refusal indexes the concomitance of the construction of Blackness as an ontological foil for whiteness and the construction of autism as a standard of disordered sociality that neuronorms can be measured against. My reading of Unkindness suggests that the extant techniques of literary narratorship are political instruments that will, unless repurposed, continue to disseminate these dispossessive dialectics. (shrink)

The term empathy (Einfühlung) is rooted in philosophical aesthetics. It was used by German philosophers toward the end of the nineteenth century to describe our ability to imaginatively “feel into” works of art, which speak to us in a certain humanlike way insofar as they contain traces of what Mikel Dufrenne calls a “quasi-subjectivity” (1973, 393). In this chapter, rather than looking to art as an object of empathy, we instead consider art—and more specifically, music—as a resource that can facilitate (...) empathy. More precisely, we turn to two cases in which music seems to establish spaces that enable and sustain empathic connectedness, as well as the ability to explore and experiment with different forms of social understanding and affective sharing. The first case comes from the music tradition of free improvisation. Based on ethnographic fieldwork with the saxophone player, Torben Snekkestad, we become acquainted with an approach to performance that does not concern music primarily as an aesthetic product, but as a shared process of communicating and connecting nonverbally with others—a process that is essentially about exploring and experimenting with different forms of intersubjectivity and empathy. The second case comes from music therapy and autism, which can involve listening, singing, or joint music-making. We discuss studies indicating that musical interventions positively address core impair- ments in capacities required for empathy: for example, joint attention, social reciprocity, and verbal and nonverbal communication, as well as comorbidities of atypical perception, motor performance, and behavioral problems. Although these two cases are different, they share the trait of using music to establish spaces of nonverbal communication and empathic understanding. Drawing on these two cases, this chapter analyses how musical-empathic spaces emerge and how these spaces solicit the integration of both low-level affective and bodily resonance mechanisms as well as high-level acts of meta-reflection, imagination, and planning that contribute to different forms of empathic understanding. (shrink)

Synesthesia literally means a “union of the senses” whereby two or more of the five senses that are normally experienced separately are involuntarily and automatically joined together in experience. For example, some synesthetes experience a color when they hear a sound, although many instances of synesthesia also occur entirely within the visual sense. In this paper, I first mainly engage critically with Sollberger’s view that there is reason to think that at least some synesthetic experiences can be viewed as truly (...) veridical perceptions, and not as illusions or hallucinations. Among other things, I explore the possibility that many forms of synesthesia can be understood as experiencing what I will call “second-order secondary properties,” that is, experiences of properties of objects induced by the secondary qualities of those objects. In doing so, I shed some light on why synesthesia is typically one-directional and its relation to some psychopathologies such as autism. (shrink)

I use critical phenomenological resources in Tetsurō Watsuji and Sarah Ahmed to explore the spatial origin of some social impairments in Autistic Spectrum Disorder (ASD). I argue that a critical phenomenological perspective puts pressure on the idea that social impairments in ASD are exclusively (or even primarily) neurocognitive deficits that can be addressed by focusing on cognitive factors internal to the autistic person — for example, training them to adopt a more neurotypical approach to social cognition. Instead, I argue that (...) the structure and character of some neurotypical spaces may play a regulative role in shaping aspects of at least some of the social impairments autistic people exhibit when they inhabit these spaces. I also briefly consider some possible therapeutic applications of this critical phenomenological approach. (shrink)

Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research results. Ethical (...) issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. (shrink)

In this thesis, I investigated the self in autism using tools from philosophy and experimental cognitive science. Our self-representation shapes how we act in the world, and the feedback we receive in turn shapes how we represent ourselves. In the predictive processing framework I use, autism is characterised by differences in modelling or predicting the world under uncertainty which impacts both perception and action. Findings from the thesis show that individuals with more autistic traits are more prone to act early (...) in the face of rising uncertainty. The thesis also raises questions about the appropriate core features of autism. (shrink)

This paper discusses different frameworks for understanding imagination and metaphor in the context of research on the imaginative skills of children with autism spectrum disorder (ASD). In contrast to a standard linguistic framework, it advances an embodied and enactive account of imagination and metaphor. The paper describes a case study from a systemic therapeutic session with a child with ASD that makes use of metaphors. It concludes by outlining some theoretical insights into the imaginative skills of children with ASD that (...) follow from taking the embodied-enactive perspective and proposes suggestions for interactive interventions to further enhance imaginative skills and metaphor understanding in children with ASD. (shrink)

