{"id":775,"date":"2016-09-30T12:01:16","date_gmt":"2016-09-30T11:01:16","guid":{"rendered":"http:\/\/blogs.exeter.ac.uk\/exploringdiagnosis\/?page_id=775"},"modified":"2016-09-30T12:01:16","modified_gmt":"2016-09-30T11:01:16","slug":"debate-1","status":"publish","type":"page","link":"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/","title":{"rendered":"Essential Nature"},"content":{"rendered":"

Debate 1. Does autism have an essential nature?<\/span><\/h1>\n

Damian Milton, <\/strong>a sociologist and activist
\nand
\nSami Timimi <\/strong>a child and adolescent psychiatrist<\/p>\n

The essential nature of autism (and the merits of diagnosis) in a series of emails in summer 2016 before an initial meeting of the Rethinking Autism Network (RAN).<\/p>\n

\n

Sami:<\/strong><\/p>\n

I have read articles by you, Larry Arnold, Dinah Murray and after your email had a quick browse of the 4 issues of \u2018Autonomy\u2019.<\/p>\n

However, none that I read have addressed the problem of \u2018essentialising\u2019 that happens when you assume that there is something out there in the real \u2018natural\u2019 world that is inscribed in your biology as a constant and specifically \u2018autistic\u2019 entity and that there are people who \u2018know\u2019 (whether its experts or self diagnosers) how to discover those who have this specific entity and divide them away from those who do not. The idea of dividing humanity into \u2018neurotypical\u2019 and \u2018neurodiverse\u2019 and that such a categorical division is possible is different to medical diagnostic discourse only in its value judgements about such categorical divisions. The movement you have identified with fits very comfortably in a medical model framework and therefore can do little to challenge the dominant social constructions of\u00a0medical and psychiatric practices. It accepts uncritically the idea that there are essential and knowable biological differences that construct our social identities and behaviours. It cannot from such a starting point adopt a meta-perspective that is able to question why \u2018autism\u2019 emerged (as opposed to being discovered) as a phenomena and became so popularised in the last few decades and what this social and cultural phenomenon might tell us more broadly about
\npolitical, economic and cultural developments. Whilst the neurodiversity movement has helped with combating stigma and negative stereotyping it can only do so for those like you who are happy to self-identify with a pseudo-scientific construct \u2013 many can\u2019t and don\u2019t want to (like many young people I see), for whom something more helpful appears to have been explaining that autism is just a description and doesn\u2019t mean anything more than that, searching for exceptions to the diagnostic descriptions, to help a more complex idea of a person to emerge and undiagnosing those who wish to (let\u2019s face it you can\u2019t \u2018undiagnose\u2019 someone with heart failure, but because autism is a construct that emerges primarily out of the imagination of the diagnoser with no biological marker, it\u2019s possible to do that in autism \u2013 doesn\u2019t that tell you something?).
\nIf I were to use a political analogy (which I\u2019m sure I\u2019ll end up regretting), Neurodiversity is a bit like the soft left, who accept neoliberal capitalism as the \u2018natural\u2019 dominant system by which economies have to be organised, but want more protections compared to the soft right \u2013 but neither see the whole framework of neoliberal capitalism as the root of the problem. That\u2019s why I don\u2019t think there is anything particularly \u2018critical\u2019 about your approach. From my perspective I have rejected as a scientist and practitioner the notion that there is any firm knowable biological entity called \u2018autism (and I would like to see what evidence you can bring forth to argue otherwise) in the same way I have rejected the idea that neoliberal capitalism holds the solutions to our current social, political and economic crisis or can do anything constructive about the gross inequalities we have in our societies.<\/p>\n

Damian:<\/strong><\/p>\n

“…coming back to you and your colleague\u2019s articles, none that I read have addressed the problem of \u2018essentialising\u2019 that happens\u2026\u201d<\/p>\n

Then you have not read widely enough.<\/p>\n

\u201c\u2026when you assume that there is something out there in the real \u2018natural\u2019 world that is inscribed in your biology as a constant\u2026\u201d<\/p>\n

None of the above writers see autism as a biological constant \u2018out there\u2019 in the real world that can be easily defined and bracketed, but as a social construct. We do talk of embodied diversity and subjective experiences though.<\/p>\n

\u201c\u2026and specifically \u2018autistic\u2019 entity and that there are people who \u2018know\u2019 (whether its experts or self diagnosers) how to discover those who have this specific entity and divide them away from those who do not.\u201d<\/p>\n

None of the above writers do so by reifying the dominant medical models of autism, but talk of a social grouping and with a great deal more nuance than you are describing:
\n\u201cWhat I have come to understand is that autism is not one single invariate thing.\u201d (Arnold, 2004). What we argue is that there are differing social positionings that occur such as those diagnosed, those who are not who wish to, those who are who don\u2019t and so on. Where we may differ is perhaps on regard to embodied diversity and experiences and their relevance to the debate?<\/p>\n

\u201cThe idea of dividing humanity into \u2018neurotypical\u2019 and \u2018neurodiverse\u2019 and that such a categorical division is possible is different to medical diagnostic discourse only in its value judgments about such categorical divisions.\u201d<\/p>\n

Nonsense\u2026
\nThe division between neurotypical and neurodivergent (not neurodiverse) is an arbitrary and social one (I have been arguing such distinctions to be social conventions since the 90s but never mind). The term neurotypical originated as a mickey-take of the way medics describe \u2018autistic people\u2019\u2013 for me it has come to mean an idealised fantastical construction of neoliberal ideology \u2013 the \u2018mythical norm\u2019 (but you seem too busy putting theories into other people\u2019s minds perhaps?). Yes \u2013 there are \u2018autistic people\u2019 who see this as distinct biological line \u2013 not me \u2013 and not many\u00a0others.\u00a0\u201cExtremes of any combination come to be seen as \u2018psychiatric deviance\u2019. In the argument presented here, where disorder begins is entirely down to social convention, and where one decides to draw the line across the spectrum.\u201d (Milton, 1999 \u2013 spectrum referring to the human spectrum of dispositional diversity).
\n\u201cThus in this formulation, there is no neuro-typical to deviate from other than an idealised fantastical construction of Galtonian inspired psychological measurement.\u201d (Milton, 2014a).<\/p>\n

\u201cThe movement you have identified with fits very comfortably in a medical model framework and therefore can do little to challenge the dominant social constructions of medical and psychiatric practices.\u201d<\/p>\n

Your argument over generalises the views of an entire community and movement as one static thing \u2013 this is a nonsense and silences critical autistic scholars who have been deconstructing such labels for many years from a perspective of someone so labelled \u2013 this to me and others is thus a highly damaging narrative to be extolling.<\/p>\n

\u201cIt accepts uncritically the idea that there are essential and knowable biological differences that construct our social identities and behaviours.\u201d<\/p>\n

No it does not !<\/p>\n

\u201cIt cannot from such a starting point adopt a meta-perspective that is able to question why \u2018autism\u2019 emerged (as opposed to being discovered) as a phenomena and became so popularised in the last few decades and what this social and cultural phenomenon might tell us more broadly about political, economic and cultural developments.\u201d<\/p>\n

Other than writers were discussing such issues (like Martijn Dekker and Larry Arnold) long before Nadesan was. A history that you are furthering to obscure.<\/p>\n

\u201cWhilst the neurodiversity movement has helped with combating stigma and negative stereotyping it can only do so for those like you who are happy to self-identify with a pseudo-scientific\u00a0construct\u201d
\nAgain \u2013 I don\u2019t, I reframe what autism \u2018is\u2019 against dominant theories, as do the other writers mentioned. We identify with a social construction and identifier and reinterpret its meanings \u2013 clumping us all together and dismissing us by creating a straw man argument only creates anger and frustration at the numerous mistakes you consistently make (and then are referenced by others \u2013 another horrendous example being the Jassma and Welin piece).<\/p>\n

\u201c\u2026explaining that autism is just a description and doesn\u2019t mean anything more than that\u2026\u201d<\/p>\n

No \u2013 nothing is ever \u2018just a description\u2019 \u2013 especially when people labelled autistic die decades early (recent Swedish report) \u2013 as just one example. Discourses have consequences \u2013 as yours of the neurodiversity movement without sufficient interactional expertise with such communities does to.<\/p>\n

\u201cNeurodiversity is a bit like the soft left, who accept neoliberal capitalism as the \u2018natural\u2019 dominant system by which economies have to be organised, but want more protections compared to the soft right \u2013 but neither see the whole framework of neoliberal capitalism as the root of the problem.\u201d<\/p>\n

Utter rubbish \u00a0if you don\u2019t mind me saying so. Neurodiversity means that all humans have diverse neurology and that has an impact on embodied experience. I think that is where we may differ? Although I find it hard to see how one can argue against that. Your characterisation of the neurodiversity movement is wholly inaccurate \u2013 at least simplistic in the extreme \u2013 and thus is like a man describing feminism as a static and singular mode of thought based in neoliberalism etc. and for me should be called out and criticised for it. Seeing as Insel, London, Gillberg et al. would agree with you about disbanding the label and going with dimensional scales of deficit are more in keeping with your way of thinking currently? Seems neither of you are paying much attention to autism as a cultural identity marker, the social lives of those so labelled, their variety of views and experiences, and so on.<\/p>\n

\u201cThat\u2019s why I don\u2019t think there is anything particularly \u2018critical\u2019 about your approach.\u201d<\/p>\n

That is because you have little idea as to what my approach entails \u2013 which bounces around phenomenology, Marxism, and post-structuralist ideas (but heigh ho).<\/p>\n

\u201cFrom my perspective I have rejected as a scientist and practitioner the notion that there is any firm knowable biological entity called \u2018autism (and I would like to see what evidence you can bring forth to argue otherwise)\u2026\u201d<\/p>\n

Lol \u2013 that is because I was arguing it wasn\u2019t long before you were!<\/p>\n

