Devon Price
Autism Activist.
Professor of Social Psychology.
- How "unmasking" leads to freedom for autistic and other neurodivergent people, Life Kit, NPR, 18 April 2022.
- Unmasking Autism: Discovering the New Faces of Neurodiversity, 2022.
Autism: From Disorder to Oppression
Price reconceptualizes autism in three stages:- Demedicalization: from disorder to difference.
- Identitarianism: from difference to identity.
- Politicization: from identity to oppression.
Price accepts that the central problem in autism is in the domain of social communication and interpersonal functioning.
What he rejects is that this due to an impairment or deficits in the capacity for verbal or non-verbal communication and social cognition.
Price's frames autism as a normal human variant with a different cognitive / communication style.
It is this mismatch of styles, he asserts, that accounts for the interactional problems between autistics and non-autistics.
Devon Price:
Price's conceptualization of disability is most easily understood by examining the ways in which it departs from the standard biopsychosocial model of disability as described in the public health literature:
Autism is neurological.
Autism is a developmental disability that … appears to be largely genetically heritable …
[Much] of what researchers consider the “social deficits” of Autism aren’t really deficits at all; they’re just differences in our communication style that neurotypicals don’t adjust to. …
Autistic people don’t actually lack communication skills, or a drive to connect. …
[The] idea of pursuing a treatment “for” Autism is predicated on the idea we are broken or sick … an idea the neurodiversity movement completely rejects. …
Where the medical model of disability fails is in making sense of disabilities that come from social exclusion or oppression. …
[We] are disabled, robbed of empowerment and agency in a world that is not built for us. …
The world actively dis-ables people by failing to provide accommodations they need.
Naming the reality of disability shows respect for disabled people and awareness of how we are oppressed. …
[Neurotypicality] is more of an oppressive cultural standard than it actually is a privileged identity a person has. …
[There] are just so many ways in which we are punished for deviating from the norm. …
Ableism is a pervasive social force, and one we can’t entirely escape …
The criminal justice system and mental health system are deeply interwoven, and they both serve to perpetuate ableism.
Ableism is a powerful force of oppression. …
Almost every person with a mental illness or disability … has repeatedly tried and failed to earn acceptance by playing the rules of a game that was designed to harm us. …
Being Autistic in a neurotypical world is often traumatizing, and being forced to mask is essentially an experience of society-driven abuse.…
[Your] disability isn’t to blame for what happened, and neither are you.
It was a far-reaching, centuries-old system of injustice that left you in such a difficult spot. …
Almost anyone can be viewed as defective or abnormal under our current medicalized model of mental illness …
By tearing down our current, constricting definition of mental health, and celebrating different ways of thinking, feeling, and behaving, we can improve countless lives. …
Our caring professionals and educators must be made aware … that their prejudicial attitudes often create disability where none might otherwise be there. …
When we teach children about racism, sexism, and imperialism throughout history, we should highlight how the oppressed were often branded as hysterical, paranoid, and insane.
It’s important that all people — neurodiverse and neurotypical alike — come to realize how narrow definitions of sanity and “functioning” are used to harm and dehumanize.
As the diagram indicates … disability and functioning are viewed as outcomes of interactions between health conditions (diseases, disorders and injuries) and contextual factors.
Among contextual factors are- external environmental factors (for example, social attitudes, architectural characteristics, legal and social structures, as well as climate, terrain and so forth); and
- internal personal factors, which include gender, age, coping styles, social background, education, profession, past and current experience, overall behaviour pattern, character and other factors that influence how disability is experienced by the individual.
So the standard view of disability is that it results from an interaction between individual impairment (due to a disease or disorder) and environmental conditions.
The archetypal example someone in a wheelchair being disabled due to the absence of wheelchair access.
The impairment is an inability to walk.
The disability is due to impairment (due to some disease or disorder) interacting with an external environmental factor (eg a lack of accessibility).
No impairment (ie no disorder), no disability.
If there is impairment, whether or not there is associated disability may depend on environmental conditions (eg ramps).
In contrast with mobility, is it likewise possible that a neurologically based social ineptitude could be severe enough to cause significant psychosocial impairment?
The scientific community says yes.
Price says no: autism does not cause impairment, therefore it is not a disorder.
In what sense, then, is autism a disability?
