Part 26: Is Autism a Disorder?

Hello, and welcome back to The Autistic Writer.

Last week, you might remember, I backed out of my intention to tackle the question, is autism a disorder? This was because I felt I needed a little more time to research, and to think it through. I’m ready to try to lay out my argument now. By way of introduction, I should make it clear that I have raised this question several times before on social media. I have strong feelings on the subject, but strong feelings don’t make a great argument. In fact, they often weaken an argument, because passion can sometimes blind you to logic. Hence the need for further thinking time.

When I’ve previously questioned the validity of autism being classed as a disorder, I’ve found many people agree with my position, and many people don’t agree. That is fine. But one thing that has left me a little baffled is when people post online replies incredibly quickly after the question has been asked. It baffles me because I wonder how much consideration has been given to the issue of what the question means. Sometimes, a question, when considered carefully, has hidden twists. So when someone answers with a swift, “Of course it’s a disorder,” or, “Of course it’s not a disorder,” and then launches into some vaguely ad hominem rant, I’m left wondering what criteria they applied to the question.

There are two main prongs to think about when considering the question, is autism a disorder:

Firstly, there is the conceptual position: If autism is described as a disorder in medical and psychology literature, is that actually fair or accurate? Does the nature of autism sit comfortably within the official definitions of disorders? Is the presentation of autism something that realistically conforms to what we consider disorders to be?

Secondly, there is the social-semantic position: Is the use of the word disorder to describe autism fair to autistic people? Are the connotations helpful, neutral, or harmful within the social setting? My oft-repeated mantra comes into play here: Words have power. It matters which words we choose to use, and how we deploy those words. This is a concept many people baulk at; it provokes mockery and anger in some quarters. Some people think that a word means what a word means, and there’s no debate to be had. But if that were true, then poets, bards, and storytellers would have a much more difficult time… not to mention politicians! Words have multiple meanings, not only in the sense of multiple dictionary definitions, but also in the sense of the slippery, subtle connotations that apply out there in the social world, and in the various contexts they are deployed. Language is fluid, malleable, and to dismiss concerns over how words are used is to bury one’s head in the sand… only metaphorically, of course.

The two issues; the conceptual position, and the social-semantic position cannot completely be discussed separately from each other. At some point, any argument on this subject will have to marry the two, as ultimately the words used are signposts to the concept. And it is in that detail, in fact, where the devil lies.

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Is it conceptually correct to identify autism as a disorder?

Okay, I am going to tackle whether the mental health professionals are right in calling autism a disorder, but before I do, I think it’s necessary to cover off some of the arguments the non-experts put forward claiming the experts must be right. Here goes…

Autism is a disorder because the psychologists say it is.

This is a logical fallacy; the argument from authority. When discussing this fallacious position, it actually doesn’t even matter whether the psychologists are right or wrong. The point is, you can’t assume one thing must be another thing just because an authority or expert says so. The experts are sometimes wrong. Sometimes, experts are wrong because they don’t really understand the issue (Linus Pauling and vitamin C). Sometimes, experts are wrong deliberately and maliciously (Andrew Wakefield and vaccines). Sometimes, experts might have done huge amounts of research and have accumulated vast knowledge, only to draw the wrong conclusions, and get things badly and dangerously wrong (Lovaas and ABA). What you can draw from the examples I’ve just given is that when experts get it wrong, they do not do so in isolation. They tend to have people agree with them. It can take a lot of time and effort to put the error right, and sometimes, the erroneous thinking continues in the population at large anyway (just look at the anti-vaxx movement, and the sales of vitamin supplements). So, the argument from authority is worthless here. Case dismissed.

Autism is a disorder because the DSM says so.

The Diagnostic and Statistical Manual of Mental Disorders lists autism as a disorder, so it must be one, right? This argument is similar to the one above, in that it calls upon authority, but it actually goes further than that: It is circular reasoning. How do we know autism is a disorder? Because the psychologists say so. How do psychologists know autism is a disorder? Because the DSM says so. Why does the DSM say autism is a disorder? Because the psychologists say it is. Appealing to the DSM is also begging the question: If we are trying to determine whether the experts are correct in calling autism a disorder, it hardly makes sense to appeal to the manual they wrote which assumes it is a disorder!

Autism is a disorder because it is called autism spectrum disorder.

I’m almost embarrassed to include this, but in all honesty, this argument has been thrown at me online. It is refuted as in the argument above: You can’t answer the question of whether it is right to call autism a disorder by pointing to the fact it is called a disorder; yet again it begs the question.

Autism is a disorder because autistic people are in the minority.

