PreOccupied

 

The latest incarnation of the Diagnostic and Statistical Manual of Mental Disorders, the DSM5, proposes yet again a shifting and redefining of autism, migrating and merging allied diagnostic categories and simultaneously arousing an astonishing public response, both positive and negative. But while such reformulations raise vital questions about insurance, over-diagnosis, and delivery of services, it may be worthwhile to sidestep the fray of dominant debate and to come at the DSM sideways (or, crip-wise), asking not about specific changes and their impact, but about the intellectual work of diagnostic classification itself. I would like to propose, in fact, that the taxonomical zeal evidenced in the DSM is a watermark of autistic cognition, autistic writing, and autistic aesthetic values. While the DSM would seem to stand as the emblem of medical authoritarianism and as the extreme counter-discourse of a neurodiversity movement, it seems possible instead that autism may share a surprising role in the authorship of this document, acting as a radical subversive occupier of that text which is typically understood as defining and inscribing autism as a form of mental disorder.

In the first of J.K. Rowling’s popular Harry Potter novels, the reader is introduced to an interesting device, a Sorting Hat which determines the house to which students newly arrived to the Hogwarts School of Witchcraft and Wizardry will belong. The hat introduces itself with a song:

There’s nothing hidden in your head

The Sorting Hat can’t see,

So try me on and I will tell you

Where you ought to be. (Rowling 117)

Then, sitting atop the head of each subject, one-by-one, it determines not only where that person may belong, but also figures “what they are and what they may become” (Mendlesohn 171). Equipped with extraordinary insight, the Sorting Hat is an icon of objective discernment and confidence, swiftly and efficiently assigning each child a place in the Hogwarts order.

Like the supernatural omniscience of the Hogwarts Sorting Hat, the DSM may be understood as possessing a kind of magical and deterministic authoritarianism; with its passive rhetoric, its “god-trick” objectivity, this bible of psychiatric diagnosis wisely assigns each candidate to a “house,” sorting each docile human subject into its proper pathological category, into a rigid, genericized taxonomy (Haraway 581). Speaking to just such work, Michel Foucault observes that rhetoric of this kind serves as an instrument that reduces the organic “to a system of variables all of whose values can be designated . . . by a perfectly clear and always finite description” (136). One of the most infamous examples of how the DSM has composed mental illness, historically speaking, is “homosexuality, which was once seen primarily as a moral evil, [was then … ] pathologized as a mental disorder, then depathologized and ultimately dropped from the DSM in 1974” (Couser 26). In fact, the DSM, as the standard document ordering mental disorder, suggests by its very existence that our natural and benign social, sexual, affective, and cognitive variation must be scrutinized, policed, disciplined, restricted, and sorted into a predetermined rubric of disease and failure, a monologic structure of power so obviously controlling and repressive that the observation need scarcely be made.

Or, maybe not . . .

In fact, the DSM is rather too easy a target; written by committees rather than individuals, the imperfect product of endless negotiation and compromise, developed to define identities that few persons are glad to publicly own and occupy, the DSM is a text surprisingly easy to challenge, to resist, and to critique. What’s more difficult is unpacking from this dry and reductive tome, from its rigid essentialism, another kind of voice—thoughtful, creative, intelligent, complex, and itself resistant to the tyranny of convention and expectation. This is the voice of autism.

Despite the fact that autism is encoded in the pages of the DSM as a form of mental disorder, an act of strategic cultural containment that keys autism to the medical and pathological (as opposed to the cultural or the cognitive), autism winds up being a slippery customer. Elusive, autism refuses its category, refuses any category, migrating around the DSM, coming forward in non-authorized categories of pathology, and ultimately occupying the very rhetorical structure of the guide, inhabiting the logic and language that parse mental disorder into discrete categories to begin with. (Ain’t nothing autism likes better, after all, than a list.) In this respect, and despite attempts by the collective composers of the DSM to still autism, to fix it, to keep it in its place, autism emerges as implicit coauthor of the very document by which it is simultaneously located and defined as pathology.