Here Price draws a distinction between impairment related (medical) disability and non-impairment related (social) disability; arguing that autism is a social / political / cultural / normative disability, not a medical disability.
And the source of this social disability?
Ablelist / neurotypical oppression.
Though, if Price is correct about the lack of impairment, this cannot, strictly speaking, be 'ablelist' in the usual sense of the word.
Ablelism is discrimination based on actual medical impairment.
Since, for Price, there is no impairment in autism, one would need to expand the meaning of ableism to include the false imputation of impairment where none exists, then stigmatizing autism based on this mislabeling.
So, these semantic contortions leave us with two novel senses of 'disability' and of 'ablelism'.
In summary, neurotypical oppression leads to social disability based on a biological difference between non-autistics and autistics (or alternatively between the neurotypical and the neurodiverse), not a difference between health and disorder, but a difference between two normal human developmental variants.
The source of the disability is not individual disorder / impairment but the prevailing system of oppressive societal norms.
Ableism dis-ables autistics in the same way as slavery dis-ables the enslaved.
According to this view autistics are being compelled to conform to unjust cultural standards only to be excluded when they (inevitably) fail.
What are the difficulties of this theory?
To describe severe autistics, those without language, unable to attend to their own basic self-care and protection, as being normal developmental variants, seems to deny an obvious reality, hiding it behind a screen of confusing language and political ideology.
In any other context — perinatal anoxia, traumatic brain injury, disabling genetic syndromes — such reduced capabilities would be regarded as major psychosocial impairments .
They require intensive professional (ie formal) assistance and support.
Consider the definition of mental disorder:Mental_disorder:
One might add that by 'significant' is meant severe enough to be the focus of clinical / research attention ie professional (formal) intervention as distinct from subclinical, which is manageable by informal supports (self-help, peer-support, life-coaching, personal development).
A mental disorder … is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.
(Wikipedia, 18 September 2023)
That is to say, those who fall below the clinical threshold of severity do not have a disorder in the sense of requiring formal assistance.
Whether the 'challenges' of this population are primarily due to systematic oppression, as Price contends, is debatable.
While there is overlap between the concepts of oppression, stigmatized difference, and discrimination, they are not the same thing and are not freely interchangeable.
The mind-body distinction plays a role here.
Certain physical problems, like a broken bones, are not stigmatized.
Communicable diseases on the other hand are stigmatized, for obvious reasons.
Problems with the brain, affecting mind and behavior, are more closely linked with moral personhood.
Mental dysfunction naturally bleeds over into adverse judgements of the self.
Price's seeks to demedicalize autism (presumably) in order to destigmatize it.
Because he takes an identitarian approach to autism, demedicalization is necessary because it is unacceptable to identify with a stigmatized entity.
If autism is identified with the self, and autism is a disorder, then the self is disordered.
And the self has to be defended at all costs.
There's nothing wrong with me, society's to blame.
It's not me that needs to be fixed, but the world.
One can address medical stigma directly, or as in Price's case, indirectly, by denying one has a disorder so as to avoid the associated stigma.
The alternative is to directly address the stigmatizing of illness in general, and developmental disorder in particular.
This identitarianism is expressed in the preference for disability-first over person-first terminology:- being an Autistic person vs a person with autism,
- being an schizophrenic person vs a person who suffers from schizophrenia,
- being an Asian person vs being a person of Asian descent,
- being a gay person vs being a person who is same sex attracted.
In the area of race this is especially dangerous.
Defining people by their ethnicity is the foundation of biological racism.
It essentializes ethnicity and conflates linguistic and cultural identity with biological descent.
There are numerous diasporas where immigrants are fully integrated with the majority culture despite differences in physical appearance.
One is not defined by one's ancestry any more than one is defined by one's neurology.Benjamin Zachariah [Historian]:
While it is true that Oliver sought to draw attention to the environmental factors contributing to disability it seems he did not believe these were the only factors involved.
Once upon a time, essentializing people was considered offensive, somewhat stupid, anti-liberal, anti-progressive, but now this is only so when it is done by other people.
Self-essentializing and self-stereotyping are not only allowed but considered empowering.
(After the Last Post: The Lives of Indian Historiography, 2019)
Devon Price:
[It’s] more sensible to view Autistic identity through a social lens than a strictly medical one. …
[The] social model of disability, originally coined in the 1980s by disabled academic [sociologist] Mike Oliver.
