The Construction of “Autism”

🇬🇷 Ελληνικά

The construction of “autism” is traced throughout the Summary series and other blog posts.

“Autism” as an entity

At the foundation of the entire medical model framework of perception, we can identify an initial construction of “autism” as an entity: a) nosological and b) behavioral.

The goal of elimination or invisibility rather than support — which the construction of “autism” facilitates — becomes evident in the direction toward behavioral normalization, the search for cause and cure, and the dissemination of negative stereotypes and narratives.

The construction of diagnosis

If we follow the history of pathologization of Autistic being and the construction of diagnosis, we observe the influence of ableist, eugenic, and sexist ideas (in the division of “functionality,” in visibility centered on white boys, in gender-based differences, etc.) that have nothing to do with mental health, nor with Autistic being itself. Over the years, the DSM appears to modify the diagnosis as perceptions of Autism shift. At the same time, symptoms of distress and traumatization are included as diagnostic criteria for “autism,” understood as a “disorder.” Misconceptions about Autistic being lead to contradictions that do not hold together conceptually, and to categorizations that cannot be coherently made.

The term itself originates within the medical model and was first used as a differentiated diagnosis by Sukhareva, while earlier Bleuler had used it to describe a condition that did not constitute a separate diagnosis in itself.

Until 1994, the DSM included “Autistic Disorder” as a diagnosis (along with several related diagnoses that were later removed), which according to their criteria identified very few cases. Asperger separated certain Autistic boys (only boys) whom he judged to meet the criteria of human worth according to National Socialist ideals. In 1994, “Asperger’s Syndrome” was included in the DSM as a distinct diagnosis. In 2013, the diagnosis was removed, and it was recognized that — together with the other related diagnoses — it referred to the same “condition” within the medical model, leading to the current diagnosis of Autism Spectrum Disorder.

“Sociality” is presented as an inherent trait (and its absence as inherent deficiency) both in the medical model and in the concept of “Gemüt” within the National Socialist framework. In the 1940s, traits which existed throughout human history were labeled as signs of “psychopathy.” (1)

[See Edith Sheffer, Asperger’s Children: The Origins of Autism in Nazi Vienna]

“Functionality” is defined according to social and systemic standards.

The problem with “autism levels”

The categorization of the diagnosis into “levels” refers to support, but there are perceptions associated with these levels that need to be disentangled. These perceptions concern, more broadly, the framework of “diagnosis” (viewing autism as a “disorder,” and therefore a nosological entity, with levels translated as “mild” or “severe”), its historical context, and the dominant ideas and stereotypes that spread socially through the prevalence and authority of medical model approaches. They concern ideas of “high intelligence” or “normal behavior” that have prevailed as the basis for the division into levels.

Historical context

The eugenic and sexist origins of the “functioning” divide, linked to ideas of “high intelligence,” the “male brain,” and views of disability as a measure of the value of human life. From this emerged the notion of “levels” as two extremes — “high-functioning” and “low-functioning.” These ideas have influenced the medical model throughout its historical continuity and have shaped perceptions and stereotypes that continue to permeate society.

• “Intelligence” as a comparative measure and criterion of value.

• Ideas of “productivity”, “usefulness” of people in society, and of “sociality”, as defined (also) in National Socialism as an inherent characteristic and its deficit (Gemüt).

• The origins of diagnosis within the historical context of National Socialism and the child psychiatry that prevailed as its continuation. Asperger’s separation of certain white Autistic boys who met criteria, and the extermination of all the rest, including all the girls. The impact is evident in the predominance of diagnosis in boys and socially in the stereotype of the white Autistic boy with “high intelligence”.

Recently, extensive historical evidence about the context of diagnosis has come to light, including in Edith Sheffer’s book Asperger’s Children: The Origins of Autism in Nazi Vienna (2018). This article offers a concise and helpful review of the book (1): https://dsq-sds.org/article/id/864/

Perception of functionality as behavior based on allistic functioning, reflected in ideas about “camouflage”. It involves the erasure and denial of the real difference in functioning. From this emerges the idea of “levels” as, on the one hand, pathologized “autism”, and on the other, the non-recognition of difference (and what that entails), reframed instead as a “personality type”. The behavioralization and psychologization of difference in functioning.

