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Introduction ................................................................................................. 1
What’s The Difference?
C.D. Herrera
Chapter One............................................................................................... 18
Noise and Metonymic Thinking in the Philosophy of Arthur
Schopenhauer: Some Benefits of Retrospective Psychiatric Diagnosis
Alexandra Perry
Chapter Four.............................................................................................. 67
Mindblindness: A Troubling Metaphor?
Janette Dinishak
Notes........................................................................................................ 286
Contributors............................................................................................. 295
Index........................................................................................................ 300
ACKNOWLEDGMENTS
Winter, 2013
C. D. Herrera and Alexandra Perry, Society for Moral Inquiry
INTRODUCTION
C.D. HERRERA
Overview
There are trivial differences between people, just as there are what we
might consider trivial labels and offenses to go along with those differences.
Nevertheless, trivial differences are at least noticeable (as when we
routinely distinguish between those who have a sense of humor and those
who do not). They are noticeable enough to raise important questions
about which differences we are supposed to honor with a label, and what,
if anything, should be said when we do. I would have a hard time
convincing people that you had offended me when you claimed that I had
a bad memory. We typically make light of such things. But what if my bad
memory is due to some disability that I have had since I was a child? In
another setting, what if I say that you make me uncomfortable when you
walk over and begin speaking to me? It would be hard to fault me for that,
though I might not be given this latitude if I announced that it is not you,
but your kind that makes me uncomfortable.
Questions about differences and labels are no easier to avoid than
human interaction is, and it is hard to envision how we could survive
without both. In the settings that I just sketched, the point is to show that
there are things about those differences that we're not supposed to say, and
as some advocates for a more inclusive society might add, things we're not
supposed to think either. Interestingly, the warnings about how careful we
should be to respect differences have a familiar ring to them, as do the
warnings that we should be on the lookout for differences in the first place.
We are used to hearing that labels lead to or are a form of exclusion,
and that this is especially wrong when the differences have to do with
ethnicity or gender, for instance. Most of us probably also have a fairly
good grasp of the reasons for thinking that labels can cause harm. This is
easy to understand where skin color is concerned. Among the things that
2 Introduction
was wrong with the rules for segregated water fountains in the U.S., for
instance, was the fact that they left members of both groups to wonder
what they had done to merit such exclusive treatment. One cannot choose
a skin color, we might explain. Similar explanations would account for the
improvement in attitudes which led to more females being able to enter the
workplace. One can now change gender, but not easily, and this does in
any event only lead to new questions about that difference.
In instances like these, the question is not whether differences exist,
but what society ought to make of them. The good news is that many now
think that differences should be irrelevant for purposes of choosing
employees or allowing people to hydrate. Even the most cynical among us
can find some encouragement in the fact that society is taking more
responsibility for clarifying the issues related to difference, inclusion,
accommodation, and justice. But we are less accustomed to discussing
differences that seem to relate to cognitive abilities or behavioral traits,
and I will try to say a bit about those here.
As an introduction to the essays in this anthology, I want to address the
following problem. We take it on faith that it is better to live in a world
where no person has to feel excluded, and one suspects, where fewer
people need to feel uncomfortable. But the challenge has always been one
of knowing how we can make good on such a lofty promise. I will try to
pose questions rather than supply answers. I am not convinced that the
answers we need exist.
My goal is to take a skeptical view, and suggest ways that we might
rethink the philosophical side of our labeling routines. If I am correct, we
are too casual about the fact that the same person who devotes her life to
eliminating discrimination in society can take real offense at being told
that she should simply flip a coin to decide on a spouse, or that she should
consult tea leaves when deciding whether to share a reading table with two
acquaintances. Our reform efforts must include an examination of the
ways that we might cite these comparatively "new" differences when we
explain who it is that we want to spend time with, who we want to work
next to, and how we want our children to choose their friends.
We need to do this if we want to respond to what are also relatively
new claims of injustice or offense. But allegations about exclusion or
injustice have proven to be challenging topics of conversation, let alone
reform, in part because the linguistic customs that we use even to discuss
these things are themselves prone to misinterpretation and controversy
(Agam Segal, 2009). A common way to offend someone in scholarly
discussion is to allege that a claim of injustice is in fact trivial. So long as
the perceived seriousness of an offense can turn on a disputed interpretation
What’s the Difference? 3
make one of the most visible distinctions, that between rational beings and
those, such as animals, that we think act only on instinct or genetic
momentum. There is a great deal of wishful thinking in our preoccupation
with using rationality as this dividing line:
If human equality is true, it is not in respect to any host property we can
see or touch; it is, as we have urged, because all rational persons share
uniformly the capacity to be morally good. But that is believable if, first,
all rational humans have a uniform capacity freely to strive to discover and
realize the correct way and, second, if this striving works towards a
person's moral self-perfection (Coons & Brennan, 1999, 121).
Even where we can say that our desire for this kind of taxonomy is
itself made on more rational grounds, it has always been hard to avoid the
political or social bias. The fact is that we very often want to live
alongside others whose behavior can in some respects be understood, if
not predicted. And we know what type of behavior we would like to
follow from this common rationality, and that is not limited to the
behaviors used to solve math problems or find the best price on new
furniture.
The sentiment behind wanting to use rationality as a baseline does
seem to be aimed in the right direction, that of trying to align different
perspectives to a common morality. But there is more than one rationality
to speak of, and there are still many more cognitive or behavioral
differences that, taken in themselves, do not immediately bear on moral
issues or even a vague sense of a social good. There is, for this reason, no
solution to our problems in the systematic treatment of unequals, or those
who we feel are unequal, as though they are equal. A strategy where we
talk of embracing difference without making value judgments about which
ones should take priority would have us acting" as if we were so impressed
by the fact that we could not unscramble scrambled eggs that we denied
that any legitimate distinction could be made between the ingredients"
(Cooper, 1981, 65).
There is also the possibility that in our attempt to avoid privileging one
claim of injustice over another, we would reduce complex moral issues to
the equivalent of slogans ("celebrate difference!"). Slogans, we know from
the history of social reform, tend to be bundled tightly with accusations
and moral obligations, both so vague that society finds it almost
impossible to respond to them in a way that does not leave everyone
involved vulnerable to the next round of slogans. It seems, then, that we
must draw some lines when we weigh claims about injustice, or when we
talk of goals like inclusion. If we don't, we are going to be hard-pressed to
What’s the Difference? 5
defend the solutions that we do arrive at. It does not make much sense if
we, in an honest attempt to get serious about the full range of offense
claims, work from a model of justice that will in the end leave us able to
respond only to a few of them. This guardedly skeptical outlook follows
from the belief that any account of justice worth having is going to ask that
we make tough choices in light of our increasing stock of knowledge. The
outlook is rationalistic as well, in the sense that reform is needed because
in almost everything we do, we risk misunderstanding the motives, interests,
and abilities of others.
they use to self-identify give others reason to want to find another place to
conduct their lectures. "They have their place, and we have ours," we
might say, if we wanted to put a spin on a very conventional interpretation
of justice or personal liberty.
The trouble this time is that history reminds us that we know better.
We know that in our conversations about difference it can appear that
separate but equal is often too separated and not very equal. There is also
the fact that, some would say, we are learning more about how many of
the differences can be modified, treated, and even eliminated. This is
another point on which it is difficult to make analogies to, say, ethnic
differences, but it is also not something that gives us very much traction
for reform. The prospect that things like differences in emotional reaction
might be altered through various means does not tell us very much about
whether they should be. If anything, that prospect delivers new puzzles
about the boundaries of individual and community. If you notice my
anxiety at parties, can you argue that I need treatment for that, so as not to
upset the other guests? Should Uncle David seek medication that will
block his urge to share smutty thoughts during family gatherings? Why
can't he reply that the rest of the family should not impose their standards,
and their labels, on him?
There are several ways to understand the tension in scenes like these.
But I am interested in the idea that our feelings about cognitive or
behavioral differences are not always reliable guides to what an
appropriate reaction would be. I think that this unreliability is due in part
to the deep-seated ambiguity about what it is that qualifies as a difference
(a word that can itself function as a label), and the way that our reactions
to difference, and our sense that we are different, are in the end expressions
of feelings. It is a truism that one person can never share another person's
feeling the way the two might share a park bench, so to the extent that the
most common way to express and compare those feelings is to rely on
language, we can answer calls for social reform by committing ourselves
to better understanding the labels that we use when we describe differences.
When we try to understand labels, differences, and reactions to both,
we should assume that there is not much that is new or simple in the
puzzles related to our labeling. Questions about how we should describe
and understand differences have been asked, since ancient times, within
the larger conversations about human flourishing and what it can tell us
about how to structure society. There are questions which have to do with
the ontological status of the categories that we attach the labels to. Is there
a real line between the normal and the deviant, or only an imagined,
constructed one? Can a person be in one category while experiencing some
What’s the Difference? 9
play. On the contrary, it is probably true that games like cops and robbers
have never been terribly sensitive to the realities of police work or the self-
image of robbers. But the thought experiment can test intuitions that we
have about labels like "autistic" or "bipolar," for instance. If we don't think
that children should act out the roles that go along with such labels, it is
worth asking why. It is noteworthy also that parents do ask similar
questions about whether games of cowboys and Indians are insensitive
toward certain groups too. And there the idea is that it is not enough to
draw on what we think we know about our social world and its linguistic
counterpart. The point is to challenge that knowledge. It would be a
valuable lesson in itself if children could grow up thinking that some
labels are ruled out today as holdovers from a time when we did not
understand differences as we do now.
I have no illusions that these would be easy lessons to share with
children either. The difficulty in talking about such things with adults
suggests otherwise. In any event, there seems as much of a risk in thinking
that children don't reflect as much as we might want them to about labels
as there is a risk that we adults will come away from such hypotheticals
thinking that we are better at that reflection than we really are. To that end,
we would want the children to understand that, as vague as our labels can
be, it is rare that we know for sure how they might affect the people we
label. We would want to explain that tossing questions about roles back
and forth is a complicated, serious game in itself because it forces us to
poke around in so many other areas of private and public life.
This dynamic occurs when we focus on things like the different
emotional reactions that people have to environmental stimuli. We
probably think that we have a good idea of what to tell children about how
they should react towards police officers (or cowboys and Indians).
Shouldn't we be able to explain to someone who asks what should be done
when a person in our midst expresses sadness in a way that we don't
expect? We might think that something is amiss if a person laughs during
a funeral ceremony. The trouble is in getting clear on what the wrongness
involves, or how we should deal with the person who finds humor in that
situation. The lines quickly blur when we try to describe the emotional
reactions and judge their social value. If this were not the case, it would be
a simple task to explain why we think that it is right that people be moved
when looking at, say, photos of the victims of a natural disaster, and wrong
that they be moved by looking at photos of their neighbors undressing.
We might imagine how a student could feel an emotional connection
with a particular culture that he has learned about from his teacher. The
student might then try to dress and speak like the people he associates with
What’s the Difference? 13
We Should Talk
These sketches are meant to get at question like the following. What is
and what should be happening when we apply labels and make choices in
light of them? Why is one act of ranking people acceptable and another is
exclusionary or discriminatory? What should we make of a girl who
attempts to model her behavior on the behavior of people she thinks
exhibit symptoms of depression? Or another student who admires what he
takes to be deaf culture, and announces that he will respond to others only
if he can lip-read, for example? Would we judge these students the same
way we might a student who is enamored with what he thinks are aspects
of the culture of the Scottish Highlands, and takes to wearing a "kilt" to
school?
Such questions seem to reveal the two elements at the core of many
labels: a claim that X belongs in a certain group, and a claim that one
ought to feel a certain way about that. The labels let us distinguish: we
carve the social world with our words, and then, standing back, we rate our
efforts. But as useful as these distinctions are, our rules of language use
leave out an account of whether the same moral rules, for instance, which
allow us to tell children not to accept a ride home from someone we would
label a stranger, will let us decide whose children get to sit next to ours on
the bus. When we make social distinctions, we usually do so in a way that
will allow us to discriminate based on the qualities that we think a person
ought to possess in a specific context, and based on the behaviors that we
ourselves value in it.
To return to the skeptical point that I mentioned at the start, it seems
that loaded into these distinctions are cultural values that might or might
not have rational backing. This suggestion, that our use of labels outstrips
14 Introduction
our ability to justify ourselves, will for some require an explanation. There
are some who would argue instead that, as it often happens, their labels
have a self-contained justification, one that somehow immune from
rational reconstruction. I have occasionally heard something to this effect,
and the argument goes like this. Labels are to be fought over like turf, and
the claim to that territory will be established by those who truly understand
the real interests of the who are labeled. Where those who are labeled lack
political or economic clout, it is necessary to establish spokespersons,
institutions, and social movements in support of the reform of language,
and in the name of justice. This could then be seen a positive development,
a way of giving a voice to those who would otherwise have been left out
of our discussions about difference.
In other cases, however, this idea that, once established in their proper
social domain, labels are beyond moral criticism, can be an invitation to
demagoguery and still more discrimination. It is as if the spokespersons
are under the impression that we can speak of inclusion while we build
even more fences. Activists who approach problems related to difference
this way often have a bone to pick with scholars and other researchers who
would recommend that we understand labels as dynamic reflections of the
changing values in society. For those researchers, the way to arrive at
proper balance of difference and discrimination is to update our labeling
routines using scientific or clinical knowledge.
The advocates of this rationalistic method sometimes overstate the
chances of success. As I have tried to explain, whether there is a rational
justification for our labeling routines should not be the question. The better
question is how open to examination our reasoning is, and where we can
look for help when we want to validate it. If one agrees that this is
important, then it would make sense to also examine our methods of
arriving at conclusions about the social world, since that is where the
labels and our routines are. I think that when we look there, we will find
more pluralism and change than we will stability and consensus. Questions
about offense, labels, and justice are controversial because so many of
them turn on more fundamental disputes about how well they should hold
up to scientific and moral scrutiny.
I am not sure that there is a way around the responsibility we have to
continually reinterpret labels. It seems reasonable to assume that we keep
improving our ability to identify one person as belonging to a particular
group (and most people as belonging to several), for instance, just as we
can identify behavior or attributes that we propose as being better or
worse, more advanced, and so on. And if we want to understand how
principles of justice can apply to those people, we must take seriously the
What’s the Difference? 15
idea that there are empirical characteristics that the sciences might study,
and abstract or conceptual details that philosophy might examine.
What worries some critics is that neither science nor philosophy can
claim priority within the process itself. They warn that since these and
other disciplines have not always been good at self-policing, we should not
trust the scholars to reform our thinking about differences. The trouble is,
when we talk about inclusion, it is unclear where the discussion should
turn if not in the direction of philosophical and scientific territory. The
hope is that science, philosophy, and other speculative disciplines like
fiction can offer checkpoints for our attempts to get clear on what it is that
people are capable of, interested in, and just as important, how we ought to
react to whatever that is. If we assume that the talks that we should be
having will concern what constitutes "normal," for example, any consensus
will require judgments that are themselves informed by scientific accounts
of things like human physiology. In that case too, the only live issue then
is how much philosophy and science we think we need.
In some quarters, drawing those lines is as difficult as it is to know
what should count as a meaningful discussion about justice. Not long ago,
I participated in a panel discussion about, among other things, what should
be done to improve the treatment of cognitively impaired patients. Things
looked promising because the room was packed with scholars and
specialists from across the disciplines, assembled for a day-long conference
on neuro-diversity. But this discussion was off to a bad start when the first
panelist worked a number of jokes into her introduction, announcing at
one point that "when you meet one moral philosopher, you've met them
all." (This was supposed to play on a popular slogan which refers to
persons with autism.) This was followed by suggestions that writers in
philosophy had become, at best, distractions in the public conversations
that we should be having about difference. If there was any consolation to
be had for philosophy that day, it was in the message that science comes
out of all of this looking even worse. The ideas said to come from moral
philosophers, having to do with personhood or moral agency, were
described as flawed if not insulting, mainly because they piggybacked on
developments in medicine.
The accusation was that those of us in philosophy knew just enough
about developments in cognitive science, for example, to be offensive, and
that we knew just enough about logic to be able to convince the wrong
people. Yet who doubts that we all face a significant problem in knowing
how we should translate the feelings that we have about human welfare
and experience into rational arguments, and vice-versa? Once the laughter
had died down in the panel discussion, the speaker began to discuss
16 Introduction
References
Agam-Segal, R. (2009). Contours and Barriers: What Is It to Draw the
Limits of Moral Language? Philosophy, 84 (4), 549-570.
Coons , J. E. & Brennan, P. M. (1999). By Nature Equal: The Anatomyof a
Western Insight, Princeton: Princeton University Press.
Cooper, N. (1981). The Diversity of Moral Thinking. NY: Oxford
University Press.
Oberdiek, H. (2001). Tolerance: Between Forbearance and Acceptance.
Lanham, MD: Rowman & Littlefield.
Strawson, G. (2007). Episodic Ethics. In Hutto, D. (ed), Narrative and
Understanding Persons, 85-115. NY: Cambridge University Press.
Temkin, L. (1993). Inequality. NY: Oxford University Press.
CHAPTER ONE
ALEXANDRA PERRY
superior to theirs. Yet in fact this is just our society’s way of thinking: true
for us and our world, but not necessarily true for other societies and other
times. (Cunningham, 2002, 14).
Metonymical Thinking
The term “metonymic” refers to a rhetorical device similar to a
metaphor called “metonymy.” Metonymy, as figurative language, is the
22 Chapter One
affair); instrumental (the phrase “live by the sword, die by the sword” uses
the word “sword” as metonymical for “violence” because it is a tool or
instrument of violence); or associatively (“locker room behavior” might
refer to the kind of gender-specific joking or bonding that might
commonly take place in a gym locker room).
be perceived.
In discussing the concept of the self, Schopenhauer proposes a duality
that mirrors his view of the world. He argues that there are two kinds of
knowledge. The first, intuitive knowledge, is not representational, but
rather a view of the body “in-itself.” Intuitive knowledge, then, is an
analog to the will. The second form of knowledge, abstract knowledge, is
representational, and is analogous to the world as idea. So, while the
world exists as will and idea, the self exists as intuition and abstraction or
representation.
While this metaphysical theory is not extreme in its own right,
Schopenhauer’s proposal that this dual-nature of the self be extended to
our understanding of the world is one that is often viewed with some
skepticism (Jacquette, 2008, 73). Schopenhauer “proposes that this dual
knowledge and dual-sidedness of the self be extended to the world as a
whole” and that “insight into one’s own nature as will thereby provide us
with an analogical understanding of the inner nature of the World as Will”
(Shapshay, 2010, 799).
This generalization from self to world, individual to collective, is
typical of the philosophical moves that Schopenhauer makes in using
phenomenological accounts. Jacquette (2008) claims that Schopenhauer’s
analogy falls short because:
“[P]erceptual knowledge of the body is not merely analogous to knowledge
of the world as representation as a whole, and hence not a basis for
analogical inference, but is rather a focus of perceptual knowledge directed
specifically to the individual knowing subject’s body.”
Thus, since he aimed at finding for every empirical function of the faculty
of knowledge an analogous a priori function, he remarked that, between
our empirical perceiving and our empirical thinking, carried out in abstract
non–perceptible concepts, a connection very frequently, though not always,
takes place, since every now and then we attempt to go back from abstract
thinking to perceiving. We attempt this, however, merely to convince
ourselves that our abstract thinking has not strayed far from the safe
ground of perception, and has possibly become somewhat high–flown or
even a mere idle display of words, much in the same way as, when walking
in the dark, we stretch out our hand every now and then to the wall that
guides us. We then go back to perception only tentatively and for a
moment, by calling up in imagination a perception corresponding to the
concept that occupies us at the moment, a perception which yet can never
be quite adequate to the concept, but is a mere representative of it for the
time being (Schopenhauer, 1818, 449).
one resonates with and thus gains insight into the essence of these
emotions—regardless of where, when, why, and in whom they occur... It is
not that such symphonic music is felt upon reflection to be like or similar
to the vicissitudes of blind willing, just as Juliet is felt to be like Romeo’s
sun, to play the kind of role in his life that the sun plays for all living
creatures. Rather, music is, according to Schopenhauer, the most direct
expression of the will a human being can experience, seen through the
lightest of veils—in time, but outside of space and distinct from particular
motives, and without the distortions created by the subject’s own willing.
(Shapshay, 2008, 219)
Bartleby is not typical, preferring not to write for his employer yet
continuing to show up to his job each day, putting in longer hours than
anyone else in the office.2 The narrator seems to oscillate between
reverence and revulsion for Bartleby, but in either case views Bartleby as
residing outside of the norms. As the story ends, the narrator leaves his
readers with the following commentary on Bartleby:
Conceive a man by nature and misfortune prone to a pallid hopelessness,
can any business seem more fitted to heighten it than that of continually
handling these dead letters, and assorting them for the flames? For by the
cart-load they are annually burned. Sometimes from out the folded paper
the pale clerk takes a ring: --the finger it was meant for, perhaps, moulded
in the grave; a bank-note sent in swiftest charity: --he whom it would
relieve, nor eats nor hungers any more; pardon for those who died
despairing; hope for those who died unhoping; good tidings for those who
died stifled by unrelieved calamities. On errands of life, these letters speed
to death. Ah Bartleby! Ah humanity! (Melville, 1853)
As Aaij (1999) points out, “...the narrator is wholly given over to his
poetic imagination--he does not answer to us exactly how Bartleby stands
for humanity.” It is not clear, however, how Melville or the narrator saw
Bartleby as metonymically related to humanity. Perhaps this last
paragraph might be clarified a bit if the narrator had made a claim that
Bartleby was representative of how society ought to be, but it is not clear
how he represents society as such. Rather, this seems to be an example of
an atypical metonym, one in which the user felt a true connection between
two things but did not take account of how unconventional this metonym
actually was.
Literary critics have also cited some of Melville’s other short stories
and novels, such as The Paradise of Bachelors and the Tartaus of Maids
(Melville, 1855), and Pierre: or, the Ambiguities (Melville, 1852), as
using metonym in atypical ways. In both cases, Melville makes references
to women in ways that illustrate complex metonymical thinking, and his
contrasted is contrasted with the more typical metonymical use of
Hawthorne (Levine, 2008; Dimock, 1997).
The use of metonym in Moby Dick (Melville, 1851) has also been
noted as atypical and open to multiple interpretations (Reed, 2005).
Scholars have cited Melville’s use of “whiteness” in describing the whale,
and also the use of whalebone to replace Captain Ahab’s formerly ivory
prosthetic leg as examples of atypical metonym (Taylor, 2011). Other
indications of autistic experience, such as a strong interest in details
related to a particular and narrow interest have also been observed in Moby
Dick. The level of detail with which Melville describes whales and the
Noise and Metonymic Thinking in the Philosophy of Arthur Schopenhauer 31
the behaviors of others, then he or she may ascribe his or her own mental
states to others. Schopenhauer, it seems, does this in his relation of
“genius” to his own view of metaphysics. Similarly, Melville illustrates
this kind of ascription in his use of metonym. He assumes, for example,
that his readers will understand the metonymic relationship between
Bartleby and humanity when this relationship is not as straightforward as
he seems to think that it is.
woeful and disastrous, cutting his thought asunder, much as the executioner’s
axe severs the head from the body. (218)
Sensory experiences, like those that Grandin points out, are commonplace
across the spectrum (Klintwall, 2011). Further still, Schopenhauer again
demonstrates the ascription of his own mental states to others, a move that
is associated closely with autism. He writes:
There are people, it is true- nay, a great many people- who smile at such
things, because they are not sensitive to noise, but they are just the very
people who are also not sensitive to argument, or thought, or poetry, or art,
in a word, to any kind of intellectual influence. The reason of it is that the
tissue of their brains is of a very rough and coarse quality. On the other
hand, noise is a torture to intellectual people. In the biographies of almost
all great writers, or wherever else their personal utterances are recorded, I
find complaints about it; in the case of Kant, for instance, Goethe,
Lichtenberg, John Paul; and if it should happen that any writer has omitted
to express himself on the matter, it is only for want of an opportunity (216).
on autism and might also inform the decisions that the patient’s caretakers
make (Perry, 2012).
One problem with views like those of Hacking and McGeer is that,
perhaps because of the ability that autistic stories and narratives have to
transform public understanding of autism, bias-free accounts of autistic
experience are hard to come by. Narratives and stories might support or
be written from the point of view of the recovery movement, which views
autism as a disorder likely caused by vaccine damage or environmental
factors. Narratives might also support the views of the neurodiversity
movement, which views autism as a naturally occurring human difference.
Dramatizations of Autism like the movie Adam, or the television show
Parenthood for example, feature autistic characters who want to be
accepted for their differences, and who try to help others understand
autistic experience. This is also true of a character in the novel The Speed
of Dark. In movies such as Rainman or Mercury Rising and in books
such as The Girl with the Dragon Tattoo, and The Curious Incident of the
Dog in the Night-Time, however, characters with autism are portrayed as
struggling against a disorder that leaves them struggling and, in extreme
cases, unable to engage with their environment. The movie Mozart and
the Whale takes on this polarity and features two characters. One
character is proud of being on the spectrum while the other tries to be
“normal” and keep his diagnosis from his co-workers and employers. The
movie illustrates the tension between the two characters and the positions
that they represent. Autobiographies by those on the spectrum are often
faulted for the same bias and one-sidedness.
Given the current climate surrounding autism, narratives and stories of
autism written today are often biased to the point of being useless.
Though Cunningham’s objections to retrospective diagnosis certainly
make the use of historical methods to diagnose autism risky, one
advantage that the retrospective diagnosis of historical figures might offer
is that they were undiagnosed while they were living. If Schopenhauer
were writing today he might feel the pull to downplay his natural aversion
to noise and to condemn those who had caused the noise in the first place
citing noise-aversion as a valuable human difference. Likewise, if
Schopenhauer had been brought up under the recovery movement
paradigm, he might be compelled to view noise-aversion as pathological,
something that set him apart from the world. As it stands, Schopenhauer
was undiagnosed, and so clinicians and the general public might make use
of his philosophy to understand autistic thought patterns and of his
introspective accounts to understand the degree to which sensory
disturbances might affect autistic functioning or experience.
36 Chapter One
References
Abel, D. (1969). Black Glove and Pink Ribbon: Hawthorne’s Metonymic
Symbols. The New England Quarterly 42(2) pp. 163-180.
Bredin, H. (1984). Metonymy. Poetics Today 5(1) pp. 45-58.
Brown, J. (2010). Writers on the Spectrum
—. (2010). Writers on the Spectrum: How Autism and Asperger Syndrome
have Influenced Literary Writing. Philadelphia: Jessica Kingsley
Publishers
Chew, K. (2008). Fractioned Idiom: Metonymy and the Language of
Autism. In Autism and Representation, ed. Osteen, M. New York,
NY: Routledge. pp. 133-144.
Cunningham, A. (2002). Identifying Disease in the Past: Cutting the
Gordian Knot. Asclepio 54: 13-34.
Dimock, W.C. (1997). Reading the Incomplete. In Melville’s Evermoving
Dawn: Centennial Essays, John Bryant and Robert Milder, eds. Kent,
Ohio: Kent State University Press, 99-118.
Dolis, J. (1984). Hawthorne’s Metonymic Gaze: Image and Object.
American Literature 56(3) pp. 362-378.
Fitzgerald, M. (2005). The Genesis of Autistic Creativity.
Garrard, P., Maloney, L., Hodges, J., and Patterson, K. (2005) The effects
of very early Alzheimer's disease on the characteristics of writing by a
renowned author. Brain 128(2), 250-260.
Noise and Metonymic Thinking in the Philosophy of Arthur Schopenhauer 37
EQUALITY, CAPABILITY,
AND NEURODIVERSITY
DOUGLAS PALETTA
morality, the government should not prioritize one set of goods or values
over another. Rather, politically we should be concerned with what
everyone values. Rawls called these primary social goods which “are
things it is supposed a rational man wants whatever else he wants”
(Rawls, 1999, 79). These goods are unique in being all-purpose means
and include things like rights, opportunities and money. Regardless of
what someone values, these are the kinds of resources that allow any
citizen to develop and pursue what they think it means to live a good life.
Ensuring citizens have equal access to primary social goods thereby
respects everyone’s standing as agents in a scheme of social cooperation.
While this traditional paradigm works well when idealized, the account
sidesteps issues of neurodiversity in at least two ways: one methodological
and one more substantive. Methodologically, Rawls sets out to determine
“what is the most appropriate conception of justice for specifying the
terms of social cooperation between citizens regarded as free and equal,
and as normal and fully cooperating members of society over a complete
life” (12). He considers this the fundamental question of justice because
failing here means the theory fails in the least ambiguous philosophical
context. The goal is to find a successful theory in the clearer context and
expand the theory to harder philosophical cases. In doing so, he explicitly
sets aside individuals who do not fit neatly into the system as part of his
methodology.
More substantially, this understanding of the point and currency of
equality has implications for who should count as a citizen. Citizens are
characterized as having two moral powers: rationality and reasonableness
(Rawls, 1980, 525).2 Citizens are rational in that each can develop an idea
of what it means to live a good life and devise a plan to pursue it. Being
reasonable, citizens recognize others as legitimate sources of limits on
their pursuits and are motivated to abide by rules that others also accept. In
short, citizens demonstrate a level of motivation, analyticity, sociality and
independence that allows them to contribute to a scheme of social
cooperation. The focus on primary social goods recognizes that these
abilities and skills require certain conditions be in place to develop them,
but traditionally neurological variation among those who have the skills or
capacity to develop those skills is not seen as relevant to the justification
of principles of justice. Rather, from the standpoint of justification Rawls
suggests we should use an ideal “conception of ourselves as moral persons
and of our relation to society as free and equal citizens” (520). Doing so
relegates facts about human variation to secondary considerations.