In his writing, Oliver described disability as a political status, one that is created by the systems that surround us, not our minds and bodies.
That he distinguished between impairment and disability indicates he did believe that impairments existed and played a role in disability.
As originally conceived, the social model of disability was a model of impairment-related disability, not a social model (or lens) of identity.Social model of disability:
The social model of disability diverges from the dominant medical model of disability, which is a functional analysis of the body as a machine to be fixed in order to conform with normative values. …
In this model, the word impairment is used to refer to the actual attributes (or lack of attributes) that affect a person, such as the inability to walk or breathe independently.
It seeks to redefine disability to refer to the restrictions caused by society when it does not give equitable social and structural support according to disabled peoples' structural needs. …
Oliver did not intend the social model of disability to be an all-encompassing theory of disability, but rather a starting point in reframing how society views disability.
This model was conceived of as a tool that could be used to improve the lives of disabled people, rather than a complete explanation for every experience and circumstance.
A primary criticism of the social model is its centering of the experiences of individuals with physical impairments, which has resulted in overlooking other forms of disability, such as mental health conditions. …
In the late 20th century and early 21st century, the social model of disability became a dominant identity for disabled people in the UK.
Under the social model of disability, a disability identity is created by:- "the presence of impairment,
- the experience of disablism, and
- self-identification as a disabled person."
In addition to with arguing that autism is not a disorder, Price also criticizes the syndromic approach to diagnosis in general, at least when it is applied to conditions whose manifestations are 'mental' (psychological or behavioral), rather than 'physical' (neuropathic pain).
Again, he concedes that autism has a physical cause, but not that it is a disorder.Devon Price:
If you reject expert opinion using on objective criteria (syndromal diagnosis based on patterns of signs and symptoms), how do you determine your neurotype?
[For] many illnesses and disabilities, medical care and a medical lens is undeniably appropriate.
If you’re someone who is in excruciating, daily pain due to nerve damage, medical treatment and medication can help you.
If you have a degenerative condition that progressively gets worse, such as multiple sclerosis, you have every reason to support medical research in pursuit of a cure. …
[It’s] arguable whether the disability should even be defined by the presence of clear behavioral signs, such as- trouble reading social cues or
- hesitating to initiate contact with other people. …
- the neurobiological markers of the neurotype, and
- the internal experiences and challenges that Autistic people themselves report. …
When it comes to mental illness and disability, diagnostic categories are really flawed things.
A disorder is a cluster of symptoms and traits that tend to go together, but don’t always, and the way those clusters get organized tends to change over time. …
Our understandings of these labels are constantly in flux, and who gets stuck with a particular label varies across time and cultural context. …
This dynamic is particularly challenging for people with Autism Spectrum traits, because our neurotype is so multifaceted and so easily mistaken for other conditions. …
I prefer the terms self-determination or self-realization to self-diagnosis, because I believe it’s more sensible to view Autistic identity through a social lens than a strictly medical one.
Diagnosis is a gatekeeping process, and it slams its heavy bars in the face of anyone who is too poor, too busy, too Black, too feminine, too queer, and too gender nonconforming, among others. …
[Self-definition] is a means of reclaiming our power from the medical establishment that has long sought to corral and control us.
Neurotype:
A type of brain, in terms of how a person interprets and responds to social cues, etc.- 2018, Steve Bloem, The Pastoral Handbook of Mental Illness, page 56:
And the neurotypes aren't random.
They align with their symptom clusters along two major axes: anxiety and anhedonia (the inability to feel pleasure).
('Neurotype' does not yet appear in OED online)
Is it something you knows instinctively, like same sex attraction?
Do you conclude you are Autistic because you feel an affinity with others who identify as Autistic?
How did they discover they were Autistic?
Is it all about identification:- gender: male / female / non-binary?
- race: black / white / colored?
- neurotype: neurotypical / neurodiverse?
There are no 'neurobiological markers of the neurotype'.
There is no neuroscience or recognized classification of neurotypes.
There are only neurobiological correlates of known clinical syndromes.
Substituting the word 'neurotype' for 'diagnosis' is just trying to demedicalize autism by linguistic manipulation.