\u201c\u2026in the same way I have rejected the idea that neoliberal capitalism holds the solutions to our current social, political and economic crisis or can do anything constructive about the gross inequalities we have in our societies.\u201d<\/p>\n

Funny that \u2013 me too! I think I will leave the last word here to Larry:
\n\u201cNotwithstanding the difficulties we face as a marginalised group making inroads into the academic disciplines, it is so often the case that those disciplines themselves exist within silos, failing to understand the contributions that other disciplines have to make on each other.\u201d (Arnold, 2012).<\/p>\n

Sami:<\/strong><\/p>\n

I like your answer! I can hear your passion and your frustration at feeling that I have missed the more nuanced position you occupy and your alertness to multiplicity, diversity and your wish to avoid simplistic identity politics. I suspect you are right that I haven\u2019t read enough nor have I read with sufficient openness and sensitivity and you then (rightly) fear this leads me away from connecting with real lived experiences of those who are labelled with autism. If this is partly what you are getting at then fair point and it makes sense then your feeling that there should be more representation from those with lived experience.
\nHowever, the central problem remains and I can\u2019t see anything in what you have written that is able to deal with this. In your writing you use a concept of the \u2018autistic person\u2019 and refer to yourself as being \u2018on the autistic spectrum\u2019 and others who are \u2018on the autistic spectrum\u2019 or is an \u2018autistic person\u2019 \u2013 If you really see autism as a social construct then how do you get to there being something \u2018essentially\u2019 different that marks out an \u2018autism community\u2019 or \u2018autism communities\u2019 or \u2018autistic person\u2019? Where do you imagine this particular difference comes from (it can\u2019t be geographical, language, tradition, age etc. that are the more common markers of community)? Is the commonality the doctors who diagnose it (power over knowledge), the \u2018idea\u2019 that there is something different (social construction i.e. choosing to focus on a specific aspect of a person for a particular purpose), something inherent in the embodied experience (biology) that means that the person labelled autistic has unique experiences of the world that cannot be similarly experienced by someone who is not an \u2018autistic person\u2019 (in which case how do we figure who can or can\u2019t relate to the embodied experience)? In other words how do you get to the \u2018autism\u2019 in the autistic person? Of course I am mindful I have laid the problem out in categorical and dualistic terms, but this is intentional in order to help understand how you figure the epistemological\/ontological basis on which you have arrived at an acceptance of there being such a thing as the \u2018autistic person\u2019 (as opposed to the person who has been diagnosed with autism).<\/p>\n

Damian:<\/strong><\/p>\n

Hello Sami,<\/p>\n

It seems we may be getting somewhere with this debate now.
\n\u201c\u2026alertness to multiplicity, diversity\u2026\u201d<\/p>\n

Yes \u2013 I would argue that a number of \u2018autistic\u2019 scholars are alert in this respect.<\/p>\n

\u201c\u2026and your wish to avoid simplistic identity politics.\u201d<\/p>\n

There was an interesting and critical presentation that talked about this at Autscape the other week by Martijn Dekker. There is a trend toward identity politics within \u2018autistic culture\u2019, which is a bit simplistic, but this is not hegemonic within the community within the UK imv. There is a worrying trend I see on social media and from some aspects of US-based activism though (particularly around arguments about facilitated communication \u2013 where I am more in line with Mark Sherry\u2019s recent article on the matter).<\/p>\n

\u201cI suspect you are right that I haven\u2019t read enough nor have I read with sufficient openness and sensitivity and you then (rightly) fear this leads me away from connecting with real lived experiences of those who are labelled with autism. If this is partly what you are getting at then fair point and it makes sense then your feeling that there should be more representation from those with lived experience.\u201d<\/p>\n

Not exactly no. I do think that you could do with understanding more of the diversity of views within \u2018autistic culture\u2019 that have arisen and be more respectful of this history, particularly in regard to critical theorists who have been so labelled or who so identify for whatever reason. I think there should be thus more open invites to \u2018autistic\u2019 critical theorists who have been doing such work for some time or who have some interesting views to contribute to such discussions (like those previously mentioned by me).<\/p>\n

\u201cHowever, the central problem remains and I can\u2019t see anything in what you have written that is able to deal with this. In your writing you use a concept of the \u2018autistic person\u2019 and refer to yourself as being \u2018on the autistic spectrum\u2019 and others who are \u2018on the autistic spectrum\u2019 or is an \u2018autistic person\u2019 \u2013 If you really see autism as a social construct then how do you get to there being something \u2018essentially\u2019 different that marks out an \u2018autism community\u2019 or \u2018autism communities\u2019 or \u2018autistic person\u2019? Where do you imagine this particular difference comes from (it can\u2019t be geographical, language, tradition, age etc. that are the more common markers of community)?\u201d<\/p>\n

Why not? In an article I did in 2014, I explore to what extent the breakdown in interactional expertise between \u2018autistic\u2019 and \u2018non-autistic\u2019 people is cultural or embodied in nature. Of course, one can probably never adequately answer such a question, but I did propose that I suspect that in many respects the barriers are cultural ones that can to some extent be bridged (at least where there is some kind of mutually communicable use of language). The use of language and perceived semantic meaning is an interesting area with regard to the \u2018autism spectrum\u2019 though. So, if I had to say what the essential difference is, I would say that autistic culture is a subculture that has developed in reaction to being so labelled and the various constructions of \u2018autism\u2019. I do think there are also embodied differences between people in terms of \u2018disposition\u2019 though, and that some of this has a biological aspect. For instance, for a simplistic example, I have no idea what it is like to have a life threatening illness (as yet). Back in the 1990s I used the phrase \u2018the human spectrum of dispositional diversity\u2019. This was before I knew much about the construction of autism other than having watched Rainman etc. This was partly in response to the numerous psychiatric labels I acquired as a teenager. Yet, I was arguing (and still do really) that whatever the embodied and cultural differences that influence a person\u2019s disposition, that those deemed outside the ever-narrowing \u2018norm\u2019 were discriminated against in numerous ways (e.g. I was bullied and marginalised due to my perceived otherness long before I was diagnosed as autistic). Indeed, such a discrimination and resultant psycho-emotional disablism may be the most common factor amongst \u2018autistic people\u2019?<\/p>\n

\u201cIs the commonality the doctors who diagnose it (power over knowledge).\u201d<\/p>\n

Well \u2013 this is a big one! It is realised that the community \/ culture as such would not exist without changes to diagnostic criteria and culture. At the same time, much like in \u2018Mad Studies\u2019, there is often a revulsion of having been somewhat defined by the medical fraternity (this also came up in Martijn Dekker\u2019s recent presentation). There are of course issues with \u2018self-diagnosis\u2019 (if not in personal identity terms than in practical terms) and especially if people take it upon themselves to identify\/diagnose others. The community seems to be more galvanised around ideas about those who are \u2018neurodivergent\u2019 (although with the idealised notion of normalcy this could include just about anyone!). But as I say, this is often coming from an experience of embodied\/cultural \u2018otherness\u2019 of some kind.<\/p>\n

\u201c\u2026the \u2018idea\u2019 that there is something different (social construction i.e. choosing to focus on a specific aspect of a person for a particular purpose), something inherent in the embodied experience (biology) that means that the person labelled autistic has unique experiences of the world that cannot be similarly experienced by someone who is not an \u2018autistic person\u2019 (in which case how do we figure who can or can\u2019t relate to the embodied experience)?\u201d<\/p>\n

To me, this is a matter of interactional expertise (see my article from 2014 on this) as I would \u2018theorise\/model\u2019 it. There is little empirical evidence in this regard, but some work by Liz Sheppard et al. recently found that \u2018non-autistic people\u2019 struggled to read the emotions of autistic people they watched on film. This suggests that \u2018theory of autistic mind\u2019 may leave something to be desired too.
\nSo, why is this? Is it purely a cultural phenomenon? To me, this is unlikely. To say there can be mutual incomprehension between people of differing dispositions seems fair to me (although that can be for whatever reason \u2013 e.g. watch a conversation between \u2018techies\u2019 and \u2018non-techies\u2019 within a project team for a simplistic example). Just because I think there is \u2018neurological diversity\u2019 and that impacts on disposition and experience, the category of \u2018autism\u2019 is at least somewhat arbitrary.<\/p>\n

\u201cIn other words how do you get to the \u2018autism\u2019 in the autistic person?\u201d<\/p>\n

Like asking how does one get to the \u2018gay\u2019 in the \u2018gay person\u2019. It is a cultural identity marker and \u2018technology of self\u2019 one could argue?<\/p>\n

\u201cOf course I am mindful I have laid the problem out in categorical and dualistic terms, but this is intentional in order to help understand how you figure the epistemological\/ontological basis on which you have arrived at an acceptance of there being such a thing as the \u2018autistic person\u2019 (as opposed to the person who has been diagnosed with autism).\u201d<\/p>\n

I prefer the term \u2018autistic person\u2019 as it is used by others to describe my brain, neurology, way of being (lifeworld), cognition, behaviour (actions) etc. Such things are not attached to me, but are pretty central to whatever \u2018me\/I\u2019 is to be conceptualised in a way that a medical diagnosis in and of itself is not (although that is another story too \u2013 what is a self anyway etc.?). If one is to reframe such a positioning when one has been so labelled, then I claim it as much as I would other identity markers (e.g. I am a \u2018critical theorist\u2019!).<\/p>\n

In terms of \u2018cognitive theories of autism\u2019 \u2013 the one most fitting to my experience would be \u2018monotropism\/polytropism\u2019 \u2013 as that suggests a diversity of potential strategies being employed with regard to attention\/interest (and can be applied to any human). Sensory \/ information processing seems to be central issues for me if one can pin down embodied differences (yet perhaps not anything near adequate categories?). They may not be connection to such ideas at all for someone else diagnosed as \u2018autistic\u2019 though. There is some support for EF theory (yet I find it very problematic). As for ToM theory\u2026(grrr\u2026!).\u00a0Can one generalise to \u2018all autistic people\u2019 from this \u2013 of course not. Can anyone \u2018represent the autistic voice\u2019 \u2013 no \u2013 not any more than someone can represent the \u2018non-autistic voice\u2019. It is a nonsense to suggest as such (as I have reported to some self-advocacy
\norganisations)
\nShould \u2018autism\u2019 as a description be disbanded altogether? Well \u2013 it probably will one day, but until that time I think it has some practical usage. \u2018Asperger Syndrome\u2019 is no longer in the DSM, but that won\u2019t stop people using the term. Like any identifier it can be used in any\u00a0number of ways though (to greater or lesser affect perhaps).<\/p>\n