Neurological variation becomes a fact that needs to be considered when
constructing actual laws rather than something that informs the fundamental
42 Chapter Two
Normalizing Neurodiversity
The fact of neurodiversity serves as an important corrective at several
levels in political theorizing. The central insight provided by neurodiversity
involves a change in perspective that challenges heretofore assumed
notions of the normal. As sketched in the previous section, philosophers
tend to ignore and more recently idealize away neurodiversity. As
understood in the literature, the neurodiversity movement makes two
central claims (Jaarsma and Welin, 2012, 20-21). First, the difference
between the neuro-typical members of society and those neurologically
different results from natural human variation and does not signal a sharp
break between the normal and abnormal. In part because there is not a
sharp break, a significant amount of the characterization, stigma and
differences in treatment is rooted in the social. Second, we should value –
or at least not stigmatize – our cognitive differences. For present purposes,
we need a framework for understanding this variation to inform both our
account of equality and how it may apply politically. 3
Neurodiversity refers to the neurological constellation of different
neurological types, which can be delineated according to a trait or set of
traits. Understanding diversity in terms of traits is important since several
neurological types, like autism, are “diagnosed solely on the basis of
observed behavior” (Baker, 2006, 19). Other commonly cited examples of
neurological variation range from temporal lobe epilepsy and depression
to hypergraphia (Glannon, 2007, 3). While sometimes referred to as a
spectrum, these examples show that neurodiversity does not distinguish
types using a single criterion. Rather, the variation is set by establishing
different combination of traits. For example, autists have difficulty
communicating and interpreting social cues, hypergraphists feel a
compulsion to write and “temporal lobe epilepsy has … been associated
with a heightened sense of spirituality or mystical visions”(3). While these
traits among others can be used to distinguish different neurological types,
declaring some type of neurological difference a disability makes the
further claim that the difference is an undesirable disorder or deviation
from the norm that requires fixing. Neurodiversity activists claim that
Equality, Capability, and Neurodiversity 43
these different sets of neurological traits can, and do, comprise individual’s
identity and potentially provide a basis for culture (Davidson, 2008).
The sharp distinction between the neuro-typical and others breaks
down when considering two factors: the differences already present within
the neuro-typical community and the similarity between those perceived as
low-functioning and those perceived as neuro-typical at different stages in
life. The first shifts from a binary notion of agency focused on rationality
to one that admits of difference and degree. The second demonstrates
overlap between those normally included and those excluded in a way that
further blurs the line of normal.
Rawlsian rational and reasonable citizens gloss over a range of
diversity within the traditional normal range. Many within the range are
autistic, obsessive, compulsive, depressed, and so on. The focus on rational
agency fails to capture the first or second personal agency of these people.
As mentioned earlier, these people are not otherwise neuro-typical with
some affliction, but instead the combination of characteristics or traits
partly makes up who they are. Someone is not a person with autism, but an
autistic person. Put differently, someone’s neurological make up has a
significant impact on how they agentially approach the world. Again
consider the case of an autistic person. This neurological difference will
affect how he perceives the world and thus how he processes decisions. To
take the first, an autist “can focus on the details of parts but not on the
general patterns of wholes” (Glannon, 2007, 2).4 This affects both the
information he has to act on and the way he makes decisions. For example,
one study found that autist’s “susceptibility to the frame manipulation
[including frames invoking emotional context cues] was markedly
reduced” (De Martino, 2008, 10478). This led autists to make more
consistent decisions in risky situations than non-autists. Making more
consistent decisions does not necessarily indicate that autists make better
or worse decisions, the framing or emotional cues may contain important
information or be irrelevant depending on the situation. It does, however,
point to a sharp difference in how autists relate to the world. Importantly,
many people with these neurological traits may well be rational and
reasonable in Rawls’s sense. However, characterizing their agency, and
subsequently disseminating the same bundle of resources, fails to
recognize the difference in agency and thereby equalizes citizens in a way
that is not sensitive to that difference. In fairness, the traditional theory
isn’t supposed to capture these differences, but this is precisely the
problem.
Second, accepting the impact of neurological variation on agency
further makes sense of how to include those in dependency relationships.
44 Chapter Two
social goods is that though some may find them more or less useful this
bundle of goods will have the kind of things that allow people to pursue a
meaningful life. The fact of neurodiversity greatly expands the range of
how useful citizens will find primary social goods. Different neurological
traits leading to different modes of engaging the world may have a
significant impact on the usefulness, and perhaps even recognition, of
certain resources. If the point of primary social goods is to enable citizens
to pursue a good life, in a neurodiverse society resources serve as a poor
proxy for flourishing. In contrast, the capabilities approach cuts directly to
the point. The goal of equality is not to give people the same starting point
but to allow them to function in a way that enables them to meaningfully
engage the world as each sees it. As Nussbaum puts it, the goal is to
ensure citizens live with dignity.
birth anyone who could potentially develop the capacities for rationality
and reasonableness still need certain conditions to be in place to direct and
ensure their growth. For example, historical conditions that deprived
women of education and locked them into servile roles in misogynistic
cultures inhibited their development of capacities. Wong argues liberal
societies “must provide citizens labeled with cognitive disabilities with the
Enabling Conditions until they become fully cooperating members of
society” (399). Failing to do so marginalizes a group that explicitly
deserves membership in the political community. In addition to ensuring
that borderline cases have the opportunity to become part of the
community, denying rightful members of the community access to the
political sphere directly disenfranchises them. To deny those labeled
cognitively disabled relevant enabling conditions and access to the
political arena errs on the side of injustice.
The opposite seems less true. The potential harm of including in so-
called low-functioning individuals who turn out to lack sufficient capacity
to engage politically, even with enabling conditions in place, attaches to
those in the political community rather than the person who falls short of
being able to become part of it. This potential harm may manifest itself in
various ways. The next section will address a potential worry about the
costs associated with providing enabling conditions, though it should be
noted these concerns with efficiency may not trump concerns about
equality and justice. Perhaps the chief concern is granting equal political
power to an individual who is incapable of wielding it. The lack of
capacity motivating this concern, however, partly mitigated the worry. If
someone who seems like a borderline case turns out not to be able achieve
some minimal level of capacity, he literally will not be able to politically
engage and thereby will not be able to act in a way that significantly
impacts the polis. Selecting between erring on the side of irrelevance
rather than erring on the side of injustice creates a justice-based reason for
inclusion.
Conclusion
From this discussion, there are a few important points to take away.
The fact of neurodiversity should impact our theorizing as much as it does
our practice. Though the issue has largely been set aside, we already have
large segments of theory to address issues of neurodiversity. Most
importantly, we should not let the perfect be the enemy of the good. We
have a pretty good, though still nascent, philosophical framework for
incorporating and addressing neurodiversity. It is a framework that
mitigates some of the concerns over limits and points to several areas, like
creating more neurologically open public spaces, that can be implemented
and lead to a more equal society.
References
Anderson, Elizabeth. What Is the Point of Equality? Ethics 109, no. 2
(January 1999): 287–337.
Baker, Dana. Neurodiversity, Neurological Disability, and the Public
Sector: Notes on the Autism Spectrum. Disability and Society 21, no. 1
(2006): 15–29.
Carlson, Licia, and Eva Feder Kittay. Rethinking Philosophical
Presumptions in Light of Cognitive Disability. Metaphilosophy 40, no.
3–4 (July 2009): 307–330.
Carmien, Stefan, Melissa Dawe, Gerhard Fischer, Andrew Gorman, Anja
Kintsch, and James Sullivan Jr. Socio-Technical Environments
Supporting People with Cognitive Disabilities Using Public
Transportation. ACM Transactions on Computer-Human Interaction
12, no. 2 (June 2005): 233–262.
Crow, Kevin. Four Types of Disabilities: Their Impact on Online
Learning. TechTrends 52, no. 1 (February 2008): 50–54.
Davidson, Joyce. Autistic Culture Online: Virtual Communication and
Cultural Expression on the Spectrum. Social and Cultural Geography
9, no. 7 (2008): 791–806.
De Martino, Benedetto, Neil Harrison, Steven Knafo, Geoff Bird, and
Raymond Dolan. Explaining Enhanced Logical Consistency During
Decision Making in Autism. The Journal of Neuroscience 28, no. 42
(October 15, 2008): 10746–10750.
Gagnon, Louise, Laurent Morrton, Louis Bherer, and Yves Joanette.
Quantification Judgement in High Functioning Autism: Superior or
Different? Journal of Autism and Developmental Disorders 34, no. 6
(2004): 679–689.
Equality, Capability, and Neurodiversity 51
POLICING NEURODIVERSITY
IN HIGHER EDUCATION:
A DISCOURSE ANALYSIS OF THE TALK
SURROUNDING ACCOMMODATIONS
FOR UNIVERSITY STUDENTS
Introduction
Currently, nine percent of students enrolled in US colleges and
universities have disabilities (Institute for Higher Education Policy, 2010).
Historically, university systems have relied upon federal laws to set the
tone and create the policies that facilitate the inclusion and/or exclusion of
students with disabilities. Specifically, the rights of university students
with disabilities are protected under the Americans with Disabilities Act
(ADA, 1990) and Section 504 of the Rehabilitation Act (1973). Yet, even
with legalized norms in place, the meanings ascribed and access granted to
students with disabilities is left, in many regards, to the individual
university to construct. While some universities make claims of pursuing
and welcoming a diverse student body, others express caution in moving
too far beyond their established norms.
Within this chapter, we present findings from a discourse analysis,
informed by poststructural thought (Derrida, 1981; Laclau & Mouffe,
1985) and discursive psychology (Edwards & Potter, 1993), examining
how the top 30 universities and colleges in the United States position the
meaning of disabilities and construct their role in facilitating access for
students with disabilities. Specifically, we analyzed the publically available
web pages of the universities’ offices of disability services, taking note of
Policing Neurodiversity in Higher Education 53
the ways in which they took up (or not) legal discourses when making a
case for why (or why not) accommodations should be provided to students
with disabilities. We attended to how the offices of disability services were
described, with some being positioned as existing because of the law, in
spite of the university’s interests. Others presented their existence as being
about something far more than a law, as they sought to become a space of
inclusion and diversity. We discuss here the function and potential
consequence of discourses that position students’ rights in opposition to
the integrity of institutional programs. In such instances, the university’s
obligation resides not with defending students’ rights, but in protecting the
integrity of institutional objectives. In a previous study (Dostal, Gabriel, &
Lester, in press), we reported on the ways in which the language employed
on many university websites positioned access for students with
disabilities as something that resides outside of the university; housed
instead within federal law. We discussed how orienting to equal access as
being beyond the scope of the university results in students with
disabilities being positioned as too far beyond the norm to be fairly
included. In this chapter, we build upon this earlier work, specifically
illustrating the ways in which neurodiversity is policed and restricted by
the language choices employed on the selected university webpages.
We first present a brief review of the literature surrounding access in
higher education for those who identify and/or are identified as students
with disability labels. Then, we discuss the theoretical commitments that
framed this project and sensitized our data analysis and interpretation.
Next, we conclude by presenting the findings, with discussion embedded
throughout.
Literature Review
The Association of Higher Education and Disability (AHEAD) has
developed and disseminated standards and indicators for disability service
providers on college campuses (Dukes, 2006; Shaw & Dukes, 2006), as
well as a tool for the evaluation of disability services (Dukes, 2011). Such
tools have informed the evaluation and design of a number of offices, as
well as research that examines the relationship between disability service
unit and the larger institution (Harbour, 2009), and the governing
philosophy of a given unit (Guzman & Balcazar, 2010).
The majority of studies in the area of disability services in higher
education focus on program design or service delivery and have relied
upon survey data or other forms of self-reported data (e.g., interview,
questionnaire, etc.). For example, drawing upon a disabilities studies
54 Chapter Three
Theoretical Perspectives
There were several theoretical perspectives that shaped the way we
made sense of the data. First, we assumed that the very notion of “normal”
and “abnormal” (Kincheloe & Steinberg, 1993) is constructed in and
through discourse. Bodies, minds, and identities materialize in and through
the symbols and images that are part of the everyday, mundane activities
of life. Canguilhem (1989) suggested that “normal” is always compared to
that which is constructed as “pathological,” with the two constructs being
mutually constituted. For instance, one cannot be a disabled college
student, unless there is an abled college student by which to compare her.
Canguilhem further stated that “every conception of pathology must be
Policing Neurodiversity in Higher Education 55
based on prior knowledge of the corresponding normal state” (p. 51), for
“this normal or physiological state is no longer simply a disposition which
can be revealed and explained as fact, but a manifestation of an attachment
to some value” (p. 57). Therefore, through a priori standards that are
situated within culturally and historically contingent values and practices,
that which counts as “abnormal,” “disabled,” or “pathological” is always
already constituted and reconstituted.
Positions that invite neurodiversity inevitably confront and conflict
with a deficit and binary-based (you are either “normal” or “abnormal”)
perspective. In contrast to a deficit perspective, a perspective that invites
neurodiversity describes persons through a lens of diversity across
identities (e.g., ethnicity, religion, gender, nationality, ability, sexual
orientation, etc.) (Robertson, 2010). Identity is presumed to be shifting,
dynamic, multiple, and socially embedded. Strengths and weaknesses are
presumed to exist, yet are located within the contexts in which they
emerge. In other words, a college student who identifies as disabled may
only experience “disabling effects” when the environment is structured in
such a way that it makes achievement and access impossible. If, on the
other hand, environmental re-structuring occurred, the student may access
and achieve what they sought to achieve. A socialized orientation to
disability has certainly resulted in a shift from focusing on the “individual”
as the sole “problem” to the ways in which the environment itself can be
shifted to eliminate or (at least) decrease the effects of disabling barriers.
Thus, rather than asking what “deficits” are within the individual that
result in them not being able to access higher education, we can ask: how
can the environment be changed in order to increase the students’ access to
the learning environment?
So, when considering the broader discussion surrounding neurodiversity
(Savarese & Savarese, 2010), it is important to recognize that discourses
about allowable educational accommodations often function to police and
limit the degree to which neurodiversity, at an individual and collective
level, can be “achieved” within university systems, as well as other
contexts. Foucault’s (1995) notion of the “power of the Norm” (p. 184) is
useful when considering how certain identities and ways of being become
privileged, normalized, and positioned within hierarchical systems. He
noted that:
The power of the Norm appears through the disciplines...Let us say rather
that, since the eighteenth century, it has joined other powers—the Law, the
Word (Parole) and the Text, Tradition—imposing new delimitations upon
them...normalization becomes one of the great instruments of power at the
end of the classical age. For the marks that once indicated status, privilege
56 Chapter Three
Method
We took a discourse analysis approach (Wood & Kroger, 2000), which
was shaped by the theoretical perspectives discussed above. In taking this
approach, we assumed that discourse is action-oriented; which led us to
focus on what text does within a given context (Potter, 2004). What
identities are produced and made relevant, for instance? We also oriented
to discourse as constructed, resulting in a focus on what various rhetorical
devices do to reify certain versions of reality. Finally, we oriented to
discourse as situated, always being bound up and embedded within given
interactions and institutional practices and norms. Thus, as we pursued the
analysis process, we attended carefully to the language choices and how
such choices constructed certain realities, making some actions and
identities (im)possible. This method informed the type of data we collected
and our analytical approach.
Findings
Perspectives that embrace neurodiversity have primarily been outlined
by federal laws in order to protect the rights of students with disabilities.
Offices of Disability Services (ODSs) on college and university campuses
exist, at least in part, to ensure compliance with federal laws related to
equal access and opportunity for individuals with disabilities in education.
Indeed 80% (26/30) of the sites we analyzed made at least one explicit
reference to The Individuals with Disabilities Education Act (IDEA)
(2004), most often within their mission or “about us” statements. Still,
some ODSs described their work as going beyond protecting the university
by simply ensuring compliance with the law and reached towards a more
comprehensive approach to the creating access for students with
disabilities. We noted that universities within our sample fell along a
spectrum from opposing to actualizing the larger mission of the university
(Dostal, Gabriel & Lester, in press). For instance, for some universities,
being responsive and inclusive of students with disabilities stood in
opposition to what they often phrased their “academic integrity.” In
contrast, other universities defined their very identity as embedded within
an approach that invited all students, shifting, when needed, their
environment in order to facilitate access. This spectrum illustrated the
contrasts in approaches and highlighted the many points of tensions for
universities in relation to their institutional (legal) and ethical
responsibilities. We show here how universities were positioned as
policing what counts as a disability, as well as what should be allowed as
an accommodation for students with disabilities. Unlike other offices
designed to provide services or advocacy for students, some ODSs
actually described themselves as working on behalf of the university,
58 Chapter Three
Presenting a Purpose
We highlight here the ways in which the purpose statements on the
ODS website served to frame the inclusion/exclusion of students with
disabilities in particular ways. We present contrasting excerpts.
Excerpt 1 serves as an example of a university that locates inclusion as
central to its overarching mission, not as an aside.
Excerpt 1.
Welcome to the Office of Accessible Education! Stanford University has a
strong commitment to maintaining a diverse and stimulating academic
community, representing a broad spectrum of talents and experiences.
Students with disabilities, actively participating in the various aspects of
life at Stanford, are an essential part of that diversity.
Excerpt 2.
MIT Student Disabilities Services, as required under the Americans with
Disabilities Act (ADA) of 1990 and Section 504 of the Rehabilitation Act
of 1973, makes every reasonable effort to provide appropriate
accommodations and assistance to students with disabilities. The objective
is to ensure that our students receive equal access to all Institute programs
and services. To that end, we seek to balance the student's right to access
with our obligation to protect the integrity of Institute programs and
services.
Excerpt 3.
The mission of the Disability Services Office is to assist students with
disabilities at Boston College in achieving their educational, career, and
personal goals through the full range of institutional and community
resources. The office ensures that students with disabilities receive support
services and accommodations that permit equal access to all Boston
College programs and the opportunity to realize their potential and develop
effective self-advocacy skills.
Excerpt 3 uses the word “full” when describing how Boston College
will go about assisting students achieve their goals (“through the full range
of institutional and community resources”). Accommodations, here, are
positioned as that which results in “equal access”, standing in contrast to
the notion that only “reasonable” accommodations remain as the goal (as
was noted in Excerpt 2). If the goal is to assist students, rather than solely
and primarily protect the “integrity” of the university, there is no dilemma
when deciding what accommodations to allow. On the other hand, for
some institutions, as was noted in Excerpt 2, the ODS is positioned as
being required to mediate tensions between what students with disabilities
request and what the university is prepared and willing to give. Excerpt 2
represents a case in which the amount and kind of accommodation is
constructed as an ethical dilemma because of the ways in which
participation at the university level has been conceptualized. In contrast,
within Excerpt 3, a dilemma is not made relevant as “full...resources” and
“equal access” subsumed within the overall mission.
62 Chapter Three
Excerpt 4.
I don’t know if I have a “disability” per se, but I am having academic
difficulties that don’t make sense to me, and I might want to explore the
possibility. Can SAS help?
We may! Very bright individuals - such as those accepted for selective
schools like Dartmouth College - can have a so-called “cognitive
disability” that goes undetected through high school. “Cognitive disabilities”
refers to various neurologic-based impairments that significantly affect
learning and perhaps other major life activities. Some cognitive disabilities
result from head injuries. Some are lifelong circumstances experienced
from childhood.
Excerpt 5
To ensure the intellectual richness of research and education, the
University of Chicago seeks to provide an environment conducive to
learning, teaching, working, and conducting research that values the
diversity of its community. The University strives to be supportive of the
academic, personal and work related needs of each individual and is
committed to facilitating the full participation of students with a disability
Policing Neurodiversity in Higher Education 63
Excerpt 6
Service eligibility is based in large part on the quality and comprehensiveness
of a student’s disability documentation and degree of current functional
need. A record of prior accommodation, in and of itself, is usually
insufficient to support academic accommodations in higher education. A
physician’s, psychologist’s or other practitioner’s determination/
recommendation/assertion about appropriate accommodations is valued, but
there are many factors to consider and the ultimate judgment rests with a
college or university.
Concluding Thoughts
There are potential, perhaps unintended, consequences when particular
discourses position students’ rights in certain ways: some in opposition to
the integrity of institutional programs and others in alignment with the
aims of the institution. First, rights and identities, when constructed, create
certain degrees of possibility. The ways in which an ODS positions itself
in relation to the interests of students, and the ways in which this position
constructs the degree of alignment between students’ rights and university
integrity, can have an impact on the meaning of disability in that setting.
Moreover, through our discourse analysis, we have noted that universities
are often positioned as the authority on both the presence of a disability
and the institutional response to disability. Thus, we argue here that
language choices employed often serve to police what counts as “normal”
or “abnormal”, delineating what qualifies as being an “abled” or
“disabled” way of being and way of learning. Such policing is also
accomplished in texts that construct certain versions of what it means to
make accommodations – with some universities orienting to
accommodations with and for students and some agreeing to only do what
they deem “reasonable” and “appropriate”.
The very idea of neurodiversity within higher education has a direct
ethical implication. Do institutions of higher education, for instance,
intend to include those who have impairments that might result in the
restructuring of the educational environment? For many institutions, this
frequently results in an ethical dilemma that appears to be “talked away”
by citing the ADA and all that it does not require them to do. How, then,
are students who are positioned as “atypical” to be included?
Policing Neurodiversity in Higher Education 65
References
Americans with Disabilities Act of 1990, Pub. L. No. 101-336, § 2, 104
Stat. 328 (1991).
Canguilhem, G. (1989). The normal and the pathological. Brooklyn, NY:
Zone Books.
Collins, M., & Mowbray, C. (2008). Students with psychiatric disabilities
on campus: Examining predictors of enrollment with disability support
services. Journal of Postsecondary Education and Disability, 21(2),
91.
Derrida, J. (1981). Positions. Chicago: University of Chicago Press.
Dostal, H., Gabriel, R., & Lester, J. N. (In press). Disabilities at work in
school: A critical analysis of disability services and support for faculty
at U.S. colleges and universities. K. R. Johnson & K. Couture (Eds.),
Disability discrimination at work. Piraeus Books, LLC.
Dukes, L. (2006). The process: Development of the revised AHEAD
program standards and performance indicators. Journal of
Postsecondary Education and Disability , 19(1), 5.
—. (2011). The iEvaluate OSD guidelines and exemplars: A disability
services evaluation tool. Journal of Postsecondary Education and
Disability, 24(2), 71.
Edwards, D. (2000). Extreme case formulations: Softeners, investment,
and doing nonliteral. Research on Language and Social
Interaction, 33(4), 347-373.
Edwards, D., & Potter, J. (1993). Language and causation: A discursive
action model of description and attribution. Psychological review,
100(1), 23-41.
Foucault, M. (1995). Discipline and punish: The birth of the prison. New
York, NY: Vintage.
Guzman, A., & Balcazar, F. (2010). Disability services' standards and the
worldview guiding their implementation. Journal of postsecondary
education and disability , 23(1), 48.
Harbour, W. (2009). The relationship between institutional unit and
administrative features of disability services offices in higher
education. Journal of Postsecondary Education and Disability , 21(3),
138.
Kincheloe, J., L. & Steinberg, S. R. (1993). A tentative description of post-
formal thinking: The critical confrontation with cognitive theory.
Harvard Educational Review, 63(3), 296- 320.
66 Chapter Three
MINDBLINDNESS:
A TROUBLING METAPHOR?
JANETTE DINISHAK
Introduction
Currently autism is understood as a pervasive, lifelong,
neurodevelopmental condition that can manifest in diverse ways. It is
diagnosed via a triad of behavioral criteria: difficulties with social
interaction (e.g., little or no eye contact), linguistic challenges (e.g.,
misunderstanding pragmatic uses of language), and repetitive or
stereotyped activities (e.g., spinning objects). There are few uncontested
facts about autism. Although we have some clues about possible
environmental triggers and the biological underpinnings of autism, its
causes are unknown. An intensely debated issue is whether we should
develop ways to eliminate autism, if and when its causes are discovered.
Ongoing debates about autism create “looping effects”— where those
classified interact with their classification, remaking both the classification
and what it is to be a person so classified (Hacking, 2007). One important
mechanism for looping effects is metaphor.
Metaphor is describing and conceptualizing one thing in terms of
another. Generally speaking, many metaphors have the form “A is (like)
B.” To cite a familiar example from Shakespeare, “Juliet is the sun.” A
“[m]etaphor selects, emphasizes, suppresses, and organizes features of the
principle subject [A] by implying statements about it that normally apply
to the subsidiary subject [B]” (Black, 1962, p. 44). Metaphors are
powerful rhetorical devices that can carry affective content that literal
descriptions of the same subject do not. Our choice of metaphors reflects
and reinforces values, and creates and promotes stereotypes, expectations,
and ways of feeling (Sherwin, 2001).
68 Chapter Four
In short, metaphors are not just empty tags; they have practical and
ethical significance because they may influence how we think and feel
about the subjects they describe.
Many metaphors, especially in science, prompt a conceptual movement
from the known to the unknown. They invite us to understand the
unknown through the known by making a comparison between the two.
Autism is often depicted as a deeply mysterious condition that resists
understanding. For instance, a widely used and controversial autism
awareness symbol is a puzzle piece. Given all that we do not know about
autism, it is unsurprising that metaphors figure prominently in scientific,
medical, and media representations of it. For instance, autists1 are
portrayed as robotic or alien, as people whose real selves are missing,
hidden, or kidnapped by autism.2 Another metaphor for autism is
“mindblindness.” “Mindblindness” has been used pervasively since Baron-
Cohen (1990) introduced it to characterize autism. The metaphor appears
frequently in the scientific literature on autism (e.g., Baron-Cohen, 2002,
2008, 2009; Carruthers, 1996; Harris, 1999, 2009; Lombardo & Baron-
Cohen, 2011; Myers, Baron-Cohen, & Wheelwright, 2004; Senju,
Southgate, White, & Frith, 2009), practical guides for caregivers and
teachers (O’Toole, 2012; Stanford, 2011; Williams, Wright, & Young,
2004), news pieces (e.g., Gopnik, 2005; Harmon, 2011; Linklater, 2006;
Martin, 2010; Moore, 2001; Ojalvo, 2010; Stevens, 2008;), and even in the
title of a fictional work with an autistic character (Roy, 2010) and a work
in popular psychology that discusses “temporary autism” (Gladwell, 2005).
In this paper I identify three problems with using mindblindness as a
metaphor for autism. First, the comparison between autism and blindness
is misleading in some respects. Second, common uses of “mindblindness”
do not make clear how the difficulties that people with autism have
understanding mental phenomena relate to the difficulties that non-autistic
individuals have understanding mental phenomena. Third, common uses
of “mindblindness” do not do justice to the conceptual distinction between
differences and deficits, a distinction that is important to autism debates
and advocacy movements. Given these limitations, if we continue to use
the metaphor, we should do so in ways that better reflect the complexities
of autists’ social and communication differences and how these
differences overlap with and differ from the social and communication
challenges that non-autistic individuals face in their interactions both with
Mindblindness: A Troubling Metaphor? 69
between these children and the access people without autism naturally
have to other people’s minds” (1990, p. 88). In this quote Baron-Cohen
provides two rationales for his choice of metaphor. First, the metaphor
stresses that, on this theory, the cognitive deficit that explains autistic
persons’ social-communicative difficulties is specific. Impairments in
“general intelligence” (e.g., mental retardation) are not a sufficient
explanation for social-communicative difficulties associated with autism
(Baron-Cohen, Leslie, & Frith, 1985). Second, the metaphor makes vivid
the gulf between autistic and non-autistic persons. Autists are “blind to the
existence of mental states” (Baron-Cohen, 1990, p. 83), while non-autistic
individuals “naturally have [access] to other people’s minds” (Baron-
Cohen, 1990, p. 88). After 1990, Baron-Cohen began using “mindblindness
theory” to designate his theory of autism.
One shortcoming of the mindblindness theory, acknowledged by
Baron-Cohen himself (2008), is that it does not explain the “nonsocial”
features of autism (e.g., attention to detail, the need for sameness)
(Boucher, 2012). Another is that it does not take into account the aspect of
empathy that involves responding appropriately to the feelings and
thoughts of others (Baron-Cohen, 2008). To address these limitations
Baron-Cohen (2002) developed the empathizing-systemizing theory.
Before I discuss problems with dominant uses of the mindblindness
metaphor, I should note the features of Baron-Cohen’s revised theory that
are relevant to my analysis of those uses in the sections below. On the
revised view, autism is best explained with reference to two psychological
factors, empathizing and systemizing. Delays and deficits in empathizing
explain the social features of autism (i.e., social and communication
difficulties), while “intact or even superior skill in systemising” (Baron-
Cohen, 2008, p. 113) explains the nonsocial features of autism (Baron-
Cohen, 2009). Systemizing is defined as “the drive to analyze objects and
events to understand their structure and to predict their future behavior”
(Baron-Cohen & Belmonte, 2005, p. 110). For example, a person with
Asperger Syndrome might excel at understanding the fine details of an
intricate machine’s parts and mechanisms or be able to detect patterns in
data such as train timetables more rapidly and easily than others.
Empathizing, the second factor in the theory, has two major components:
the cognitive component, which involves attributing mental states to others
and predicting their actions based on those attributions (Baron-Cohen,
2009), and the affective component, which involves having a correct
affective response to the thoughts and feelings of others (Baron-Cohen,
2009). Mindblindness is subsumed under the cognitive component of the
empathizing factor. Despite these revisions to his initial theory, Baron-
Mindblindness: A Troubling Metaphor? 71
respect and support autistic individuals that see their autism as an essential
part of their identity. Not all differences are deficits. Some differences are
not harmful to oneself or to others. And some differences are advantageous
to oneself and to others. Can the mindblindness metaphor accommodate
manifestations of autistic social and communicative differences that are
not deficits? Insofar as “mindblindness” is widely used to designate a
deficit, it leaves no conceptual room for understanding some social and
communication behaviors of people with autism as differences that are not
deficits.
Baron-Cohen aptly observed that supporting an “autism is a difference”
point of view and alleviating disabilities are not mutually exclusive:
Nobody would dispute the place for interventions that alleviate areas of
difficulty, while leaving the areas of strength untouched. But to talk about
a 'cure for autism' is a sledge-hammer approach and the fear would be that
in the process of alleviating the areas of difficulty, the qualities that are
special - such as the remarkable attention to detail, and the ability to
concentrate for long periods on a small topic in depth - would be lost.