Before pursuing this co-authorship, however, we need to visit one shameful little site. Confession: at one time, I was eager, in a mean-spirited and politically dubious way, to read Leo Kanner himself as autistic. For those who haven’t spent much time amusing themselves, as I have, by autism surfing, Leo Kanner is the inventor of what is often described as “classic autism” or “early infantile autism.” (Hans Asperger comes up with the idea of autism at more-or-less the same time, but we can leave him out of it for now.) In his ground-breaking 1943 article in Nervous Child, “Autistic Disturbances of Affective Contact,” Kanner collects data from 11 children to define a new disorder which he dubs “autism.” Describing an expansive set of eccentric affective and cognitive features, including irregularities of speech, eye contact, and overall social relation, Kanner sees as central to these irregularities a tendency to be “anxiously and tensely impervious to people, with whom . . . [the subjects] do not have any kind of direct affective contact” (249). The joke, as I once saw it, is that Kanner’s conduct, detailed by himself in his own essay, appears a little atypical from an “affective contact” point-of-view. In the “case” of Charles N., for instance, Kanner describes “a well-developed, intelligent-looking” four-year-old boy who had brought with him to the lab “a copy of Readers Digest and was fascinated by a picture of a baby.” According to Kanner, Charles kept saying “Look at the funny baby,” sometimes adding “Is he not funny? Is he not sweet?” (34-35). Rather than using this point of interest as a possible site of connection, however, Kanner instructs his staff to take away the cherished magazine, to throw it to the floor, and to step on it to prevent the child from picking it up (while Charles cried out to his mother to get it back). Later in the same session, Charles is deliberately “pricked with a pin” and, naturally, he “shrank from further pricks” (35). (I would have shrunk from those pricks, too, I think.)

Kanner looks like a pretty smart guy and it doesn’t seem like he’s trying to be a jerk. There is a purpose to his experimentation—he’s checking to see whether the child engages with the person who’s messing with him or if Charles is focused instead on the object (i.e., the foot or the pin) that’s inflicting the outrage. Ironically, however, Kanner never regards his own clinical detachment through the same lens he uses on his autistic subjects. I am stuck with a lingering urge to make this observation public: that the diagnostic and clinical groundwork for a theory of autism was laid by a guy who exhibited to a significant degree some of the same characteristics he describes in his subjects. (He is not funny. He is not sweet.) The truth, however, is that Kanner looks like an insensitive jerk and that insensitive jerkiness ought not be regarded as a defining feature of autistic personhood. Rather than pathologizing Kanner, punishing him retroactively for the world of hurt he unleashed upon the cognitively idiosyncratic everywhere, and rather than castigating the DSM for its punitive categorization of the diverse range of personhood, I ask that we explore instead the prismatic rhetorical framing of the DSM and think about the creativity and autistic dimension of its inherent taxonomic impulse.

Autism-world is populated by inveterate listmakers, coders, framers, categorizers, collectors, and organizers (that is, people who like to develop texts that fit the generic parameters of the DSM). A recent clinical text notes that the “special interests” of most Asperger people “will have a repetitive, list-making, classifying or collecting element” (Tantam 35), an observation in keeping with those made by families of autistic people as well as with many self-identified autists; the blog “Stuff Asperger People Like,” an ongoing numbered report, lists its number one “like” as “Making Lists.” It is significant, though, that whether listmaking is associated with autism, in which case it is likely to be pathologized as “obsessive,” noncommunicative, or “stereotyped” (Kanner 248, 227, 241), or, whether it is seen as the product of a nonautistic person, texts falling into the listmaking category—from strings of associated or semi-associated words to encyclopedias, dictionaries, indices, catalogues, manifests—are frequently dismissed and devalued. The making of a list or the ordering or categorizing of any content is almost universally tainted as a mechanistic exercise, without real intellectual value or creativity; it is seen, rather, as an automated production, a re-inscription of the already known. Such thinking is, however, itself a mechanistic re-inscription. The making of lists, the ordering of content, is not necessarily a rigid and unimaginative performance, but an act of creative engagement, a practical deployment of the imagination upon the seething world of data.

When we criticize the apparent rigidity of the DSM, its perseverative categorization of the organically human, part of the desire to read the pathologizing text as itself pathological has to do with our discontent with this practice of order, our resistance to the radically ineffectual effort to abstract and discipline uncontainable content. We are impatient, culturally speaking, with the indexer and the cataloguer who distribute and align content rather than Romantically “creating” or “inventing” some new idea; likewise, we disapprove of children who play “improperly” with their toys, lining them up instead of developing their play as functionally communicative, having their toys co-participate in recognizable imaginative discursive text. (In other words, the larger culture demands that we write monographs rather than bibliographies and that our children make their Matchbox cars and Polly Pocket dolls talk to one another rather than setting them up in patterns.) Some of our most commonly valued cultural texts, however (think Leviticus and Wikipedia as well as the DSM), rely on this kind of generic patterning; mass desire for and consumption of list-texts abounds even as we dismiss the cognition and the aesthetic practice out of which they are generated. Writing of the life work of Peter Roget, for instance, biographer Joshua Kendall attributes Roget’s inclination for verbal ordering entirely to “his anxiety” and his unhealthy need “to feel a sense of mastery, no matter how illusory.” Kendall speaks of Roget’s “inventory of the world” and his efforts at “organizing these items in his notebook” as “an obsession” (40). It doesn’t matter how much we implicitly value that thesaurus or how indebted we are to the process from which it emerges, when we talk about Peter Roget, his massive intellectual labor is reduced to pathological reflex.