It seems to me that a number of \u2018autistic scholars\u2019, scientists, critical theorists etc. \u2013 all suggest that autism is not a definable \u2018natural kind\u2019, but arguing against neurological diversity is another thing, or discussing the potential impact of such diversity (which is like asking the nature vs. nurture question \u2013 a bit of a non-starter). If one is to replace autism diagnosis \u2013 in practical terms, what does one replace it with? For me, such a discussion should include those most affected by such changes wherever possible.<\/p>\n

And so on and so on\u2026<\/p>\n

Most social differences get labels, some very derogatory ones, but not all are medicalised. One can be deemed an extravert, lazy, spirited, stupid and so on.<\/p>\n

As a teenager I was diagnosed with all sorts, the most striking labels being BPD and Catatonic Schizophrenia. Needless to say, some of my experiences back then put me off psychiatric labelling! My disposition and development were anything but normal though. I have a very high IQ and higher non-verbal IQ, have quite extreme reactions to certain sensory stimuli, am very poorly coordinated, struggle to process more than one thing at a time, so I tend to listen to people rather than look at them when they are talking. Despite my measured IQ, teachers thought of me as a stupid, lazy and underachieving pupil who was deliberately being obstructive. I have had a
\nsmall number of very strong interests which often turn into large collections to be stored. And so on\u2026<\/p>\n

I read more about autism and the differing views. I had never attached the label to myself, as the minimal descriptions I had come across I did not relate to. This changed somewhat though when I read autobiographical accounts. This produced a very powerful sense of recognition and indeed empathy from me, something very rare in my experience. So this led me to
\nlook more deeply and thus I started to critique everything that had been said about this description of disposition \u2013 as little seemed to be doing a good job of it. When I went for a diagnosis, I was partly at the time doing it as a kind of social experiment, to see if psychiatrists would define me as autistic. My mother and I gave as accurate answers as we could give, and over the space of a day they came back with a diagnosis of Asperger\u2019s. I was proven right in my hypothesis that I would be so labelled in such a situation. When I asked \u2018are you sure\u2019, they replied \u2018unequivocal on all counts\u2019 (interesting when thinking of diagnostic practices to some here perhaps?).<\/p>\n

Given the complexity of what we are dealing with, I doubt one will ever find the \u2018essential autism\u2019 at least without changing the meaning of what autism currently is. Which for me is a social construction (or set of very differing accounts) to try and analyse and model such dispositional diversity (in certain perceived traits at least). Such dispositional diversity for me is a given though, we are not identical clones with identical experiences. So on this level, the double empathy problem exists in interactions between anyone to a greater or lesser extent.<\/p>\n

Autism is not a clear boundary or category, but in everyday practical terms such dispositional differences are going to be named, and some discriminated against. Even if one used the term dispositionally or neurologically divergent, someone might say \u2018in what way?\u2019. So, if one is to replace the term autism, and it\u2019s various explanations, what is one going to replace it with? How does one explain the above?<\/p>\n

It is one thing to say that a term or explanation is not really \u2018real\u2019, it is quite another to come up with a better explanation of such dispositional and experiential diversity \u2013 and then practically help people who are being discriminated against largely because of their disposition.<\/p>\n

 <\/p>\n

Sami:<\/strong><\/p>\n

I like your answers and it does make me feel that I do indeed need to better educate myself about the critical autism writings you refer to. Perhaps you can suggest or send two or three key papers that you think would help summarise some of the history, theory and practice that you consider important to get across. I think you have done great work to open up spaces for those who wish to identify with the autism construct so that the word can be de-colonised to some degree and develop alternative and less damaging associations and possibilities enveloped in it.
\nBut I\u2019m afraid you are still caught in the diagnostic idiom and using the same epistemology as the medics and have not been able to respond to my main issue around the essentialism and universalism. You still cling onto an idea that somewhere medics stumbled on a concept, a fact of nature (rather than culture), that they may have viewed in a negative light, but which has a \u2018truth\u2019 to it. You still talk of autistic people and are arguing that there is something innate\/internal\/at least partly biological driving the way the \u2018autistic person\u2019 engages with the world. You have your own take on this and talk about \u2018dispositional\u2019 tendencies and then it seems to me get hopelessly lost in trying to define how to understand this, where the boundaries are, how context dependent this is etc. Which is not surprising, because you have stumbled into the epistemological\/ontological quagmire of trying to figure out what this abstract concept of autism \u2018is\u2019 and then have to resort to some home spun philosophy untethered from any factual\/empirical evidence to \u2018prove\u2019 its existence. You see this is where I think the sort of critique I am involved in takes us properly out of the \u2018soft left\u2019, as I have referred to it, of trying to reconstruct an abstract concept and naming it for what it is \u2013 something that does not exist in any concrete form beyond the imagination of those using the concept (whether in deficit or difference forms). Most other service user movements in mental health have been rejecting the excesses of medical model psychiatry for a while and reject the idea that psychiatric diagnoses have validity and many feel trapped by the labeling process. It seems from what you have written you too may have experienced negative labeling being applied to you as a teenager, yet are we to believe that there is something different about \u2018autism\u2019?
\nYes all these other diagnoses (ADHD, schizophrenia, depression) are labels created by a few powerful white men (generally) and that can be seen to lack reliability and validity, but why should autism be different? Well it isn\u2019t and you are unable to give me an empirically grounded evidenced argument to support your idea that there is something in the measurable empirical world of brain and biology, because there is nothing you can give. What you are then reduced to is pure interpretive anecdote (e.g. making some rather context depleted comparisons with others you deem \u2018non\u2019 autistic) or personal examples from your own experience. Empirically this proves nothing.
\nThis is no different to the countless debates I\u2019ve had with other medics around diagnosis or effects of medication (for example). When I point out the lack of evidence, biological markers, lack of explanatory capacity, lack of evidence on matching treatment to diagnosis predicting outcomes from treatment etc. they come back with anecdote and their own home spun theories (because the science is missing) \u2013 like saying \u201d Oh yes, but I know there is too much diagnosis, but of course there are cases of \u2018true ADHD\u2019 (insert favourite diagnosis here) which we need to diagnose\u201d or despite showing evidence that nearly all anti-depressant effect is placebo \u201cBut I know it works I\u2019ve seen it in the patients I\u2019ve treated\u201d. So anecdote is regularly used when scientific evidence is missing. I\u2019m afraid your responses have convinced me that you have no empirical evidence to back up your idea that there is something empirical \u2018out there\u2019 that exists in you or anyone else that is specifically and characteristically different that equates to \u2018autism\u2019. If you have evidence other than anecdote, please put this forward. However, don\u2019t expect me to believe that you having a diagnosis gives you any special privileges into \u2018knowing\u2019 what autism is any more than doctors making the diagnosis have any special privileges to knowing what autism is. As autism (disease or difference) is conceptualised as hardwired in some way, then until evidence for what this is that is specific and characteristic is forthcoming (and there is no sign of that being consistently found and replicated in either neuroimaging or genetic or indeed any other studies) then the ONLY scientific conclusion you can come to is AUTISM DOES NOT EXIST as biological fact \u2013 it exists as a cultural fact.
\nOne of the reasons I think many of us feel the need to speak out about this, is that a lack of acknowledgement that autism is a construct leads, as with other diagnoses in psychiatry, to reification \u2013 a mistaking of a humanly made ideas for concrete reality (I don\u2019t have time to go into the full ramifications this can have on people\u2019s lives, some of which I suspect you experienced with other labels when you were a teenager). Autism is a \u2018brand\u2019. Neoliberal values encourages individuals to compete with each other resulting in \u2018winners\u2019 and \u2018losers\u2019, and where the ever present anxiety of losing has been subject to market forces resulting in the growth of a profitable mental health industry that locates causes and solutions of perceived \u2018failure\u2019 and other struggles as residing within the individual. \u00a0Autism is sold like other diagnoses with promises and whilst its popular right now (we have so many parents and teachers locally wanting children assessed for \u2018autism\u2019 \u2013 whilst learning difficulties has very little value as a brand, so I can\u2019t remember the last time someone asked for their kid to be assessed for learning difficulties), dangers lurk, not just in the effects of internal stigma and labeling, but its \u2018desirable\u2019 status may change \u2013 for example, we are increasingly straying into \u2018anti-social personality disorder\u2019 territory with professionals arguing that many criminals in fact have \u2018autism\u2019. If it gets conflated with \u2018dangerousness\u2019 beware.<\/p>\n

Damian:<\/strong><\/p>\n

There you go again \u2013 putting words in my mouth and making assumptions \u2013 please use more of the strategy of asking questions \u2013 less stressful.<\/p>\n

\u201cBut I\u2019m afraid you are still caught in the diagnostic idiom and using the same epistemology as the medics and have not been able to respond to my main issue around the essentialism and universalism.\u201d<\/p>\n

I am certainly not using the same epistemology as the medics in the slightest \u2013 get that please (indeed \u2013 it would seem to me that you are the one arguing from an empiricist \/ positivist argument alone!?!).
\nThe \u2018essential difference\u2019 of autism? As you know, nobody has the answer to that and it looks increasingly likely nobody ever will. It has always been diagnosed on the medic\u2019s view of expressed behaviour etc. \u2013 thus autism never has been a natural kind referring to an essential difference. Many psychological theories have been proposed but all lack full explanatory value. So \u2013 on this front I am much more in line with your way of thinking than you would give me credit for \u2013 and that repeated mistake is getting quite annoying!<\/p>\n