• This is also expressed in the idea of “therapy”, behaviorism, and the behavioral practice “ABA,” aiming to change “behavior” and eliminate so-called “Autistic behavior”. If the person themselves “achieves” camouflage, they supposedly do not need anything; they are normal. Or they have mental health issues, trauma, personality disorders, and other diagnoses for which they must seek therapy or “manage” individually. The aim is the elimination of Autistic existence through “behaviorism” — elimination they call treatment — or invisibility.

• Allistic functioning as a measure of comparison and a criterion of value, health, and normality.

• Symptoms of distress and trauma interpreted as symptoms of “autism”.

• Framing the issue as “learning social skills”, “foreign languages,” or “acting skills”.

• This point, too, is intertwined with and deeply rooted in the historical context of diagnosis — as are ABA, its ties to “conversion therapies,” and its founder, Ivar Lovaas.

• Projection of traumatic, antisocial, hostile, and inaccessible environments and systems as inherent deficits in “sociality” and “empathy”, as pathologized or negative “traits,” and as “behavior problems.”

• Victim-blaming. Mechanisms of rationalization and enabling of exclusion and abuse.

The construction of an invisible “functioning level”

“Camouflage” is conveniently charged to us as something we do — a personal act of invisibility that some of us are supposedly “capable” of. A false status that maintains our lack of access and our oppression. And those who are seen as “not capable” are expected to try harder — or to achieve it through conversion therapies. A massive industry and system built on the promise of this false status, with long, exhausting conversion therapies that are traumatic and destructive. These practices can cause PTSD, while also making people — especially the children targeted — vulnerable to abuse and unable to assert their own will. This exposes children to numerous dangers and undermines their boundaries and self-respect.

The construct of “camouflage” as a goal of elimination and invisibility within dominant medical-model approaches.

Dominant approaches shape social understandings of camouflage.

Internalized ableism

As Autistic identity becomes destigmatized, more and more people who consider themselves “high-functioning” realize and accept that they are Autistic. However, they separate themselves from the pathologized stereotype, which they reject as part of their own identity.

Yet depathologization does not mean “levels,” with one level being pathological and another being a “personality type.” In reality, they have not accepted it. They have accepted something else about themselves. Then the impression of a “trend” is created, and all of this is recycled without resolution, offering itself up as a show and for exploitation.

The condition we experience within a hostile social and systemic environment not structured for us: oppression, suppression of functioning and potential, lack of access, traumatization.

An ableist culture, centered around allistic functioning and norms, dominates the social and systemic environment and remains profoundly hostile toward the Autistic neurotype. 

The entire environment is structured around allistic experience, functioning, nervous system, ways of being, communicating, and relating — which differ from our own. The environment affects us differently and has different consequences for us; it harms us as long as we are required to adapt. The coercion to adopt a different mode of functioning constitutes a violation of our boundaries, which is normalized as they deny difference. This oppressive and traumatic environmental condition is either individually attributed to us (as "traits") or pathologized, while simultaneously stripping us of access and the opportunity to develop our potential.

The allistic notion of “masking” — the performance of allistic functioning as image — is imposed and constitutes our oppression. The “possibility of unmasking” means the possibility to exist without this oppression, within a safe environment. It is not “psychological.” The enforcement of the ableist notion of "masking" as a "skill" or a choice normalizes the suppression of our neurotype, our traumatization, and our oppression. It does not constitute access. It does not constitute functionality (it reduces or entirely cancels out our performance by suppressing our natural functioning).

Traumatization is attributed to an inherent pathologization of the neurotype, reinforcing the perception of the medical model while offering no real benefit or support. The medical model appears to target early childhood and to pursue the “normalization of behavior,” at the expense of the individual’s health — a process that in itself leads to traumatization.

Read on the blog

Summary series (Label)

The Problem with “Autism Levels” – Topic Presentation

Η κριτική μου στοχεύει όσους εκμεταλλεύονται το θέμα, και τις νοοτροπίες εσωτερικευμένου Ableism.

Η Ableist Κατασκευή του «Καμουφλάζ»

Highlights and Quotes

Videos

Common Misconceptions About Autism Levels – What It Really Means

The Ableist Construct of “Camouflage”

Deconstructing Autistic Camouflage

Podcast Autistic Journals Project 

A personal voice on the Αutistic experience, sharing a different understanding shaped by my journey. If parts of your experience leave questions unanswered, this open space for thought may be just what you’re looking for. Available in English and Greek (audio and subtitles).

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