In addition to the larger cultural rejection of categorization and the taxonomical aesthetic, the DSM disturbs readers for another rhetoric-based reason—its omniscience. Bad enough this document acts like it knows us, like we’re knowable, even; bad enough to get shoved into this cell or that. To add irritation to this insult is the voice—the non-voice, really—that commands, that instructs, that pronounces from the inviolable position of the nonhuman. The DSM isn’t just setting us into folds like so many sheep; God-like, it does so without any personal agenda, without any explicit identity of its own. The passive voice that characterizes the text—“An individual must meet criteria A, B, C and D”—allows no recourse, no dialogic, no place for the self beyond submission. The DSM is a know-it-all, dishing out its diagnoses from the most perfect rhetorical position of Teflon-coated passivity. The DSM speaks like the autistic child described in the diagnostic literature, prone to a “way of talking … very fast and formal, ‘like a professor’” (Gillberg 138). The DSM is Asperger’s “Little Professor” writ large, its voraciously observant monologic script apparently unresponsive to dialogic potential and without any effectual capacity “for conceiving of other people as creatures who think and feel” (Gillberg 139; italics in original).

The main reasons, then, that we are culturally resistant to the text-list genre is that our humanity is affronted. Lists, even complex lists, even lists devoted exclusively to human content, are quite literally acts of subordination, quietly using the power of rhetoric to construct hierarchy, relationship, and content position. The insubordinate among us (that would be just about everyone) resist the yoke, refuse to listen, run counter to rules and dictates—unruly and undisciplined. The autistic among us (including the many who are undiagnosed and/or liminally autistic) often enjoy the same kind of reception, our various framings and re-framings of the world and our sometimes imposing approach to dialogue meeting with diverse forms of non-engagement. The urge to order and the urge to inform authoritatively are experienced receptively as attempts to dominate. In this respect, both Leo Kanner and the DSM look like bullies, but so, too, do many autistic people who lean toward coded order (like the syllabus) and tend to draw others into operating within this prescribed text.

Thing is, even though the autistic penchant for taxonomy and ordered authoritative speaking in the DSM might be experienced as an instrument of monologic domination, there are other possible interpretive positions: one of these is that categorical and taxonomic writing might actually be a fluid and multiple way of knowing, complex and creative. Rather than being regarded as a mechanism of formal confinement (rigidly autistic), the list might instead be regarded as a means of testing boundaries and definitions. In this respect then, autism’s devotion to taxonomy might be seen as interpretive, curatorial, exploratory, the language of order not laying out for us the way it is, but serving instead to investigate content relationships.

The ordering of sign does not necessarily imply an insistence on the existence of correctness, completeness, or the absolute. In fact, order is bound to disorder, entropy, and failure; the creation of a logical frame, rather than diminishing or glossing over that which does not fit, instead elevates and makes visible the unique, the unfitting, the nonstandard. As Umberto Eco has observed, lists are always suggestive of “immensity,” their multitudinousness serving a capacious inclusivity, or alternatively, pointing to a limitless excess beyond the frame (81). The re-categorization and redefinition of autism in various editions of the DSM presents a felicitous example of just such creative fluidity. In the DSM-III (1980), autism was identified as “Infantile Autism” and Asperger syndrome did not exist as a diagnostic category; with the publication of the DSM-III-R (1987), the autism category was renamed “Autistic Disorder”; the advent of the DSM-IV (1994) saw the creation of a new diagnostic category, “Asperger’s Disorder” (understood as separate from “Autistic Disorder” although inhabiting the same spectrum); and the long-awaited publication of the DSM5 will fold the autism spectrum back into a single diagnostic category inclusive of the disorder-formerly-known-as Asperger’s and other much criticized and inconvenient diagnostic appendages like PDD-NOS (i.e., Pervasive Developmental Disorder-Not Otherwise Specified) which, like homosexuality will now fall into diagnostic extinction. The troubling of this category, though, while it may reflect cultural or medical questions about the definition of autism, need not be read as a desperately comic effort to force a fit, but might instead be attributed to the surprising elasticity of taxonomical rhetoric. Despite dominant cultural constructions, symbolic ordering is not a rigid and unimaginative aesthetic practice, but is rather a conscious engagement with chaos, a practice that actively grapples with change.