\u201cYou still cling onto an idea that somewhere medics stumbled on a concept, a fact of nature (rather than culture)\u2026\u201d<\/p>\n

Wrong!<\/p>\n

\u201c\u2026that they may have viewed in a negative light\u2026\u201d<\/p>\n

Yes \u2013 those deemed autistic by the medical profession are seen within a deficit normative model that I would not at all personally adhere to.<\/p>\n

\u201cYou still talk of autistic people\u2026\u201d<\/p>\n

As a cultural entity (as well as talking of embodied dispositional diversity).<\/p>\n

\u201c\u2026and are arguing that there is something innate\/internal\/at least partly biological driving the way the \u2018autistic person\u2019 engages with the world.\u201d<\/p>\n

Yep \u2013 as I would all human beings \u2013 what the \u2018cut off\u2019 boundary is \u2013 as I have said is down to social convention and the perception of the one doing the cutting.<\/p>\n

\u201cYou have your own take on this and talk about \u2018dispositional\u2019 tendencies and then it seems to me get hopelessly lost in trying to define how to understand this\u2026\u201d<\/p>\n

No more lost than any other when discussing the \u2018nature vs nurture\u2019 debate \u2013 I just state it as an unanswerable question to ponder possibilities about \u2013 rather than stating a conclusion one has no evidence for.<\/p>\n

\u201c\u2026where the boundaries are\u2026\u201d<\/p>\n

Are entirely down to social convention \u2013 see my quote from 1999<\/p>\n

\u201c\u2026how context dependent this is etc.\u201d<\/p>\n

Very \u2013 all use of language is \u2013 no?<\/p>\n

\u201cWhich is not surprising, because you have stumbled into the epistemological\/ontological quagmire of trying to figure out what this abstract concept of autism \u2018is\u2019\u2026\u201d<\/p>\n

A contested social construct regarding people so labelled.<\/p>\n

\u201c\u2026and then have to resort to some home spun philosophy untethered from any factual\/empirical evidence to \u2018prove\u2019 its existence.\u201d<\/p>\n

I am not trying to prove autism as an essential natural kind definable biological entity. What I do see as biological\/dispositional\/social reality is diversity which is then talked about, categorised and labelled by people.<\/p>\n

A side point \u2013 empirical work directly looking at monotropism has never been funded to my knowledge (although even Lovaas of all people talked about a similar phenomena, albeit from a highly pathologising narrative).<\/p>\n

\u201cYou see this is where I think the sort of critique\u2026\u201d<\/p>\n

Which keeps missing the point entirely it would seem.<\/p>\n

\u201c\u2026are involved in takes us properly out of the \u2018soft left\u2019\u2026\u201d<\/p>\n

I really don\u2019t agree with you \u2013 it would seem to me that you are arguing for some kind of positivist essentialist truism or that a label should be abandoned \u2013 would you do the same for gay people or punks? It seems to me your epistemology is one that is in line with positivism and science (not that I am against such work where appropriate for what is being studied) \u2013 I will let others decide who they think the \u2018soft left\u2019 is here in this discussion.<\/p>\n

\u201c\u2026something that does not exist in any concrete form beyond the imagination of those using the concept (whether in deficit or difference forms).\u201d<\/p>\n

If you are talking about \u2018autism\u2019 \u2013 \u2018autistic people\u2019 said this long before any of you in this group did (Larry Arnold, 2004 as an example).<\/p>\n

If you are talking about the neurodiversity of people \u2013 I think you are
\ntalking obvious nonsense.<\/p>\n

\u201cMost other service user movements in mental health have been rejecting the excesses of medical model psychiatry for a while and reject the idea that psychiatric diagnoses have validity and many feel trapped by the labelling process.\u201d<\/p>\n

Yep \u2013 I have been one for many years \u2013 perhaps you would like to look up the \u2018Mad Studies and Neurodiversity Symposium archive\u2019 as a starting point?<\/p>\n

\u201cIt seems from what you have written you too may have experienced negative labelling being applied to you as a teenager, yet are we to believe that there is something different about \u2018autism\u2019?\u201d<\/p>\n

In the way the culture had developed and various members express themselves \u2013 yes.<\/p>\n

\u201cYes all these other diagnoses (ADHD, schizophrenia, depression) are labels created by a few powerful white men (generally) and that can be seen to lack reliability and validity, but why should autism be different?\u201d<\/p>\n

In that respect, it isn\u2019t.<\/p>\n

\u201cWell it isn\u2019t and you are unable to give me an empirically grounded evidenced argument to support your idea that there is something in the measurable empirical world of brain and biology, because there is nothing you can give.\u201d<\/p>\n

In terms of \u2018autism\u2019 this is not what I am arguing \u2013 in terms of neurodiversity \u2013 look at any collection of brain scans, or talk to people!?!<\/p>\n

\u201cWhat you are then reduced to is pure interpretive anecdote (e.g. making some rather context depleted comparisons with others you deem \u2018non\u2019 autistic) or personal examples from your own experience. Empirically this proves nothing.\u201d<\/p>\n

I wasn\u2019t trying to prove anything empirically with them \u2013 merely exploring the practical use of the term in context. You have often stated that the label can have a negative effect on those so-labelled, not once have I seen you talk about perceived positives (whatever you and I may make think of these). So \u2013 who is that is missing out evidence that is contrary to their arguments? Maybe you can say why it is you concentrate solely on the negative in this respect?<\/p>\n

Also \u2013 do you think \u2018situational knowledge\u2019 is a waste of time? Who is being patriarchal there then?<\/p>\n

\u201c\u2026Oh yes, but I know there is too much diagnosis, but of course there are cases of \u2018true ADHD\u2019 (insert favourite diagnosis here) which we need to diagnose\u201d or despite showing evidence that nearly all anti-depressant effect is placebo \u201cBut I know it works I\u2019ve seen it in the patients I\u2019ve treated\u201d. So anecdote is regularly used when scientific evidence is missing.\u201d<\/p>\n

You are ranting here \u2013 I was not trying to use anecdote as evidence of biological difference.<\/p>\n

\u201cI\u2019m afraid your responses have convinced me that you have no empirical evidence to back up your idea that there is something empirical \u2018out there\u2019 that exists in you or anyone else that is specifically and characteristically different that equates to \u2018autism\u2019.\u201d<\/p>\n

I haven\u2019t tried and wouldn\u2019t wish to.<\/p>\n

\u201cHowever, don\u2019t expect me to believe that you having a diagnosis gives you any special privileges into \u2018knowing\u2019 what autism is any more than doctors making the diagnosis have any special privileges to knowing what autism is.\u201d<\/p>\n

Well \u2013 other than embodying a disposition so-labelled (at least culturally),\u00a0being an active sociologist in the field, being an active member of autistic communities and culture \u2013 all of which gives me (I feel) a greater \u2018interactional expertise\u2019 with said cultures (I say this with confidence given your repeated misrepresentations, overgeneralisations and simplifications). Using the idea that those so labelled cannot give an explanation empirically as to what it is (when scientists cannot) as a way of dismissing what is said by them is to me a bit bizarre and unethical. Collins and Evans (2007) argue that \u2018interactional expertise\u2019 could be seen as a minimum standard for studying cultural groups \u2013 I would say this is something you show no evidence of. I would also say that those with \u2018contributory expertise\u2019 within such cultures are of value when talking about said cultures and the variety of viewpoints that exist therein.<\/p>\n

\u201cAs autism (disease or difference) is conceptualised as hardwired in some way\u2026\u201d<\/p>\n

Well it is used as I have said before to describe one\u2019s neurology, cognition, way of being, behaviour etc. by medics and so on.
\nA brain and subjectivity develop over time. Do you deny (as people) we have differing (yet developing and non-static) brains? Differing ways of being in the world? Differing experiences? And that some whether willingly or not are ascribed a status of \u2018autism\u2019 as a descriptor of said perceived differences (in any of the above mentioned)? Whether or not \u2018autism\u2019 is an empirically justified category or not is immaterial it would seem to such ascriptions being made (and experiences of being so labelled being different to not being so \u2013 and a multitude of other experiences associated with being seen as an \u2018outsider\u2019 for one\u2019s disposition and way of being in the world \u2013 however one wants to describe it oneself).<\/p>\n

\u201c\u2026then until evidence for what this is that is specific and characteristic is forthcoming (and there is no sign of that being consistently found and replicated in either neuroimaging or genetic or indeed any other studies) then the ONLY scientific conclusion you can come to is AUTISM DOES NOT EXIST as biological fact \u2013 it exists as a cultural fact.\u201d<\/p>\n

Quite so \u2013 the same studies show neurodiversity to be a \u2018fact\u2019 in your view \u2013 or not?<\/p>\n

\u201cOne of the reasons I think many of us feel the need to speak out about this, is that a lack of acknowledgement that autism is a construct leads, as with other diagnoses in psychiatry, to reification \u2013 a mistaking of a humanly made ideas for concrete reality (I don\u2019t have time to go into the full ramifications this can have on people\u2019s lives, some of which I suspect you experienced with other labels when you were a teenager).\u201d<\/p>\n

The term \u2018teaching your grandmother to suck eggs\u2019 springs to mind. I do not need a lesson in reification.<\/p>\n

\u201cAutism is a \u2018brand\u2019.\u201d<\/p>\n

Or several competing?<\/p>\n

\u201cNeoliberal values encourages individuals to compete with each other resulting in \u2018winners\u2019 and \u2018losers\u2019, and where the ever present anxiety of losing has been subject to market forces resulting in the growth of a profitable mental health industry that locates causes and solutions of perceived \u2018failure\u2019 and other struggles as residing within the individual.\u201d<\/p>\n