Autism is both a disability and a difference. We need to find ways of
alleviating the disability while respecting and valuing the difference (qtd.
in Saner, 2007).
about cattle that others did not attend to, and this helped her to design
more humane slaughterhouses. She believes that her autism results in
heightened sensory perceptions that allow her to imagine how an animal
will feel moving through a system. Below she describes some of her
observations of cattle behavior and how they informed her slaughterhouse
designs:
The principle behind my designs is to use the animals’ natural behavior
patterns to encourage them to move willingly through the system. If an
animal balks and refuses to walk through an alley, one needs to find out
why it is scared and refuses to move… It is the little things that make them
balk and refuse to move, such as seeing a small piece of chain hanging
down from an alley fence…Cattle will also balk and refuse to walk through
an alley if they can see people up ahead…This is one of the reasons that I
designed curved single-file alleys with solid sides. They help keep cattle
calmer…the cattle are unable to see people up ahead, and each animal
thinks he is going back where he came from (pp. 142-149).
Conclusion
The psychiatric diagnostic category “autism” has undergone a variety
of changes, and scientific and media representations of autism have shifted
over time. Yet the mindblindness metaphor persists, especially in scientific
discourse on autism, where it is used pervasively. I have argued that
common uses of the mindblindness metaphor are troubling in several
respects and have invited the reader to consider some of the potential
pitfalls of such uses. In the light of these concerns, we should consider
revising our use of the mindblindness metaphor to better reflect the
complexities of autists’ social and communicative differences. This brief
examination of a particular metaphor (mindblindness) for a particular
condition (autism) can also serve a more general purpose. Namely, it
confirms and reminds us of familiar truisms that tend to escape our notice
or are neglected, especially when theorizing: metaphors can be useful tools
that facilitate understanding and render abstract scientific concepts more
accessible to non-specialists. But we should take care to remember that
metaphors can also constrain and distort, especially when we fixate on a
single metaphor. Above all, we must not reify them: “[m]etaphors, once
forgotten or ignored, are easily mistaken for objective facts. If that
happens in science, analogies congeal into dogmas, losing the elasticity
that made them useful in the first place” (Geary, 2011, p. 178).9
80 Chapter Four
References
Akhtar, N., & Gernsbacher, M. A. (2008). On privileging the role of gaze
in infant social cognition. Child Development Perspectives, 2, 59-65.
http://dx.doi.org/10.1111/j.1750-8606.2008.00044.x
Akhtar, N., & Jaswal, V.K. (in press). Deficit or difference? Interpreting
diverse developmental paths: An introduction to the special section.
Developmental Psychology.
Baron-Cohen, S. (1990). Autism: A specific cognitive disorder of ‘mind-
blindness’. International Review of Psychiatry, 2, 81-90.
http://dx.doi.org/10.3109/09540269009028274
—. (1995). Mindblindness: an essay on autism and theory of mind.
Cambridge, MA: MIT Press.
—. (2002). The extreme male brain theory of autism. Trends in Cognitive
Sciences, 6 (6), 248-254.
http://dx.doi.org/10.1016/S1364-6613(02)01904-6
—. (2008). Theories of the autistic mind. The Psychologist, 21 (2), 112-
116.
—. (2009). Autism: The empathizing-systemizing (ES) theory. Annals of
the New York Academy of Sciences, 1156, 68-80. doi: 10.1111/j.1749-
6632.2009.04467.x
Baron-Cohen, S., & Belmonte, M.K. (2005). Autism: A window onto the
development of the social and analytic brain. Annual Review of
Neuroscience, 28, 109-126. doi:
10.1146/annurev.neuro.27.070203.144137
Baron-Cohen, S., Leslie, A., & Frith, U. (1985). Does the autistic child
have a “theory of mind”? Cognition, 21, 37-46.
http://dx.doi.org/10.1016/0010-0277(85)90022-8
Becker, L. (2011, November 28). Theory of mind? Just whose mind are
we referring to here? [Web log comment]. Retrieved from
http://www.autismandempathy.com/?p=818
Black, M. (1962). Models and Metaphors. Ithaca, NY: Cornell University
Press.
Blume, H. (September 30, 1998). Neurodiversity. The Atlantic. Retrieved
from http://www.theatlantic.com
Boucher, J. (2012). Putting theory of mind in its place: Psychological
explanations of the socio-emotional-communicative impairments in
autistic spectrum disorder. Autism, 16 (3), 226-246.
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Mindblindness: A Troubling Metaphor? 81
Wells, H.G. (2006). The country of the blind. In M. Gardner (Ed.), The
country of the blind and other science-fiction stories (pp. 4-30).
Mineola, NY: Dover Publications. (Original work published 1904).
Williams, C., Wright, B., & Young, O. (2004). How to live with autism
and Asperger Syndrome: Practical strategies for parents and
professionals. London, UK and Philadelphia, USA: Jessica Kingsley
Publishers.
Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation
and constraining function of wrong beliefs in young children’s
understanding of deception. Cognition, 13, 103-128.
http://dx.doi.org/10.1016/0010-0277(83)90004-5
Wittgenstein, L. (1953). Philosophical investigations. Oxford, UK:
Blackwell.
—. (1980). Remarks on the philosophy of psychology I. Oxford, UK:
Blackwell.
CHAPTER FIVE
ANTIDEPRESSANTS, GENDER,
AND THE CONSTRUCTION
OF THE MORAL SELF
should prompt us to revisit the problem from a new perspective, one that
takes more seriously women’s moral experiences and opens the door to a
fuller understanding of the feminist implications of antidepressant use.
construction of the self, and antidepressant use are even more complex,
and perhaps a little mysterious. Two of Kramer’s cases illustrate this point.
Lucy was an over-sensitive, young college student who suffered
childhood trauma (Kramer 1993, pp. 103-107). Her difficulties were
predominantly in handling relationships. She was incredibly sensitive in
her interpretations of other people’s actions: she perceived even the
smallest of slights, intended or not. This sensitivity nearly undermined her
ability to have functional relationships. Very short-term use of Prozac
made a big difference for Lucy: just a brief period on the drug altered her
perceptions of herself (Kramer 1993, pp. 102-103). The drug made her less
vulnerable, even if briefly, so that she could then begin to see the ways in
which her behavior appeared to other people. Even after she was off the
drug, she was able to alter her understanding of her own behavior, which
in turn enabled her to alter her behavior itself. This indicates that in Lucy’s
case the use of Prozac prompted self-reflection, rather than being the result
of it.
Kramer’s case of Allison provides an even more compelling case for
alternative interpretations of the relationship between Prozac and self-
reflection. Allison suffered from such dramatic low self-esteem that she
could hardly see herself except for her faults (Kramer 1993, pp. 204-208).
It was as if she felt foreign to herself: she was detached from her own
successes, could barely connect the image in the mirror with herself, and
experienced consistent impending tearfulness. Treatment with Prozac,
after many years of therapy, enabled her to be sure of her husband’s love,
to feel confident in her work, and to feel like a more loving person. As
Kramer puts it, “when the change occurred, it seemed a matter of changed
self-valuation leading to changed self-understanding, rather than the
reverse: the medication allowed her to locate herself” (1993, p. 208).
Surely both Lucy and Allison experience the changes as significant
improvements in their lives. It is hard to imagine these changes as
anything less than life-altering. Being able to perceive oneself differently,
or moreover to “find” a self that had been nearly invisible can only be a
profound experience. But this possibility should prompt us to rethink a bit
the significance of what these drugs can do and their potential to alter our
selves and our moral experience. As Lucy’s and Allison’s experiences
indicate, reflection and self-construction are symbiotic processes, not with
one preceding the other, but with reflection and self-construction working
together in a give and take.
This understanding of the way that antidepressants might affect
reflection and our understanding of the self is consistent with the kind of
approach advocated in a narrative conception of the self. On a narrative
90 Chapter Five
Maartje Schermer points out, the mountain climber who takes a helicopter
to the top has certainly arrived at the top of the mountain, but any sense of
himself as a mountain climber is merely delusional (2008, p. 360). The
Physicians Committee on Bioethics suggests that this same kind of
distinction is relevant in thinking about antidepressants. They suggest that
antidepressants encourage us to treat states of mind as goals and targets
separate from the process of arriving at them (2003, pp. 238-239).
In the case of the construction of the self (and likely also in many other
activities), however, the distinction between a process good and an
outcome good is not so clear-cut. On a narrative conception of the self, the
self is often described in terms that would imply it is a fixed state. This
would make it seem like an outcome good, for example, I might want to
come to have certain traits, and the achievement of them might be viewed
as an outcome good. At the same time, we typically also value a particular
process in coming to a sense of self. Unless we value the self as fixed and
unchanging, it will undergo a continual process of change and alteration. It
undergoes constant revision as new experiences and new insights become
parts of the narrative. These alterations may not always be significant or
meaningful, but on a narrative conception of the self, the self is always
something of a work in progress. Thus, on a narrative conception of the
self, the self may be properly conceived of as both an outcome good and a
process good. We care both about who we are and how we acquired that
identity, and in a narrative conception of the self, who and how are
intimately intertwined.
It is easy, then, to think that antidepressants are problematic insofar as
they unduly influence the narrative; they derail the narrative in progress,
so to speak. However, radical life experiences could also influence the
narrative in profound and significant ways. Many people talk of
transformative life experiences that cause them to see themselves in
different ways, or suddenly allow them a kind of personal insight. In that
sense, antidepressants might be powerfully significant, but not necessarily
more significant than other kinds of experiences. Though it may
consistently contain common elements or themes, our understanding of the
self is also constantly undergoing revision as the narrative unfolds, or is
created or told.
Additionally, part of the concern with antidepressants seems to be that
the source of the new narrative thread is outside ourselves, or is not of our
own creation. But, many of the aspects of ourselves that help to form a
narrative identity arise externally. On the narrative account, I formulate
and make sense of my experiences, but many of those experiences are not
in my control. In fact, much of my narrative may have been influenced by
Antidepressants, Gender, and the Construction of the Moral Self 93
roles. However, numerous sources indicate that the pressure for women to
take on caring responsibilities has not shifted in any significant way. Arlie
Hochshild’s famous book, The Second Shift, laid out the dilemma that
many women experience (1989). Though now quite a few years old, more
contemporary literature suggests that the balance has not shifted that
much. Anne-Marie Slaughter might have stated the case as compelling as
one could expect in her recent cover story for the Atlantic titled “Why
Women Still Can’t Have It All” (2012). Karine Moe and Dianna Shandy’s
new book, Glass Ceilings and 100-Hour Couples, lays out the challenges
of balancing family and a career for contemporary women (2009). Nancy
Folbre argues in The Invisible Heart that we must, as a society, begin to
consider the economic costs of caring (2002). No one of these books or
articles will easily confirm that women tend to experience their moral
selves differently than men do. However, if our selves are developed
partly in response to our role, this diverse literature does indicate that
women’s role is still not the same as men’s and that they still experience
the pressures of caring as an important part of their role. If this is the case,
and women are experiencing these demands as a significant challenge as
much of the literature indicates, then the fact that they would seek
assistance through the use of a drug that can make personal relationships
less stressful and less demanding should not come as any real surprise.
Antidepressants can make patients less sensitive to rejection, more
confident in relationships, more able to navigate complex psychological
situations, more outgoing, and less obsessive. One of Kramer’s patients
finds herself less over-sensitive to the needs of others and less sensitive to
conflict; she was able to abandon a humiliating relationship and gained
social confidence (Kramer 1993, p. 10). The kinds of traits that
antidepressants make possible are just the kinds of traits that are valued in
a mature manifestation of a caring approach to the moral self.
Notably for Lucy and Allison, Kramer’s patients, part of the appeal of
an antidepressant was the ability to feel more at ease in personal
relationships: Lucy wishes to stop fearing constant rejection, and Allison
finds that Prozac enables her to be more sure of her husband’s love and to
be a more loving person. If we think that effectively navigating relationships
is central to the moral life and that the self is significantly constructed and
finds value through relationships, then it appears that Prozac has radically
altered their ability to lead develop moral selves. And if no other means
would get Lucy and Allison to this point, then the fact that Prozac has
enabled a kind of fuller moral engagement with the world and a more
satisfying sense of self is a significant accomplishment.
98 Chapter Five
Nothing I have said here can draw a straight line between the
expectations of a caring approach to the self and women’s use of
antidepressants. Surely the relationship is not altogether direct. However, I
take the differing moral and psychological expectations for men and
women to be a fruitful line of inquiry, one that deserves further attention.
Perhaps women are more inclined to antidepressant use because it enables
them to live up to moral expectations that are more frequently held of
women than of men. Nothing in this suggestion should undermine the
value of a caring approach to the moral life and the moral self. But, we
must note that expectations for the moral self can also be experienced as
burdens if they seem out of reach.
References
Barber, Charles. (2008a). The medicated Americans. Scientific American
Mind. February/March 2008, 45-51.
—. (2008b). Comfortably Numb: How Psychiatry is Medicating a Nation.
New York: Pantheon Books.
Begley, Sharon. Happiness: enough already. Newsweek, February 11,
2008.
DeGrazia, David. (2000). Prozac, enhancement, and self-creation.
Hastings Center Report, 30, 2, 34-40.
Folbre, Nancy. (2002). The Invisible Heart: Economics and Family
Values. The New Press.
Gilligan, Carol. (1983). In a Different Voice: Psychological Theory and
Women’s Development. Cambridge: Harvard University Press.
—. (1987). Moral orientation and moral development. In Eva Kittay and
Diana Meyers (Eds.) Women and Moral Theory. Rowman &
Littlefield.
Goodman, Rob. (2010). Cognitive enhancement, cheating, and
accomplishment. Kennedy Institute of Ethics Journal, 20, 2, 145-160.
Hochschild, Arlie. (1989). The Second Shift. Viking Penguin.
Kass, Leon. (2003). Beyond Therapy: Biotechnology and the Pursuit of
Happiness. Harper Perennial.
Kramer, Peter. (1993). Listening to Prozac. New York: Penguin Books.
MacIntyre, Alasdair. (1981). After Virtue. Notre Dame: University of
Notre Dame Press.
Moe, Karine and Dianna Shandy. (2009). Glass Ceilings and 100-Hour
Couples: What the Opt-Out Phenomenon Can Teach Us About Work
and Family. University of Georgia Press.
Antidepressants, Gender, and the Construction of the Moral Self 99
DO NO HARM:
NEURODIVERSITY, HEALTH CARE ADVOCACY,
AND THE LANGUAGE AND CULTURE
OF INFORMED CONSENT
Perchance he for whom this bell tolls may be so ill as that he knows not it
tolls for him. And perchance I may think myself so much better than I am,
as that they who are about me, and see my state, may have caused it to toll
for me, and I know not that.
—John Donne
Meditation 17, Devotions Upon Emergent Occasions
vulnerability. People do not seek medical care because health exists, but
because illness and injury (often covertly) do. Moreover, caregiver-patient
communications continue, despite impressive institutional efforts to
minimize examination times, because they are crucial to recognizing the
strengths and vulnerabilities likely to affect patient health at the time of the
exam.
These communications are documented. An abbreviated summary,
along with laboratory and imaging findings, potential treatments, and/or
interventional strategies, are entered into each patient’s chart via a
nomenclature rarely unencumbered by health care lore. When read by
other health care professionals, these entries have the potential to evoke
ritualized responses and interchanges (Goffman 1981). Thus in the patient
chart, whether documented in digital or paper format, communities and
standard of care, legal liability, and patient statements summarily converge
in a formalized vocabulary that can enhance or degrade care. Where
physician interview empathy is concisely represented in this record,
respect for the patient – and concomitantly, standard of care –may be
enhanced among other caregivers; where empathy is lacking, respect and
care may well be degraded. The interprofessional exchange occurring
through patient charts is moreover not limited to language, but extends to
perusal of images, quantitative findings compared to a ‘normative’ range,
digitized diagnostic codes, and so forth.
The impact on care posed by this ritualized interprofessional
communication is itself a critical factor within the daily practice of
medicine, as all who present for care do so subject to a power imbalance
delineated by a language that routinely, perhaps of necessity, connotes
frameworks of vulnerability – in medicine, human states are “medicalized.”
Thus challenges brought to the fore by advocates of neurodiversity
represent an important opportunity to examine how these frameworks have
been constructed, their particular impact upon patients who do or may
identify as neurodiverse, and conceptualizations that might better support
the difficult striking of a balance between needed protections for the
vulnerable and the safeguarding of autonomy, crucial to all collaborations.
The construction of an operative framework focusing on vulnerability
emerged in the medical literature across the 20th century through reports
examining the experiences of two World Wars (Jonsen 2000, Rothman,
2003), physician complicity in Third Reich concentration camp practices
(Lifton 2000, Weindling 2005), and egregious ethical breaches in medical
research far removed from the theaters of war (Jones 1981, Revergy 2000).
The commonly employed “benevolent deception” and “nondisclosure,”
prevalent early in that century, gave way to the practice now known as
102 Chapter Six
voluntary informed consent for both research and the selection by a patient
of available therapeutic options in accordance with personal views and
physician explanations. Improvements in standard of care developed
alongside formal frameworks supporting increased transparency in the
provision of health care information, although the burden of documenting
compliance was not trivial. Most importantly, physicians were explicitly
charged with explaining to patients the risks and benefits of competing
treatment options (including the election to forego all therapy) and, where
necessary, to further inform family or other surrogate decision-makers.
With efforts to improve the sharing of medical information, however,
came an increasing identification of gaps in expectations and care.
Discussions on these topics, many of which transpired concurrently with
reductions in times allotted for patient visits by health care institutions,
helped increase cognizance of systemic gaps in access-to-care imposed by
such factors as race and ethnicity, socioeconomic status, employment
status, language group, educational status and literacy level, cultural
assumptions, and belief systems. Debates and investigations of these
factors led to further studies assessing the negative impact they could exert
on health outcomes, as well as strategies for mitigating their impact within
clinical care (Fox 2005, Parker 2012, Delphine-Rittmon 2012) .
Not least in the rise of neurodiversity as a topic within health care
advocacy, improvements in imaging techniques resulted by the end of the
20th century in functional images of brain activity (Belliveau 1991, Kwong
2012). These images introduced a new, albeit still emerging, visual
vocabulary with a concomitant rhetoric. Functional brain images obtained
from animal models, human subjects research, patients and control
participants provided path-breaking information on anatomical structures,
physiological processes, and neurological function (Kilgore 2004, Hamann
2004, Gow 2012). The impact of these images and the wide-ranging
debates they continue to generate, however, are well illustrated by 21st
century exchanges between “locationists,” “constructionists,” and those
who have suggested a “networked” structure for the experience of human
emotion. Author interpretations from a single meta-analysis on that topic
generated 29 published responses from researchers around the world
(Lindquist 2012).
In response to findings in neuroscience and other advances, the
psychiatric and psychological communities proposed and have debated
sweeping changes in diagnostic criteria and categories for the forthcoming
DSM V, the manual delineating factors important to pathological
diagnoses. (American Psychiatric Association 2012). While the urgency
of these debates probe the utility and drawbacks to “pathologizing” human
Do No Harm 103
states and behaviors, they appear to share one assumption: “Unless one’s
brain has the capacity to represent something – percepts, images, thoughts,
emotions, abstract concepts, sense of the position of one’s body in space –
one cannot be aware of it” (Grigsby, 2000). Thus, in clinical care, a
dilemma is posed wherever a discrepancy exists between one’s capacity to
experience and one’s capacity to represent that experience. In the contexts
of informed consent and neurodiversity, this discrepancy can be pivotal to
seeking a surrogate decision-maker.
Clinicians must determine in quick succession whether or not a given
patient has the capacity to provide consent at a specific time for a specific
procedure or intervention. Given the constraints imposed by clinical
exigency, claims raised by advocates of neurodiversity for reconstituting
the understanding of health and illness may appear remote, however
important. To invite clinicians to enter meaningfully into discussions of
neurodiversity, the unstable nature of health and the sheer fact of human
vulnerability must be acknowledged. Deeply troubling experiences at the
limits of health are what clinicians are charged with ameliorating
throughout their professional lives. Better clinical care will not emerge if
their experiences are discounted. Likewise, the medical model will not
proceed apace with scientific advances if the experience of human
neurodiversity, as represented within the neurodiverse community and by
its advocates, is trivialized or ignored.
Despite advances in studies of brain function and newly emerging
visual vocabularies for health and illness, an appropriate clinical lexicon
for acknowledging neurodiversity without tacitly or explicitly representing
neurological difference as a “morbidity” remains lacking. The bell-shaped
curve’s tracing of an attribute’s distribution within a population has long
served as a “norming” description of health. Moreover, the technological
feats that prompted a reassessment of neurological “norming” through
their profound contributions to studies in development, function, and
cognition have yet to produce any reliable metric capable of framing a
better health care lexicon. Thus for physicians and other clinicians to
apply their knowledge on behalf of patients with greater confidence, a
thorough reevaluation of the terms and processes for informed consent in
the context of neurodiversity is needed. Such reevaluation will require
active collaborations between patients, physicians, advocates, bioethicists,
and others with an interest in, but expertise external to the arena of,
clinical practice.
We urgently need to explore together the impact of neurodiversity in
healthcare communications and decision-making with respect to the risks
and benefits of an approach to securing health or treating illness. A pre-
104 Chapter Six
clinician faces two key dilemmas. The first dilemma occurs when the
patient presents with a condition that he or she does not deem a pathology,
but for which the clinician possesses knowledge of potentially beneficial
resources and treatments. In this situation, such terms as patient,
pathology, therapy, therapist, and so forth are less important to the
physician than the fact that information about beneficial possibilities
cannot be accessed owing to a strict interpretation of and adherence to
definitions. The second scenario occurs when the communication of
alternatives to care is blocked by a difference in how such information is
processed. In this case, differing beliefs concerning pathology and health
are not at stake, but rather currently unbridgeable differences in
information processing.
Within clinical practice, this latter difference is likely to be constituted
as “difference as comorbidity.” The physician possesses information
concerning a greater “access-to-health” that cannot be communicated
through currently available lexicons to patients who might benefit from it
– and patients possess an experiential reality equally challenging to
represent. Communicating these experiences so as to render the fund of
knowledge of each party accessible remains a key goal for actually
securing informed consent or dissent in the context of neurodiversity.
Until this challenge is surmounted, rather than a charted “yes-no” rubric of
capacity for a given patient deemed applicable at every juncture, a sliding
scale assessment, obtained at specific decision-making junctures, could
demonstrate salient ‘capacity’ features of concern to patients, advocates,
physicians, families, and frontline caregivers. Such a time- and situation-
limited scale could for the moment help safeguard autonomy, protect the
vulnerable from exploitation and manipulation, and counter opportunities
for stigmatization, social marginalization, and concomitant degradation of
care.
Whenever controversies exist with respect to clinical alternatives for
neurodiverse patients, and in the absence of an incontrovertible need for
surrogacy, the inadequacy of our present approach to communications,
professional judgment, and the language of record in patient charts
continues to support a pernicious tendency toward labeling that can
degrade standard of care. As such, the current health care lexicon has a
strong potential to harm. Given this fact, and in light of the Hippocratic
tradition, a physician’s responsibility to neurodiverse patients must now
include engagement of the sociocultural processes by which new terms for
neurodiversity, supportive of higher standards of care, autonomy, and
justice, can emerge and become the language of record. That language
will not provide the last word, but it may yield better health.
Do No Harm 109
References
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Diagnosis. (2012) Accessed at:
http://www.dsm5.org/Pages/Default.aspx ; Retrieved between March
15, 2012 and September 17, 2012.
Belliveau JW, Kennedy DN Jr, McKinstry RC, Buchbinder BR, Weisskoff
RM, Cohen MS, Vevea JM, Brady TJ, Rosen BR. (1991) Functional
mapping of the human visual cortex by magnetic resonance imaging.
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Blascovich J, Berry Mendes W, Hunter SB, Lickel B. (2000) Stigma,
threat, and social interaction. In: The Social Psychology of Stigma.
Eds. Heatherton TF, Kleck RE, Hebl MR, Hull JG. New York: The
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1-28.
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the ‘normal’. Journal of Ethics in Mental Health. 2007 Nov; 2 (2) 1-6.
Fox, RC. (2005) Cultural competence and the culture of medicine. N Engl
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Gawande A. (2007) Complications: A Surgeon’s Note on an Imperfect
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Glannon W. (2007) Neurodiversity. Journal of Ethics in Mental Health.
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The Guilford Press, 2000, p236.
110 Chapter Six
AUDREY L. ANTON
Introduction
The scientific community recognizes both Psychopathy and Sociopathy
as disorders. But what constitutes a disorder? Are all disorders bad?
Intuitively, we can say that a condition is a disorder if it is out of order
relative to that of typical human functions. But we must be more precise,
since having an eidetic memory, for example, is certainly an abnormal
function of the mind, but we are reluctant to call that condition a disorder.
In fact, an eidetic memory would seem to be more of a blessing than a
curse. It seems that disorders also constitute disadvantages for the subject.
However, this notion illuminates another problem: it is not clear that
psychopathy and sociopathy are disadvantages for the “afflicted.”
Perhaps our quandary needs a new approach. Perhaps we ought to
question whether psychopathy and sociopathy truly are disorders in the
traditional sense. According to Craig et al. (2009), a psychopathic trait is:
“Not a fault necessarily, and not something that could be classified as a
disease or that is always a disadvantage. At a certain frequency in the
populations, the traits of psychopathy may be highly advantageous to the
individual.” In this paper, I shall argue that psychopathy and sociopathy
can be advantages for both the patient and society when social conditions
are right. Indeed, the psychopath and sociopath have the potential to
develop certain virtues that the rest of us are ill equipped to acquire.
112 Chapter Seven
Neurobiology
In order to consider our psychopath’s potential virtues, we must first
investigate what distinguishes them neurologically and psychologically
from the rest of us. Recent research in the fields of psychiatry and
neurobiology suggests that the structure and processes of the brains of
psychopaths are significantly distinct from those who are neither. For
example, from the mid-1990’s through 2002, R. James Blair studied how
psychopathic inmates were able to distinguish moral rules and transgressions
from conventional ones. Blair’s control participants distinguished well moral
from conventional rules, whereas his psychopathic inmates found difficulty
The Virtue of Psychopathy 115
Julia Annas (2011) argues that we must continually develop and maintain
our virtues in the face of trying to minimize or render ineffective our vices.
The simultaneous development and completion of all virtues presents
another problem for the unity of the virtues. Given that we learn virtue
through experience and habit and different moral facts are salient in
different situations, it seems highly unlikely that we learn a little bit about
all of the virtues as we become virtuous. Certainly, some virtues do what
Annas calls clustering—they are often found together in complimentary
ways. For instance, the virtues of generosity, kindness, and justice are
often coextensive. One might kindly give to a needy person whose need
justifies them as a beneficiary. Still, it is difficult to see how this relates to
courage. Most importantly, the unity of the virtues is contrary to our
experience. Everyone seems more virtuous in certain ways and less
virtuous in others. If this is the case, we can safely say that one can be
more virtuous in some regards while failing to exhibit all of the virtues.
I acknowledge that some philosophers disagree with the position
advanced here. For example, Martha Nussbaum (2012), a critic of the
relative virtue movement, states:
The rejection of general algorithms and abstract rules in favor of an
account of the good life based on specific modes of virtuous action is
taken, by writers as otherwise diverse as Alasdair Maclntyre, Bernard
Williams, and Philippa Foot, to be connected with the abandonment of the
project of rationally justifying a single norm of flourishing life for and to
all human beings, and with a reliance, instead, on norms that are local both
in origin and in application (p. 756).
Philosophers who believe that all virtues are relative to societies and
social contexts deny that anything grounds similarities between a virtuous
person in one culture and a virtuous person in another. Proponents of this
view point to the fact that no universal list of virtues exists; something
considered a virtue by one culture could be a vice in another. Alasdair
McIntyre (1997) unites distinct views of the virtues across cultures by
connecting them to a few basic, broadly defined, cardinal virtues. For
McIntyre, the virtues of truthfulness, justice, and courage are essential to
all cultures; how they manifest in other ways depends on a culture’s values
as determined by its practices.
Regardless of whether we take up a thoroughly relativistic view of the
virtues or a moderate one like McIntyre’s, it is easy to see how a sociopath
could acquire some virtues. For example, a capitalist’s idea of truthfulness
is thin. There are times when lying is inappropriate (basically, when it is
against the law), but otherwise truthfulness is optional. Similarly, a
capitalist’s idea of justice is whatever the market produces, and courage is
118 Chapter Seven
the will and fortitude necessary to take financial risks. So it is possible for
one to be a virtuous businessperson with characteristics like truthfulness,
justice, and courage while being a sociopath. The sociopath can value
being the best swindler possible while “fairly” acquiring such wealth. This
is compatible with deceiving others routinely so long as such deception is
permissible according to the rules of the practice.
It is perfectly consistent to say that sociopaths are precluded from
becoming virtuous people while maintaining that there are virtues the
sociopath can acquire. This is my stance on the issue. I recognize a
difference between being a good human being and being a good American,
for example. In fact, it seems to me that very few people become virtuous
qua human being, whereas many people have character traits that can be
considered virtues in their given contexts.7 Therefore, if we abandon the
ideas that a virtue is context-independent and necessarily united to all
other virtues, we can see how even a sociopath could have some virtues
(even if she has many vices!). In order to see this possibility, we must
envision the kind of context in which sociopathic characteristics are
valuable and facilitate flourishing.
in her basement, her guile is not a virtue in the sense under consideration.
Her guile might be useful for her, but it only harms society. In this sense,
her guile is merely a personal advantage and not a virtue.
job is to kill other human beings to protect oneself, one’s fellow soldiers,
and mission at hand. Having a conscience could make it very difficult to
perform these essential tasks well. The following analogy to drives the
point home: a soldier with a strong conscience is like a pair of scissors
with dull blades. While both might be able to perform their functions, in
neither case will the outcome be excellent. Regardless of whether the
soldier is in a defensive or offensive context, she cannot afford to hesitate
or struggle with her conscience. A good soldier’s conscience does not get
in the way. A good soldier gets the job done.