This is a horribly dangerous argument. It was put to me on Reddit this way:

I imagine the logical flaws in this position are self-evident to most people, but we still need to break this exchange down. We’ll call this person, who claims to be autistic himself, C. The first point made by C is begging the question, as described above; saying autism is a disorder because it is called a disorder. My response to him, asks what if it’s the neurotypicals that are disordered. Obviously, (I hope), this was a rhetorical question; I was not claiming that neurotypicals are mentally disordered, I was actually trying to prompt thought about what a disorder actually is. But then C dropped his bomb: “Well, statistics show that we’re 1% of the population. So, no. We’re the ones with the disorder.” I’m going to ignore the appeal to statistics, and whether the statistic he quotes is reliable, and move on to the real problem: His claim that because “we” (autistic people) are a tiny minority, we must accept that we are disordered. To truly understand the insidious nature of the argument, you necessarily have to consider points I will come to in detail later: That the label disordered is often used as a pejorative term, that people labelled with such a term with pejorative connotations are often treated unfairly in society, and that, medically, having a disorder means that something is wrong with you. So, C’s position is that the neurological differences autistic people embody means they are disordered (have something wrong with them) because people with other neurological variations (neurotypicals) are in the majority, so what they are like represents the “correct” neurological structures. Can you see the problem, yet? Let’s put it like this:

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• P1: Group A have characteristic X
• P2. Group B have characteristic Y.
• P3: Characteristics X and Y are incompatible.
• C1: Therefore, either X or Y must be wrong (disordered).
• P4. Group A is a large majority, group B is a small minority.
• C2: Therefore group B is the wrong (disordered) group.

It’s easy to see that both conclusions are non-sequiturs, so this argument fails miserably. But it gets worse. Imagine applying this type of *cough* “logic” to other situations. It happens. History is filled with examples of one group of people slaughtering, enslaving, or marginalising another group of people, and justifying it with notions of a superior majority. It is a hateful, horrible, dangerous position to take. I don’t think C has the vaguest idea of the awful consequences of making such an argument. But he undermines it anyway with his next comment:

“Because we’re not ordered mentally,” he says, begging the question once more, then adding, “We have a different way of functioning mentally compared to the general population.” Well, he gets that bit right, and reveals the flaw in his thinking: Yes, autistic people have a different way of functioning mentally compared to the general (majority, neurotypical) population. But there is no logical link between being in the minority, and being disordered (and we don’t even have to agree on what “disordered” means to see that logical flaw!) His argument evaporates into nonsense.

The Experts

Okay, that covers off the most common online retorts from people who charge into claiming autism must be a disorder, without thinking it through. Now it’s time to look at whether the experts are justified in claiming autism is a disorder.

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I’ve already pointed out the problem with appealing to dictionary definitions, and the DSM, but when we ask the question, are the experts correct in classifying autism as a disorder? we have no option but to look at definitions; the question, by its very nature, has to examine those definitions. In other words, we need to know what a disorder is, what characteristics a thing must have for it to be called a disorder in the realm of the experts. In a book like the DSM, you might expect one of the first things to be covered in an introduction would be the question, What is a disorder? But it doesn’t, exactly. What it does is list criteria for deciding that something is a disorder. And it has a familiar ring to it. According to the DSM, something is a mental disorder if it is a psychobiological dysfunction – in other words, it’s a disorder because it’s a disorder. Or, it’s a disorder because it manifests as a behavioural or psychological syndrome – in other words, it’s a disorder because it’s a disorder. Clearly, I have barely skimmed the surface of the DSM here. It is a large, detailed book. But I believe the two examples I’ve highlighted from the defining criteria of disorders in the DSM are clear. The experts have self-referentially defined the meaning of disorder.

This is a bit of a problem for us, then. Can we look anywhere else for a definition? You might expect dictionaries to be a good place to start. Different dictionaries actually have slightly differing definitions, but that might be a good thing for this discussion, as it forces us to accept a wider view of definitions, rather than just plumping for one we like. I’d like to post some links to definitions from dictionaries of repute, such as the OED online, but they tend to guard access with paywalls and membership sign-ups, so there’s little point. You can, however, get snatches of definitions with a simple internet search, should you wish to check for yourself. Anyway, let’s have a look at some common definitions pulled from the web:

I could go on in this vein, but I’m not sure it would add anything, because the point I want to make here is pretty clear: If the experts say you have a disorder, the understanding is that there is something wrong with you. But confusion emerges because, as you can see below, even the NHS tells us that autism is not a disease or illness…

… and yet, autism is diagnosed. Diagnosis is something we associate with illness and disease; someone who had been diagnosed has something wrong with them. But autism is not an illness… but, wait, according to the DSM, it’s a disorder, subject to diagnosis. But according to the NHS (and many, many sources that autistic people will be familiar with), it is simply a different way for the brain to work. Now, I know many people will come back with a lot of, Yes, but, responses – but it doesn’t matter. What I have described here is at the crux of the problem with calling autism a disorder: There is confusion and contradiction.