Again \u2013 \u2018teaching grandmother\u2019.<\/p>\n

\u201c\u2026dangers lurk\u2026\u201d<\/p>\n

And yet, you have yet to address my question (originally first asked to you in 2012) about what you would replace diagnosis with and what the practical ramifications of that would be \u2013 or would you deny any neurological \/ dispositional differences between people? And so \u2013 no need for a replacement? It is not very radical (nor ethical) to me to propose we disband the label without having some kind of idea about \u2018what next\u2019.<\/p>\n

\u201c\u2026with professionals arguing that many criminals in fact have \u2018autism\u2019. If it gets conflated with \u2018dangerousness\u2019 beware.\u201d<\/p>\n

Lol \u2013 I think that happened a long time ago!?!<\/p>\n

\u201cPerhaps you can suggest or send two or three key papers that you think would help summarise some of the history, theory and practice that you consider important to get across.\u201d<\/p>\n

Well \u2013 I don\u2019t think the below really summarise, but may give you a taste of what is available?<\/p>\n

https:\/\/madstudies2014.wordpress.com\/archive\/mad-studies-neurodiversity-symposium-archive\/\u00a0<\/a><\/p>\n

http:\/\/www.autscape.org\/2015\/programme\/handouts\/Autistic-Culture-07-Oct-1999.pdf<\/a>
\n(old article, his views have of course changed a lot since)<\/p>\n

http:\/\/shopfront.chester.ac.uk\/images\/normalcy\/stevengraby.pdf<\/a><\/p>\n

http:\/\/www.larry-arnold.net\/Autonomy\/index.php\/autonomy\/article\/view\/AR2\/html<\/a><\/p>\n

http:\/\/www.larry-arnold.net\/Autonomy\/index.php\/autonomy\/article\/view\/AR10\/html<\/a><\/p>\n

http:\/\/www.autscape.org\/2016\/programme\/presentations<\/a><\/p>\n

http:\/\/dsq-sds.org\/article\/view\/3876\/3405<\/a><\/p>\n

http:\/\/shura.shu.ac.uk\/7164\/<\/a><\/p>\n

I know it is different, but what evidence can you show me of an essential difference of \u2018being gay\u2019? I guess not a great deal that is fully explanatory at least! So, if this is nothing but a cultural categorisation, should we disband the term because someone who doesn\u2019t so identify thinks so? Should \u2018autism\u2019 be disbanded as a diagnostic category? Perhaps so? But then, what would you \u2018diagnose\u2019 and how would people acquire services and support from that model? Or do you think people don\u2019t need anything but the same as everyone else? Universal Design in all things? How would you like to practically bring that about? And how will that help the well-being and life chances of \u2018autistic people\u2019 when that change occurs? Saying autism is a myth, but giving no alternative explanation for dispositional differences and experiences and discrimination \u2013 nor practical strategies and ideas \u2013 is ill-conceived and potentially damaging.<\/p>\n

So \u2013 what is your plan as to what we\u00a0should change to?<\/p>\n

Sami:\u00a0<\/strong><\/p>\n

I do want to reiterate that I have found your replies interesting and informative. I admire your tenacity and willingness to engage in this discussion and I like your \u2018pulling no punches\u2019 approach. You have important things to say and as I said in my last email I believe that your work and those of colleagues from the critical autism movement aligned with your understanding has been extremely important in opening up new and creative spaces for those labelled autistic and their supporters. I do want to educate myself further on these perspectives and am grateful to the links you\u2019ve sent me and will get round to looking at them further. I do also understand that many people have positive experiences of being labelled, whether it\u2019s a parents struggling with a sense that their child\u2019s struggles are because they are a \u2018bad parent\u2019 or someone trying to make sense of why they are struggling\/suffering. I understand there are many psychological functions of labeling from validation, understanding, promise of change and so on. However, in terms of autism the potential negative effects have hardly been mentioned in available discourses hence our small attempt to give such a perspective an airing, grounded in the knowledge that autism as a label in our current state of knowledge can have no explanatory capacity.
\nI think we have much ground in common and I like the concept of autistic\/neurodivergent cultures and the understanding of the culturally constructed nature of the spaces created by this. There does remain an important difference. I will try and make a final attempt at articulating this difference in hopefully a more respectful manner than my last email.
\nLet me if I may take a few direct quotes from your previous answers:
\n[autistic people as]\u00a0 \u2026\u201dembodied dispositional diversity\u201d, agree with my statement that you are arguing \u201cthat there is something innate\/internal\/at least partly biological driving the way the autistic person engages with the world\u201d, \u201cWhat I do see as biological\/dispositional\/social reality\u201d,\u00a0\u201cDiffering ways of being in the world\u201d, \u201cembodying a disposition so-labelled\u201d etc. You then give an account of how you connected with autobiographical accounts, but had to rely on a medical process to confirm that you had a similar diagnosis to those biographical accounts.
\nSo if I can attempt to summarise what comes across to me from this account is a concept that there is a \u2018dispositional\u2019 tendency in people that is driven from within and that accounts (i.e. has explanatory capacity) for differences in the way (for example) you interact with the world. You also tacitly acknowledge that this dispositional tendency has been first introduced to us via the medical community naming certain tendencies as \u2018autism\u2019 and I am guessing that at present in order to have entry into the \u2018autism\u2019 communities you first need the medical community to make the diagnosis. I understand you disagree with what they then do with this diagnosis, but it is still these people who have adopted the role of \u2018expert\u2019 in diagnosis that are needed in order to signify entry (unless, perhaps, you believe that there should be self-diagnosis, although you do state \u201cThere are of course issues with \u2018self-diagnosis\u2019\u201d).
\nThere is a point of departure between us and I think there is an epistemological issue here, although and I am not stating that this is the totality of what can be said about embodied difference. To arrive at a notion that there is an innate\/biological disposition that has a certain specificity (currently requiring doctors to identify that) and has explanatory capability for one\u2019s behaviours regardless of context, then the most relevant epistemological framework to confirm or refute that is the positivist, empirical, scientific one. You have put forward a hypothesis concerning causality and this needs to be tested. In science, we always start with the null hypothesis \u2013 we assume no link or causality until it can be proven that this assumption must be incorrect. This is where I believe the argument that there is a biological\/innate basis is struggling to be made. The null hypothesis currently stands \u2013 there is no innate characteristic discover-able, biological \u2018substrate\u2019 that coincides with those diagnosed with \u2018autism\u2019 (or to use your concept \u2013 having those dispositional tendencies) and can explain the way their \u2018being in the world\u2019 manifests. To talk about us having different brains doesn\u2019t add anything to the argument and is as unhelpful to unpacking this as saying all behaviours are ultimately down to genes (which of course they are). So my epistemic point here is that the most relevant framework for establishing the idea that those who belong to the autism communities have a biologically\/neurologically based disposition, which causes them to interact differently with the world \u2013 is the scientific, materialist, positivist one \u2013 as that is how we establish biological facts. As there is insufficient evidence to support the null hypothesis as being incorrect, then there is no biological basis for what currently doctors diagnose as autism. But it exists in our discourses; therefore it exists as a fact of culture, and not as a fact of nature. This means I am right there with you when you explore the cultural aspects of what you call autism communities, but I diverge, when you start ascribing \u2018dispositional\u2019 qualities with explanatory capacities.
\nIt should be fairly straightforward from this to understand why I don\u2019t share your idea that autism cultures\/communities can be straightforwardly compared to gay or punk communities. The latter referred to are more easily self-identified (sexual preference or music preference, which then develop various cultures e.g. around dress or lifestyle), do not need to posit a biological disposition (whether there is or not), do not need a doctor to identify and allow potential entry into the communities etc. Of course there are some similarities too (dealing with stigma, emancipation, gaining comradeship etc.) that sit in the realm of social and cultural life.
\nYou also asked what to use instead if not autism. The problems associated with seeing people through the \u2018prism\u2019 of autism was my initial driver to writing about this in a world of expanding numbers being diagnosed. As you know the \u2018Myth of Autism\u2019 book I co-wrote with Neil and Brian looked at the drawbacks and their experiences as two people diagnosed with an ASD were not as positive as yours about the diagnosis. Two immediate problems: two tier services \u2013 where children diagnosed with autism get a service (such as autism outreach to schools) whereas others who don\u2019t get the diagnosis, but could equally benefit from such services (e.g. diagnosed with the increasingly unpopular label LD) don\u2019t. Secondly, the opposite can happen, where someone is denied a service (e.g. presenting with anxiety around other kids) because they have a diagnosis of autism and therefore they are told it is part of their autism and there is nothing we can do about it or the service doesn\u2019t deal with those diagnosed with autism or a practitioner imagines they don\u2019t have the \u2018expertise\u2019 to deal with autism etc. Autism, like any label, can obscure the particular challenges, dreams, strengths, skills, lack of certain skills, problems, resources etc. of any person. What diagnostic based practice leads to is a focus on process (because they \u2018have\u2019 autism, we must follow this or that \u2018pathway\u2019) even though the evidence on outcomes has not found any specific \u2018treatments\u2019 that deferentially improve outcomes for those diagnosed with autism compared to those who are not and are at a similar level of functioning. Also diagnostic based practice leads to a focus on \u2018symptoms\u2019 (i.e. in autism\u2019s case behaviours). You will I, expect, have similar critiques to me on these aspects. My practice focuses on outcomes (whether from the perspective of those I\u2019m working with things are improving or not) and here diagnostic discussions can be put to one side and hardly ever feature. Different people have different ideas about what they would like to change or understand. From working to improve relationships to skills for managing anxiety, to helping parents understand emotional dynamics \u2013 every person diagnosed or not has a different tale to tell, context to live, and change they wish to achieve. People don\u2019t get stuck with long term treatments or invited to a deficit view \u2013 the idea of difference that you rightly promote is something I regularly use, and probably take a bit further stressing that though we have various similarities that can bind us (interests, music, family whatever), each one of us is ultimately unique and how wonderful is that, knowing that there is absolutely no one else anywhere in the world who is exactly the same as you. I have no problem with people using a shorthand of \u2018autism\u2019, just ask that it is kept in mind that this is used as a strategy to manage a situation no more, no less.
\nOK. Hopefully I haven\u2019t been too \u2018ranty\u2019 this time, but it\u2019s me signing off from this particular debate<\/p>\n