One’s conscience might get in the way even after the job is done. For
instance, thoroughly training a man with a conscience might eradicate all
hesitation when under fire. However, thorough training is not sufficient for
mitigating guilt after the fact. As Jonathan Shay (1995) argues in his book,
Achilles in Vietnam: Combat Trauma and the Undoing of Character, the
increase of post-traumatic stress disorder among Vietnam Vets is not
simply due to the fact that so many veterans were civilians drafted and
given minimal preparation. On the contrary, argues Shay, the trouble
stems from the lack of time extended to soldiers to grieve. Given the
difficulties that American troops faced in Vietnam, there was no time for
processing trauma, resting, or even enjoying peace of mind between
battles. Military leaders cultivated the anger of remorseful soldiers and
encouraged the expression of rage in future acts of destruction as
substitutes for grieving. Naturally, this strategy created a vicious cycle of
guilt and remorse, and it drove many of our soldiers insane. A sociopathic
soldier, on the other hand, would not have such problems.
Some might object that while sociopathic soldiers wouldn’t suffer from
extreme guilt and remorse, they could still suffer from the stress of
constant fear for their lives. While this objection has some weight, it
highlights another typical (though not necessarily universal) characteristic
of sociopaths. Many sociopaths are high risk-takers with a high threshold
for stimulation. Sociopaths reportedly are comfortable taking safety risks
and some even need to so do regularly to “feel alive” (Hare 1999, pp. 61-
62). This thrill-seeking characteristic might shield sociopaths from post-
traumatic stress related to extreme dangers. In fact, since they seem to
crave such high stimulation, perhaps extreme danger creates an opportunity
for the sociopath to flourish.
The Virtue of Psychopathy 123
others to purchase your product whether they need it or not. For example,
when someone wants to convey that someone else excels in sales, they say
of the person, “He could sell ice to Eskimos!” The objective is to convince
customers that they do need your product. Such convincing might only be
possible if the seller manipulates the customer. The businessperson must
imagine the potential customer’s desires and finding ways to connect the
desires with the product. Certain positions in business give sociopaths
permission to practice such techniques and earn money while doing it.
Western capitalism is particularly attractive to sociopaths, given the
role that corporations play in the marketplace. In the U.S., corporations are
considered legal persons who have rights to own and sell property, among
other things. A corporation’s only responsibility is to maximize profits for
its shareholders. In fact, the popular documentary film The Corporation
diagnoses this collective person as psychopathic (Achbar et al., 2004). If
the nature of a corporation is psychopathic, corporations are inviting
places to work for psychopaths. Someone must represent the whole by
acting in accordance with its sociopathic principles—who better to do that
than an actual sociopath?
Our culture is also a factor in the prevalence of sociopaths in the
corporate workforce. As Stout (2005) surmises:
It is entirely possible that the environmental influences on sociopathy are
more reliably linked with broad cultural characteristics than with any
particular child-rearing factors…Instead of being the product of childhood
abuse within the family, or of attachment disorder, maybe sociopathy
involves some interaction between the innate neurological wiring of
individuals and the larger society in which they end up spending their lives
(p. 135).
experts agree that certain cultural norms constitute fertile grounds for
raising sociopaths.
In business, sociopaths have certain advantages over their empathic
counterparts. Having little emotional interest, a sociopath can compete
objectively in the marketplace. She can envision herself as a client or
competitor and easily imagine what their selfish motives might be. When
she purchases and dismantles other corporations, she does so without
remorse. She is, in essence, the impartial judge. She may be a very partial
negotiator, but her ability to see all sides strengthens her hand in
negotiations.
While a business can benefit greatly from a sociopath at the helm, such
sociopaths will need empathic “normal” people as guides in matters of
justice. For example, in the 1970’s, the Ford motor company manufactured
and sold the Pinto, a car they knew to have safety deficiencies that could
result in explosions of gas tanks that could severely injure or kill
passengers. The vehicles could have been altered to prevent such
explosions—a part installation costing approximately $11 per vehicle.
Refraining from the part upgrade was a legal option. Top executives and
analysts did a cost-benefit analysis to determine whether “it was worth it”
to upgrade the cars. They determined that the number of likely deaths
resulting from no upgrade was relatively low. Ford anticipated paying less
in damages for such incidents than it would cost to upgrade the Pintos. The
company opted not to repair the cars and continued production of the Pinto
as planned.
What Ford did not anticipate was public knowledge of this calculation.
When Ford was brought to court to answer for several cases, juries
determined that Ford should be punished severely and they awarded
complainants exponentially more money than Ford had anticipated. The
“normal” empathic jurors relied on a sense of justice that the (possibly)
sociopathic Ford executives did not consider. While corporations behave
sociopathically and the marketplace can be like a Randian state of nature,
companies must remember that their clients are often civilized, ethical
people. Therefore, I do not mean to suggest that all businesspersons ought
to be sociopaths—no more than I would suggest that all businesspersons
be generous saints. Certain social processes work best when the people
involved are diverse. That is why we should appreciate the neurodiversity
of sociopaths and psychopaths. While there are many more in the
corporate world than in the general population, sociopaths remain a
minority compared to non-sociopaths. It is for this reason that their
neurological differences can be advantageous. Like many things in life, it
126 Chapter Seven
References
Achbar M. (Director/Producer), Abbott, J. (Director), Bakan, J. (Writer),
& Simpson, B. (Producer) (2004). The corporation [DVD]. Canada:
Big Picture Media Corporation.
Babiak, P., & Hare, R.D. (2006). Snakes in suits: when psychopaths go to
work. New York: Harper.
Blair, R.J. (2010). A cognitive developmental approach to morality:
investigating the psychopath. In T. Nadelhoffer, E. Nahmias & S.
Nichols (Eds.), Moral psychology: historical and contemporary
readings (pp. 48-63). London, England: Wiley-Blackwell.
Board, B.J. & Fritzon, K. F. (2005). Disordered personalities at work.
Psychology, Crime and Law, 11, 17-32.
Brophy, M. (2010). Sympathy for the devil: can a serial killer ever be
good? In S. Waller (Ed.), Serial killers: being and killing (pp. 78-89).
London, England: Wiley-Blackwell.
Cahn, S.M. & Markie, P. (2012). Ethics: history, theory, and contemporary
issues. 5th edition. Oxford: Oxford University Press.
Cooke, D.J. (1998). Cross-cultural aspects of psychopathy. In T. Millon,
E. Simonsen, M. Birket-Smith, & R. D. Davis (Eds.), Psychopathy:
antisocial, criminal, and violent behavior (pp. 260-276). New York:
Guilford Press.
Craig, M., Catani, M., Deeley, Q., Latham, R., Daly, E., Kanaan, R.,
Picchioni, M., McGuire, P., Fahy, T., & Murphy, D. (2009). Altered
connections on the road to psychopathy. Molecular Psychiatry, 14
(10), 946-953 DOI: 10.1038/mp.2009.40
128 Chapter Seven
Millon, T., Simonsen, E., Birket-Smith, M., & Davis, R.D. (Eds.). (1998).
Psychopathy: antisocial, criminal, and violent behavior. New York:
Guilford Press.
Nadelhoffer, T., Nahmias, E. & Nichols, S. (Eds.). (2010). Moral
psychology: historical and contemporary readings. London: Wiley-
Blackwell.
Nichols, S. (2010). How psychopaths threaten moral rationalism: is it
irrational to be amoral? In T. Nadelhoffer, E. Nahmias & S. Nichols
(Eds.), Moral psychology: historical and contemporary readings (pp.
73-83). London, England: Wiley-Blackwell.
Nussbaum, M. (2012). Non-relative virtues: an Aristotelian approach. In
S.M. Cahn & P.M. Markie (Eds.), Ethics: history, theory, and
contemporary issues, 5th edition (pp. 755-774). Oxford: Oxford
University Press.
Reid, W. H. (1998). Antisocial character and behavior: threats and
solutions. In T. Millon, E. Simonsen, M. Birket-Smith, & R. D. Davis
(Eds.), Psychopathy: antisocial, criminal, and violent behavior (pp.
110-121). New York: Guilford Press.
Rygaard, N. P. (1998). Psychopathic children: indicators of organic
dysfunction. In T. Millon, E. Simonsen, M. Birket-Smith, & R. D.
Davis (Eds.), Psychopathy: antisocial, criminal, and violent behavior
(pp. 247-259). New York: Guilford Press.
Shay, J. (1995). Achilles in Vietnam: combat trauma and the undoing of
character. New York: Simon & Shuster.
Siever, L. J. (1998). Neurobiology in psychopathy. In T. Millon, E.
Simonsen, M. Birket-Smith, & R. D. Davis (Eds.), Psychopathy:
antisocial, criminal, and violent behavior (pp. 231-246). New York:
Guilford Press.
Stout, M. (2005). The sociopath next door. New York: Three Rivers Press.
Vargas, M. (2010). Are psychopathic serial killers evil? In S. Waller (Ed.),
Serial killers: being and killing (pp. 66-77). London, England: Wiley-
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Walker, I., (Director) & Regan, S., (Producer) (2008). I, Psychopath
[DVD]. Australia: Fibro Majestic Films Pty Ltd.
Waller, S., (Ed.). (2010). Serial killers: being and killing. London: Wiley-
Blackwell.
Welchman, J., (Ed.). (2006). The practice of virtue: classic and
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Widiger, T.A. & Lynam, D.R. (1998). Psychopathy and the five-factor
model of personality. In T. Millon, E. Simonsen, M. Birket-Smith, &
R. D. Davis (Eds.), Psychopathy: antisocial, criminal, and violent
behavior (pp. 171-187). New York: Guilford Press.
CHAPTER EIGHT
THE NEURODIVERSE
AND THE NEUROTYPICAL:
STILL TALKING ACROSS AN ETHICAL DIVIDE
DEBORAH R. BARNBAUM
Introduction
Persons with autism occasionally refer to themselves as “neurodiverse”
and refer to those without autism as “neurotypical.” Not all persons with
autism think of themselves as aligned with the “neurodiverse,” or the
“neurodiversity moement,” just as not all persons with typically
developing cognitive processes think of themselves as “neurotypical.”
However, for purposes of this paper, I will refer to those with ASD as
“neurodiverse” and those without ASD as “neurotypical.” The neurodiverse
and the neurotypical differ with respect to some cognitive characteristics.
But in addition to cognitive differences, many persons who are
neurodiverse hold a view about autism that many neurotypicals do not:
Many of the neurodiverse argue autism should not be cured.1 Neurotypical
persons are usually less persuaded of this belief. Many neurotypicals
spend enormous time, resources, grant monies and charitable contributions
trying to cure autism, even as the neurodiverse discourse passionately in
books, at conferences such as the annual Autreat, or on websites and
blogs2 that they have no disorder for which they need a cure.
The neurodiverse and the neurotypical can be envisioned as occupying
two camps, each positioned on the edge of an unbridgeable chasm. One
camp believes autism should be cured; the other doesn’t perceive autism
as needing a cure. From the vantage point of those occupying each camp,
their positions are consistent with their theoretical assumptions. It is the
people in the opposing camps who are misguided. However, whether or
not autism should be cured is not just a matter of opinion. Curing autism
would entail fundamentally changing who autistic people are, as well as
132 Chapter Eight
What is Neurodiversity?
Philosophers have recently begun to analyze the concept of
neurodiversity. The term ‘neurodiverse’ is used to describe not only
individuals with autism, but also those with schizophrenia, bipolar disorder,
and other conditions. When considering neurodiversity and autism in
particular, it is helpful to begin with the views of Glannon, who observes
that “‘Neurodiversity’ usually appears in discussions of autism spectrum
disorders as the view that individuals with these disorders have at least as
much mental ability as disability” (Glannon, 2007b). Glannon’s claim
about neurodiversity is not as precise as one might hope. In saying that
persons with autism spectrum disorders (ASD) have “at least as much
mental ability as disability” Glannon implies that the abilities of persons
with ASD are limited, as their abilities are somehow only proportionate to
their disabilities. Glannon refines his position, later clarifying that
“…neurodiversity… recognizes that many people have a combination of
neurological and psychological abilities and disabilities” (Glannon 2009a,
quoting Baker, 2006). This is a better formulation, as it makes clear that
the abilities of persons with ASD are not limited by being merely
proportionate to their disabilities. However, this description doesn’t
sufficiently elaborate the concept of neurodiversity. Most people are hard-
pressed to think of anyone they know who doesn’t have a combination of
neurological and psychological abilities and disabilities. Glannon’s
second claim is true for most humans, almost to the point of triviality.
However, while these descriptions aren’t the full story, they do tell us
something interesting and important: The neurodiversity movement holds
that ASD is characterized not merely by impediments, but also by normal
functioning, as well as cognitive strengths. ASD, on this account, may be
best understood as a cognitive difference, not as a shortcoming. This
observation is significant, echoing Francesca Happé’s claim that ASD
characterized by weak central coherence reflects a cognitive approach, not
necessarily a disorder, and thus reflects “skills as well as failures, and as
such can best be characterized not as a deficit account, but in terms of
cognitive style” (Happé, 2000).
According to Fenton and Krahan, neurodiversity is characterized by a
set of prescriptive claims in addition to the above descriptive claims: “The
neurodiverse, as they call themselves, contest the default pathologizing of
134 Chapter Eight
stand to reason that one group may be making one set of claims about
ASD, while the other could be claiming something very different. One
version of this hypothesis is that the language of the neurotypicals is
predicated on a common ascription of propositional attitudes typical of
individuals with a fully functioning theory of mind (ToM). If this
hypothesis is true, as it is postulated by psychologists such as Simon
Baron-Cohen (Baron-Cohen, 1995), then theories of meaning familiar to
philosophers that require shared propositional attitude ascription –
Gricean, Davidsonian, Lewisian – would be non-starters for persons with
ASD (Barnbaum, 2008). Grice’s theory requires that the individual who
hears a proposition uttered by a speaker understand not merely what the
hearer thinks the words mean, but also understand what the speaker means
for the hearer to think what the speaker means when language is used.
Such a complex set of iterated mental-state ascriptions, and shared mental-
state ascriptions, would seem problematic for persons with ASD on Baron-
Cohen’s absence of ToM account. Lewisian theories of meaning rely on a
shared common knowledge among users of a language, a common
knowledge which is predicated on shared mental-state ascriptions. Thus,
Lewis’s theory also poses challenges for the autistic language user.
Donald Davidson’s theory of radical interpretation, in which all speakers
attempt to interpret others’ utterances with an eye towards understanding
those utterances to be true, similarly is challenged by individuals who have
compromised ToM. All three of these theories of meaning are thus
unworkable by persons with autism, on Baron-Cohen’s account. As such,
the language used by the neurotypicals, whose meaning requires
functioning and effortless ascription of ToM, may not be the same
language used by the neurodiverse. This could explain why, according to
Alexandra Perry, “autistic individuals may process the information that
they are given in a very different way than neurotypical individuals might”
(Perry, 2011, p. 237). Perry makes her point in the context of evaluating
the validity of certain types of informed consent for medical treatments by
persons with ASD. If these differences in common language persist, then
applied concerns in ethics – informed consent, whether persons with
autism should be cured – will also be in dispute.
Victoria McGeer makes a similar point about a lack of a shared
common experience, although her observation is not dependent on the
ToM thesis advocated by Baron-Cohen. McGeer presents what she calls
the “form of life” hypothesis in which effortless third-person perspective
taking and third-person propositional attitude ascription are “explained as
a species of skilled perception that arises in conjunction with skilled
performance in any norm-governed shared practice, or form of life”
136 Chapter Eight
(McGeer, 2009). According to McGeer, persons with ASD are not skilled
in the shared folk-psychological expertise that characterizes the form of
life of the neurotypical. Thus a divide emerges by which neurotypicals
and neurodiverse do not understand each other. Instead of a “thick”
understanding, the neruodiverse and the neurotypical are both relegated to
a mere “thin” understanding of each other’s psychology (McGeer, 2009).
According to both Baron-Cohen’s ToM thesis and McGeer’s “form of
life” hypothesis, the language of neurotypicals is fraught with terms that
may be foreign to individuals with the social impairments that characterize
ASD. McGeer observes that Ian Hacking’s discussions of autobiographies
of the neurodiverse may reflect precisely this problem:
[T]he language available to display those minds is still our (nonautistic)
communal language, a language geared, for the most part, to typical
psychological experiences. As Hacking points out, autistic individuals will
have their work cut out for them to adapt, manipulate, and perhaps outright
distort the common meanings of our words in order to convey something
of their own subjective experience (McGeer, 2009).
then would we be able to determine that the two parties were in fact using
language to describe different things. But in the absence of a shared meta-
language, which could be used to arbitrate debates among the two object
languages actually being used by the neurodiverse and the neurotypical,
we would never know if this solution is correct. Another explanation that
accounts for the ethical divide is needed.
for long periods of time – surely these are nontrivial harms, say the
neurotypical. The neurodiverse respond by saying that they aren’t
suffering, or wouldn’t be, if the neurotypical were more inclusive. As
Fenton and Krahn observe, the neurodiverse “contend that autism is, or
perhaps certain forms of autism are, best regarded as different “ways of
being” from what is commonly represented… For these individuals autism
is not something from which they suffer, but is rather who they are…”
(Fenton and Krahn, 2007). It is true that those with ASD are suffering the
harms of lack of social interaction or eye contact, but only because the
neurotypicals set the agenda as to what counts as harming conditions. The
neurotypicals will respond that there is a fact of the matter that these are
harmful, and that they did not make the rules as to what counts as a harm
or not. The ethical divide can be accounted for via alternative notions of
what it is to suffer a malady, or alternative notions as to whether those
with ASD are objectively harmed by having ASD.
Finally, rather than focusing on naturalistic claims or attempting to
make claims about objective harms, a third approach holds that disabling
conditions are socially constructed:
If some portion of the difficulty of disability stems from the biological
limitations, the majority does not and is in fact socially constructed. In
asserting disability is socially constructed, I am making two claims: first,
that even those characteristics we label as “disabling” are at least partly
socially determined; second, that disability’s all-too-frequent consequences
of isolation, deprivation, powerlessness, dependence, and low social status
are far from inevitable and within society’s power to change (Asch 1989).
Conclusion
A great deal rests on bridging the divide between the neurodiverse and
the neurotypicals who disagree whether or not autism should be cured.
The decision to cure or not has an impact on health care resources,
families’ time and efforts, and the possible infringement of a right of the
neurodiverse to be left alone without being changed without consent.
Barnes and McCabe (2011) were correct to engage the arguments for and
against curing autism head-on. This chapter attempted to go a step further,
and explain why the debate among the neurodiverse and the neurotypical
exists in the first place.
Three explanations may account for an ethical divide among the
neurotypical and the neurodiverse, but many unanswered questions
remain. While the “lack of a common moral theory” is not the strongest
reason for the ethical divide among the neurodiverse and the neurotypical,
it appears that the “lack of a common language” theory is open to even
more serious objections. The “competing conceptions of disease,
impairment, malady, or disability” may best account for the divide;
however, each competing conception offers a different explanation of the
disagreement among the neurodiverse and neurotypical as to whether
autism should be cured. It is unsettled which of these competing
conceptions is correct. Perhaps the disagreement among the neurodiverse
and the neurotypical is genuinely over-determined. Until a common
understanding can be reached, the neurodiverse and the neurotypical will
still be talking across an ethical divide.
144 Chapter Eight
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Asch, A. (1989). Reproductive technology and disability. In S. Cohen
and T. Taub (Eds) Reproductive laws for the 1990’s. Clifton, NJ:
Humana Press, pp. 73.
Baker, D.L. (2006). Neurodiversity, neurological disability and the public
sector: Notes on the autism spectrum. Disability and Society vol 21,
pp. 15-19.
Barnbaum, D.R. (2008). The ethics of autism: Among them but not of
them. Bloomington, IN: Indiana University Press.
Barnes, J.L, Lombardo, M.V., Wheelwright, S., Baron-Cohen, S. (2009).
Moral dilemmas film task: A study of spontaneous narratives by
individuals with autism spectrum conditions. Autism Research vol
2(3), pp. 148-56.
Barnes, R. E. and McCabe, H. (2011). Should we welcome a cure for
autism? A survey of the arguments. Medicine, Healthcare and
Philosophy, August 12, epub ahead of print.
Baron-Cohen, S (2003). The essential difference: The truth about the male
and female brain. New York, NY: Basic Books.
—. (1995). Mindblindness: An essay on autism and theory of mind.
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Blair, R.J.R. (1996). Brief report: Morality in the autistic child. Journal
of Autism and Developmental Disorders 26(5), pp. 571-579.
Caplan, A.L. (1996). The concepts of health, illness, and disease. In R.M.
Veatch (Ed.) Medical ethics. Sudbury, MA: Jones and Bartlett, p. 66.
Cohon, R. (2004). Disability: Ethical and societal perspectives. In S. G.
Post (Ed.) Encyclopedia of bioethics, 3rd edition. New York:
Macmillan, pp. 655-668.
Fenton, A. and Krahn, T. (2007). Autism, neurodiversity and equality
beyond the ‘normal’. Journal of Ethics in Mental Health 2(2), pp. 8-
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Francesca, H. (2000). Parts and wholes, meaning and minds: Central
coherence and its relation to theory of mind. In S. Baron-
Cohen, H. Tager-Flusberg, and D. J. Cohen (Eds.) Understanding other
minds: Perspectives from developmental cognitive neuroscience, 2nd
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Gert, B., C.M. Culver and K.D. Clouser (1997). Bioethics: A return to
fundamentals. New York: Oxford University Press, pp. 104.
Gernsbacher, M. A., & Frymiare, J. L. (2005). Does the autistic brain lack
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3–16.
The Neurodiverse and the Neurotypical 145
WHO’S COUNTING?
COGNITIVE DISABILITY
AND RAWLSIAN CONTRACTUALISM
CHRISTOPHER MESAROS
range over large and diverse groups of individuals who have the potential
to exercise the two moral powers. I will also generally be referring to the
severely cognitively disabled unless noted otherwise. As far as I can tell,
the only uniform rubric for what we mean when we use the term “severe”
seems to be qualitative, in that it is a placeholder for something “like lack
of sufficient faculties that would make the individual an agent, a person, a
cooperator, etc.” I will begin with problematic features of Rawls’s own
theory and what he says regarding the disabled.
Returning to the discussion at hand, the two moral powers are meant to
provide a conception of agency that most human beings will meet at some
point in their lives. The sorts of individuals lacking in the two moral
powers are young children, elderly persons with diminished cognitive
faculties, those whose unreasonable doctrines (e.g. religious fundamentalists)
or conceptions of the good inhibit or prevent the development or exercise
of their capacity for a sense of justice, and the severely cognitively
disabled. It is significant that of this group of outliers, the disabled are the
only ones that are incapable of having the two moral powers, as all of the
rest have them, had them at one point, or will potentially develop them.
Another outlier group that share permanent lack of the moral powers
would be non-human animals, and while there is much that could be said
here, I will not be concerned to discuss Rawls and animals in this paper.
Returning to Andrew, we can see how the two moral powers may not
necessarily be an all or nothing package. For someone with a behavioral
disability:
The behavioral characteristics of emotional disturbance include an inability
to learn, an inability to build or maintain satisfactory interpersonal
relationships, inappropriate types of behavior or feelings, a general
pervasive mood of unhappiness or depression, and a tendency to develop
physical symptoms or fears (Ysseldyke, 2006, 12).
Rawls goes on to note that the decisions to be made in these cases are
ones that promote the development of the two moral powers. We should
make choices for disabled individuals from the standpoint of the OP and in
a way that we could justify these choices to the individual should they
Who’s Counting? Cognitive Disability and Rawlsian Contractualism 151
Self-Respect
Self-respect plays a crucial role in justice as fairness, as Rawls
frequently mentions it as perhaps the most important primary good. He
mentions the two most important aspects of self-respect as a person’s
sense of his own value and confidence in his ability to fulfill intentions.
Not having self-respect means not valuing one’s projects or not believing
them to be attainable. He says:
It is clear then why self-respect is a primary good. Without it nothing may
seem worth doing, or if some things have value for us, we lack the will to
strive for them…Therefore the parties in the original position would wish
to avoid at almost any cost the social conditions that undermine self-
respect (Rawls, 1971, 440).
Paternalism
In discussing the four pressure points, I mentioned above that Rawls’s
own proposal for how we might approach the disabled is to employ
paternalism after the four-stage procedure has been completed.
Unfortunately, this account of paternalism is rather underdeveloped and
leads me to some serious concerns. One worry I have is that it is not clear
exactly how we are supposed to act on the behalf of those whose mental
functioning we cannot pretend to comprehend, including what primary
Who’s Counting? Cognitive Disability and Rawlsian Contractualism 153
society, since this would mean that coma patients or anencephalic infants
count as persons despite their obvious inability to contribute. Given these
limiting cases, we should eliminate that option immediately. The other
considerations require some analysis.
It is possible to adopt a definition of personhood that makes use of IQ,
but I have already supplied an argument against this suggestion. For the
disabled, IQ measurements present a host of complications that could
artificially deflate their performance: disabilities may inhibit focus and
concentration; individuals may test highly in one area while lacking in
many others; and testing requires an ability to communicate effectively in
response to the test, which is simply not possible for some due to certain
cognitive limitations. While IQ measurements may give us precise
boundaries, the cost of the precision is exclusion of individuals who make
important contributions yet who nonetheless test poorly. As they stand, IQ
tests cannot tell us anything important about whether or not an individual
is a subject of justice, and so we should be suspicious of any normative
account that employs this empirical notion, even in part.
Another option open is to employ a certain minimum standard of moral
faculty. For Rawls, this standard is the valuing of one’s own projects and
the recognition of the right of others to value and pursue their own projects
(i.e. a capacity to be ‘rational’ and ‘reasonable’). While we might think
these qualities are valuable in those who determine principles of justice
and set policy, if the principles and policies focus only on individuals with
such moral functioning, then we run head on into my worries elucidated
above. However, I am not rejecting Rawls’s standard wholesale. As a
device for achieving agreement on principles of justice, the two moral
powers are highly apt, and so I think we should not throw the baby out
with the bathwater. Moral faculty has some place in an inclusive
conception, for example when determining principles of justice.
A final candidate consideration is contributions made by the disabled.
These contributions might be labor, taxes, voting, etc., though they need
not be. Rawls says:
Our topic…is that of social justice. For us the primary subject of justice is
the basic structure of society, or more exactly, the way in which the major
social institutions distribute fundamental rights and duties and determine
the division of advantages from social cooperation (Rawls, 1971, 7).
Stepping Back
I have been arguing that Rawls’s theory as it stands faces considerable
worries and that it must be amended in some form in order to accommodate
the disabled. I gave three desiderata that Rawls would need to satisfy, and
I have not yet said whether these can be met via a Rawslian framework.
However, there is still the option for Rawls to bite the bullet and deny that
156 Chapter Nine
this point, the compassionate approach of the 19th century backslid for
several reasons including—importantly—lack of resources such as
facilities, funding, and staff. Both electroconvulsive therapy and sedation
have been and continue to be used in contemporary America, and both
remain sources of controversy. A similar firestorm of controversy rages on
regarding the use of restraint and seclusion, both of which are the subject
of a recent Education Department report that mentions the use of duct tape
to mechanically restrain preschool aged children and one case of a woman
in Kentucky who found her autistic son stuffed in a canvas duffel bag in
his school’s hallway (Hefling, 2012).
Suffice it to say, treatment of the disabled in democracies as a whole
has been generally better than in other political systems and is trending
upward, yet there is no reason to think that each liberal democracy—which
is Rawls’s focus—would necessarily be preferable to, say, a Communist or
Socialist society for someone with mental disabilities. Even where
resources are devoted, care in the United States has the possibility for
regrettable abuses. In this regard, I agree with Eva Kittay that the caregiver
profession is grievously undervalued (Kitay, 2001, 575) and one must
wonder how commonplace these dehumanizing cases would be were
caregivers held in as high esteem as, say, nurses or compensated as well as
other healthcare providers.
The point here is to highlight the reason that justice for the disabled
should be of such concern to political philosophers. Of course, none of this
shows that our concern for the disabled should be a matter of justice rather
than a duty of benevolence, yet it is clear that those goods that are most
often a matter of justice have historically been denied to most disabled
individuals. If we take the principles of justice seriously for a liberal
democracy, then something must be done to rectify the situation, unless of
course the disabled do not merit such considerations. Though, this
dichotomy ignores a third option.
A way that Rawls might bite the bullet, as I have mentioned, is to say
that our treatment of the disabled is a moral concern, and while we have
certain obligations towards them, they are not obligations of justice. This
reply would say something like we have a duty of benevolence whereby
our relation to the disabled (familial, communal, whatever) is what
obligates us to ensure minimum standards of functioning and quality of
life.
While I do not doubt that we have some moral obligation towards the
disabled for the very same reason we have obligations to other human
beings, it is unclear to me exactly how we pull apart justice and morality
in this regard and how the moral distribution of goods (whatever this
158 Chapter Nine
would mean) for the disabled would not fall under the purview of
distributive justice.4 One could compellingly argue that parents have duties
to their disabled children, for example, but this does not explain how we as
a society regard orphaned children with disabilities. If the duty is more
general, such that we are indeed concerned to ensure a minimum standard
of living for all individuals with disabilities, and the goods being
distributed are those that any individual would require for subsistence in
society, then the only difference between one’s being a subject of justice
versus being a subject of morality is the terms involved. Morality would
either be playing the role of justice by distributing goods and structuring
laws, or it would play a less compelling normative role where we say how
we ought to treat the disabled without guaranteeing such treatment. The
former makes morality’s role redundant with that of justice and the latter
raises the question of how we compel just treatment for the disabled if not
through laws and legislatures.
The OP device is the vehicle by which we provide goods and
determine principles of justice for Rawls, and these goods range from
access to employment, to education, to protections under the law. An
alternative or ex post facto moral account would presumably distribute
many of these same resources (though perhaps not an identical set),
otherwise the disabled would be left without vital goods and services. But
if this is the case, then the distribution of goods is not merely political after
all. We might be able to say that the justification of the distribution for the
disabled is now based on moral reasons, but the fact is that we are
distributing goods that are the concern of justice. In addition, justifying the
distribution of goods on moral grounds and not because of the
contributions being made turns the disabled into charity cases and
devalues their participation. As Elizabeth Anderson says, “Self-respecting
citizens would reject a society based on principles that treat them as
inferiors, even if the principles are kept secret” (Anderson, 1999, 306). To
be satisfied with a moral account for the distribution of goods is to ignore
Andrew’s labor, love, and self-respect.