This is no substitute for a rational debate about alternative ways of categorizing phenomena.
Like using the word 'disability' in a non-impairment-related (social) sense, when in common usage it refers to disability in the impairment-related (medical) sense.
Unless done carefully, argument by redefinition just creates confusion.
Since it is unclear what the general properties of a neurotype are, one cannot be certain what entities should be included in this category.
Is anyone who is neurodiverse (ie not neurotypical), possessed of a neurotype?
Where do temperaments and personality traits fit in?
Price mentions both:- a range of specific conditions apart from autism: Tourettes, ADHD, PTSD, depression, schizophrenia, epilepsy, and Social Anxiety Disorder; as well as
- certain general categories: Mental Illness / Disorder and Cognitive Disability (TBI, CTE, dementia, ID).
Many with PTSD were neurotypical before being traumatized, and some recover.
Likewise, in a significant proportion of cases schizophrenia, depression, and epilepsy are not permanent conditions.
Price's perspective echos a range of past and current intellectual traditions:
- Demedicalization:
R D Laing:
Laing took the expressed feelings of the individual patient or client as valid descriptions of personal experience rather than simply as symptoms of mental illness. …
Laing regarded schizophrenia as the normal psychological adjustment to a dysfunctional social context, but he later acknowledged that his views on schizophrenia were wrong.
(Wikipedia, 24 September 2023)
Labeling Theory:
Labeling theory holds that deviance is not inherent in an act, but instead focuses on the tendency of majorities to negatively label minorities or those seen as deviant from standard cultural norms.
(Wikipedia, 26 September 2023) - Identitarianism:
Devon Price:
… I capitalize “Autistic” … to indicate it is a part of my identity I am proud of, and to signal Autistics have our own culture, history, and community. …
Because the neural and cognitive features of autism are so pervasive, it affects almost every aspect of a person’s body and brain. …
autism is a core part of who we are, impossible to separate from our personalities, talents, preferences, and general outlook. …
Without our disability (or our gender identity) we’d be entirely different people.
They’re both core parts [of our personhood or personality …]
Neurodiversity:
The framework grew out of the autism rights movement and builds on the social model of disability, arguing that disability partly arises from societal barriers, rather than attributing disability purely to inherent deficits.
It instead situates human cognitive variation in the context of biodiversity and the politics of minority groups.
Some neurodiversity advocates and researchers argue that the neurodiversity paradigm is the middle ground between strong medical model and strong social model.
The neurodiversity paradigm has been controversial among disability advocates, with opponents arguing it risks downplaying the suffering associated with some disabilities, and that it calls for the acceptance of things some would wish to be treated.
(Wikipedia, 26 September 2023)
Identity Politics:
Many contemporary advocates of identity politics take an intersectional perspective, which accounts for the range of interacting systems of oppression that may affect their lives and come from their various identities.
According to many who describe themselves as advocates of identity politics, it centers the lived experiences of those facing systemic oppression; the purpose is- to better understand the interplay of racial, economic, sex-based, and gender-based oppression (among others) and
- to ensure no one group is disproportionately affected by political actions, present and future.
These identity labels are not mutually exclusive but are in many cases compounded into one when describing hyper-specific groups.
(Wikipedia, 14 August 2023) - Politicization:
- sexism — discrimination / oppression based on patriarchy (eg the feminist 'male gaze' recast as the 'neurotypical gaze');
- biological racism — discrimination / oppression based on imagined biological differences between races;
- homophobia — discrimination / oppression based on sexual taboos;
- ableism — discrimination / oppression on physical or mental impairment.
Kenneth Minogue:
Ideology is commonly signaled by the presence of a tripartite structure of theory.
The first stage reveals to us that the past is the history of the oppression of some abstract class of person.
It is concerned- with workers as a class, not (as a politician might be) with workers at a particular time and place; or
- with women in general, or
- with this or that race.
The duty of the present is thus to mobilize the oppressed class in the struggle against the oppressive system.
This struggle is not confined to the conventional areas of politics.
It flares up everywhere, even in the remoter recesses of the mind.
And the aim of this struggle is to attain a fully just society, a process generally called liberation.
Ideology is thus a variation played on the triple theme of oppression, struggle, and liberation.
(Politics: A Very Short Introduction, Oxford University Press, 1995)