Damian:<\/strong><\/p>\n

\u201cYou then give an account of how you connected with autobiographical accounts, but had to rely on a medical process to confirm that you had a similar diagnosis to those biographical accounts.\u201d<\/p>\n

Nonsense \u2013 I realised the similarity in accounts (or not) when I read them, I was diagnosed five years later \u2013 as I said, I partly went through the process as a social experiment to see what psychiatrists would do and how they would define me (I had already accepted that I was \u2018somewhere on the autism spectrum\u2019 as a personal construct – not biological factual reality or static innate \u2018disposition\u2019). This had no effect on my sense of selfhood, but did give me a social status I did not have before (and one which I could continue to contest \u2013 similar to other ascriptions whether medicalised or not).<\/p>\n

\u201cYou also tacitly acknowledge that this dispositional tendency has been first introduced to us via the medical community naming certain tendencies as \u2018autism\u2019\u2026\u201d<\/p>\n

Erm\u2026nope\u2026dispositional diversity is part of human diversity and so would be as old as human beings are imv. Before I was labelled autistic, I was labelled lazy, stupid, underachiever, BPD, catatonic schizophrenic \u2013 I also attracted such nicknames as \u2018Frankenstein\u2019 and \u2018Herman\u2019 and \u2018Bolts\u2019 at school due to the way other children perceived me. This has nothing to do with how a medical professional names someone\u2019s dispositional state. If one looks at the work of Mitzi Waltz, one can see characterisations historically (and in fiction) of what we might call \u2018autistic\u2019 by today\u2019s naming of dispositional characteristics. The term \u2018autism\u2019 was first used in a clinical setting by clinicians. Calling oneself an autistic person \u2013 is not in order to reify such assertions \u2013 much like a feminist may try to reclaim terms that have been used in derogatory ways \u2013 one strategy is to reframe the discussion around dispositional diversity and what it is like subjectively for those diagnosed as \u2018autistic\u2019 and so on.<\/p>\n

\u201c\u2026and I am guessing that at present in order to have entry into the \u2018autism\u2019 communities you first need the medical community to make the diagnosis.\u201d<\/p>\n

You would be guessing completely wrong \u2013 such a simple mistake as this shows why I think you lack the interactional expertise to be writing about the views espoused within said cultures.<\/p>\n

\u201cI understand you disagree with what they then do with this diagnosis, but it is still these people who have adopted the role of \u2018expert\u2019 in diagnosis that are needed in order to signify entry (unless, perhaps, you believe that there should be self-diagnosis, although you do state \u201cThere are of course issues with \u2018self-diagnosis\u2019\u201d).\u201d<\/p>\n

Both have difficulties with them \u2013 quite obviously I think. Autistic communities tend to be inclusive of those who are diagnosed, those who self-diagnose, and those who do not identify but are simply interested for whatever reason. Some groups are more exclusive \u2013 as the culture is not one static singular entity (as cultures aren\u2019t \u2013 not to me anyway) \u2013 I would not be interested personally in any group that required a medical diagnosis for entry.<\/p>\n

\u201cTo arrive at a notion that there is an innate\/biological disposition that has a certain specificity (currently requiring doctors to identify that) and has explanatory capability for one\u2019s behaviours regardless of context, then the most relevant epistemological framework to confirm or refute that is the positivist, empirical, scientific one.\u201d<\/p>\n

I am not arguing that there is an innate\/biological disposition (see responses elsewhere), nor one with any specificity \u2013 it is \u2018social conventions\u2019 which name such things, whether very specific or not \u2013 \u2018the autism spectrum\u2019 is an umbrella term. As a (medicalised) scientific concept explaining behaviours regardless of context, I think this is nonsense (see previous comments again). Common dispositional tendencies within, without or across categorical boundaries could be operationalised and measured, but generally these have been ill-conceived imv with regard to what people call \u2018autism\u2019. Both monotropism type ideas and sensory processing differences were jettisoned early-on as specific and explanatory of what was thought of as \u2018autism\u2019 (although EF issues, ToM issues etc. as operationalised in studies are not specific and explanatory either, but never mind\u2026). One of the problems is what empirical studies are funded and what they are testing for. Still, by working back from a \u2018behaviourally\u2019 defined diagnosis, one is unlikely to find one easily identifiable common cause.
\nIn \u2018autism\u2019 this for me is like looking for the \u2018Holy Grail\u2019 (and yes I do like Monty Python).<\/p>\n

\u201cYou have put forward a hypothesis concerning causality\u2026\u201d<\/p>\n

Of \u2018autism\u2019 \u2013 no. I have said that monotropism is a common tendency I\u2019ve experienced amongst those labelled autistic. \u00a0Well \u2013 that would depend on how one conceives it perhaps? It does a good job of hypothesising possible consequences of a highly monotropic use of attention which would perhaps influence some of the dispositional tendencies people may experience \u2013 I find it a useful model for certain things personally. I would like to see more empirical studies in this area, but some have wanted \u00a0that for a long time.<\/p>\n

\u201c\u2026and this needs to be tested.\u201d<\/p>\n

Well \u2013 Liz Sheppard\u2019s team and their experiments were conducted without any knowledge of my theories regarding the \u2018double empathy problem\u2019, yet would seem to be supportive of such a model. But like monotropism, I would like to see it tested more \u2013 anyone fancy funding it?<\/p>\n

\u201cIn science, we always start with the null hypothesis \u2013 we assume no link or causality until it can be proven that this assumption must be incorrect.\u201d<\/p>\n

I first read Karl Popper\u2019s work in the early 90s.<\/p>\n

\u201cThis is where I believe the argument that there is a biological\/innate basis is struggling to be made.\u201d<\/p>\n

No kidding (see \u2018Holy Grail\u2019 comment earlier)! You were not the first to point this out though \u2013 see Larry Arnold\u2019s essay (which originates from a course he did circa 2004).<\/p>\n

\u201cThe null hypothesis currently stands \u2013 there is no innate characteristic discover-able, biological \u2018substrate\u2019 that coincides with those diagnosed with \u2018autism\u2019 (or to use your concept \u2013 having those dispositional tendencies) and can explain the way their \u2018being in the world\u2019 manifests.\u201d<\/p>\n

Nope \u2013 and given the complexity of what is placed within this umbrella term, I very much doubt anyone ever will. I am also not an eliminative materialist when it comes to philosophy of mind, so I don\u2019t think \u2018dispositional tendencies\u2019 will ever be fully explained. We can scrap the DSM etc. \u2013 but what then for the people who depend on the practical supports and benefits a label (sometimes) helps to provide? Perhaps you would like to tackle this pragmatic issue in some way? Would be nice to know more of what you think about this (I guess I will just keep asking\u2026).<\/p>\n

\u201cTo talk about us having different brains doesn\u2019t add anything to the argument and is as unhelpful to unpacking this as saying all behaviours are ultimately down to genes (which of course they are).\u201d<\/p>\n

I think it does, as does many within the \u2018neurodiversity movement\u2019 one could say.<\/p>\n

\u201cSo my epistemic point here is that the most relevant framework for establishing the idea that those who belong to the autism communities have a biologically \/ neurologically based disposition, which causes them to interact differently with the world \u2013 is the scientific, materialist, positivist one \u2013 as that is how we establish biological facts.\u201d<\/p>\n

And autism isn\u2019t one imv \u2013 or in the view of scientists like Eric London, Chris Gillberg, etc. it would seem to me. How is what you are offering different?<\/p>\n

\u201cAs there is insufficient evidence to support the null hypothesis as being incorrect, then there is no biological basis for what currently doctors diagnose as autism.\u201d<\/p>\n

Nope.<\/p>\n

\u201cBut it exists in our discourses; therefore it exists as a fact of culture, and not as a fact of nature.\u201d<\/p>\n

Yes, but dispositional diversity and the consequences of it are of course influenced by nature, and how we decide to categorise such diversity is social construction \u2013 as Larry Arnold said many years ago: \u2018shifting goalposts\u2019.<\/p>\n

\u201cThis means I am right there with you when you explore the cultural aspects of what you call autism communities, but I diverge, when you start ascribing \u2018dispositional\u2019 qualities with explanatory capacities.\u201d<\/p>\n

Dispositional qualities being described do not have explanatory capacity in empirical scientific terms \u2013 no. Are they of importance \u2013 well, they are to me. Can they be tested better \u2013 I think so.<\/p>\n

\u201cIt should be fairly straightforward from this to understand why I don\u2019t share your idea that autism cultures\/communities can be straightforwardly compared to gay or punk communities. The latter refer to are more easily self-identified (sexual preference or music preference, which then develop various cultures e.g. around dress or lifestyle), do not need to posit a biological disposition (whether there is or not), do not need a doctor to identify and allow potential entry into the communities etc. Of course there are some similarities too (dealing with stigma, emancipation, gaining comradeship etc.) that sit in the realm of social and cultural life.\u201d<\/p>\n

There are many similarities \u2013 which is why I raised it. Of course there are differences too. Yet, this community does not need to posit a static biologically explainable disposition \u2013 and generally the view being most often expressed is that of neurological diversity having an impact on social lifeworld (+disposition or what have you). A doctor is not \u2018needed\u2019 as such to experience what one experiences or how one chooses to identify whatsoever (yet I accept the tensions the history and terminology of course bring to the community) \u2013 and this is certainly not needed for entry into the community (as said before in this response).<\/p>\n

\u201cYou also asked what to use instead if not autism. How you might approach a situation differently without a label.\u201d<\/p>\n

And I said how such options are not always open to me \u2013 and sometimes I need a short-hand term.<\/p>\n

\u201cThe problems associated with seeing people through the \u2018prism\u2019 of autism was my initial driver to writing about this in a world of expanding numbers being diagnosed. As you know the \u2018Myth of Autism\u2019 book I co-wrote with Neil and Brian looked at the drawbacks and their experiences as two people diagnosed with an ASD were not as positive as yours about the diagnosis.\u201d<\/p>\n