The benefit of this account is that it secures a basic minimum for the
disabled as a matter of justice—something Rawls does not explicitly
accomplish. This also alleviates some concerns about the principles of
justice being chosen without considering the disabled, though not entirely.
While Stark’s suggestion may address worries about providing goods
for the disabled, we would still require either justification for Rawls’s
goods or a separate account of goods for the disabled, given that Rawls’s
own primary goods are contingent on a definition of personhood not
attainable by the disabled. It also fails to capture self-respect—something
that Rawls acknowledged as essential for citizens. Namely, it ignores the
self-respect of not only individuals with severe disabilities, but also those
citizens with familial connections to these individuals by still discounting
the value of their loved ones in the political process, since they still lack
representation at the most crucial stage of the procedure. That is, if self-
respect involves valuing one’s political system and the freedom of its
citizens, then seeing one’s family member who could potentially make
contributions to society treated in a less than equal manner due purely to
their natural deficits would plausibly cause one to value the fairness of
their society less, and hence damage their self-respect. In effect, Stark’s
amendment merely pushes the problem down a level without addressing
serious worries about the contributions and status of the disabled.
It is possible that Stark is worried only with those individuals that
would never be able to make contributions to the basic structure,
regardless of advances in medicine or appropriate therapy. If this is the
class of human beings with whom she is concerned, then she and I are
160 Chapter Nine
talking past one another, since I am focusing on individuals who have the
capacity to both contribute and potentially develop the two moral powers
given proper consideration. However, this would mean that she has
nothing to say about individuals like Andrew and the entire spectrum of
disabled individuals between those with the two moral powers and those
who could never develop them. I am reading her description of those who
cannot participate in a scheme of cooperation as referring to those who
may be able to contribute and yet may not be able to cooperate to a
sufficient degree. If her account is targeting individuals who could never
make contributions to a scheme of cooperation, then this makes the
amendment even more restricted in scope, and so I will read her as
focusing on the same sorts of disabled individuals with whom I am
currently concerned.
Rawls stipulates that the representatives are fully rational throughout
the four-stage procedure, and this would hold true for the constitutional
convention stage where despite the fact that the veil of ignorance is lifted
to some extent and the procedure becomes less abstract, the parties are still
imagined as fully rational. The OP, wherein the two principles are chosen,
informs the entirety of the process from thereon. By the time Stark’s
amendment comes into play, representatives would have already made
decisions that would significantly impact the formation of society by
selecting the principles of justice. Thus, it seems that even if we allow for
representation in the conventional stage, we are still doing a disservice to
the self-respect of the disabled, so long as they are not allowed to have a
voice in the OP.
While Stark’s modification does overcome certain concerns, including
a lack of treatment of the disabled within the scope of justice, it does not
satisfy all of the desiderata I have supplied, and hence falls victim to
worries similar to those I raised against Rawls. There is on this
modification at least some attempt to address goods that would be primary
for all by virtue of the fact that parties consider the interests of the disabled
at the convention stage. However, there is no obvious attempt at an
inclusive account of personhood, since this modification does more to
protect the interests of citizens with the two moral powers than it does to
consider seriously the contributions and self-respect of those with
disabilities. Concordantly, lack of representation in the OP means that
fundamental tenets of the political system are being selected without ever
considering the disabled, and by the time the parties reach the
constitutional convention stage, these principles are merely being applied,
regardless of whether they are the correct principles for all.
Who’s Counting? Cognitive Disability and Rawlsian Contractualism 161
This account allows for health care to “prevent and treat disease or
disability and other uses, for example, to enhance otherwise normal traits,”
with the caveat that these disabilities must be publicly recognizable (258-
9). The publicity condition, I take it, is meant to fend off claims of illness
that cannot be diagnosed or are not commonly recognized, e.g. being a
“sex addict.”
Daniels’s account has appeal to me, but just as did Wong’s, I believe it
misses the mark to some degree and undermines Rawls’s own account.
The project of normalization requires much more from citizens than justice
as fairness asks; it places a great deal of economic and social burden on
society in order that the disabled develop traits that may never come to
fruition. An objection to normalization where ideal citizenship is held as
the norm for all agents is that it may violate the strains of commitment for
those shouldering the costs. The economic burden on the “normal” citizens
would be quite large, if contemporary health care and education costs are
any indication: special and regular education programs costs were in
excess of $77 billion for 1999-2000 in the United States alone (“What Are
We Spending on Special Education Services in the United States”). The
disabled often require not only technology but also human assistance to
perform even the most basic functional tasks. One might think that a
society would have to be quite wealthy in order that all citizens assent to
the sort of investments that would be requisite for even the most basic
assistive technology across the board.
Of course, someone like Daniels might insist that the funding be
proportional to the wealth of the society and of course we could not
bankrupt the many for the gains of a few individuals. This also seems to
me a mistaken line of argument without an inclusive conception of
personhood precisely because justice for the disabled is then proportional
to the wealth of society and, unlike for the least advantaged, we could
conceivably have a just liberal democratic society that is economically
able to provide a minimum standard for its cooperating members yet
provides nothing for the disabled. Hence, a society lacking an inclusive
conception of personhood has the potential to be one where the disabled
164 Chapter Nine
are not regarded as a matter of justice at all, which puts us back at the
initial concern of completely discounting the disabled.
There are at least two potential ways for Daniels to avoid the worry
mentioned above. The first is to suggest that society would provide a
minimum amount of goods necessary for survival as a matter of moral
obligation that we have towards the disabled, regardless of the wealth of
such a society. However, this would mean that the modification does not
address concerns about the disabled internal to the system of justice, and
we are back where we started with an unmodified Rawlsian system. The
second way to avoid the worry is to say that society would provide such a
minimum standard as a matter of justice, perhaps by regarding the disabled
as amongst the least advantaged. I think this would be the right way of
responding to the challenge, but it is not clear to me that Daniels has this
sort of a response at his disposal, since the disabled are not regarded as
citizens in the OP and we would need additional machinery for this
account in order that they are counted as such. I will make a case for this
below.
Daniels has come the closest of all the modifications I have examined
to giving us a satisfactory account, but I have argued that simply providing
access to health care will not be sufficient. While it might be the case that
this would meet the standards for goods primary to all and also address
worries about someone like Andrew whose position may be significantly
improved with proper health care, we still lack an inclusive account of
personhood. This means that Daniels cannot yet count the disabled
amongst the least advantaged, and hence does not have the theoretical
framework in place to indemnify them against unbearable conditions.
The problems that I have elucidated for the modifications of Rawls
include violations of the strains of commitment for the cooperating
members, disregard for the complexity of the disabled as a group, and an
inability to reconcile Rawlsian contractualism with our intuitions about
political rights for the disabled in contemporary democracies. These
problems resulted from an overburdening society’s resources in the pursuit
of normalization, a lack of recognition that the disabled can have some
faculties allowing for self-respect and a conception of the good, and a lack
of clarity about why the goods and political rights we grant the disabled
would be the correct ones. Some of these problems may stem from
contractualism itself, but Christie Hartley, sees them as symptoms of
Rawls’s particular variant, insisting the spirit of contractualism allows for
an inclusive theory that abandons the Rawlsian bent (see e.g. “Justice for
the Disabled: A Contractualist Approach.”). I will now turn to Hartley’s
Who’s Counting? Cognitive Disability and Rawlsian Contractualism 165
Inclusive Contractualism
In the rest of the paper I will present a modification to Rawls’s theory,
drawing heavily on recent work by Christie Hartley, particularly her
suggestion that contribution to any form of the basic structure of society
will suffice for one to be considered a subject of justice, as laid out in “An
Inclusive Contractualism” and elsewhere. As with her account, I will be
addressing those individuals who, though they lack the two moral powers,
may nonetheless be able to develop them through adequate distribution of
goods. I reserve discussion of those individuals wholly incapable of
developing the capacities for rationality and reasonableness for a more
complete account than the one offered here. This modification is meant to
include the majority of disabled individuals and would exclude, for
example, anencephalic infants. My account will be necessarily brief, and I
do not mean to completely address my concerns elucidated above. I intend
for my desiderata for inclusive theories of justice that I have provided to
stand on their own as concerns for any theory, regardless of how
successfully I can amend justice as fairness. That said, I will now offer a
theory for an inclusive Rawlsian contractualism.
While Rawls may be susceptible to worries about the disabled being
excluded, I think that his account has incredible promise for capturing
what an inclusive account should offer. He identifies the importance of the
basic structure, formulates the concept of the primary goods, has a device
for abstracting away from bias, shows the importance of self-respect, and
provides a minimum standard of living for all citizens. What we need is a
way to include the interests and welfare of the disabled in this account, and
I mean the account I provide to function as a plausible amendment to
Rawls’s own work.
Access
In a sense, what should be sought for the disabled is not all that
different from what most persons would want for themselves. Elizabeth
Anderson offers a tripartite conception of individual functioning: as a
human being (the means to one’s biological survival); as an equal
participant (the means to contribute via labor, production, etc.); and as a
citizen. (Anderson, 1999).6 Being a citizen means having access not only
to what we typically view as political rights, such as freedom of speech,
166 Chapter Nine
but also access to civil society. This last point is particularly relevant when
discussing the disabled, so I shall dwell on it for a moment.
Civil society, according to Anderson, includes institutions like public
parks, restaurants, theaters, sports stadiums, airports, schools, hospitals,
and so on. Having the right of being a citizen means not only having
access to these institutions, but also having the right to not feel shame or
exclusion when participating in their use. She says of functioning as a
citizen, “This also entails the social conditions of being accepted by
others, such as the ability to appear in public without shame, and not being
ascribed outcast status” (Anderson, 1999, 318). We can easily imagine
where this might go awry in the public domain: segregated seating;
restrictive access; limited viewing times; inferior facilities; and less
tangible discrimination such as gawking, leers, and derision. Discreet
institutional discrimination (e.g. subtle racist hiring practices), as American
history has shown, can be just as detrimental as overt discrimination.
Access need not guarantee respectful treatment, though this should be a
goal for a liberal democracy. Andrew’s need to feel as though he fits in
should be validated to the extent that he can participate in the same
institutions as others without being the subject of ridicule or being made to
feel like an outcast. This does not suggest that a just society employs
thought police, rather that the system is structured to promote inclusion
and respect in the same way Rawls envisions we promote the development
of the two moral powers, namely through education and socialization.
Access to institutions is important, and it goes a long way towards
addressing my worry about self-respect, but if the access is not extended to
the political domain, then my worry remains. That is to say, so long as the
disabled are denied representation in the political process, including the
structuring of institutions and formulation of laws, their self-respect is
invalidated.
realize their capacities, and it does so in the OP in order that the disabled
citizens receive representation.
Goods
Rawls’s own account of primary goods is comprehensive and well
thought out to the point that I have been criticizing him by showing how
he fails to guarantee these goods for the disabled. It is of my opinion that
an inclusive account should provide those same primary goods that Rawls
proffers as valuable to rational and reasonable citizens. Again, these goods
include: rights and liberties; freedom of movement and freedom of
occupation; powers and responsibility; income and wealth, and the social
bases of self-respect. However, because the disabled face unique
challenges and because the history of Western democracies has been far
from just in their treatment of the disabled, I will be concerned to highlight
those goods that are of particular value to the disabled.
Even in contemporary democracies, the disabled often lack those basic
human necessities. For example, it is estimated that 20-25% of the
homeless in America have a severe mental illness, as compared with 6%
of the total population, suggesting that the disabled are often the worst off
among us (Mental Illness and Homelessness). Anderson notes that,
“Homelessness—that is having only public dwelling—is a condition of
profound unfreedom” (Anderson, 1999, 318). However, even having
domiciles does not guarantee protections. In 2009 there was a case of
reported abuse where the staff of a school in Corpus Christi, Texas for
adult males with severe disabilities would stage “fight clubs” by goading
the clients into fighting with one another while staff recorded and mocked
the spectacle. Police said twenty such videos were found spanning nearly a
year (Sabo, 2011). Cases like the Kentucky mother and the Texas fight
club point to mistreatment and lack of compassion even where housing
and care are made available. Counting the disabled as citizens would mean
that we would provide at least some bare minimum of support for
nourishment, housing, health care, and so forth, and all of these can easily
fall under the umbrella of Rawls’s goods, so long as the disabled are
accorded the same basic minimum as the least advantaged.
Another set of goods that often escape the disabled are protections by
the state that facilitate biological survival. This would mean not only
protection by law enforcement, but also recognition of the special needs of
the disabled when it comes to policing, e.g. training in psychological
approaches rather than physical. It would also include protection from
abuses in care settings where the disabled are often at their most
170 Chapter Nine
of threatening the ability for citizens to pursue their interests (i.e. exercise
their capacity for rationality). For an inclusive Rawlsian account, these
goods are meant to apply to all who contribute to society where
contribution is understood as benefiting the basic structure as a part of the
social community. Though my set of primary goods is identical to those
Rawls provides, this discussion is meant to illustrate that certain basic
goods are often denied to the disabled in contemporary societies which
makes their distribution for the disabled all the more important.
average citizen, and so the worst case for a disabled citizen would
potentially be even much worse than for cognitively average citizens.
There is still a question of whether or not parties would select
Rawlsian principles when given an option that still provides a basic
minimum for disabled citizens and yet does not maximize the benefit of
the least advantaged.8 For example, consider a utilitarian account that
would not allow for starvation and yet was more cost effective for the
citizens by not allocating resources for the development of the two moral
powers with regards to the disabled. In such a case, we might wonder
whether the parties in the OP would still prefer justice as fairness given the
immense burdens it may require of citizens in contrast with a more
egalitarian utilitarianism that may have a lower standard for the least
advantaged and yet does not ask them to endure an unbearable life with no
basic liberties or rights.
I believe parties in the OP would still prefer the more costly maximin
option in contrast with a utilitarian option that provides a basic minimum.
The representatives would still be behind the veil of ignorance and hence
would not have access to things like probability of having a disability or
becoming disabled. Since the primary goods are meant to apply to citizens
with the two moral powers, representatives would value those goods most
when able to exercise their capacities to a satisfactory level. One might
still have access to goods on a utilitarian scheme that provided a basic
minimum, but without the capacity to utilize such goods, it is hard to see
how they would have value for citizens. Hence, parties would be
concerned to ensure that disabled citizens would be in the best position to
value the goods they were allotted, and this means selecting the modified
veil amendment. In addition, while the economic burden of maximizing
the position of the disabled would be great, parties would be more
concerned with a fair distribution of goods and the ability to value such
goods.
The modified Rawlsian approach allows Rawls to avail himself of the
same reasoning behind the maximin strategy used in the unmodified OP.
From the perspective of parties in the OP, the worst case scenario under a
utilitarian system of justice would be potentially unbearable and certainly
less preferable, and so they would reject these principles in favor of justice
as fairness. This advantage is also unique to this particular modification,
since other modifications fail to consider the disabled or the possibility of
citizens becoming disabled when the principles of justice are being
selected, meaning that this stronger version of the maximin argument are
available to neither these modifications nor the unmodified Rawlsian
contractualism.
174 Chapter Nine
Objections
No Method for Determining Objective Interests
One objection that might be presented with respect to my account is
that I have not satisfied the second of my own three desiderata, namely
that we have a method for determining the objective interests of the
disabled. I will have to offer some defense, though I think there is still a
residual worry.
The first thing to say on my behalf is that, contrary to Rawls’s original
account, we are in a better position on my amended version to determine
the objective interests of the disabled. This is because the representatives
will know certain features of those individuals being represented, namely
that they may be disabled in any of a variety of ways. However, there is
still the cognitive barrier between the representatives and the disabled such
that if we do not have a sufficient means of understanding what goods
would be of value to irrational or unreasonable agents who may still
develop the two moral powers, it can be near impossible to determine what
goods are objectively valued by disabled citizens. We will have to hope
that in making an earnest effort we come close enough. Of course, by
promoting the development of the two moral powers we promote
capacities that would make use of the primary goods being distributed.
The second defense of my account is that we are at least making the
effort to consider what might be primary goods for the disabled. That is to
say, Rawls is open to the worry by virtue of the fact that he fails to even
consider the disabled as citizens, and so we immediately rule out concern
over whether the goods align with their actual interests. My account may
still fall victim to the empirical worry about how we actually know what
goods are the correct ones, but structuring our society in ways that attempt
to appreciate the needs of the disabled will almost necessarily do better at
finding the right goods; this is a response that I believe is open to Hartley
in defense of her own work.
speak for the future actions of those who are potentially irrational or
unreasonable. Recall Andrew who sincerely wants to fit in, yet cannot stop
himself from doing harm in a fit of rage.
My reply to this objection is to say that while the representatives
cannot give assurances, they can assent to structuring the laws in such a
way that they guarantee respectful and reasonable punishments for
violations by the disabled. I suggested earlier that police should be given
training in order to be sensitive to the special needs of the disabled, and
this would be an example of the function of representatives in the contract
that would give assurances to the other participants that defections will not
be permitted. Representatives in the OP would be able to assent to such
laws because they would uphold the principles of justice, and the disabled
would not be harmed by such laws because they would take into
consideration the limitations of some disabled persons as regards obedience
towards the law.
Conclusion
In this paper I suggested four pressure points of Rawls’s theory that
open him up to criticism by those who insist that the contributions of the
disabled merit consideration within a political conception of justice. I then
gave three desiderata that any inclusive theory would need to address,
which consisted of an inclusive conception of personhood, a method for
determining objective interests, and an accurate list of primary goods. In
the last half of the paper I gave a positive account of an inclusive Rawlsian
contractualism that builds off both Rawls and Hartley, and which
employed some work by Elizabeth Anderson. While I think critics are
right to insist that there is insufficient treatment of this issue in Rawls’s
work, I disagree that this amounts to abandoning justice as fairness as a
viable candidate for an inclusive theory of justice.
What I have offered is a modification of Rawls that is meant to treat
seriously the self-respect of someone like Andrew and the contributions of
all disabled individuals. I have rejected the idea that we face a dichotomy
between an ineffectual contractualism where everyone is allowed
participation and no overlapping consensus is possible, and a contractualism
that rejects the disabled as a subject of justice and ignores their contributions
to the basic structure of society. This modification notices that disabled
individuals are part of the web of society and so intuitively deserve rights,
recognition, and protections that derive not merely from principles of
charity.
176 Chapter Nine
References
Anderson, Elizabeth. What Is the Point of Equality? Ethics. 109.2 (1999):
287-337.
Brownlee, Kimberly and Adam Cureton (ed.) Disability and
Disadvantage. Oxford: Oxford University Press, 2009.
Comer, Ronald J. Fundamentals of Abnormal Psychology. 3rd ed. New
York: Worth Publishers, 2001. 10-11.
Daniels, Norman. Democratic Equality: Rawls’s Complex Egalitarianism.
The Cambridge Companion to Rawls. Ed. Samuel Freeman. New
York: Cambridge University Press, 2003. 241-276.
—. Equity of Access to Health Care: Some Conceptual and Ethical Issues.
The Milbank Memorial Fund Quarterly. Health and Society. 60.1
(1982): 51-81.
Hartley, Christie. “Disability and Justice.” Philosophy Compass 6.2
(2011): 120-132.
—. Justice for the Disabled: A Contractualist Approach. Journal of Social
Philosophy. 40.1 (2009): 17-36.
Hefling, Kimberly. The San Diego Union-Tribune. Activists seek to curtail
restraining students. Web. 24 March 2012.
Kittay, Eva Feder. At the Margins of Moral Personhood. Ethics. 116.1
(2005): 100-131.
—. When Caring Is Just and Justice Is Caring: Justice and Mental
Retardation. Public Culture. 13.3 (2001): 557-579.National Coalition
for the Homeless. Mental Illness and Homelessness. July 2009. Web. 2
June 2011.
Nussbaum, Martha C. Beyond the Social Contract: Capabilities and Global
Justice. Oxford Development Studies. 32.1 (2004): 3-18.
—. Frontiers of Justice: Disability, Nationality, Species Membership.
Cambridge: Harvard University Press, 2006.
—. Sex and Social Justice. New York: Oxford University Press, 1999.
Rawls, John. A Theory of Justice. Cambridge: Harvard University Press,
1971.
—. Justice as Fairness. Cambridge: Harvard University Press, 2001.
—. Political Liberalism (Expanded Edition). New York: Columbia
University Press, 1993.
—. The Law of Peoples. Cambridge: Harvard University Press,
1999.Sabo, Tracy. “‘Fight club’ set up at school for mentally disabled,
police say.” CNN. 10 March 2009. Web. 2 June 2011.
Who’s Counting? Cognitive Disability and Rawlsian Contractualism 177
KEISHA RAY
Asperger’s Syndrome
Asperger’s syndrome is a cognitive disorder with autistic-like
characteristics, but without significant linguistic or cognitive delays.
Although AS is a form of autism, AS is typically contrasted with autism
based on the typically above normal intellectual abilities. This includes a
typical superb sense of their surroundings, but below normal social skills
possessed by some individuals with AS (Landeweerd, 2011). The below
normal social skills typically associated with individuals with AS include
the inability to empathize with others, act in accordance with commonly-
held rules of social interaction, and appear interested in conversation.
Also, individuals with AS often have very rigid, specific interests
(“Asperger’s Syndrome,” n.d.; Ghaziuddin, 2010; Landeweerd, 2011).
Because individuals with AS often have a high level of intelligence
(Horowitz, 2008), they are often thought to have an advantage that most
individuals without AS do not have. Additionally, they are often thought
to not have a disability or a disadvantageous condition that needs to be
treated. Attesting to this, Baron-Cohen (2000) states that describing AS as
a disability may be an inappropriate description of the syndrome, rather
“difference” may better describe the disability. For funding purposes,
however, Baron-Cohen states that we might want to continue to describe
AS a disability. In further support of Asperger syndrome’s questionable
disability status, Landeweerd (2011) gives a testimony from a mother with
AS who explains the disadvantages AS brings to her social life, yet she
also notes the advantages it has brought to her children. Landeweerd
(2011) also gives a testimony from a graphic designer/photographer with
AS who explains how her “disability” allows her to perform her job better
because it made her a visual thinker, a skill important to her career. As
additional testament to the growing belief that AS is not always a
disadvantageous condition, it has been debated whether AS should not be in
the DSM-V, partly because some believe AS to be no different than high
functioning autism (Ghaziuddin, 2010), an uncontested condition, and
arguably, partly because of the believed advantages it brings individuals
with AS demonstrated by the testimony of the designer/photographer.
Based on the characteristics associated with AS, namely high level of
intellectual abilities, individuals with AS are often thought to be normal or
above normal by at least some explanations of normal. Perhaps because of
the potential career and monetary benefits of superior intellectual ability
and societal values of capitalism and financial security, the intellectual
abilities of individuals with AS often overshadow the social impairments
associated with AS, even though social skills, arguably, are also a societal
How Empirical and Social Explanations of Normal Influence 181
Normal Functioning
Judgments concerning whom health care personnel is and is not
obligated to treat as a part of a system of just health care are often
grounded in an explanation of “normal.” For example, a function of health
care can be viewed as personnel making attempts to maintain individuals’
health and to rid individuals of at least some diseases, conditions, and
ailments. If this is the case then Boorse (1975,1977) gives us one
understanding of justice in health care—treat individuals with a disease, or
individuals that do not meet a predetermined standard of normal. Boorse
utilizes an understanding of “normal” to distinguish “health” from
“disease” in which “health” can be viewed as the body (understood as the
body and any the parts that comprise it) functioning normally, or by
viewing the body as goal-oriented parts, with that goal being to operate
according to their natural or biological function. Health can also be
understood as statistical normality of biological function, whereas
“disease” can be viewed as a deviation from statistical, functional, and/or
biological normality. According to Boorse, theoretically speaking, “health”
182 Chapter Ten
Treatment/Enhancement Distinction
Like philosophers of medicine, political philosophers have also offered
accounts of just health care. For instance luck egalitarianism, a philosophical
position that distinguishes between luck and choice to determine what is a
just distribution of resources, offers an account of just health care. Shlomi
Segall (2010) uses the differences between medical intervention that is
considered treatment and medical intervention that is considered
enhancement to describe one such luck egalitarianism account of just
health care. Treatment can be understood as medical interventions that are
medically necessary and/or medical interventions that are meant to restore
individuals to normal health. Conversely, enhancement can be understood
as medical interventions that are medically unnecessary and/or interventions
that are meant to elevate individuals’ functioning to a level that is beyond
normal. This distinction is commonly referred to as the “treatment/
enhancement distinction” (Colleton, 2008), or T/E as I refer to it.
According to Segall (2010), biomedical intervention should be allowed
and funded by society, regardless of whether intervening would be
considered enhancing normal human functioning. Under this specific
account of luck egalitarian and its application to medical intervention,
medical intervention for enhancement purposes is permissible. I use LE to
represent Segall’s (2010) explanation of the luck egalitarian account of
just health care.
Medical intervention that is considered enhancement is permissible
under LE when health care personnel intervene to ameliorate unwanted
and reasonably unavoidable, disadvantageous conditions that are not
186 Chapter Ten
Treatment/Enhancement Distinction
and Asperger’s Syndrome
A consensus concerning whether AS is a disease would make the
question of whether AS is a concern of health care personnel much easier
to answer within the framework of T/E. Within the framework of T/E, AS
188 Chapter Ten
Conclusion
I have offered common judgments concerning just health care that are
grounded in an explanation of normal. These judgments can be used to
exclude individuals with Asperger’s syndrome from health care by
supporting the viewpoint that these individuals are functioning normally.
To counter this viewpoint I have given ways that individuals with AS can
benefit from health care, and how they may be at a disadvantage because
of AS. Although I used the specific case of individuals with AS, my
argument could easily apply to any member of the neurodiverse
community. Any member of the neurodiverse community whose place
within the wide spectrum of normal and not normal is unclear is subject to
my argument. Any member of the neurodiverse community who does not
neatly and without controversy fit societal, empirical, and/or functional
accounts of what it means to be normal, could potentially be excluded
How Empirical and Social Explanations of Normal Influence 189
from the benefits of health care, even though they could benefit from
mental health therapy.
I give the example of individuals living with AS to give light to the
problems that arise when we use standards of normality to make
judgments about individuals who make it particularly difficult to judge
whether they are normal or not normal. Although we must have some
method of distributing health care’s limited resources, and utilizing
explanations of “normal” is one way to do that, we cannot help but
question the value of “normal” in such judgments if utilizing this concept
has the potential to withhold treatment from members of the neurodiverse
community. I do not claim that we should completely terminate using
judgments concerning just health care that utilize explanations of
“normal;” however, utilizing normal must be weighed against values such
as equality. In the name of other societal values, in some instances we are
required to ensure mental health therapy, despite the guidelines that may
be set forth by explanations of “normal” in cases where individuals can
reasonably be expected to benefit from medical intervention.
References
Asperger’s syndrome. Retrieved June 5, 2012, from http://www.autism-
society.org/about-autism/aspergers-syndrome/
Baron-Cohen, S. (2000). Is Asperger syndrome/high-functioning autism
necessarily a disability?. Development and Psychology, 12(3), 489-
500.
Boorse, C. (1975). On the distinction between disease and illness.
Philosophy & Public Affairs, 5(1), 49-68.
Colleton, L. (2008). The elusive line between enhancement and therapy
and its effects on health care in the U.S. Journal of Evolution and
Technology, 18(1), 70-78.
Daniels, N. (1977). Health as a theoretical concept. Philosophy of Science,
44(4), 542-573.
—. (1981). Health-Care needs and distributive justice. Philosophy &
Public Affairs, 10(2), 146-179.
—. (1984). The Right to a decent minimum of health care. Philosophy &
Public Affairs, 13(2), 55-78.
—. (1985). Just health care. New York: Cambridge University Press.
—. (2000). Normal functioning and the treatment-enhancement
distinction. Cambridge Quarterly of Healthcare Ethics, 9, 309-322.
190 Chapter Ten
FROM NEURODIVERSITY
TO NEUROCOSMOPOLITANISM:
BEYOND MERE ACCEPTANCE
AND INCLUSION
RALPH SAVARESE
Neurodiversity has begun to receive its due. More and more attention
is being paid to the idea of neurological differences as both a natural
reflection of human variation and a complex, if not paradoxical, boon—
what one writer, speaking of bipolar disorder, calls “a gift with a shadow
side” (Antonetta, 2010, p. 73). My own co-edited special issue of Disability
Studies Quarterly, “Autism and the Concept of Neurodiversity,” presents
some forty contributors from different academic disciplines and indeed
occupations, each of whom argues in her own way for the need to
eschew a strictly pathologizing view of autism (E. Savarese & R.J.
Savarese, 2010.) Half of these contributors are on the spectrum
themselves--and not just the so-called “high-functioning” end of the
spectrum—and they include such self-advocate luminaries as Amanda
Baggs, Tito Mukhopadhyay, Ari Ne’eman, Dawn Prince, Scott Robertson,
Tracy Thresher, and Melanie Yergeau.
Two contributors, Amanda Baggs and Dawn Prince, lay out the
conventional diversity argument while also gesturing at what I have come
to call neurocosmopolitanism. At the risk of impeding the further
acceptance of the concept of neurodiversity, I want to suggest some of its
limitations and to put forward this more active, mobile, and participatory
notion. If the shibboleth of diversity has made room in the public sphere
for all manner of formerly marginalized peoples, it has also largely
atomized these groups, allowing them to co-exist anxiously and with
relatively little interaction. At my college, for example, where we
interpret our social justice mission as demanding, among other things, a
192 Chapter Eleven
intellectual disability with her keen sense of argument, Baggs wants the
viewer to appreciate her more natural way of experiencing the world. The
viewer can both hear and see her playing with running water in a sink.