Now, let me expand the discussion: If you are diagnosed with a disorder, you are basically being told there is a problem in some way with your functioning; something wrong with you. This may be an accurate way of describing some disorders. For example, if you have a disorder that stops your legs working, and prevents you from walking, that is a problem with the functioning of those limbs. But that is not the same as looking at the different walking gaits that many people have, and deciding that an unusual or uncommon gait is a disorder. Can you see where I’m going here? We know that autism is a way of the brain working that is different from the most common, or neurotypical way. Does that really mean it should be called a disorder? Further confusion comes with the conditions that are said to be co-morbid (a term I have used in the past, but have come to dislike as I have educated myself) with autism. Autistic people tend to encounter all kinds of problems related to being autistic, and it might be that these issues encourage the idea that autism is a disorder. There are mainly two types of (ugh) co-morbidities of autism: physical, such as gastrointestinal issues, and psychological, such as anxiety and depression. A physical problem such as the GI type is horrible, but it is not autism – it may be co-morbid (yuk) with autism, but it is not autism itself.

What about the psychological type? I’ll give you a personal reflection: From childhood, right up until my autism diagnosis at age 54, and beyond, I have struggled with depression and anxiety. In light of finding out I am autistic, I have been able to apply useful context to my depression and anxiety. I can see the triggers. I now know that if I could, for example, live in an isolated rural cottage, where contact with other people is both more limited than living in a big city, and more under my control, and if I didn’t have to go out to work for a large organisation every day, therefore not being bombarded by sensory overload, then my depression and anxiety would evaporate. Living in such circumstances, would autism cause me any problems at all? Nope. I’d be left with all the benefits. My problems with autism are all to do with living in an environment made by and for neurotypical people. Autism in and of itself is not necessarily a problem. Of course, my autism is not the same as everyone else’s; every autistic person has an autism as unique as a fingerprint. But I would ask anyone, when looking at the physical, mental or behavioural issues faced by an autistic person, to consider whether autism really is the problem, or whether you are seeing an expression of something related to (co-morbid with) autism. Some people, I know, will respond to this quickly, without giving the implications of what I am saying full consideration: “Of course it is autism, my child is autistic and does… blah, blah, blah…” No. Stop and think it through.

So, what do we have here? Autism is classed by the experts, the mental health professionals, the psychologists and psychiatrists, as a disorder because, erm, well, because they class it as a disorder. But as the experts also say, it is just different neural architecture. That non-majority, autistic way of experiencing and interacting with the environment becomes problematic only because of the type of environment; not because autism means the autistic person is in any way faulty… or disordered. This understanding is closely related to the social model of disability. Autism is classed as a lifelong developmental disability, but autism is clearly not disabling in and of itself; autistic people are disabled by society, in the same way that a wheelchair user is disabled by a building that only has steps for entrance.

So, to summarise: My point here is that there is no sufficient justification for experts to class autism as a disorder. The characteristics of autism mean the disorder label is inaccurate and misleading. Yet, the definition in places such as the DSM persists, and because so many people blindly accept the authority of it, they will continue to disagree with me and insist autism is a disorder. No amount of logic or reasoned debate will change the minds of these people. This means the concept of autism as a disorder remains out there in society, which brings me to point 2: The problem with the social-semantic position.

So we’ve seen that the word disorder is widely recognised and defined as something that is a problem, a functional abnormality or disturbance that prevents a person from working properly. Everything about the various definitions is couched in negative terms; abnormality, impaired functioning. This conveniently allows the neurotypical world to carry on as it is with little or no consideration for autistic people, because it assumes the autistic person is the problem. This dovetails with other negative ideas out there. The hate group Autism Speaks, which masquerades as an autism support charity, is committed to erasing autism, and thus autistic people. It presents autistic people as problems to be solved, or “cured”. It doesn’t take much searching online to find autistic people being described as “retards”. Hardly a week goes by without a news report of autistic people being attacked, abused or killed by people in authority, such as police officers. The world is full of negative ideas and stereotypes of autistic people, and these ideas are perpetuated by the language used to describe them. Am I saying people have died because autism is called a disorder? No, not directly, at least. But the classification of autism as a disorder, and the negative semantic connotations attached to that, form part of a drip-drip of language-driven ideas that perpetuate negative opinions, enabling pejorative descriptions and, even worse, enabling discriminatory behaviours. Autistic people need society to stop seeing them as a problem. Modifications to language use will help.

With all the above in mind, is it really that difficult for people to stop saying autism is a disorder? Really?

That’s all for this week. Thank you for reading. Please take care of yourselves, but also, take care of each other.

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Why do I write this blog?

When I was first diagnosed as autistic, at the age of 54, I quickly learned that there was a serious shortage of information and resource for newly-diagnosed adults.  It’s my aim to inform about autism and autism-related issues as I learn.  I will never hide what I do behind a paywall.  If you like what you read and want to chip in, feel free to “buy me a coffee” by clicking the icon below.

You might also be interested in David Scothern’s blog, Mortgage Advisor on FIRE, which covers a range of topics including mental health issues and financial independence.