Yep \u2013 but your book is thus as skewed as one that concentrated on only the positives (in this regard) \u2013 yes I can see you were trying to rebalance the discourse, but one would have to read more widely to get a fuller picture. So \u2013 for me it came across as potentially you choosing experiences \/ co-producers to fit your argument (although that is a common human \u2018trait\u2019 perhaps?).<\/p>\n

\u201cTwo immediate problems: two tier services \u2013 where children diagnosed with autism get a service (such as autism outreach to schools) whereas others who don\u2019t get the diagnosis, but could equally benefit from such services (e.g. diagnosed with the increasingly unpopular label LD) don\u2019t.\u201d<\/p>\n

Such as? My diagnosis of Asperger\u2019s has not led to anything but a small bit of help once from the DSA. I think this is too simplistic. Also \u2013 many services for autistic people shall I say are \u2018counterproductive\u2019 (or much worse).<\/p>\n

\u201cSecondly, the opposite can happen, where someone is denied a service (e.g. presenting with anxiety around other kids) because they have a diagnosis of autism and therefore they are told it is part of their autism and there is nothing we can do about it or the service doesn\u2019t deal with those diagnosed with autism or a practitioner imagines they don\u2019t have the \u2018expertise\u2019 to deal with autism etc.\u201d<\/p>\n

Well \u2013 often they don\u2019t have sufficient expertise imv. Saying something is \u2018part of their autism\u2019 as if separate to the individual in some way is to me an ontological error, as autism is a description of said person\u2019s \u2018disposition\u2019 and their actions and not a \u2018biological fact\u2019 as you point out. When a service says they can\u2019t help people \u2013 then I suggest gaining more expertise in the lived experiences of said group \u2013 or stop excluding people etc. Yes \u2013 \u2018autism\u2019 can be used to exclude, but one doesn\u2019t need a label of autism to be excluded due to people\u2019s perceptions and reactions to one\u2019s \u2018disposition\u2019.<\/p>\n

\u201cAutism, like any label, can obscure the particular challenges, dreams, strengths, skills, lack of certain skills, problems, resources etc. of any person.\u201d<\/p>\n

For me, that would depend somewhat on the meanings one attaches to the label. It doesn\u2019t have this effect for me in my own personal constructs \u2013 may do if I use the term in certain social situations. At times useful, sometimes not so \u2013 a linguistic \/ social \u2018technology of self\u2019 or some such?<\/p>\n

\u201cWhat diagnostic based practice leads to is a focus on process (because they \u2018have\u2019 autism, we must follow this or that \u2018pathway\u2019)\u2026\u201d<\/p>\n

Yes \u2013 but I argue against the use of the term \u2018has autism\u2019 or such one-size-fits-all practices in regard to people, autistic or not.<\/p>\n

\u201c\u2026even though the evidence on outcomes has not found any specific \u2018treatments\u2019 that deferentially improve outcomes\u2026\u201d<\/p>\n

Often defined as reducing deficits \/ normalisation of dispositional differences from the idealised norm \u2013 and not something that I would agree with the argument for \u2013 but yes, evidence of these outcomes of specific \u2018treatments\u2019 is shoddy to say the least. I have written about this too (in various ways in various articles).<\/p>\n

\u201c\u2026for those diagnosed with autism compared to those who are not and are at a similar level of functioning.\u201d<\/p>\n

Seeing as there is not at \u00a0all good evidence for medical interventions with autistic people \u2013 as you say \u2013 so what? Says nothing about \u2018autistic people\u2019 who have \u2018spiky profiles\u2019 of abilities and who are not classically \u2018LD\/ID\u2019 either.<\/p>\n

\u201cAlso diagnostic based practice leads to a focus on \u2018symptoms\u2019 (i.e. in autism\u2019s case behaviours). You will I, expect, have similar critiques to me on these aspects. My practice focuses on outcomes (whether from the perspective of those I\u2019m working with things are improving or not) and here diagnostic discussions can be put to one side and hardly ever feature.\u201d<\/p>\n

Really \u2013 not feature? Why not? What would you advise for someone who already has a diagnosis and is worried about when they get their PIP brown envelope through the door and their benefits being possibly cut? That their diagnosis is not based on biological fact? How is this going to help them?<\/p>\n

Sami:<\/strong><\/p>\n

Appreciate your responses and suggested readings, which I have found interesting and useful, but you have not convinced me about utility or validity of your version of socially constructed nature of autism\/neurodivergence debate, nor do I feel you have addressed my points properly. Reading some of the authors you pointed me to, further confirmed my \u2018bias\u2019. Like you I argue (and wrote about years ago) that the nature v nurture debate is pointless, unnecessary, and unhelpful. However, I don\u2019t think, despite your protestations, you can escape that the concepts you and your critical colleagues use (autism, neurodivergence, disposition, mono tropism etc.) have more than just descriptive function and in the way they are being used are meant to have a \u2018explanatory\u2019 purpose (that \u2018autism\u2019 explains something about a person\u2019s diagnosed\/identified with autism\u2019s behaviour). This is particularly true of some of the other writers you referred to: e.g. Steven Graby \u201cThere is a spectrum of neurological difference \u2013 I see this as incontestable\u201d or Larry Arnold \u201cBrain scanning and other research has borne out that we look at people differently and tend to use the same parts of the brain to process people as NTs use for objects\u201d. Just the word \u2018neuro\u2019 points to where the assumption lies about what is driving differences (at least in part \u2013 and in the above statements in large part).
\nSo can we at least agree that we diverge in our view about autism having any explanatory capacity that is (at least in part) driven by \u2018neurology\u2019 (I don\u2019t agree with either of those positions obviously)?
\nI also see that you are struggling with the same problems of description\/caseness that the medics struggle with and haven\u2019t properly addressed. You managed a reasonable deconstruction of the problems involved in personality type and trait theories propounded by, for example, Eysenck, in a 2014 paper of yours in \u2018autonomy\u2019, but seem to have a blind spot when it comes to applying the same critique to concepts of autism (reminds me of Michael Rutter, who does a reasonable job of pointing out problems with diagnostic concepts lacking a \u2018marker\u2019 or some sort of anchor, such as dyslexia, but has a blind spot when applying the same standards to autism). You are unable to sufficiently address the problem of heterogeneity (that bedevils medical definitions), so what you end up with is a vague, difficult to pin down (or even understand) of \u201cAutistic people could be said to exhibit a dynamic quality of perception, one less stratified by learnt schemas, one less socialised into obeying normative ideologies, but an embodied sociality nonetheless\u201d \u2013 try operationalising that! I think you obfuscate this problem by referring to philosophers like Merleau-Ponty and their concepts of embodiment in a way that was not used by him. What this then leads to is an idea, again similar to medics, that it is only someone who has \u2018expertise\u2019 in autism who can have the relevant knowledge of what autism \u2018is\u2019 and thus how to recognise and deal with it, such as in your email you say \u201cWhen a service says they can\u2019t help people \u2013 then I suggest gaining more expertise in the lived experiences of said group\u201d. So you just have a different idea of who has the authority to be granted an \u2018expert\u2019 status\u2019. I see being an expert in autism as an oxymoron. So can we agree that we diverge on our views as to whether autism describes\u00a0anything specific or characteristic?
\nFor me the problem remains that the neurodivergent view of autism is the opposite side of the same coin that the \u2018disorder\u2019 view of autism represents. Like all other diagnoses made in psychiatry (apart from the dementias though there are some problems here too), there are the similar problems of explanatory capacity and descriptive specificity. Thus the neurodivergent view has been easy to usurp into current practice as it upholds the idea that there is a \u2018thing\u2019 out there that can be recognised and is called \u2018autism\u2019, and as a result the \u2018difference\u2019 view is now often covered in mainstream literature. I think it has contributed to the lack of critique on the rapid expansion of the numbers being diagnosed with autism, which shows little signs of slowing down. This is why I think the critical autism we are involved in is different to the one you are involved in. You are critiquing the medical view; many of us are critiquing the whole lot including your positions.
\nDamian:
\n<\/strong>
\nIt seems that you are still missing the point. So again, I will try and explain\u2026<\/p>\n

Most of the concepts I have referred to are being used descriptively, particularly \u2018autism\u2019.<\/p>\n

Monotropism is offered as a model of differing attention\/interest strategies being used cognitively. Dinah Murray (and some others) argue that those that have a tendency toward a monotropic attention strategy are often deemed \/ described as autistic.<\/p>\n

Disposition is being used as I described before. Neurodivergent is more of a social category (as neurotypical is also a social construct based on embodied diversity).<\/p>\n

The quote you use of Steve Graby does not refer to Autism, but the idea that neurological diversity is a brute fact. Something I would agree with. Diversity in neurological development will impact on perceptions and experiences of the social lifeworld, whether labelled \u2018autistic\u2019 or not. The quote you use from Larry is now an old one and I am sure his position will likely have changed on this. However, the best people to ask would be Steve and Larry \u2013 which is why I struggle to see why one would not wish to invite them to such a gathering of people to discuss such issues.<\/p>\n

I do not think autism as a medical \/ biological category has explanatory value, or the dominant cognitive theories of autism.<\/p>\n

I do not see autism in terms of a set of definable traits \u2013 and I apply the same critique of trait theory to autism trait theory (such as the work of Baron-Cohen).<\/p>\n

What I suggest regarding dynamic quality and the use of schemas has and is being studied in various ways and has resulted in a number of contested arguments between cognitive scientists. There was a paper some time ago now on \u2018hypo-priors\u2019 as a theory. So very hard to operationalise and research, but not impossible, and I hope to see some directed research in certain areas of cognition in future. I very much doubt there will ever be anything that is explanatory of all that are currently labelled autistic though, as I have said previously, this is like looking for the Holy Grail \u2013 it most likely does not exist. So it does not describe anything specific \u2013 unless used in a cultural context.<\/p>\n