“The water doesn’t symbolize anything,” she explains. “I am just
interacting with the water as it interacts with me” (2007). “Far from being
purposeless,” she adds, “the way that I move is an ongoing response to
what is around me” (2007).
At this point in the YouTube, Baggs explicitly politicizes the
denigration of her kind of thinking: “Ironically, the way that I move when
responding to everything around me is described as ‘being in a world of
my own’ whereas if I interact with a much more limited set of responses
and only react to a much more limited part of my surroundings, people
claim I am ‘opening up to true interaction with the world’” (2007).
Rejecting what Erin Manning calls “the primacy of the verbal” (2009, p.
39) and the narrow engagement it affords, Baggs uses her senses in an
utterly dynamic and yet non-symbolic manner. She “call[s] forth a field of
relation rather than a static, interactive self” (2009, p. 40), a self that
masters such sensation with meaning. “To interact in a self-contained
verbal way,” Manning contends, “would involve parsing [the world’s]
taking-form into a simple activity” (2009, p. 40). Might neurotypicals,
then, Baggs implies, fit the definition of autism: people alone in the world,
unable to interact fully and appropriately with their (nonhuman)
surroundings?
Of course, this more holistic response to the environment puts at risk
the personhood of the autist. For one thing, being so attuned to the
relational field can render linguistic distinction a baffling contrivance and
make the autist seem intellectually disabled. Baggs, argues Manning,
“cannot easily subtract from the hyper-relation of her synesthetic and
cross-modal experience to present herself as a unified verbal self” (2009,
p. 40), and yet she is capable of doing it. She simply resents the privilege
that attends to symbolic thinking and the arduous labor necessary for her
to be regarded as competent. “The thinking of people like me is only taken
seriously if we learn your language,” she remarks. “I find it interesting
that a failure to learn your language is seen as a deficit, but a failure to
learn my language is so natural” (2007). Here Baggs reveals the
completely one-sided nature of cross-cultural or cross-sensorial exchange:
act like the majority, or you won’t be recognized. Come the full way, or
you won’t be judged to have value.
In Finding Amanda (2008), the CNN documentary that Baggs’
YouTube inspired, my son, DJ, can be seen communicating with Baggs
via the internet. DJ speaks of organizing a summit for autistic people so
From Neurodiversity to Neurocosmopolitanism 195
while bedecked, say, with sound jewelry. In fact, Baggs almost seems to
intuit a Bragg-like meeting ground or “halfway” point in symbolic
language.
Nevertheless, she says that “patterns and connections,” which arise
from “the movements of [her] body” and “the smells in the air,” are “more
[her] language than the words that appear on the screen when [she] let[s
her] fingers use the keyboard” (2010). And she shows how autism can act
like a pattern forging accelerant, as differently expressive and communicative
as typical language:
I have a body language that some others—usually autistic people—can
under-stand. I have the way I interact with things around me at a particular
time,compared to how I usually interact with them. I have ways of
arranging objects and actions that give clues about where my interest is
directed and in what manner. I can tap out rhythms in general or those of
my favorite numbers (I really like the rhythm of seven, for example.). I
can speak Feline about as well as anyone with my limited human senses
(2010).
oneself means being at home with all manner of organisms and entities,
for identity is always mixed, fluid, and permeable.
It is precisely her feeling of “extreme connection” (Savarese, R.J.,
2010), to borrow Tito Mukhopadhyay’s phrase, the force of her
synesthetic understanding, that allows Prince to communicate with the
non-human world in what she calls “the language of silence”:
When I was young I talked to animals in that language of silence. I knew
what trees and streams were saying because they told me. I knew what
sow bugs were saying because they molded me. I grew together with them
because of the words of living together in a world where everything needed
everything else. Sometimes my grandfather would ask me in the garden,
“What are the worms saying today?” “Fine fine slither dirt push good
rotting green,” I would answer smiling (2010b).
Here again, the alternative language conceit strives to give voice to the
voiceless, if only to undermine the privileged status that neurotypical
humans grant themselves. Unfortunately, this happy, animistic time didn’t
last because Prince was compelled to use language more conventionally--
as a “weapon…that cut up the world [and] also cut groups of people one
from another” (2010b). In this way, “autism” became a term denoting
pathological otherness and deficiency, not relational wholeness.
As Prince relates in Songs of a Gorilla Nation (2010c), she found
herself increasingly alienated from neurotypical society, even becoming
homeless for a while. Only by interacting with gorillas at the zoo, by
mimicking their behavior and language, was she able to reaffirm her
difference and eventually to return to college and even to embark on a
Ph.D. in anthropology. One day, while in graduate school, she flew down
to Decatur, Georgia to meet Kanzi, a Bonobo chimpanzee famous for his
acquisition of human language through keyboard lexigrams and whom
Prince calls a “captive born man” to stress the way that neurotypicals
enforce a rigid and condescending distinction between our species and
other animals. “Naturally, I fell into the gorilla language I knew,” she
reports in “The Silence Between” (2010b). After she had developed a
relationship with Kanzi by “play[ing] chase up and down the fence line,
both of [them] on all fours, smiling in a sea of breath” (2010b), he pointed
to the word “gorilla” on his word board and then made the American Sign
Language sign for “question,” though he himself had only seen a video of
a gorilla using ASL. Because Kanzi hadn’t seen any other gorillas, he
assumed that all gorillas communicated in this fashion. “Are you a
gorilla?” he was asking.
“There were so many miracles of language in that one interaction,”
Prince explains, “that I didn’t know where to start writing about it within
From Neurodiversity to Neurocosmopolitanism 199
the rules: I couldn’t build on other people’s ideas. I couldn’t cite previous
research, I couldn’t capture what had happened in terse and distant
language. Even the subject itself was taboo as ‘anthropomorphism’”
(2010b). This sort of “halfway” moment seems to mock the categorical
division upon which conventional language is based, to say nothing of the
tradition of disinterested investigation. If a bonobo chimpanzee can call an
autistic woman a gorilla, why can’t an autistic woman call the bathroom a
hippopatamus? Kanzi’s act of species misrecognition—one might even
say of species neurocosmopolitanism--inspires Prince to imagine a larger
community of the unrecognized and disregarded:
All of these creatures the normal world imagines silent. The autistic child,
the ape in the zoo or in the laboratory, the homeless, dogs in cages.
Thinking their silence means they lack language, lack consciousness, is
convenient. We are starting to speak the language of the masses, though,
and the time of silence without meaning is coming to a close…. A
language of the masses larger than us--the world as it warms, the ground as
it’s choked with trash, the animals saying goodbye—is either having the
last word or the first. It depends on our conception of language (2010b).
else that matters” (2010). Echoing Nancy Frazer, she calls for a “parity of
participation,” and we certainly see that in Mottron’s lab.
In his essay “Communicate with Me,” my son declares, The time has
come…to get ready for college, so I am here to ask you to help me. What
can you do to help me? The answer is to communicate with me. Boldly
reach out to me, and together we will goldenly share our views of the
world we long to greet (2010).
References
Antonetta, S. (2010). Dis. Seneca Review, 39-40 (2-1), 68-74.
Baggs, A. (2007). In my language. Retrieved October 8, 2012 from
http://www.youtube.com/watch?v=JnylM1hI2jc
—. (2010). Up in the clouds and down in the valley: my richness and
yours. Disability Studies Quarterly, 30 (1). Retrieved October 8, 2012
from http://dsq-sds.org/issue/view/43
Bragg, B. (1989). Lessons in laughter. Washington, D.C.: Gallaudet
U.P.Finding amanda. (2007). Anderson cooper 360. CNN. Television.
Gilroy, P. (2006). Postcolonial melancholia. New York: Columbia U.P.
Manning, E. (2009). What if it didn’t all begin and end with containment?
Toward a leakysense of self. Body & Society, 15 (3), 33-45.
Park, M. (2010). Beyond calculus: apple-apple-apple-ike and other
embodied pleasures for A child diagnosed with autism in a sensory
integration based clinic. Disability Studies Quarterly, 30 (1). Retrieved
October 8, 2012 from http://dsq-sds.org/issue/view/43
Prince. D. (2010a). My grave and the last sideshow tent. Seneca Review,
39-40 (2-1), 47-63.
—. (1995). Songs of the gorilla nation: my journey through autism. New
York: Three Rivers Press.
—. (2010b). The silence between: an autoethnographic examination of the
language prejudice and its impact on the assessment of autistic and
animal intelligence. Disability Studies Quarterly, 30 (1). Retrieved
October 8, 2012 from http://dsq-sds.org/issue/view/43
Ramazani, J. (2001). The hybrid muse: postcolonial poetry in English.
Chicago: University of Chicago U.P.
Savarese, D.J. (2010). Communicate with me. Disability Studies
Quarterly, 30 (1). Retrieved October 8, 2012 from
http://dsq-sds.org/issue/view/43
From Neurodiversity to Neurocosmopolitanism 205
WILLIAM SIMKULET
Personhood
Autism is a neurological condition characterized by atypical social
interaction and communication skills, as well as repetitive behavior and
Neurodiversity and Personhood 207
beliefs. A human being lacking any of these traits would have a hard time
navigating and flourishing in her world.
Rather than approach the concept of personhood from arbitrary
biological or psychological terms, I think the best way to understand
persons is in moral terms - persons are moral agents. Moral agents can be
said to have the right to life; meaning that all else being equal, it is morally
wrong to kill innocent moral agents. 1 To be a moral agent is to be the sort
of thing that can be truly morally responsible for one's actions. To be truly
morally responsible for one's actions requires that one is the nonarbitrary
source of one's actions; such that it makes sense to trace the goodness or
badness of one's actions back to the agent herself and no farther. Beings
that lack this are not in an enviable position, and to deprive one of such
freedom is amongst the greatest harms that can be done. For the remainder
of this chapter, I use the term "personhood" to pick out all and only the
things that can be appropriately held morally responsible for their actions.
By this, I do not mean to say that only persons have value, or that it is
morally acceptable to ignore the wellbeing of nonpersons.
The control principle, a foundational moral principle, states that one
cannot be morally responsible for something that is outside of one's
control. Assuming the truth of the control principle, personhood requires
free will, or the ability to choose one's actions from a list of possible
alternatives - it is to have the ability to choose either to do the right thing,
or to do the wrong thing. Moral agency, or personhood, of this kind is a
prerequisite for moral praiseworthiness. To be a full moral agent one must
be able to choose one's actions for reasons - to act for good reasons is to be
praiseworthy, to act for bad reasons is to be blameworthy. Beings who
lack the ability to differentiate good reasons from bad reasons cannot be
held fully morally responsible for their actions - for example children, the
ignorant, and human beings with various severe mental disorders often
lack the ability or experience to judge their actions, and are thus not
responsible for their actions in the same way a well informed adult moral
agent would be.
Children generally lack the psychological characteristics and knowledge
to be either responsible moral agents or fully morally responsible for their
actions. It is possible that there are some adult autistic human beings that
might similarly lack complete moral personhood of this kind, either as a
result of unsatisfactory education, or because some neurological processes
associated with autism might act as an impediment towards the informed
exercise of free will.
Moral agency is a necessary, but not sufficient, condition to live a
good, praiseworthy life. To be deprived of full personhood is a substantial
Neurodiversity and Personhood 209
moral harm - arguably one of the worst possible harms that can befall a
human being. If, in some cases, autism prevents full personhood, then
autism in those cases causes a substantial moral harm to the individual. In
such cases, there would be a strong moral reason to provide drug X to the
autistic individual. For these individuals, drug X would, by stipulation,
cure them of the neurological impediments to full moral personhood. It is
worth noting that drug X, also by stipulation, does not discriminate
between good and bad aspects of autism, and may end up taking valuable
neurological processes away to be replaced with their lesser neurotypical
counterparts. If taking drug X is a morally acceptable treatment in this
cases, it is so in the same way amputation is a treatment to stop the spread
of gangrene - by taking the good with the bad.
Quality of Life
In the previous section, I argued that if atypical neurological processes
prevent an autistic individual from developing as a moral agent, it is one of
the greatest moral harms that can befall them because they can never be
truly morally praiseworthy for their good deeds. However, surely the vast
majority of autistic individuals aren't in such a position. What reason do
these persons have for considering drug X?
One of the most notable conditions associated with autism is the
difficulty many autistic persons have communicating with their neurotypical
peers. Compare this with other, neurotypical groups such as the mute and
deaf communities. Although these conditions do not undermine the moral
worth of persons, it does have a noticeable, often negative impact on their
quality of life. There is good reason to think that those who have trouble
communicating with others miss out on a significant number of goods that
come from interacting with other persons.
Set aside for the moment the personal goods that come from relatively
effortless verbal communication; being nonverbal serves as a substantial
impediment in one's professional life. Even in a nonbiased society, there
would be fewer quality professions open to nonverbal autistic persons than
their verbal peers. Many contemporary jobs for nonverbal autistic persons
are low paying jobs, such as reshelving library books, factory assembly
work, janitorial and cleaning jobs, restocking shelves, and data entry
(Grandin, 1999). However, even in these professions, nonverbal autistic
individuals face steep competition from their verbal peers who can
communicate with coworkers with less impediments.
Another concern facing autistic persons across the board are higher
than average medical costs.2 Even assuming no neurological bias and
210 Chapter Twelve
Consent
In the previous sections we've seen that in some cases, some aspects of
autism might constitute serious harms and some less serious harms. In the
second section, I argued that autistic persons ought to have the same right
to self-determination as any person, including the right to expand or limit
their opportunities as they see fit. In this section, I seek to address whether
parents and guardians exert similar rights over those autistic individuals
they are charged with who cannot give their own informed consent. To
that end, it is important to distinguish between two categories of autistic
individuals - first, those judged to be incapable of achieving personhood
without intervention, and second those who are expected to achieve full
personhood at some point in the future without intervention.
In the first section, I argued personhood is a necessary condition to live
a morally praiseworthy life. In light of this, informed legal guardians who
are taking care of autistic individuals of the first kind, those whose autism
stands between them and full moral personhood, have a prima facie strong
moral obligation to consent to treating their charges with drug X if
available. Cases where informed legal guardians fail to do so would seem
to constitute abuse; analogous to parents of coma patient victims refusing
treatment that is expected to awake their charges from their coma.
In cases where both X and X* are available, the anti-cure movement
might advocate choosing X* over X. If X* would liberate an autistic
individual to develop full personhood, assuming no negative side effects
associated with X* and that X would still be available to said person in the
future, there is reason to believe X* is a morally acceptable alternative to
X - at the very least, it is a conservative alternative. When no such
treatment is available, guardians of these autistic individuals have a moral
obligation to seek one out.
Often there are substantial risks involved with medical treatments,
especially treatments of the kind in question. Suppose there was no X or
X* available, but instead there was an experimental drug XX which
medical professionals have shown has a small chance of facilitating full
personhood to autistic non-persons, but that has dangerous, often fatal,
side effects. Would it be morally acceptable for guardians to give XX to
those they take care of? Because moral agency is such an instrumental
and intrinsic good, it seems guardians would not only be allowed to give
this drug, but obligated to do so.5 To not provide such treatment is to deny
Neurodiversity and Personhood 213
An Anti-Cure Response
In some cases, some aspects of autism may constitute serious harms to
autistic individuals. I have argued that autistic persons have the right to
pursue treatment for autism if so desired, and that they may have good
reason to do so. I have also argued that we have a moral obligation to
confer personhood on autistic nonpersons if possible, as personhood is a
prerequisite for moral praiseworthiness. Finally, I have argued that
guardians of autistic individuals have a moral obligation to pursue the
treatment they believe is in the best interest of those they are charged with
taking care of, and in many, but not all cases, this may constitute treatment
of autism. This has all been built on an assumption - that an autistic
human being is the same person prior to treatment that they would be post
treatment. Jim Sinclair challenges this notion, contending that autism is
inseparable from the individual (Sinclair, 1993). According to Sinclair, to
wish that an autistic person is cured just is to wish that person disappeared
and another, completely different person existed in her place.
There is an ambiguity in Sinclair's claim - the same sort of ambiguity
that faces anyone attempting to articulate a theory of personal identity over
time. The overwhelming commonsense moral intuition is that in the
majority of cases, the person you are now is numerically identical to the
person you were 5 minutes ago, the person you were as a child, and the
person you will be 5 minutes or 5 years from now (if all goes well).
Assuming this, personal identity survives substantial neurological change -
it survives even the change from non-person to person. Our childhood
selves had a radically different neurology and understanding of the world
than we do, yet we believe, in all relevant respects, that we are the same
person we once were. If this is true, personal identity survives such
changes.
There are exceptions to this commonsense notion of personal identity -
one person may become a separate, numerically distinct person by a
number of extreme, atypical, changes to their neurological composition -
for example, it is sometimes said that an amnesiac might be a different
person than they were before they lost their memory. When one's cerebral
hemispheres are separated, arguably one person has become two separate
persons, neither of which is numerically identical to who they were before.
Similarly, the destruction of a large portion of one's mind might constitute
the creation of a new person. There is, at least, a passing similarity
between these kinds of radical, often artificial or atypical, changes to one's
mind and the change drug X is stipulated to have in autistic individuals.
Neurodiversity and Personhood 215
The primary problem with Sinclair's position is that it rests upon the
assumption that we are who we are because of our composite neurology -
rob us of a piece of what makes us tick, and you have a different watch.
But this is a mistake - our commonsense intuition is that we were the same
people we were as kids, even though we have grown up, changed our
priorities and adopted both radically different beliefs and radically
different ways of viewing the world than we had as children. If autism is
to be understood as a set of neurological traits, it seems plausible that
identity persists through the removal and replacement of these traits by
drug X just as it would by the removal or replacement of any number of
other neurological traits that come and go as we develop. This is to say
that there is no reason to think that our personal identity is disproportionately
related to those particular neurological traits than any other neurological
traits. For Sinclair's assertion to be taken seriously would require that
autism not simply be understood as a small set of traits, but a substantial
percentage of an autistic human's neurology - to rob such a human of
autism, then, would be akin to ripping out a hemisphere of their mind.
This, I think, is a mistake - an autistic person is more than just autism with
a little bit of extra neurotypical bits dangling; they are a person with a
certain set of neurological traits. One can take pride in these traits, just as
one might take pride in any number of other traits, abilities, or beliefs one
has, without being defined by them.
Conclusion
The neurodiversity movement is an important one - many human
beings with autism are uncontroversially full moral agents living robust
lives full of goods. To discriminate against such persons solely because
they are not neurotypical is arbitrary and immoral. That said, there are
many traits associated with autism that may make one's life significantly
worse off than if one did not have these traits. These liberty-sapping traits
are like any other liberty-sapping trait - things to be cast aside if the price
is worth paying. I've argued that in cases where autism delays or denies
personhood, it is standing in the way of a good life and should be removed
if possible, and I've argued autistic moral agents have the right to pursue
the removal of their autism, and that in some cases they may have good
reason to do so. Furthermore, I've argued that legal guardians of autistic
persons and non-persons have a moral obligation to do what they believe
is in the best interest of those they are responsible for.
216 Chapter Twelve
References
American Psychiatric Association, Diagnostic and Statistical Manual of
Mental Disorders, 4th, text revision (DSM-IV-TR) ed. 2000. ISBN 0-
89042-025-4, accessed 2-12-2012
http://www.cdc.gov/ncbddd/autism/hcp-dsm.html
Grandin, Temple, 1999, Choosing the Right Job for People with Autism or
Asperger's Syndrome, accessed 2-18-2012,
http://www.autism.com/ind_choosing_job.asp
Jaarsma, Pier; Welin, Stellan, 2011, "Autism as a Natural Human
Variation: Reflections on the Claims of the Neurodiversity Movement,"
Health Care Anal, accessed 2-17-2012
http://www.imh.liu.se/avd_halsa_samhalle/filarkiv1/1.264263/Jaarsma
Welin2011Autismasanaturalvariation.pdf
Marquis, Don, 1989, “Why Abortion is Immoral,” The Journal of
Philosophy, Vol. 86, No. 4 (Apr., 1989), pp. 183-202
Sinclair, Jim (1993). "Don't mourn for us," The Edmonds Institute,
retrieved 2007-11-07,
http://en.wikipedia.org/wiki/Autism_rights_movement, originally:
http://www.edmonds-institute.org/dontmour.html
Solomon, Andrew, 2008-05-25, "The Autism Rights Movement," New
York, accessed 2-12-2012 http://nymag.com/news/features/47225/
Woodford, Gillian, 2006, "'We Don't Need to be Cured' Autistics Say,"
National Review of Medicine, Volume 3. No. 8., accessed 2-17-2012
http://www.nationalreviewofmedicine.com/issue/2006/04_30/3_patient
s_practice05_8.html
CHAPTER THIRTEEN
ERICK RAMIREZ
how we think about the nature of moral reasons and moral motivation.
Some philosophers argue that psychopaths are capable of understanding
moral norms without feeling motivated to act upon them and that this tells
us something important about the nature of moral reasons.3 Furthermore,
because psychopathic agency combines the paradoxical capacities of
pragmatic rationality and moral incompetence it poses a challenge to
theories of moral responsibility. While psychopaths are capable of causing
immense suffering to others and of violating our trust, psychopathic
agency leaves moral reasons outside of what Cleckley called their “orbit of
awareness” (Cleckley 1941/1988, 40). For these reasons, psychopaths are
said to suffer from moral blindness. Philosophers disagree on whether this
moral blindness exempts them from responsibility for their bad behavior.
In this section I map the contours of the traditional debate over moral
responsibility. I pay special attention to views that give pride of place to
moral emotions; I then show why adherents of these theories claim that
psychopaths cannot be held accountable for their actions. I conclude by
offering an alternative to this view. I argue that psychopaths are open to
several forms of normative address despite their lack of moral
responsibility. These forms of address are based on what psychopathic
choices express, the kinds of attitudes psychopathic harms evoke, and
ultimately the forms of punishment psychopathic actions merit.
R(A): A person is the proper source of their action if and only if they
are an apt target for reactive emotions in a general sense.
R(x): A person is morally responsible for a specific action, x if and
only if they are an apt target for the reactive attitudes generally and it is
appropriate to respond to the agent reactively in virtue of his or her x-ing.
action. When you rightly resent me for having stepped on your toes
maliciously you do so because of my malicious intent. This is why
resentment is not be appropriate when I step on your toes to save you from
the spider. It is in this sense that reactive attitudes focus on the quality of a
person's will. Call this the quality of will thesis. We can define excuses
and exemptions by their effects on our reactive attitudes. When a person
has a legitimate excuse it is inappropriate for us to continue expressing
negative reactive attitudes toward them. An excuse shows us that we were
mistaken about the quality of a person's will (Wallace 1994, 136-147). If
you knock me over I might resent you until I learn that you pushed me out
of the way of falling debris. If made aware of this, I might instead feel
gratitude but should find it inappropriate to continue resenting you.
Excuses inform us that we were mistaken about what action was done.
Excuses do not cast doubt on a person's ability to be an agent, their
attributability, but instead inform us that we were wrong about what action
we attributed to them. Excuses are singular events. Particular actions are
excused. If you have a global excuse then you are exempt from
responsibility.
Exemptions cause us to question whether a person meets the
attributability requirement. Imagine again that I get knocked over except
now I learn that the person who knocked me over suffers from significant
and persistent psychotic delusions that lead her to believe that she is at
constant risk of alien abduction and that I was an alien. Unlike excuses, a
person whose agency is hampered by delusions as severe as these is not a
proper target for our reactive attitudes at all. Agency as abnormal as this is
exempt from judgments of attributability and accountability. Exempt
agents are not the true source of their actions because exempt agents lack
the ability to regulate their behavior in an intelligibly rational way
(Wallace 1994, 166-180).
The logic of excuses and exemptions implies that responsible agency
requires at minimum the ability to perceive moral reasons and the ability
to understand how these reasons function. Furthermore, many believe that
an agent must have the opportunity to avoid wrongdoing as a result of his
or her agency in order to satisfy the attributability requirement (Shoemaker
2011, 6). Psychopaths, because they seem both rational and morally
incompetent, cut across these traditional distinctions. They possess some
but arguably not all of the necessary qualities for full moral agency.
Psychopathy, Moral Reasons, and Responsibility 229
whether psychopaths are morally responsible for their choices given what
we know about psychopathic agency.
If moral responsibility requires the capacity to understand moral
reasons as distinctly moral and this is grounded on a further capacity to
empathize with others, then psychopaths cannot understand moral reasons.
This lack of understanding is shown by their performance on
distinguishing between moral and conventional norms. For some, this is
enough to exempt psychopaths from responsibility: “[c]ertain psychopaths
...are not capable of recognizing...that there are moral reasons...this sort of
individual is not appropriately receptive to reasons, on our account, and
thus is not a morally responsible agent” (Fischer and Ravizza 1998, 79).
Further, if the reactive attitudes germane to accountability are sensitive to
the quality of an agent's will, then psychopathic agents cannot express
immoral wills because they do not understand morality. This deficiency
affects the degree of control they have over their choices because “[w]hat
makes it appropriate to exempt the psychopath from accountability...is the
fact that psychopathy...disables an agent's capacities for reflective self
control” (Wallace 1994, 178).
A number of philosophers argue that this analysis of psychopaths and
reactive attitudes is incomplete. We are better served, they argue, by
appreciating the full scope of reactive attitudes and how these attitudes
correspond with the kind of will psychopaths can express with their
actions (Greenspan 2003; Talbert 2008; Talbert 2012). This highlights an
important sense in which some reactive attitudes are appropriate to direct
at the psychopath. These attitudes respond to the lack of care psychopaths
express about human worth when they cause us harm. Successful
psychopaths prove that psychopaths, even if not capable of understanding
moral reasons, are capable of conforming their behavior to moral norms.
Insofar as psychopaths have this capacity, they are appropriate targets for a
wide array of non-moral reactive attitudes (and hence accountable).
To see how these views work, we must more carefully describe
psychopathic judgments. Although psychopaths are not capable of moral
judgments, they are capable of making judgments about value and about
the kind of standing their victims have to them. We know that psychopaths
do not suffer from practical irrationality. They are quite good at means-end
reasoning. Successful psychopaths understand what reasons are, how
reasons work, and how to weigh reasons against each another to achieve
their desired ends. When a psychopath judges that it is permissible to
assault me in order to steal my wallet, we can attribute to the psychopath
the judgment that 'there is nothing about my status or standing that
232 Chapter Thirteen
that she believes that no sufficient reasons speak against working on that
day. Members of her community could hold the atheist accountable for her
decision to flout divine reasons despite her inability to understand or
appreciate them. Although it would be unfair to damn the atheist (i.e. to
religiously condemn her) because she lacks the right kind of access to the
concept of damnation, it may be appropriate for members of her
community to express contempt toward her, a non-religious attitude, given
the kinds of values her judgments express.6
The same holds for the psychopath. Psychopaths satisfy the
attributability requirement in virtue of their practical rationality. They can
deliberate about what to do and modify their desires in the light of reasons.
However, their inability to fully understand moral reasons disqualifies
them from moral accountability. This fact does not imply that psychopaths
are free from all forms of accountability. Psychopathic judgments can
express values that we find contemptible, hateful, spiteful, or disgusting.
In many cases it would be appropriate to express these attitudes at
psychopaths because the attitudes would be appropriate given the values
expressed by their judgments. In doing so we hold them accountable
despite the fact that it would not be appropriate to hold them morally
accountable via attitudes like resentment or indignation. When a
psychopath judges that nothing speaks against repeatedly lying to or
manipulating others we can justifiably direct reactive attitudes at the
psychopath because of the quality of will these actions express. Reactive
attitude theorists are correct that psychopaths cannot fairly be held morally
responsible but moral accountability does not exhaust the forms of reactive
accountability available to us.
Conclusion
Psychopathy is a controversial and complicated phenomenon. Well
before psychopathy became clinically sharpened as a diagnosis in the 20th
and 21st centuries, moral philosophers worried about how best to handle
people who frequently violated moral norms and who were devoid of guilt
and shame. These questions remain relevant today. Although psychopaths
lack an understanding of moral emotions, they seem to be rational agents.
Successful psychopaths are especially good at understanding reasons and
use this understanding to manipulate others. Successful psychopaths have
been identified working in managerial positions in corporations, (Babiak,
Neumann, and Hare 2010) as practicing lawyers, and even psychology
students (Mullins-Sweat, Glover, Derefinko, Miller, and Widiger 2010).
Successful psychopaths make clear that the affective deficits characteristic
234 Chapter Thirteen
References
American Psychiatric Association. (2000). Diagnostic and statistical
Manual of Mental Disorders 4th ed., text revision. Washington, DC
Babiak P., Neumann C., and Hare R.D. (2010). Corporate Psychopathy:
Talking the Walk. Behavioral Sciences and the Law Vol. 28, 2, 174-
193.
Barbaree, H. (2005). Psychopathy, Treatment Behavior, and Recidivism:
An Extended Follow-Up of Seto and Barbaree Journal of Interpersonal
Violence Vol. 20, 1115-1131.
Blair R.J. (1995). A Cognitive Developmental Approach to Morality:
Investigating the Psychopath. Cognition, Vol. 57, 1-29.
Brink, D. O. (1997). Moral Motivation. Ethics Vol. 108, 1, 4-32.
Cleckley, H. (1941/1988). The Mask of Sanity: An Attempt to Clarify
Some Issues About the So-Called Psychopathic Personality. 5th ed.,
scanned facsimile produced for non-profit educational use.
Clotilde-Penteado, Morana H., Arboleda-Florez, J., and Portela Camara, F.
(2005). Identifying the cutoff score for the PCL-R scale (psychopathy
checklist-revised) in a Brazilian forensic population. Forensic Science
International Vol. 147, 1–8.
DeMateo, D., Heilburn, K., and Marczyk, G. (2006). An Empirical
Investigation of Psychopathy in a Noninstitutionalized and Noncriminal
Sample. Behavioral Sciences and the Law Vol. 24, 133–146
Dolan, M.C., Fullam, R.S. (2010) Moral/conventional Transgression
Distinction and Psychopathy in Conduct Disordered Adolescent
Offenders. Personality and Individual Differences, Vol. 49, 995–1000
Edens, J.F., Lilienfeld, S.O., Marcus, D.K., Poythress, N.G. (2006).