This is the secret lesson of the Sorting Hat. As Harry sits, tense and anxious, watching the other boys and girls get sorted while he awaits his own turn, he makes a curious observation. “Sometimes … the hat shouted out the house at once, but at others it took a little while to decide” (Rowling 120). When he sits to be sorted himself, Harry discovers the reason for these hesitations. “Looking at the black inside of the hat,” Harry waits:

“Hmm,” said a small voice in his ear. “Difficult. Very difficult. Plenty of courage, I see. Not a bad mind either. There’s talent, oh my goodness, yes—and a nice thirst to prove yourself, now that’s interesting. … So where shall I put you?”

It turns out the Sorting Hat isn’t at all about clear boundaries and predetermined decisions, the orderly and efficient assignment of a diverse humanity into neatly fitting categories, but is engaged in an act of figuring, a dialogic practice of testing and questioning. When Harry thinks “Not Slytherin, not Slytherin,” the voice responds: “Are you sure? You could be great, you know, it’s all here in your head, and Slytherin will help you on the way to greatness, no doubt about that”—a frank acknowledgment of legitimate alternative categorization—before acceding to Harry’s wishes and assigning him instead to Gryffindor house (121). Sorting Hats, diagnostic categorization, listmaking, autistic expression: what looks from the outside like silent mechanistic determinism may turn out to have a surprisingly complex dialogic interiority, reasoned, dynamic, and sensitive to external stimuli.

 

Top image credit: Kayleigh Roberts

Works Cited

Asperger, Hans. “‘Autistic Psychopathy’ in Childhood.” Autism and Asperger Syndrome. Ed. Uta Frith. New York: Cambridge UP, 1991. 37-92.

Couser, Thomas. “What Disability Studies Has to Offer Medical Education.” Journal of Medical Humanities 32 (2011): 21–30. Print.

Eco, Umberto. The Infinity of Lists. Trans. Alastair McEwen. New York: Rizzoli, 2009. Print.

Foucault, Michel. The Order of Things: An Archaeology of the Human Sciences. New York: Pantheon Books, 1971. Print.

Gillberg, Christopher. “Clinical and Neurobiological Aspects of Asperger Syndrome in Six Family Studies.” Autism and Asperger Syndrome. Ed. Uta Frith. New York: Cambridge UP, 1991. 122-46. Print.

Haraway, Donna. “Situated Knowledges: the Science Question in Feminism and the Privilege of Partial Perspective.” Feminist Studies. 14.3 (1988): 575-599. Print.

Kanner, Leo. “Autistic Disturbances of Affective Contact.” Nervous Child 2 (1943): 217-50. Rept. in Anne M. Donnellan, Ed. Classic Readings in Autism. New York: Teacher’s College, 1985. 11-52.

Jordan, Rita and Stuart Powell. “Encouraging Flexibility in Adults With Autism.” Adults With Autism: A Guide to Theory and Practice. Ed. Hugh Morgan. Cambridge UP, 1996. 74-88.

Kendall, Joshua C. The Man Who Made Lists: Love, Death, Madness, and the Creation of Roget’s Thesaurus. New York: G.P. Putnam’s Sons, 2008. Print.

Mendlesohn, Farah. “Crowning the King: Harry Potter and the Construction of Authority.” The Ivory Tower and Harry Potter: Perspectives on a Literary Phenomenon. Lana A. Whited, ed. Columbia: U of Missouri P, 2002. Print.

Rowling, J.K. Harry Potter and the Sorcerer’s Stone. New York: Scholastic, Inc., 1997. Print.

Sacks, Oliver W. Rage for Order: Autism. Princeton, N.J: Films for the Humanities & Sciences, 2002. DVD.

Tammet, Daniel. Born on a Blue Day: Inside the Extraordinary Mind of an Autistic Savant : a Memoir. New York: Free, 2007. Print.

Tantam, Digby. “Asperger’s Disorder (ii).” Autism and Related Disorders: The Basic Handbook for Mental Health, Primary Care and Other Professionals. Eds. Geraldine Holt and Nick Bouras. Great Britain: Henry Ling, 2002. 32-41. Web.

Williams, Donna. Nobody Nowhere: The Extraordinary Autobiography of an Autistic. New York: Perennial, 2002. Print.

 

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