Several theories propose that one of the core functions of inner speech (IS) is to support subjects in the completion of cognitively effortful tasks, especially those involving executive functions (EF). In this paper we focus on two populations who notoriously encounter difficulties in performing EF tasks, namely, people diagnosed with schizophrenia who experience auditory verbal hallucinations (Sz-AVH) and people within the Autism Spectrum Conditions (ASC). We focus on these two populations because they represent two different ways in which IS can (...) fail to help in EF tasks, which can be illustrative for other mental conditions. First, we review the main components of EF (Section 1). Then we explain the functions that IS is taken to perform in the domain of EF (Section 2) and review the evidence concerning problems about EF in the two populations of our study: Sz-AVH (Section 3) and ASC (Section 4). After this we further detail our account about what a properly functioning IS can do for both populations and how different IS profiles may impact EF performance: in the case of Sz-AVH, the uncontrolled and intrusive character of IS negatively affects EF performance, whereas in ASC, EF is not sufficiently supported by IS, given the tendency in this population to present a diminished use of IS (Section 5). We finally briefly discuss Attention Deficit/Hyperactivity Disorder (ADHD) and Developmental Language Disorders (DLD). (shrink)

Wie jedes Krankenhaus hat Charité ihre Geschichte, die mit dem Erlaß des preußischen Königs Friedrich I. vom 14. November 1709 zur Gründung von Lazareth-Häusern anfing, um der Ausbreitung der Pest entgegenzuwirken, wozu es allerdings in Berlin nie gekommen ist. Am 9. Januar 1727 verfügte König Friedrich Wilhelm I. die Umwandlung des vor dem Spandowischen Tor errichteten Lazareth in ein Hospital und nannte es „das Haus die Charité“ nach dem Vorbild von Hôpital de la Charité in Paris. -/- Das Wort und (...) der Begriff Charité ist wesentlich älter als das Krankenhaus. Das Französische charité ist äquivalent dem Englischen charity und dem Deutschen Barmherzigkeit, während ihre Ursprünge im Griechischen zu finden sind: χάρις bedeutet Gnade, Gunst, χαριτόω Gnade oder Gunst zeigen oder empfangen, favorisieren oder favorisiert werden, gnädig oder begnadet sein. Das Krankenhaus ist ein Ort der Gnade, welche den Kranken und Bedürftigen zusteht aufgrund allgemeiner Verpflichtung, seinen Nächsten so zu lieben wie sich selbst. Die Gunst und die Gnade zu erweisen heißt auch, sich zu erbarmen und mitleidig sein, eigenes Herz für fremdes Leid zu offnen. -/- Seit ihrer Gründung weichte Charité von diesem Grundgedanke mehrmals ab, was bisher in ihrer Geschichtsschreibung mehr oder weniger wahrheitsgetreu festgehalten wurde. Dieser Tradition des Festhaltens und der Wiedergabe der Wahrheit bin ich verpflichtet, weil offizielle Geschichtsschreibung erneut beginnt, von der Realität abzuweichen und die Tatsachen zu leugnen, die sowohl unzweifelhaft sind als auch unzweifelhaft würdig sind, erzählt zu werden, weil es dabei um die Frage des Auftrags der Charité geht. -/- Charité wurde gegründet, um das Unheil abzuwenden, dennoch war ihre Geschichte keine Heilsgeschichte, wie ich bereits feststellte. Das Unheil setzte sich im 21. Jahrhundert fort, was ich zu unterbinden suche. Einziges Heilmittel dagegen ist die Wahrheit, daran besteht kein Zweifel, und der Weg, um die Wahrheit zu erkennen, ist die Barmherzigkeit. (shrink)

One way to determine whether a mental condition should be considered a disorder is to first give necessary and sufficient conditions for something to be a disorder and then see if it meets these conditions. But this approach has been criticized for begging normative questions. Concerning autism (and other conditions), a neurodiversity movement has arisen with essentially two aims: (1) advocate for the rights and interests of individuals with autism, and (2) de-pathologize autism. We argue that denying autism’s disorder status (...) could undermine autism’s exculpatory role in cases where individuals with autism are charged with a crime. Our argument raises a dilemma for the neurodiversity movement: advocating for the rights and interests of individuals with autism may require viewing autism as a condition that can be inherently disabling (at least for some individuals). If this is right, autism’s disorder status might be maintained (again, at least for some individuals) without deriving this result from any general account of disorder. (shrink)