Psychopath, Not Psychopath: Taxometric Evidence for the Dimensional
Psychopathy, Moral Reasons, and Responsibility 235
MARA BOLLARD
Introduction
In recent years, psychopaths have been of special interest to moral
philosophers. Psychopaths are famously amoral, so some theorists have
thought that an examination of their peculiar deficiencies might shed light
on the capacities that are required for moral agency. More specifically,
theorists have looked to empirical findings about psychopaths to help
determine whether moral agency is underwritten by reason, or by affective
sentiments.1 With respect to the latter possibility, empathy is often taken
as the primary focus, something that isn’t all that surprising in light of the
commonsense appeal of the idea that empathy matters a great deal to
morality (Roskies, 2011).2 Given that one of psychopaths’ most glaring
deficits is a lack of empathy, they seem perfectly suited as a test case for
the hypothesis that empathy is necessary for moral agency.
However, psychopaths are not the only group of philosophical interest
when it comes to empathy: people with autism also lack empathy, so it is
reasonable to think that any empirically-informed attempt to answer the
question of whether empathy is necessary for moral agency should give
due attention to findings from autism as well as from psychopathy.
Jeanette Kennett’s thought-provoking paper, ‘Autism, Empathy and Moral
Agency’ (2002), which analyses the respective moral statuses of
psychopaths and autistic people, is the first and arguably the most notable
example of such an attempt. As such, this chapter will take Kennett’s
paper as its focus in an effort to further elucidate the role of empathy in
moral agency.
In brief, Kennett’s argument runs as follows: She begins with the claim
that psychopaths are amoral, and that a common and plausible explanation
as to why this is so is that psychopaths lack empathy. However, autistics,
Psychopathy, Autism and Questions of Moral Agency 239
like psychopaths, lack empathy, yet, unlike psychopaths, they are not
amoral. As such, a lack of empathy cannot explain psychopaths’
amoralism. In order to account for the differing moral statuses of the
groups, Kennett argues that autistic people possess a certain ‘reverence for
reason’ that enables them to become capable moral agents. Psychopaths
lack this rational capacity, and it is this defect, not the empathic one, that
explains why they are amoral. Kennett therefore concludes that empathy is
not necessary for moral agency. Rather, she holds that ‘reverence for
reason’ is sufficient.
In this chapter, I argue that Kennett’s argument is untenable. First, I
review the empirical evidence in order to demonstrate that there is a
component of empathy called affective empathy that is impaired in
psychopaths but largely preserved in autistics. As such, the claim that
psychopaths and autistics share a common lack of empathy is unjustified.
Second, I challenge Kennett’s claim that empathy plays no role in
explaining the moral difference between psychopaths and autistics.
Instead, I contend that the intact affective empathy of autistic people is a
crucial component of their capacity to act out of reverence for reason.
Background
The Traditional Form of the Debate: Hume versus Kant
Kennett’s argument is best understood in the context of the long-
running debate between sentimentalists and rationalists. In this debate,
“the relation between reason, emotion, moral judgment, and behavior is an
old and contested one, with paradigm and opposing positions associated
with Hume on one side and Kant on the other” (McGeer, 2008). According
to Hume (and proponents of sentimentalism in general), “sympathy alone
can be the foundation of morals” (Hume, 1777): that is, that to be a moral
agent is to possess the capacity for sympathy (where sympathy
corresponds to what we currently call ‘empathy’). Conversely, for Kant
(and rationalists in general), to be moral is just the same as being rational.
Kant argued that the requirements of morality are based upon a supreme
rational principle known as the categorical imperative (Kant, 1785). To
qualify as a moral agent is to obey the categorical imperative, which, in its
first formulation, is to “act only in accordance with that maxim through
which you can at the same time will that it become a universal law” (421).
In other words, agents must act for reasons of a type that they would
regard as valid for anyone else in similar circumstances. Agents are
capable of acting in accordance with the categorical imperative only
240 Chapter Fourteen
age. They are impulsive, irresponsible, and have a constant need for
excitement. They also tend to live parasitic lifestyles and are sexually
promiscuous. Further, they are unable to set or stick to realistic goals for
themselves or to consider the possible consequences of their actions,
which can lead to self-destructive behavior.
Defining Empathy
It is often claimed that our present understanding of empathy derives
from Hume’s concept of sympathy. Hume thought that sympathy – the
capacity to receive and respond to the sentiments of others – was a
sentiment available to and experienced by all people, albeit in varying
degrees. A generally accepted modern definition says that empathy refers
to the emotional or affective reaction of a given subject in response to the
expressive behavior of others (Davis, 1994). However, empathy is a
notoriously tricky concept, the study of which has often been attended by
definitional disagreement. As Nancy Eisenberg and Janet Strayer write,
“the notion of empathy is, and always has been, a broad, somewhat
slippery concept” (Eisenberg and Strayer, 1987, 3). With this in mind, it’s
not surprising that not all definitions of empathy in the literature are
compatible.
Some researchers emphasise that empathy is a cognitive process,
whereas others take it to be a primarily affective process. Cognitive
empathy may be thought of as the ability to adopt another’s perspective
and to infer or imagine her thoughts, feelings or intentions. It is often
referred to as “mentalizing” or “simulation” (Hoffman, 2000, 29). On the
other hand, affective empathy is the experience of an emotional response
upon perceiving another’s emotion or attending to her situation (30). The
emotional response need not be an exact match with what the target person
is experiencing, but it does need to be congruent with, or appropriate to,
the other person’s emotional state or situation. For example, take the
Psychopathy, Autism and Questions of Moral Agency 243
Differing Deficits
Thus far, we have seen that Kennett’s conception of empathy lines up
with a view that is broadly agreed upon in the literature insofar as she
thinks that empathy consists in a cognitive and an affective component.
However, in stating that the emotional response stems from simulation,
Kennett is claiming that cognitive empathy is a necessary precursor to
affective empathy. This is contentious. Although cognitive and affective
empathy may sometimes interact, the presence of one need not necessarily
imply the other. As such, it is reasonable to think that different types of
244 Chapter Fourteen
above) also lends support to this point. Though the autistic group struggled
to infer the mental states of the individuals in the photographs, when they
were given feedback about the correct answer – i.e. when the emotional
information about the people in the photos was made salient – they
exhibited emotional reactions in response to the pictures that were on par
with (normal) responses shown by controls [35].
So, it seems that, as long as the emotional expression of others is
obvious enough, autistic people display an appropriate emotional response
to others. This is evidenced by Sacks’ description of a conversation he had
with Grandin during which he told her about a young man with Tourette’s
syndrome who, afflicted by violent tics, gouged out his own eyes.
According to Sacks, Grandin was deeply affected by the story. Sacks
writes that, when it came to “expressions of raw impulse, violence, pain,
she perceived [and] reacted to them straight away” [36]. In a similar vein,
Margaret Dewey says,
“In cases where the pain and suffering of other people is spelled out clearly
– as in the headline, “children are dying from hunger” – the autistic person
can show as much deep concern as any other caring and sensitive person”
[37].
Which Reverence?
For Kant, ‘reverence for reason’ means respect for the moral law. To
have reverence for reason is to act in accordance with the moral law for
the sake of the moral law; in other words, to act from duty [50]. To say
that an agent acts from duty is to say that he acts because he thinks he is
morally required to act. Only actions that are performed from duty can be
said to be morally worthy. Also, for Kant ‘practical reason’ is the process
by which an agent works out, prospectively, how he ought, morally, to act
[51].
Like Kant, Kennett explicitly equates reverence for reason with duty,
describing “reverence for reason – or duty – [as] the core moral motive”
[52]. More specifically, she says that the preserved moral sensibility of
autistics can be explained by their ability to “develop or discover moral
rules and principles of conduct for themselves by reasoning” [53]. I think
we can plausibly take the latter claim to mean that autistics engage in
practical reasoning in order to work out the rules, or maxims, that they
ought to act on. Rules are of great value to autistics because establishing
and following rules is a means by which they can find their way through a
confusing social landscape [54]. As a result, autistic people are highly
motivated to follow rules and are concerned that others do so too. Given
that moral rules are seen as a fundamental feature of Kantian ethics [55],
either in the form of the categorical imperative or as rules of duty that
result from subjecting one’s specific maxims to the categorical imperative,
it is understandable why Kennett identifies autistics’ concern with rules
and routines as evidence that their moral sensibilities look Kantian rather
than Humean.
“[Grandin] had built up a vast library of experiences over the years… they
were like a library of videotapes which she could play in her mind and
inspect at any time – ‘videos’ of how people behaved in different
circumstances. She would play these over and over again and learn, by
degrees, to correlate what she saw, so that she could then predict how
people in similar circumstances might act” [56].
common lack of empathy, and the subsequent claim that autistic people
display intact affective empathy, I think that we have found a way by
which we can legitimately incorporate affective empathy into a Kantian
framework. In what follows, I aim to show that it is possible to view
affective empathy as an important source of information that helps agents
to act out of reverence for reason. I also briefly discuss the implications of
this interpretation for our assessments of the moral statuses of psychopaths
and autistic people.
us, and to make use of them as so many means to sympathy based on moral
principles and the feeling appropriate to them. – It is therefore a duty not to
avoid the places where the poor who lack the most basic necessities are to
be found but rather to seek them out, and not to shun sickrooms or debtors’
prisons and so forth in order to avoid sharing painful feelings one may not
be able to resist. For this is still one of the impulses that nature has
implanted in us to do what the representation of duty alone might not
accomplish” [64].
From this, it can be seen that Kant considers affective empathy – here
described as the emotional response one has to others’ suffering – as one
of the natural endowments that we are morally required to cultivate [65].
In doing so, we increase our receptiveness to the concept of duty, thereby
increasing the number of actions we perform from duty, and making
ourselves into morally better agents.
Conclusion
In this chapter, I examined Jeanette Kennett’s compelling paper,
‘Autism, Empathy and Moral Agency’. I argued that Kennett’s argument,
as it stands, is untenable because it rests on a false premise: that autistic
people and psychopaths share a common lack of empathy. This is because
the empathic deficits of the two groups cannot be said to be equivalent:
psychopaths possess intact cognitive empathy but are deficient when it
comes to affective empathy, whereas autistics lack cognitive empathy but
retain intact affective empathy. I went on to attempt to provide a Kantian
argument for why affective empathy is, at least sometimes, necessary for
morally worthy action. It is important to note, however, that from the
Kantian perspective we only have grounds to value affective empathy as a
morally necessary means, not as intrinsically valuable. This means that my
arguments in support of the importance of affective empathy do not imply
that we ought to reject a Kantian moral framework in favor of a Humean
one. But this has never been my intention. Rather, I have tried to show that
Kennett’s removal of empathy from her rationalist framework and her
subsequent insistence that empathy does not play a role in the explanation
of why autistic people are capable of moral agency but psychopaths are
not has given rise to an impoverished account that does not paint a full
enough picture of the respective moral sensibilities of autistic people and
psychopaths.
Ultimately, it is clear that I have reached much the same conclusions as
those reached by Kennett: I agree with her that autistic people are at least
sometimes capable of becoming morally admirable agents, whereas
psychopaths most certainly are not, because (some) autistic people – but
not psychopaths – possess reverence for the moral law. However, though I
agree with Kennett when she insists that an agent is capable of moral
agency insofar as she is capable of the perception of a principle or reason
to which she feels bound, I have criticized her for failing to appreciate that
affective empathy is one way by which the agent can come to have that
perception.
More broadly, in arguing for empathy’s inclusion within a Kantian
framework, I have aimed to show that there is room for a more nuanced
approach to the debate between Kant and Hume than the traditional
“reason versus empathy” view. If we are to gain anywhere near a complete
understanding of the nature of moral agency, we must dispense with any
sort of all-or-nothing approach that forces either reason or empathy out of
the equation.
258 Chapter Fourteen
References
American Psychiatric Association (1994), Diagnostic and Statistical
Manual of Mental Disorders (4th edn.; Washington, DC: Author).
Bemporad, J. (1979), 'Adult recollections of a formerly autistic child',
Journal of Autism & Developmental Disorders, 9, pp. 179-97.
Blair, R., L. Jones, F. Clark & M. Smith (1997), ‘The psychopathic
individual: a lack of responsiveness to distress cues?’ Psychophysiology,
34, pp. 192-98.
Cesaroni, L. & M. Garber (1991), 'Exploring the experience of autism
through first hand accounts', Journal of Autism & Developmental
Disorders, 21, pp. 303-12, p. 310.
Cleckley (1964), The Mask of Sanity (4th edn.; Saint Louis: C.V. Mosby
Co.).
Corcoran, R. (2000), ‘Theory of mind in other clinical conditions: is a
selective 'theory of mind' deficit exclusive to autism?', in Simon Baron-
Cohen, Helen Tagger-Flusberg & Donald J. Cohen (ed.), Understanding
Other Minds: Perspectives From Developmental Cognitive
Neuroscience (2nd edn.; Oxford: Oxford University Press), pp. 391-
421, p. 407.
Dewey, M. (1992), 'Autistic Eccentricity', in Eric Schopler & Gary B.
Mesibov (ed.), High-Functioning Individuals With Autism (New York
& London: Plenum Press), pp. 281-88, p. 284.
Dziobek, I., Kimberley Rogers, Stefan Fleck, Markus Bahnemann,
Hauke R. Heekeren, Oliver T. Wolf, & Antonio Convit (2008),
'Dissociation of cognitive and emotional empathy in adults with
Asperger syndrome using Multifaceted Empathy Test (MET)', Journal
of Autism & Developmental Disorders, 38, pp. 464-73.
Frith (1989), Autism: Explaining the Enigma (Oxford: Basil Blackwell
Ltd.), pp. 154-55.
Grandin, T. & Margaret M. Scariano, (1986), Emergence: Labeled Autistic
(New York: Arena Press), p. 12.
Hare, R. (1991), The Hare Psychopathy Checklist - Revised (Toronto:
Multi-Health Systems).
—. (1999), Without Conscience: The Disturbing World of the Psychopaths
Among Us (New York: Guilford Press), p. 45.
Herman, B. (1993), The Practice of Moral Judgment (Cambridge &
Massachusetts: Harvard University Press), p. 74.
Hobson, P. (1993), 'Understanding persons: the role of affect', in Simon
Baron-Cohen, Helen Tager-Flusberg & Donald J. Cohen (ed.),
Psychopathy, Autism and Questions of Moral Agency 259
Introduction
Jacob is a sixteen-year-old student at an alternative learning center and
is diagnosed with autism. Although he can feed and bathe himself, and is
even able to perform basic math equations, he is unable to construct full
sentences without being aided by another. Each day he aims to earn going
to the school library to look at Clifford books, and as he reads through
them all he begins to narrow the list down to his favorite. The problem,
however, is that Jacob has a habit of putting items that he desires to make
his own into his book bag when he thinks that no one is looking, and this
particular book has become his new target. After realizing that he would
not succeed in hiding the book in his bag since the classroom teacher
started to check it each day before Jacob would get on the bus, Jacob
devised a plan. One day he went home, took the same Clifford book out of
his own collection, and attempted to make it look exactly like the book in
the school’s library. Using construction paper he made a place for the
library card, taped a red circle to the book’s spine (indicating what section
that book belonged in), and even wrote the name of the librarian on the
back inside-cover. When he came to school the next day he ran into the
library and attempted to switch the two books without anyone noticing
(unfortunately for Jacob, his paraprofessional was with him the entire
time).
While outside at recess one day, Mary, a fifteen-year-old student with
autism, decides that she would like a specific chair that is against the
school building. Like Jacob, Mary is considered to have the same
cognitive ability as a first-grader, and is unable to complete full sentences
without aid. After making this decision, she begins to move the chair a few
inches closer to her classroom window each day until it is close enough for
Are People with Autism Morally Responsible for Their Harmful Actions? 261
her to run to the window and attempt to pull it through from the other side.
This required planning over a long period of time, and indicates that she
knew what she was doing was not acceptable since she seemed to attempt
to move the chair at a rate that would go unnoticed.
Alexander is a fifteen-year-old boy with autism and is generally non-
violent. He tends to repeat the same sentences continually on impulse, and
is considered to be on the same cognitive level as a pre-kindergartener.
What the staff at his school has to watch for, though, is when a particular
female student enters Alexander’s view. If this happens, he begins to
perseverate on her name and violently attacks her, showing no remorse if
he is successful in hurting her.
What these cases share that is most relevant to this chapter is that, due
to the severity of Jacob and Mary’s diagnoses, neither would be held
morally responsible for their actions (at least not nearly to the degree that
an individual without autism would). This chapter will address how to
assess the moral responsibility of people with autism for their actions; this
will include all actions, but our focus will be on those that harm or distress
others, and also on cases where they do not show care or attention to
others where there are normally expectations to do so. The main point is
to understand what difference autism makes to a person's moral
responsibility. We will argue that there are ways that autism does make a
difference, but having autism does not take away moral responsibility
altogether.1
From the start, it is worth emphasizing the tentative and preliminary
nature of this discussion. While there has been a great deal of scientific
study of autism, it is not a well understood condition. The criteria for what
counts as having autism are subject to change, and the autistic spectrum
covers a wide range of conditions. There is room for doubt that the
spectrum is unified by a common feature, and there is evidence that it
instead will require multiple explanations (Volkmar et al, 2009; Happé,
2006). So the ideas about moral responsibility will apply differently
depending where on the spectrum an autistic person is.
A central concern in the project of assessing moral responsibility of
people with mental and neurological disorders is that it may play into
further stigmatizing them and making their lives more difficult. Readers
may wonder what motive authors have for wanting to raise the possibility
of blaming autistic people for their problematic or socially disapproved
behavior. It is a responsibility for us to be mindful of such concerns. We
can make two main points in explaining the project. First, to argue that
people with autism have moral responsibility for their actions is to
emphasize their moral agency and their status as part of our moral
262 Chapter Fifteen
Overall Position
We can start off with uncontroversial claims: simply having a mental
disorder does not mean that a person is no longer morally responsible for
their actions. It is of course true that people with mental disorders are
often held legally responsible for their criminal actions. It is also true that
having depression, anxiety, and even non-psychotic mania do not count as
complete excuses for hurting others. Many, and probably most, people are
inclined to hold psychopaths morally responsible for their harmful
behavior, and also they hold sexual abusers, especially those of children,
morally responsible, even if they have a diagnosis of a sexual disorder.
It is possible that some might hold a much more restricted notion of
what counts as a mental disorder, what would not include many conditions
that currently count in the West. In such a case, it would be more feasible
to insist that genuine mental disorders do preclude moral responsibility for
behavior that is symptomatic of that disorder. However, this is to go
against the current trend towards more inclusive approaches to mental
disorders. While there is some debate around whether autism is always a
disorder rather than a difference (especially in regards to Asperger's
syndrome), there is general agreement that autism should count as a
disorder at least for most of the cases currently on the autistic spectrum.
So there is no particular reason here to question the standard approaches to
classification of mental disorders.
Nevertheless, people do also have strong intuitions that having a
mental disorder does make a difference to a person's moral responsibility
for their actions. This is especially true for disorders that make it more
difficult for people to know what they are doing, such as in cases of
delusion. It is also true for disorders where behavior is driven by anxiety,
compulsion, impulsiveness, or powerful emotions. In these cases, while
people may know what they are doing, they have great deal of difficulty
264 Chapter Fifteen
getting their actions to fit with their inner values, because they are less
able to control their behavior. There is plenty of sympathy that
accompanies the idea that in some sense, the person is taken over by the
disorder and is not fully responsible for their actions.
So we need to look at the particular features of autism to see how it
might affect judgments of moral responsibility. Our method here will not
be to try to develop a whole philosophical theory of moral responsibility.
Rather, it will be much more modest, in comparing autism with other
disorders and seeing if this helps shed light on how we consider the moral
responsibility of the autistic person.
Empirical Research
One recent paper reports, "Little is known about risk factors for
violence among individuals with autism spectrum disorder (ASD)"
(Långström, Grann, Ruchkin, Sjöstedt, & Fazel , 2009). Nevertheless, a
paper does report that aggression "is a common and serious problem
268 Chapter Fifteen
Philosophical Discussion
Philosophers have been particularly interested in psychopaths and their
moral responsibility because it is an important test case for different
theories (See for example Nichols, 2002). Some of this interest has
extended to autism precisely because, like psychopathy, autism involves a
deficit in the ability to empathize with others, yet at the same time it is
such a different condition that it is far from clear that what would be true
of the moral responsibility of psychopaths would also be true of people
with autism. One prominent discussion is by Kennett. Kennett (2002)
argues that people with Asperger’s are capable of moral understanding
because they are able to understand moral rules, even though they have
less ability to experience empathy with other people. She uses this to
Are People with Autism Morally Responsible for Their Harmful Actions? 269
argue for a Kantian over a Humean view of the nature of morality. That is
to say, she believes that the capacity to be a moral agent consists in the
ability to understand and follow moral rules, and thus is a matter of
theoretical and practical rationality. She argues that people with Asperger's
have this form of rationality, even if they have difficulty understanding
moral feelings. The opposing Humean view is that what makes a person a
moral agent is the ability to be moved to action by feelings of sympathy,
compassion, outrage at injustice, resentment at maltreatment, and other
distinctively moral emotions. While people with Asperger's may lack
feelings of empathy for other people, they are good at understanding rules,
and they have the capacity to modify their actions to guide their actions in
accordance with those rules. By way of contrast, she argues that while
psychopaths may achieve some shallow understanding of the rules (in the
sense that they are aware that other people follow those rules), they do not
modify their behavior accordingly, to treat others as they would want to be
treated, for example, and they also have problems with impulse control.
One question that arises for Kennett is whether her analysis rests on a
simplistic or incorrect characterization of Asperger's. This worry is raised
by Krahn and Fenton (2009), who point out that “Adopting an analysis of
empathy that distinguishes cognitive and affective empathy, for example,
has yielded experimental results that suggest a largely spared capacity for
affective, though probably not cognitive, empathy among HFAs [High
Functioning people with Autism]. Unqualified claims about a lack of
empathy among individuals with autism seem suspect in this light" (page
158). Thus, although people with Asperger's may have difficulty
recognizing the emotions of others as registered in their facial expressions
and body language, they still have the capacity for emotions reflecting
those of others. If Krahn and Fenton are right, then even Humeans will be
more inclined to agree that people with Asperger's are capable of moral
responsibility.
Another worry we might have with Kennett's assumptions is in her
supposition that people with Asperger's do not have significant problems
with impulse control and more generally with practical reason, the ability
to act on one's beliefs. The evidence cited earlier that they have a higher
risk of criminal prosecution, and the high rate of ADHD in the population,
suggests that impulse control and reaction to emotional stimuli may be
particularly difficult for them. If so, this would mean that they have more
problems with practical reasoning, and thus on Kennett's own criteria, they
are more similar to psychopaths than she realizes.
More work needs to be done on getting a good way to categorize
different subtypes of autism with respect to people's relevant moral
270 Chapter Fifteen
that very difficult, and they can react strongly. Sometimes the reactions
can be violent (Bronsard, Botbol, & Tordjman, 2010). Another frequent
explanation of the difficult behavior of people with ASD is that they have
a low frustration tolerance. They have difficulty making themselves
understood. They may also be perfectionists, and of course perfection is
very difficult to achieve. Because of their frustration, they sometimes
become agitated and violent. These explanations are fairly easy for people
without autism to understand. We all experience frustration and it is easy
to empathize with overstimulation; introverts, for example, do not like to
be among many people, and often people find the experience of going into
a casino very difficult with all the flashing lights, the loud noise level, and
the different kinds of games going on around. We can easily imagine
reacting badly to such circumstances. However, if typical adults become
violent after getting frustrated or overstimulated, we would see this as a
moral failing. This would be true even if they were very frustrated. So
merely experiencing frustration or overstimulation is not by itself a
complete justification for violent or hurtful behavior. However, it does
give us some reason to understand the violent reaction.
People with autism can have temper tantrums, rage, and extreme anger.
These emotions can lead to violent behavior towards others. Again, these
episodes may be caused by frustration and overstimulation. However,
they are still attitudes and actions that we directly condemn in typical
adults; we only think that people are justified in becoming very angry if
they, or people they care for or represent, have been badly treated or
denied rights. When people get angry to a degree out of proportion to the
original problem, we don't regard their tiredness, frustration, or personal
problems as any sort of justification. It might serve as an excuse (the
distinction between justification and excuse for bad behavior is debated.
For one recent discussion, see Baron, 2007). Our reaction towards those
attitudes in typical children is more complicated, because we recognize
they are still developing emotional competency and our main aim is to
teach them to react more appropriately; a “punishment” is meant to be a
lesson and is not generally to blame them. So our reaction to children with
autism will certainly take such considerations into account. Even adults
with autism may be regarded as developmentally delayed. Of course, we
should be very careful about the danger in equating such adults with
children. Nevertheless, there will be some similarities between
developmentally delayed adults and children, by definition (Bronsard et
al., 2010). So our moral reaction to violent developmentally delayed
adults may mirror some, most, or all of our reactions to violent children.
272 Chapter Fifteen
Forgiveness
Given that autism is a real disability and a struggle, we should be very
open to forgive people with autism who are (to an extent) morally
responsible for hurting others. We might even be willing to do this in
cases of terrible action such as murder, and we should be ready to do it in
cases of everyday frustration. Of course, the notion of forgiveness is not
simple, and there are questions it raises. Should we forgive someone who
remains defiant or simply will not ask for forgiveness? Should we forgive
immediately, as a default position, or should we be selective about what
actions to forgive? How do we decide if any actions are unforgiveable?
These are difficult questions that take us in a different direction, and may
be impossible to answer without specifying a more particular moral stance,
such as Christianity.
While there has been considerable philosophical discussion of
forgiveness and the conditions necessary for it to be appropriate, virtually
none of that is about the actions of people with neurodevelopmental
conditions or mental illness. As Hughs (2010) writes, the standard
definition of forgiveness "is the re-establishment or resumption of a
relationship ruptured by wrongdoing." There may be a psychological
necessity for caregivers of people with autism to forgive actions which
they hold their charges or relations morally responsible, if they are to
remain in the position of caring. It is difficult to simultaneously be a good
caregiver and harbor feelings of resentment and anger towards the person
you are helping. If they cannot forgive, then they may need to give up
their position as a caregiver.
What seems pretty clear is that even when people with autism have
done something harmful or hurtful for which they carry at least some
moral responsibility, they still have a strong claim to forgiveness. This
claim derives from the fact that their autism makes life more difficult for
them in many ways, and they have been unlucky in having the condition of
autism. We might also note that should we rethink the status of autism as
a disability, deciding to describe it a difference instead, then we will be
likely to rethink the claim of a person with autism to forgiveness.
Conclusion
As this discussion has exemplified, the discussion of the moral
responsibility of people with autism for their actions is by nature
speculative and tentative, and it will be difficult to achieve any certainty in
conclusions. Nevertheless, we hope that we have shown that it is at least
Are People with Autism Morally Responsible for Their Harmful Actions? 273
possible to systematically address the issues and shed some light on what
is at stake. Given the uncertainty involved, and the vulnerable position of
people with autism in our society, we need to be cautious in the expression
of blame towards them for their actions. Anger, resentment and blame can
be caustic emotions, and they can damage the lives of the people they are
directed at.
Nevertheless, there is a case to be made that people with autism have
the ability to experience moral feelings and that they are capable of
understanding moral rules. Their abilities, especially in regards to
understanding and sympathizing with the experiences of other people, may
be impaired, but they still exist in many cases. According to the main
theories of moral agency, it follows that people with autism can be moral
agents, deserving of praise and blame for their actions. There may be
occasions when it is entirely appropriate and reasonable to express moral
disapproval and anger to them for their actions, and to request an apology.
In the cases of people who have strong verbal abilities and who are
high-functioning, this conclusion seems easy to accept. While they are
different from people without the condition, and they have distinct
challenges in their moral understanding, they are still rather obviously
capable of moral credit and blame for their actions, even if they have blind
spots in their understanding where we will be less inclined to hold them
responsible for failings.
So let us finish by considering the cases of Jacob, Mary and Alexander,
who we started with. These three young people had more severe
problems, with developmental delays and major deficits in their language
abilities and their cognitive abilities. Given their environment and their
limited emotional understanding, it would be irresponsible to express any
anger to them. The people serving as their teachers and helpers need to
educate them. Nevertheless, to ignore the moral elements in their behavior
is to ignore their agency. We need to recognize the fact that they are
planning, they have schemes, and they have formulated specific goals
which they are acting on. They have some understanding of the fact that
others disapprove of the particular actions described. To understand this
part of their complex set of goals and their attitude towards other people,
we get a more complete and a less anemic picture of who they are. The
reward systems we implement in alternative learning schools and inclusion
programs, such as earning tokens to be turned in for a certain puzzle the
individual enjoys, or extra computer time, attest to this, since these types
of behavior plans assume a degree of control that the individual has over
his or her actions. Additionally, the use of storytelling tailored specifically
to the individual’s behavior presupposes that the individual is able to learn
274 Chapter Fifteen
social rules and appropriateness (a story about a student getting on the bus
being tailored for an individual who is obstinate when needing to leave for
school in the morning, for example). With the considerations mentioned
in this paper and the effectiveness of these practices in mind, it seems,
then, that the conditions that lead us to assume some degree of agency of
even some of the severe cases of autism are the same conditions that allow
us to think of and treat individuals with autism as moral agents.
References
Baron, M. (2007). Excuses, excuses. Criminal Law and Philosophy, 1(1),
21–39. doi:10.1007/s11572-006-9001-2
Eshleman, A. (2009). Moral Responsibility. Retrieved from The Stanford
Encyclopedia of Philosophy: http://plato.stanford.edu/cgi-bin/ency
clopedia/archinfo.cgi?entry=moral-responsibility
Fischer, J. M. (2006). Free Will and Moral Responsibility. In D. Copp,
The Oxford Handbook of Ethical Theory (pp. 321-356). New York:
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Grandin, T. (1995). Thinking in pictures: and other reports from my life
with autism XE "autism" . New York: Doubleday.