As I have said before, autistic culture exists and one can gain expertise in that. There is also expertise in the lived experience of those so labelled (much like in Mad Studies). There are other forms of expertise applied to the culture of autism. What you have consistently shown me is that you lack is interactional expertise with autistic culture \u2013 and it is infuriating that you continue to misrepresent it, whilst not letting said people speak for themselves, either in the book, or it would seem this event.<\/p>\n

What you are critiquing as the \u2018difference model\u2019 is not my view, but a simplistic mischaracterisation and straw man argument. What you call \u2018critical autism studies\u2019 \u2013 I see as a misuse of the term. Criticising the scientific literature on autism and saying that autism is not a definable natural kind is nothing new.<\/p>\n

So \u2013 rather than interrogating my position \u2013 can we interrogate yours?<\/p>\n

If autism is a myth, what explanation do you have for the lived experiences reported, for \u2018stimming\u2019, for not perceiving past or future (for a particular case study) \u2013 and so on? An individual profile? How will this work in practice?<\/p>\n

It is one thing to say that the models others use lack explanatory value; it is something else to try and explain what is going on. So \u2013 do you think neurological diversity is a myth? Do you think that this has no impact on lived experience and development? Do you not think that people who are \u2018neuro\u2019 divergent are not discriminated against? Do you think we have nothing to learn about such experiences from the people experiencing them?<\/p>\n

What is your explanation and practice model?
\nSami:<\/strong><\/p>\n

We are indeed going round in circles. You seem intent on labeling me as \u2018misrepresenting\u2019 you. I do not believe I am. I understand your reference to autistic culture as \u2018existing\u2019 as being a social construct with many facets that is useful for many people so labelled or not (such as having a personal empathy\/connection with said cultures). As I have repeatedly said I have found some of your explanations helpful, informative and enriching and I will certainly be making greater use of these insights in my own clinical practice. But, I remain unconvinced that you have addressed some essential problems I have with your on-going confused definitions and embedded idea of explanatory value, which I believe leads to some similarities with the problems from medical definitions (DSM remember is meant to be descriptive with no assumptions about cause \u2013 but it just keeps creeping in). I can\u2019t help feeling you want to bake your cake and eat it! In your latest email you say (for example) \u201d Most of the concepts I have referred to are being used descriptively, particularly \u2018autism’\u201d and \u201cNeurodivergent is more of a social category\u201d and then start using them as potential explanatory vehicles (but of your own theory), for example, \u201cWhat I suggest regarding dynamic quality and the use of schemas has and is being studied in various ways and has resulted in a number of contested arguments between cognitive scientists. There was a paper some time ago now on \u2018hypo-priors\u2019 as a theory. So very hard to operationalise and research, but not impossible, and I hope to see some directed research in certain areas of cognition in future\u201d. You can\u2019t help but get drawn into this and have repeatedly done so and then denied you\u2019ve done it! The quotes from other authors were only one of many and they were directly from the papers you pointed me in the direction of, which I subsequently read, with the Larry Arnold quote coming from a publication in Autonomy in 2012.<\/p>\n

With regards descriptive utility\/specificity, again you haven\u2019t been able to address the question of heterogeneity and lack of specificity, leading you to effectively invent your own version of what \u2018autism\u2019 is and you can then avoid these more empirical questions by the get out clause of its a social construct. However, you also guard entry into this by self-defining who has the right to be seen as \u2018expert\u2019 by talking about those with lived experience \u2013 and so you neatly avoid the problem of those with lived experience of \u2018what\u2019? The reason you continue to avoid dealing with these more empirical questions is that you can\u2019t and so you won\u2019t. Fair enough, but let\u2019s at least acknowledge that this is a point of divergence between the sort of critical autism I\u2019m engaged with and you are. I am not trying to suggest that one is better than the other, just that they have some important differences in focus \u2013 and the focus I and colleagues are engaged with is just as legitimate as yours.<\/p>\n

In terms of what to do instead, this is the reason I personally critique autism and all other mental health\/psychological diagnoses. Unlike most of my colleagues I monitor outcomes using a brief patient and\/or parent rated outcome measure (Outcome Rating Scale) so I keep a focus on whether what we are doing together is leading the people I see to record improvements (from their perspective, by whatever is important to them) and I therefore have an on-going record of their outcomes. Unlike the outcome literature on outcomes in standard mental health services and some national surveys, which finds as few as 8% of patients seen by CAMHS services in some areas experience significant improvements, my personal outcomes run at around 70-80% of my cases, which is similar to that found in research and also means that most of the people I see improve by their own perception and get discharged. I do that primarily by NOT focusing on diagnosis (I\u2019ve attached a couple of \u2018magaziney\u2019 articles I wrote about that way of working in case you\u2019re interested).<\/p>\n

I also think it\u2019s ludicrous to accuse me or any others in this group of \u201cnot letting said people speak for themselves\u201d. You have been perfectly happy to express your opinions, nobody has stopped you, and the critical autism you represent has received wide coverage (as it should). What the RAN want to do is create some space for this other and more far reaching critique of all aspects of the concept to be made. In terms of \u2018said people\u2019 of course there is some who have a personal background with \u2018lived experience\u2019. You do not have monopoly over this area.<\/p>\n

I think it would help this discussion if you could at least acknowledge that there are some differences in what we are examining.<\/p>\n

Damian:<\/strong><\/p>\n

Rather than taking on all of your points now, I will just try and clarify a few.<\/p>\n

Whilst I think Autism is an umbrella term and not biological fact, I think embodied diversity including neurological \/ developmental differences do exist and impact on the experiences anyone has. Some of these phenomena tend to be more common imv within the population labelled autistic. Thus, I am of course interested in work into such areas, such as the hypo-prior stuff. I personally find monotropism a useful model. It is a model of human attention, perception and diversity though and applicable to anyone. The double empathy problem is applicable to any interaction too. I heard a conceptual term earlier which I thought was very similar called \u2018symmetrical reciprocity\u2019, I find this a much better explanation of social interaction breakdowns than saying autistic people lack a theory of mind.<\/p>\n

I am not denying other forms of expertise in what we call autism, just putting forward lived experience as important, as I would in regard to Mad studies. We certainly seem to disagree about how we see this issue, but perhaps have not fully unpacked those differences.<\/p>\n

I don\u2019t particularly want to split critical autism studies into sub-groupings, but would like to see \u2018it\u2019 embrace a number of different views and perspectives regarding the use of critical theory as applied to autism. I also critique the characterisation of the neurodiversity movement being embedded in what you define as a \u2018difference model\u2019.<\/p>\n

Thanks for saying something about your practice. In terms of counselling and mentoring I have a liking for personal construct theory, despite its potential limitations. I\u2019d be interested in your views on this theory and related practice.<\/p>\n

I disagree that the critical autism studies that I represent gets wide coverage, especially in academia. US-based activism has had some coverage, as have the odd hand-picked individual by charities etc.<\/p>\n

The Larry Arnold essay was first written in 2004. It was published in 2012 for historical reference. Larry\u2019s views have developed a great deal since then, but he did recognise back then that autism was not a \u2018single invariate thing\u2019.<\/p>\n

I think some of my views are much closer to yours than you realise. Some not so.<\/p>\n

Damian<\/p>\n

 <\/p>\n

Sami:<\/strong><\/p>\n

Thanks Damian<\/p>\n

I really appreciate your last email and I think we have had a productive (if at times challenging) exchange. I have learnt a lot from it and agree that there are some differences but also a lot of similarities and overlap and in particular we are all of us seeking the same ends of trying to shed light on something in a way that we hope will help improve something in the lives of people we encounter and move the discussion in clinical and academic arenas on.
\nBest wishes
\nSami<\/p>\n","protected":false},"excerpt":{"rendered":"

Debate 1. Does autism have an essential nature? Damian Milton, a sociologist and activist and Sami Timimi a child and adolescent psychiatrist The essential nature of autism (and the merits of diagnosis) in a series of emails in summer 2016 before an initial meeting of the Rethinking Autism Network (RAN). Sami: I have read articles […]<\/p>\n","protected":false},"author":1,"featured_media":670,"parent":806,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[],"acf":[],"yoast_head":"\nEssential Nature - Exploring Diagnosis<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Essential Nature - Exploring Diagnosis\" \/>\n<meta property=\"og:description\" content=\"Debate 1. Does autism have an essential nature? Damian Milton, a sociologist and activist and Sami Timimi a child and adolescent psychiatrist The essential nature of autism (and the merits of diagnosis) in a series of emails in summer 2016 before an initial meeting of the Rethinking Autism Network (RAN). Sami: I have read articles […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/\" \/>\n<meta property=\"og:site_name\" content=\"Exploring Diagnosis\" \/>\n<meta property=\"og:image\" content=\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/wp-content\/uploads\/sites\/719\/2016\/06\/frankallen_1000_2.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1000\" \/>\n\t<meta property=\"og:image:height\" content=\"288\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"70 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/\",\"url\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/\",\"name\":\"Essential Nature - Exploring Diagnosis\",\"isPartOf\":{\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/wp-content\/uploads\/sites\/719\/2016\/06\/frankallen_1000_2.jpg\",\"datePublished\":\"2016-09-30T11:01:16+00:00\",\"dateModified\":\"2016-09-30T11:01:16+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/#primaryimage\",\"url\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/wp-content\/uploads\/sites\/719\/2016\/06\/frankallen_1000_2.jpg\",\"contentUrl\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/wp-content\/uploads\/sites\/719\/2016\/06\/frankallen_1000_2.jpg\",\"width\":1000,\"height\":288},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Debates\",\"item\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Essential Nature\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/#website\",\"url\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/\",\"name\":\"Exploring Diagnosis\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Essential Nature - Exploring Diagnosis","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/sites.exeter.ac.uk\/exploringdiagnosis\/debates\/debate-1\/","og_locale":"en_US","og_type":"article","og_title":"Essential Nature - Exploring Diagnosis","og_description":"Debate 1. 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