Although enactive approaches to cognition vary in terms of their character and scope, all endorse several core claims. The first is that cognition is tied to action. The second is that cognition is composed of more than just in-the-head processes; cognitive activities are externalized via features of our embodiment and in our ecological dealings with the people and things around us. I appeal to these two enactive claims to consider a view called “direct social perception” : the idea that we (...) can sometimes perceive features of other minds directly in the character of their embodiment and environmental interactions. I argue that if DSP is true, we can probably also perceive certain features of mental disorders as well. I draw upon the developmental psychologist Daniel Stern’s notion of “forms of vitality”—largely overlooked in these debates—to develop this idea, and I use autism as a case study. I argue further that an enactive approach to DSP can clarify some ways we play a regulative role in shaping the temporal and phenomenal character of the disorder in question, and it may therefore have practical significance for both the clinical and therapeutic encounter. (shrink)

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we apply a (...) strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

Autism Spectrum Condition presents a challenge to social and relational accounts of the self, precisely because it is broadly seen as a disorder impacting social relationships. Many influential theories argue that social deficits and impairments of the self are the core problems in ASC. Predictive processing approaches address these based on general purpose neurocognitive mechanisms that are expressed atypically. Here we use the High, Inflexible Precision of Prediction Errors in Autism approach in the context of cultural niche construction to explain (...) atypicalities of the relational self, specifically its minimal, extended, and intersubjective aspects. We contend that the social self in ASC should not be seen as impaired, but rather as an outcome of atypical niche construction. We unpack the scientific, ethical, and practical consequences of this view, and discuss implications for how the challenges that autistic persons face should be approached. (shrink)

The professor of psychopathology Simon Baron-Cohen is well-known for his thesis that males are on average better at systematizing than empathizing and females are on average better at empathizing than systematizing. In this paper, I note an ambiguity in how he defines systematizing.

We argue that the notion of "mental institutions"-discussed in recent debates about extended cognition-can help better understand the origin and character of social impairments in autism, and also help illuminate the extent to which some mechanisms of autistic dysfunction extend across both internal and external factors (i.e., they do not just reside within an individual's head). After providing some conceptual background, we discuss the connection between mental institutions and embodied habits of mind. We then discuss the significance of our view (...) for understanding autistic habits of mind and consider why these embodied habits are sometimes a poor fit with neurotypical mental institutions. We conclude by considering how these insights highlight the two-way, extended nature of social impairments in autism, and how this extended picture might assist in constructing more inclusive mental institutions and intervention strategies. (shrink)

Autism has been defined as a disorder of social cognition, interaction and communication where ritualistic, repetitive behaviors are commonly observed. But how should we understand the behavioral and cognitive differences that have been the main focus of so much autism research? Can high-level cognitive processes and behaviors be identified as the core issues people with autism face, or do these characteristics perhaps often rather reflect individual attempts to cope with underlying physiological issues? Much research presented in this volume will point (...) to the latter possibility, i.e. that people on the autism spectrum cope with issues at much lower physiological levels pertaining not only to Central Nervous Systems (CNS) function, but also to peripheral and autonomic systems (PNS, ANS) (Torres, Brincker, et al. 2013). The question that we pursue in this chapter is what might be fruitful ways of gaining objective measures of the large-scale systemic and heterogeneous effects of early atypical neurodevelopment; how to track their evolution over time and how to identify critical changes along the continuum of human development and aging. We suggest that the study of movement variability—very broadly conceived as including all minute fluctuations in bodily rhythms and their rates of change over time (coined micro-movements (Figure 1A-B) (Torres, Brincker, et al. 2013))—offers a uniquely valuable and entirely objectively quantifiable lens to better assess, understand and track not only autism but cognitive development and degeneration in general. This chapter presents the rationale firstly behind this focus on micro-movements and secondly behind the choice of specific kinds of data collection and statistical metrics as tools of analysis (Figure 1C). In brief the proposal is that the micro-movements (defined in Part I – Chapter 1), obtained using various time scales applied to different physiological data-types (Figure 1), contain information about layered influences and temporal adaptations, transformations and integrations across anatomically semi-independent subsystems that crosstalk and interact. Further, the notion of sensorimotor re-afference is used to highlight the fact that these layered micro-motions are sensed and that this sensory feedback plays a crucial role in the generation and control of movements in the first place. In other words, the measurements of various motoric and rhythmic variations provide an access point not only to the “motor systems”, but also access to much broader central and peripheral sensorimotor and regulatory systems. Lastly, we posit that this new lens can also be used to capture influences from systems of multiple entry points or collaborative control and regulation, such as those that emerge during dyadic social interactions. (shrink)