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Schroeder, S. (2005). The Overt Aggression Scale for Rating
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Oxford Handbook of Bioethics (pp. 90-113). New York: Oxford
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Krahn, T., & Fenton, A. (2009). Autism, Empathy and Questions of Moral
Agency. Journal for the Theory of Social Behaviour , 39 (2), 145–166.
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Are People with Autism Morally Responsible for Their Harmful Actions? 275
KRISTINA CHEW
ȃȒʌȚȠȢ means "infant, child" and also childish" and "not yet speaking";
by extension, it means "silly, without foresight, blind."5 It is made up of
the negating prefix ȞȘ- and the word ʌȠȢ, which means "word," "speech."
ȃȒʌȚȠȢ has connotations of being unable to talk like an infant; of being
unable to communicate and to voice only sounds that have no meaning. To
be ȞȒʌȚȠȢ is to be without speech in a similar formulation as the Latin
word infans, the in- negating what follows (fans means "speaking" and is
from for, fari, fatus sum).
In ȞȒʌȚȠȢ, “not speaking” is associated with not being able to think.
Forms of ȞȒʌȚȠȢ are used 21 times in the Odyssey. Notably, the word
occurs in line 8 of the proem of the Odyssey, with the narrator castigating
Odysseus' men for eating the cattle of the sun, thereby negating their
return home.
his true identity—ȞȒʌȚȠȚ, "fools" who did not know (ȑȞȩȘıĮȞ).12 Medon
the herald also uses ȞȒʌȚȠȚ to describe the suitors, and distance himself
from them, at 22.370, in pleading for his life after hiding himself in an ox-
hide. Finally, at 24.469 ȞȒʌȚȠȢ is used (ȞȘʌȚȑȘıȚ) specifically to describe
the words of the old lord Halitherses, who rebukes the actions of the now
slain suitors to their families, who seek vengeance against Odysseus.13
To a modern reader, ȞȒʌȚȠȢ thematizes disability almost too well, as
being associated with being foolish, childlike, unable to think reasonably
for oneself and making errors of judgment. To be ȞȒʌȚȠȢ is to slow of
thought and, in essence, cognitively impaired.
Agamemnon, the commander of the Greeks, for keeping the army at Troy
into a tenth year.
[Bowl-legged he was and lame in his other foot: And his shoulders
curved, hunched over his chest and higher up
Was his malformed head, with sparse hairs on it.]
The word țĮțȠȪȡȖȠȚ means, most literally, “those doing ill,” and, by
extension, “mischievous, villanous, malefactor.” ȀĮțȩȢ is “bad” and
“evil,” while ȡȖȠȞ means “work” or “deed.” The etymology of țĮțȩȢ can
be traced back to the Proto-Indo-European word kakka, “to defecate”:
ȀĮțȩȢ means nothing nice or good. Its additional meanings are “ugly,” in
terms of appearance; “ill-born,” in terms of birth (in contrast, the heroes in
the Trojan War are all of “noble birth” (ȖȞȒıȚȠȢ); “cowardly”; “worthless,
unskilled, sorry” (for instance, of a sailor or doctor who is “bad” at what
he claims to do); “base, evil” in a moral sense; “abusive, foul,” of words.
Used as a noun (and in the neuter gender), țĮțȩȢ has the additional
meaning of “harm” or “ill,” in the sense of “evil coming to a person.”
The various meanings of țĮțȩȢ cohere with the criteria for choosing
the ijĮȡȝĮțȩȢ, the scapegoat as described by Vernant and Vidal-Naquet.
Notably, those chosen to be ijĮȡȝĮțȩi (the plural form of ijĮȡȝĮțȩȢ) were
not only those who had done some evil—a crime—but also those who
were “physically ugly,” which is another meaning of țĮțȩȢ. Physical
ugliness and deformity is, then, associated with baseness of character.
284 Chapter Sixteen
References
Autism Spectrum Disorders (ASDs), Data & Statistics. Centers for
Diseases and Control, last modified March 29, 2012,
http://www.cdc.gov/ncbddd/autism/data.html.
Grinker, R. (2003). Unstrange Minds: Remapping the World of Autism.
New York: Basic Books.
Hexter, R.J. and Selden, D.J. ed., (1992). Innovations of Antiquity
Routledge: New York & London.
Jaarsma, P. and Welin, S. (2012). “Autism as a natural human variation:
reflections on the claims of the neurodiversity movement,” Health Care
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Young, S.K., et al., “Prevalence of autism spectrum disorders in a total
population sample,” American Journal of Psychiatry 168, no. 9 (2011):
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lexicon.
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2012,http://www.perseus.tufts.edu/hopper/morph?l=neu%3Dron&la=g
reek&can=neu%3Dron0&prior=neuromh=trai#lexicontje.
Postlethwaite, N. (1988) “Thersites in the Iliad,” Greece & Rome, Second
Series, 5, no. 2, 123-136.
Rose, M. L., (2003). The Staff of Oedipus: Transforming Disability in
Ancient Greece. Ann Arbor: University of Michigan Press.
Vernant, J. and Videl-Naquet, P. trans. Janet Lloyd, (1968). Myth and
Tragedy in Ancient Greece. Zone Books / MIT Press.
Winkler, J.J. (1990). The Constraints of Desire. The Anthropology of Sex
and Gender in Ancient Greece (Routledge: New York & London,
1990).
Zeitlin, F.I., Winkler, J.J., and David Halperin, ed., (1991). Before
Sexuality: The Construction of Erotic Experience in the Ancient World
Princeton: Princeton University Press.
NOTES
Introduction
1
Discussing how it is that people might take "the moral point of view," the author
of an otherwise excellent book on the topic writes, "Think of what we are being
asked to imagine, someone with no capacity for sympathy or empathy, someone
with no concern for others, someone with no identification with any human
community, someone with no sense of fairness...What we are asked to imagine is a
truly colossal failure of socialization, someone who has no disposition that can be
satisfied by following moral rules, and who, even after serious reflection, would
still not have one. . . Such a person must be either autistic or a Martian" (Olen,
1988, pp. 51-52_). Olen, J. (1988)..Moral Freedom. Philadelphia: Temple University
Press.
Chapter One
1
Interestingly, some theorists claim that Bartleby himself is a quintessential
example of an autistic adult.
Chapter Two
1
See: Tan, Justice, Institutions, and Luck, 1.
2
For more on how Full Autonomy adds conditions to Rational Autonomy see
pages 528-530.
3
One important aspect of the literature in philosophy should be noted. While
neurodiversity refers to psychological or neurological difference, most
philosophers approach the issue by analyzing disability. While the terminology
triggers othering, here I use the ideas in service of the difference characterized with
neurodiversity.
4
One study looking at the quantification of small numbers further evidences this
point. Rather than seeing “four” when a small number of objects are presented, the
timing of responses is more consistent with a process that counts up to four and is
not subject to framing effects. See: Gagnon et al., “Quantification Judgement in
High Functioning Autism: Superior or Different?”.
5
Kittay and Carson think these individualls present the biggest challenge to
inclusion. See: Carlson and Kittay, “Rethinking Philosophical Presumptions in
Light of Cognitive Disability,” 313.
Ethics and Neurodiversity 287
6
For a nice piece that brings together Rawls’s notion of democracy and the
capabilities approach see: Anderson, “What Is the Point of Equality?”
7
For a nice schema on how to approach different kinds of positive interventions
and goals in resources allocations, see: Wolff, “Cognitive Disability in a Society of
Equals.”
Chapter Three
1
We elected not to anonymize the universities as the school rankings list is
publically available, and the included excerpts are traceable online.
Chapter Four
1
A contentious issue for autism advocates concerns the interplay between
language practices and identity. Is person-first (e.g., “person with autism”) or
autism-first (e.g., “autistic person”) language preferable? Some prefer “person with
autism” because it puts the person before the autism. Others have argued that
person-first language wrongly implies that autism is separable from the person
(Sinclair, 1999). I use both kinds of language in this paper to honor the different
ways individuals may choose to talk about themselves.
2
The existing literature on representations of autism (e.g., Broderick & Ne’eman,
2008; Duffy & Dorner, 2011; Hacking, 2009a, 2009b, 2009c; Sarrett, 2011:
Smukler, 2005) contains valuable analyses of these and other metaphors for
autism. These analyses and others like them are part of an ongoing critique of
tragedy narratives and disability, a central topic in disability studies. For more on
tragedy narratives and disability see Oliver (1990).
3
Hacking (2009c) notes: “Many people hardly waste the time to write out “Theory
of Mind” any more, they just write “ToM.” I do not follow this practice, because
the very fact that we use an abbreviation makes us take it for granted, as some sort
of proven fact” (p. 54). I am sympathetic with Hacking’s concern and do not use
“ToM” in this paper.
4
Actually, there is a slightly earlier occurrence of “mindblindness” in the autism
literature. See Frith (1989).
5
See Wittgenstein, 1953; 1980 and Köhler, 1929 for examples of perceptual access
views of other minds.
6
The views of these autistic advocates do not represent everyone on the spectrum.
Also, there are autistic persons whose functional challenges do not afford them the
opportunity to self-advocate.
7
For a thoughtful philosophical discussion of blindness, including a fascinating
discussion of Wells’ story, see the letter correspondence between the blind
philosopher, Martin Milligan and the sighted philosopher, Bryan Magee: Magee &
Milligan (1995).
288 Notes
8
And yet a metaphor that connotes “seeing differently” would still privilege vision
over the other senses and thus obscure the ways other senses may contribute to
social interaction and communication (Akhtar & Gernsbacher, 2008).
9
I am grateful to Nameera Akhtar, the audience at the Bergen Community College
conference, “Social, Political, and Ethical Perspectives on Autism” April, 2012,
and the editors of this volume for helpful feedback on earlier versions of this
paper.
Chapter Seven
1
For example, experimental philosopher Manuel Vargas claims that sociopathy,
psychopathy, and antisocial personality disorder are synonyms distinguished only
in age and are, therefore, interchangeable (2010, pp. 69-71). Clinical psychologist
Martha Stout, Ph.D. freely switches between the terms in her book The Sociopath
Next Door (2005).
2
Hopefully, this part of the conditions will be revised in the upcoming version of
the DSM, as many professionals acknowledge the existence of acquired
sociopathy, which happens as a result of extreme trauma to the areas of the brain
believed to be responsible for APDs.
3
For example, patient A might satisfy conditions 3, 4, and 5 and patient B might
satisfy conditions 1, 2, and 6. Both would have APD even though that might be all
that they have in common.
4
Lykken (1995) considers character neurosis a third species of APD and distinct
from psychopathy and sociopathy.
5
I want to leave it open that a person could be akratic (susceptible to acting
against her best judgment) and still have a conscience. While an akratic might
rarely do what her conscious demands, her conscious still makes demands of her
and punishes her with guilt and remorse after the fact. Such persons are probably
not clinically distinguishable, though their actions alone might suggest it. By
considering the meaning of the term ‘behavior’ broadly we can include emotional
experiences as well as overt actions.
6
While earlier research suggested similar conclusions, Craig et al. specifically
targeted connections between the OFC and amygdala related to white matter
connections. They found a reduced fractional anisotropy (FA) in the right unculate
fasciculus (UF) in the psychopathic subjects.
7
It should be noted that all instances in this paper that refer to sociopaths as
virtuous are to be interpreted with this caveat in mind. I argue that sociopaths can
have virtues, and that their virtues might even be enhanced and grounded in what
makes them sociopaths. I am not arguing that sociopaths can be virtuous morally
exemplary human beings without (somehow) curing themselves of their
sociopathy.
8
Babiak and Hare (2006) argue that only large businesses such as corporations are
likely to attract psychopaths since psychopaths can remain “under the radar” and
are able to climb the corporate ladder with ease and receive perquisites. Hare and
Ethics and Neurodiversity 289
Babiak doubt that psychopaths would flourish in smaller business where mobility
is limited, mutual monitoring of employees is natural, and a team effort are
expected (pp. 95-7).
9
I am grateful for the comments and suggestions made by Stephen M. Kershner on
earlier versions of this manuscript. Several conversations with participants of The
Capacity-Character Project workshop (held at Delft University of Technology, the
Netherlands, May 21-22, 2012) were formative to the writing of this piece. These
interactions, along with the suggestions of helpful anonymous reviewers, proved
invaluable in the completion of this paper.
Chapter Eight
Acknowledgments: A shortened version of this paper was given as a Bioethics
Grand Rounds presentation at the Cleveland Clinic, Cleveland Ohio, USA, in
September 2010.
1
An accessible overview of the neurotypical movement can be found at the
Wikipedia entry for “Autism Rights Movement”, cross-referenced as “Neurodiversity”
at http://en.wikipedia.org/wiki/Neurodiversity_movement
2
Some of the blogs and websites that espouse a neurodiverse perspective include:
The Autism Women's Network: http://autismwomensnetwork.org/
The Autistic Self Advocacy Network, ASAN: www.autisticadvocacy.org
Autistics.org, with a portal to Second Life: www.Autistics.org
Amanda Bagg’s Blog: http://ballastexistenz.autistics.org/?cat=128
“Neurotypicals Are Weird” Blog: http://thiswayoflife.org/blog/
Asperger Square 8 by Bev http://aspergersquare8.blogspot.com/
Autretreat Main Site: http://www.autreat.com/index.html
3
For yet a fourth analysis see Rachel Cooper, Classifying Madness: A Philosophical
Examination of the Diagnostic and Statistical Manual of Mental Disorders, Springer
(Dordrecht, The Netherlands), 2005. For a rejection of Cooper’s analysis see
Jonathan Y. Tsou, “Review of Classifying Madness” in the British Journal of
Philosophy of Science, vol 61, 2010, pp. 453-457.
Chapter Nine
1
A helpful and concise discussion of the four-stage sequence is given by Leif
Wenar in the Stanford Encyclopedia of Philosophy’s entry “John Rawls.” See,
especially, “4.9 Institutions: The Four-Stage Sequence.” Web. 6 April 2012.
2
An additional confounding factor is scatter, the phenomenon whereby some
individuals may present much higher in certain categories, e.g. verbal tests, while
having diminished capacities elsewhere. Also, because labels are not mutually
exclusive, persons with emotional disabilities or mental retardation may have other
diagnoses that impede on their performance. For example, having ADHD could
290 Notes
mean test taking exceeds the person’s attention span causing skewed results, or
having an emotional disturbance could mean frustrating and challenging questions
would be ignored, or even completing the test itself could be rendered
impracticable. Eva Kittay raises this problem in At the Margins when she says,
“Sesha has no measurable IQ because IQ tests depend on capabilities to express
cognitive capacities and Sesha lacks these expressive capabilities” (127).
3
There are further complications with trying to define who is unreasonable due to
a lack of goods (e.g. mental health facilities or medication) versus someone like
Andrew whose unreasonableness cannot [yet?] be sufficiently mitigated by goods.
4
There is a disanalogy here between duties to animals and humans viz. negative
versus positive obligations. We have obligations to not harm both humans and
animals, but we clearly do not have a positive obligation to provide for the
biological needs of all animals, whereas a strong case could be made that we do
have this obligation for all humans. I owe this objection to Blain Neufeld.
5
For examples of the range of disabilities, consider first someone who is so
paralyzed they cannot even manage communication yet who retains their cognitive
abilities. On the other end of the spectrum, consider a person whose mental
functioning is perhaps at the level of some non-human animals, yet can perform
mechanical tasks (e.g. assembly line work) that allow them to hold employment. In
the middle somewhere we would find persons who have emotional impairments or
mental illnesses such that they can revise and pursue a conception of the good,
maintain employment, yet have no sense of justice and do not recognize the rights
of others. All of these non-citizen humans are capable of contributions in their own
ways, yet none would qualify as persons represented in the OP on Rawls’s
account.
6
In communication, Hartley tells me she has something like Anderson’s goods in
mind for her own account, though this has not yet been developed in her extant
writings).
7
I am indebted to Andrea Westlund for help with this idea.
8
I owe this worry to Julius Sensat.
Chapter Ten
1
In this chapter I use the terms “normal” and “normality” interchangeably.
2
Wachbroit ultimately argues against this understanding of normality.
3
I offer many of the prominent uses on normal in health care but I do not
necessarily argue for the use of any of these explanations of normal.
4
Daniels’ more recent account of justice in health care is given in economic terms.
See “Justice, health, and health care” in Medicine and Social Justice; Essays on the
Distribution of Health Care, edited by R. Rhodes, M.P. Battin, and A. Silvers.
5
Other reasons may include, but are not limited to, as a matter of justice or
equality.
Ethics and Neurodiversity 291
6
For the sake of brevity and a limited, yet focused account of just health care, I do
not present the diverse body of literature on “disease;” however, I acknowledge
this important literature
7
For exceptions, see section “Normal Functioning” and “Normal Functioning and
Asperger’s Syndrome.”
I have benefited greatly from the University of Wisconsin-Milwaukee’s
Philosophy Graduate Student Workshop, an audience at Michigan State University
and from comments by Blain Neufeld, Julius Sensat, Andrea Westlund and Justin
Bernstein
Chapter Twelve
1
There is a simple, analytic argument for why moral agents have a prima facie
non-arbitrary right to life and wellbeing that goes like this: (1) To be a moral agent
is to be the sort of thing that can be morally praiseworthy or blameworthy. (2) To
be morally praiseworthy just is to deserve that good things happen to you. To be
blameworthy is to deserve bad things happen to you. (3) Harms, such as death, are
uncontroversially bad things to happen to individuals in most cases. (4) To say
that something has a right to life just is to say that it would be inappropriate to kill
that thing. (5) Thus, it is prima facie morally wrong to kill morally praiseworthy
moral agents.
2
See: Konrad, Walecia, 2010, Dealing With the Financial Burden of Autism, The
New York Times, accessed 2-18-2012,
http://www.nytimes.com/2010/01/23/health/23patient.html?ref=health; Rudy, Lisa
Jo, 2010, Putting the Costs of Autism in Context, About.com, accessed 2-18-2012,
http://autism.about.com/b/2010/05/18/putting-the-costs-of-autism-in-context.htm;
Ganz, Michael, 2006, “The Costs of Autism,” from Understanding Autism: From
Basic Neuroscience to Treatment, CRC Press.
3
Suppose a person with a broken leg has an interview at the top of a flight of stairs
- under normal circumstances, she would be able to climb the stairs relatively
easily; however her broken leg makes climbing the stairs more difficult. Although
such a person may be able to do all the same things she could before she broke her
leg, it makes sense to say that her broken leg undermines her liberty because
climbing the stairs is more difficult than it otherwise would be. In contrast, a
person in a coma cannot choose to climb the stairs at all, and thus we can say her
liberty is undermined because she is incapable of making such a choice.
4
See Grandin, Temple, 1999
5
Exceptions can reasonably be made if the guardians believe a similar, but safer,
treatment would be available within a reasonable amount of time.
292 Notes
Chapter Thirteen
I thank David Brink, Dana Nelkin, Julie Tannenbaum, Robb Eason, Margarita
Levantovskaya, Joyce Havstad, Adam Streed, Tim Jankowiak, Amy Berg, Per
Milam and two anonymous reviewers for valuable comments on drafts of this
material. I also thank audiences at the 2011 Pacific APA meeting in Seattle and the
2010 Rocky Mountain Ethics Congress in Boulder, CO where drafts of these
arguments were presented.
2
Yalin Yang and Adrian Raine claim that what separates the successful
psychopath from the standard psychopath is that standard psychopaths show
characteristic deficiencies in gray matter volume and that these deficits are
“associated with poor judgment and decision-making, thus rendering unsuccessful
psychopaths potentially more prone to conviction” [Yang and Raine 2008, 134-
135]. Successful psychopaths avoid incarceration but this does not rule out the fact
that they may, in Hare's defense, still behave with persistent criminality. They may
simply be better at getting away with their criminal behavior.
3
Whether moral reasons (or moral judgments) necessarily motivate agents, is a
debate between what philosophers call motivational internalism and externalism
about moral reasons. Internalists claim that moral judgments are connected with
desires to act in accordance with our judgments[Smith 1995; Garrard and
McNaughton 1998]; externalists, on the other hand, deny that moral judgments
imply or necessitate desires to act [Brink 1997; Roskies 2003]. Some alternative
positions resolve the issue by rejecting the belief-desire psychology on which it is
grounded [McDowell 1979]. It is beyond the scope of this chapter to address the
debate about internalism and the role of psychopathic agency in that debate.
4
Although I take inspiration from Watson, these distinctions have been
challenged. Jay Wallace recognizes that attributability and accountability are
separate judgments about an agent and his or her action but denies that the two
judgments are conceptually distinct. In this sense Wallace argues that the two
judgments are conceptually connected [Wallace 1994]. Watson's view of
attributability and accountability as singular concepts has been challenged. John
Fischer and Neil Tognazzini have claimed that there are at least two distinct
notions of attributability and as many as five different senses of accountability
[Fischer and Tognazzini 2011, 381].
5
Some claim that responsibility requires the possession of the kinds of capacities I
have been discussing and the further criterion that an actions flows from the right
kind of historical process. Although evil neurosurgeons may implant malicious
desires in my brain so that I, in the normal way, act on them, that process, even if it
does not undermine attributability, is not something I am fully responsible for on
these views. An action must also be traceable to past historical decisions in an
intelligible way [Fischer and Ravizza 1996, 17-206].
6
Shame is typically understood to be different from guilt because shame is a self-
directed emotion we feel when we judge that we have violated a community's
norms. Guilt, on the other hand, requires the moralized judgment that we have
Ethics and Neurodiversity 293
acted wrongly. Because of this, shame does not appear to require that we accept or
internalize our community's norms in order to feel ashamed of violating them
[Williams 1993/2008; Taylor 1985]. If this analysis of shame is correct then it
might be appropriate for the atheist to feel ashamed of herself for violating her
community's norms even though she believes that it is not wrong to violate them.
Chapter Fourteen
1
See e.g. Shaun Nichols (2004), Sentimental Rules: On the Natural Foundations
of Moral Judgment (New York: Oxford University Press); Heidi Maibom (2005),
‘Moral Unreason: the Case of Psychopathy’, Mind & Language, 20, pp. 237-57.
2
See also Jesse Prinz (2011), ‘Is Empathy Necessary for Moral Agency?’, in Amy
Coplan and Peter Goldie (ed.), Empathy: Philosophical and Psychological
Perspectives (Oxford: Oxford University Press), pp. 211-29.
3
See e.g. Timothy Krahn & Andrew Fenton (2009), 'Autism, Empathy and
Questions of Moral Agency', Journal for the Theory of Social Behavior, 39 (2), pp.
145-66 and Heidi Maibom (2009), 'Feeling for Others: Empathy, Sympathy, and
Morality', Inquiry, 52 (5), pp. 483-99.For a definition of empathy that identifies it
exclusively with sympathy, see Batson et al. (1987), 'Adults' Emotional Reactions
to the Distress of Others', in Nancy Eisenberg & Janet Strayer (ed.), Empathy and
Its Development (Cambridge: Cambridge University Press), pp. 163-84.
4
Shaun Nichols’ discussion of the existence of a double dissociation between what
he calls the Concern Mechanism (equivalent to what we have been calling
affective empathy) and perspective-taking (i.e. cognitive empathy) reinforces this
point. See Nichols (2004), p. 59.
Chapter Fifteen
1
Note that we will vary the ways that we refer to the condition of autism and the
people diagnosed with it, with some preference for "people first" language, but
also recognizing that each form of reference has its own benefits and problems. In
any case, we understand that having autism is not an exhaustive account of a
person’s identity or personhood.
Chapter Sixteen
1
Froma I. Zeitlin, John J. Winkler and David Halperin, ed., Before Sexuality: The
Construction of Erotic Experience in the Ancient World (Princeton: Princeton
University Press, 1991); John J. Winkler, The Constraints of Desire. The
Anthropology of Sex and Gender in Ancient Greece (Routledge: New York &
London, 1990); Ralph J. Hexter and Daniel J. Selden, ed., Innovations of Antiquity
(Routledge: New York & London, 1992).
294 Notes
2
Indeed, in November of 2012, the American Psychiatric Association announced
that Asperger's Syndrome will not be included as a separate condition in the fifth
edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The
DSM-V, has been widely anticipated as having the potential to alter who qualifies
as on the autism spectrum and who, therefore, can receive educational and other
services.
3
Autism Spectrum Disorders (ASDs), Data & Statistics. Centers for Diseases and
Control, last modified March 29, 2012,
http://www.cdc.gov/ncbddd/autism/data.html.
4
This translation, and all those in this essay, are by the author.
5
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012.
http://www.perseus.tufts.edu/hopper/morph?l=nhpios&la=greek#lexicon.
6
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0135:book=11
:card=440&highlight=.
7
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0135
%3Abook%3D6%3Acard%3D288.
8
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0135:book=9:
card=1&highlight=.
9
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0135:book=4:
card=1&highlight=.
10
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0135:book=9:
card=1&highlight=.
11
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0135:book=19
:card=499&highlight=?.
12
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0135:book=22
:card=1&highlight=.
13
ȞȒʌȚȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0135
%3Abook%3D24%3Acard%3D450.
14
ʌȠȜȪIJȡȠʌȠȢ, Greek Word Study Tool, Perseus, accessed December 12, 2012,
http://www.perseus.tufts.edu/hopper/morph?l=neu%3Dron&la=greek&can=neu%3
Dron0&prior=neuromh=trai#lexicontje.
15
Odyssey 11.489-491.
CONTRIBUTORS
and advocacy communities. Her research interests include literacy, ESL, and
composition. Jo Anne is currently examining the effect that communicative
models can have on hierarchies of naming, inclusion/exclusion, and stigma
in education, healthcare, and research.
E
D
education · 47, 52, 53, 54, 55, 56,
da Vinci, Leonardo · 278 57, 58, 62, 63, 64, 65, 66, 107,
Daniels, Norm · 162, 163, 164, 168, 146, 149, 158, 162, 163, 166,
176, 182, 183, 184, 186, 187, 170, 184, 208, 211, 295, 296,
188, 189, 290 297
Dartmouth College · 62, 63 emotions · 9, 16, 26, 103, 113, 114,
Davidson, Donald · 43, 50, 109, 135 217, 224, 226, 227, 233, 241,
democratic · 39, 40, 45, 48, 161, 245, 247, 248, 254, 263, 264,
163 269, 271, 273
deontological · 139 empathy · 32, 70, 101, 104, 218,
determinism · 224 220, 222, 238, 239, 240, 241,
Diagnostic and Statistical Manual · 242, 243, 244, 245, 246, 247,
112, 216, 221, 241, 277, 289, 248, 249, 250, 251, 252, 253,
294 254, 255, 256, 257, 268, 269,
difference · 1, 2, 3, 4, 5, 6, 7, 8, 12, 270, 286, 293
15, 16, 21, 35, 39, 42, 43, 68, 72, Employment · 170
73, 76, 77, 78, 79, 81, 94, 108, equality · 4, 39, 40, 41, 42, 44, 45,
110, 115, 119, 125, 126, 131, 47, 48, 49, 60, 78, 81, 109, 144,
134, 135, 140, 141, 185, 191, 162, 171, 179, 182, 184, 186,
192, 193, 199, 207, 222, 249 189, 290
disability services · 52, 53, 54, 56, Ethic of Care · 139
58, 62, 65
disabled · 47, 54, 55, 64, 66, 146,
147, 148, 149, 150, 151, 152, F
153, 154, 155, 156, 157, 158,
159, 160, 161, 162, 163, 164,
Fenton and Krahn · 142
165, 166, 167, 168, 169, 170,
Frankfurt, Harry · 224, 225, 235
171, 172, 173, 174, 175, 176,
Freedom · 225, 235, 237, 286
194, 282, 284
302 Index
Frith, Uta · 68, 69, 70, 71, 74, 80, Individual Education Programs ·
81, 84, 241, 242, 287 265
informed consent · 104, 106, 135
injustice · 2, 3, 4, 6, 9, 13, 46, 47,
G 269
introspection · 18, 21, 23, 24
Gilligan, Carol · 94, 95, 96, 98
Glannon, Walter · 42, 43, 51, 100,
109, 133, 140, 145 J
Grandin, Temple · 33, 78, 82, 209,
216, 245, 246, 250, 251, 253, justice · 2, 3, 5, 6, 8, 14, 15, 16, 39,
256, 265, 291 41, 47, 66, 68, 100, 104, 105,
Grice, Paul · 135 106, 107, 108, 117, 119, 121,
Grinker, Roy Richard · 277, 285 125, 146, 147, 148, 149, 150,
guilt · 113, 114, 122, 217, 218, 220, 151, 152, 153, 154, 155, 156,
226, 227, 233, 288, 292 157, 158, 159, 160, 161, 162,
163, 164, 165, 167, 170, 171,
172, 173, 175, 178, 179, 181,
H 182, 187, 188, 189, 190, 191,
290, 297
Hacking, Ian · 21, 34, 35, 37, 67,
76, 82, 136, 145, 287
hallucinatory disorder · 18 K
Happé, Francesca · 133, 134, 261
Hare · 112, 113, 115, 122, 123, 124, Kant, Immanuel · 24, 25, 26, 29, 33,
127, 128, 220, 221, 222, 223, 37, 145, 239, 240, 249, 250, 251,
233, 234, 235, 236, 240, 242, 254, 255, 257
288, 292 Kantian · 26, 51, 132, 139, 240,
Hawthorne, Nathaniel · 23 249, 250, 253, 254, 256, 257,
Hemingway, Ernesy · 29, 32, 33, 269
34, 36 Kennett · 238, 239, 240, 241, 242,
Hippocrates · 276 243, 244, 245, 246, 249, 250,
Homer · 276, 278 251, 252, 253, 256, 257, 262,
homosexuality · 156 268, 269
Hume, David · 218, 219, 223, 236,
239, 240, 242, 254, 257
L
I Levy, Neil · 229, 236
Lewis, Michael · 135
Iliad · 278, 281, 282, 284, 285
inclusion · 2, 4, 7, 14, 15, 16, 34,
40, 44, 45, 46, 47, 52, 53, 54, 58,
59, 147, 166, 257, 273, 286, 296
Ethics and Neurodiversity 303