In Gennaro (2016), I had originally replied to Fred Adams and Charlotte Shreve’s (2016) paper entitled “What Can Synesthesia Teach Us About Higher Order Theories of Consciousness?,” previously published in Symposion. I argued that H.O.T. theory does have the resources to account for synesthesia and the specific worries that they advance in their paper, such as the relationship between concepts and experience and the ability to handle instances of ‘pop-out’ experiences. They counter-reply in Adams and Shreve (2017) and also raise (...) further objections to H.O.T. theory which go well beyond the scope of their 2016 paper. In this paper, I offer additional replies to the points they raise in Adams and Shreve (2017). (shrink)

It often seems incorrect to say that psychiatric conditions are diseases, and equally incorrect to say that they are not. This results in what would seem to be an unsatisfactory stalemate. The present essay examines the considerations that have brought us to such a stalemate in our discussions of autism. It argues that the stalemate in this particular case is a reflection of the fact that we need to find the logical space for a position that rejects both positive and (...) negative answers. It then suggests one way in which we might find such space, by applying Michael Dummett’s notion of semantic disharmony. (shrink)

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published in 2013 containing the following changes from the previous edition: gone are the subcategories ‘Autistic Disorder,’ ‘Asperger Syndrome’ and ‘PDD-NOS,’ replaced by the single diagnosis ‘Autism Spectrum Disorder,’ and there is a new category ‘Social Communication Disorder.’ In this paper I consider what kind of reasons would justify these changes if one were (a) a realist about autism, or (b) one were a constructivist. I explore (...) various analyses of autism in the research literature that portray it as essentially either a psychological, neurological or genetic phenomenon, and discuss these by reference to the diagnostic criteria and by analogy with the way we understand race and sex categories. I conclude that no realist reasons are available to justify the changes in the diagnostic criteria, and further, that the only way the changes could be justified is if one takes the position that the DSM categories are social constructs. I conclude by exploring what implications follow from this. (shrink)

This is a review of Susan Greenfield's 2015 book 'Mind Change: How Digital Technologies Are Leaving Their Mark On Our Brains'. Greenfield is a neuroscientist and a member of the UK House of Lords, who argues that digital technologies are changing the human environment "in an unprecedented way," and that by adapting to this environment, "the brain may also be changing in an unprecedented way." The book and its author have created a surprising amount of controversy. I discuss both Greenfield's (...) book and a prominent critique by Bell et al. (2015). The exchange points to some flaws in Greenfield's argument and represents an interesting debate about the public role of scientists, but it does not undermine the value of the book as a springboard for discussions about possible policies and future research. (shrink)

One of the central claims of the neurodiversity movement is that society should accommodate the needs of autistics, rather than try to treat autism. People have variously tried to reject this accommodation thesis as applicable to all autistics. One instance is Pier Jaarsma and Stellan Welin, who argue that the thesis should apply to some but not all autistics. They do so via separating autistics into high- and low-functioning, on the basis of IQ and social effectiveness or functionings. I reject (...) their grounds for separating autistics. IQ is an irrelevant basis for separating autistics. Charitably rendering it as referring to more general capacities still leaves us mistaken about the roles they play in supporting the accommodation thesis. The appeal to social effectiveness or functionings relies on standards that are inapplicable to autistics, and which risks being deaf to the point of their claims. I then consider if their remaining argument concerning autistic culture may succeed independently of the line they draw. I argue that construing autistics' claims as beginning from culture mistakes their status, and may even detract from their aims. Via my discussion of Jaarsma and Welin, I hope to point to why the more general strategy of separating autistics, in response to the accommodation thesis, does not fully succeed. Finally, I sketch some directions for future discussions, arguing that we should instead shift our attention to consider another set of questions concerning the costs and extent of change required to accommodate all autistics. (shrink)

If one can judge a society by how it treats its prisoners, one can surely judge a society by how it treats cognitively- and learning-impaired children. In the United States children with physical and cognitive impairments are subjected to higher rates of corporal punishment than are non-disabled children. Children with disabilities make up just over 13% of the student population in the U.S. yet make up over 18% of those children who receive corporal punishment. Autistic children are among the most (...) likely to receive corporal punishment. Although they may deny or redescribe particular instances of corporal punishment or their use of restraints, educators defend such actions as legitimate punishment. In this paper, I assess the logic underlying the use of restraints and corporal punishment on autistic children by educators. The rationalizations for the corporal punishment or restraint of autistics stems from the educator’s desire to control the autistic children so as to end typical autistic behaviors such as rocking, repetitive verbalizations, or “flapping” but also the autistic child’s non-affective responses such as not appearing to feel remorse or shame or the absence of a verbal acknowledgement of remorse or shame. The educators assume that the autistic’s failure to exhibit the desired responses is evidence of the autistic’s moral incorrigibility and is, therefore, evidence of the appropriateness of corporal punishment. But this assumption of the incorrigibility of the autistic child is questionable. Indeed accepting this incorrigibility assumption reveals two important problems. First, instructors using physical punishment on autistic children do not understand autism. Second, they are not working with a tenable conception of punishment. Any action undertaken to induce socially acceptable behaviors (whether it be the end of autistic acts or responses such as remorse) is to fail to understand what the legitimate punishment of children is about. (shrink)

In recent years, philosophers have looked to empirical findings about psychopaths to help determine whether moral agency is underwritten by reason, or by some affective capacity, such as empathy. Since one of psychopaths’ most glaring deficits is a lack of empathy, and they are widely considered to be amoral, psychopaths are often taken as a test case for the hypothesis that empathy is necessary for moral agency. However, people with autism also lack empathy, so it is reasonable to think that (...) any empirically-informed attempt to answer the question of whether empathy is necessary for moral agency should give due attention to autism as well as psychopathy. Jeanette Kennett’s thought-provoking paper ‘Autism, Empathy and Moral Agency’ (2002) is an early and arguably the most notable example of such an attempt. Kennett argues that although autistic people and psychopaths both lack empathy, autistic people possess a ‘reverence for reason’ that enables them to become capable moral agents. By contrast, psychopaths lack this rational capacity, and it is this defect of reason rather than an empathic impairment that explains why they are amoral. Kennett thus concludes that empathy is not necessary for moral agency. In this chapter, I challenge Kennett’s argument. First, I review the empirical evidence in order to demonstrate that there is a component of empathy called affective empathy that is impaired in psychopaths but largely preserved in autistics. As such, the claim that psychopaths and autistics share a common lack of empathy is unjustified. Second, I challenge Kennett’s claim that empathy plays no role in explaining the moral difference between psychopaths and autistics. Instead, I contend that the intact affective empathy of autistic people is a crucial component of their capacity to act from reverence for reason. (shrink)

No two individuals with the autism diagnosis are ever the same—yet many practitioners and parents can recognize signs of ASD very rapidly with the naked eye. What, then, is this phenotype of autism that shows itself across such distinct clinical presentations and heterogeneous developments? The “signs” seem notoriously slippery and resistant to the behavioral threshold categories that make up current assessment tools. Part of the problem is that cognitive and behavioral “abilities” typically are theorized as high-level disembodied and modular functions—that (...) are assessed discretely (impaired, normal, enhanced) to define a spectral syndrome. Even as biology reminds us that organic developing bodies are not made up of independent switches, we remain often seduced by the simplicity of mechanistic and cognitive models. Developmental disorders such as autism have accordingly been theorized as due to different modular dysfunctions—typically of cortical origin, i.e., failures of “theory of mind” (Baron-Cohen et al., 1985), of the “mirror neuron system” (Ramachandran and Oberman, 2006), of “weak central coherence” (Happe and Frith, 2006) or of the balance of “empathizing” and “systemizing” (Baron-Cohen, 2009), just to list a few. -/- The broad array of autonomic (Ming et al., 2005; Cheshire, 2012) and sensorimotor (Damasio and Maurer, 1978; Maurer and Damasio, 1982; Donnellan and Leary, 1995; Leary and Hill, 1996; Donnellan and Leary, 2012; Donnellan et al., 2012) differences experienced and reported by people with autism have by such theories typically been sidelined as “co-morbidities,” possibly sharing genetic causes, but rendered as incidental and decisively behaviorally irrelevant symptoms—surely disconnected from cognition. But what if the development of cortically based mental processes and autonomous control relies on the complexities and proper function of the peripheral nervous systems? Through such an “embodied” lens the heterogeneous symptoms of autism invites new interpretations. We propose here that many behavioral-level findings can be re-defined as downstream effects of how developing nervous systems attempt to cope and adapt to the challenges of having various noisy, unpredictable, and unreliable peripheral inputs. (shrink)