Backgound

John Harris has written a substantial and thoughtful article in the Guardian today about the growing controversy surrounding autism diagnoses.

I agree that the issues he raises deserve serious consideration. But I think there is another dimension to this debate that needs to be explored.

Harris asks what autism is, who should be diagnosed with it, and what support they should receive.

I want to ask a different question. Why has our society become so intolerant of human difference that those who do not conform to its expectations are so frequently treated as the problem?

My suggestion is that the answer has a great deal to do with neoliberalism and its assumptions about what human beings are for.

John Harris's question

John Harris' central question is whether the concept of an autistic spectrum has become so broad that it is losing its meaning, or whether we are finally beginning to recognise the diversity of autistic experience.

It is an important question, and Harris handles it with sensitivity, as I would expect of him in general and because I know he has an autistic son. He recognises the very different experiences of autistic people, the difficulties faced by those requiring substantial lifelong support, and the importance of diagnosis to people who have spent much of their lives struggling to understand why they experience the world differently from others. He also explores disagreements among leading autism researchers, including Uta Frith, Simon Baron-Cohen and Francesca Happé, about whether the existing diagnostic framework remains appropriate.

I do not wish to dismiss any of those arguments. The questions about diagnosis, clinical evidence and the allocation of support are real. They deserve serious consideration. But I think the analysis needs to go much further.

My suggestion is that the problem being discussed is not just about autism. It is about what we think it means to be human, and this debate needs to make that explicit.

Humanity and the neoliberal dimension

More particularly, I suggest that the controversy surrounding autism reflects a much deeper conflict between the diversity of human experience and the demands of the neoliberal economic system within which we are now expected to live.

Neoliberalism is not simply a political and economic philosophy that says markets should allocate resources within society with minimal government intervention. It also encourages a particular understanding of human beings and their place within society. Within this worldview, people are increasingly treated as units of economic input. Their value is assessed by their capacity to work, compete, consume and contribute to the production of the financial returns neoliberalism demands as an indication of success.

The ideal person within this system is adaptable, productive, competitive, self-reliant and capable of meeting externally imposed expectations. They are also expected to conform. They must fit into standardised systems of education, employment, assessment and social behaviour. They must accept the objectives set for them, respond appropriately to incentives designed by others, and demonstrate their worth through measurable outcomes. They are not necessarily encouraged to question why those objectives exist, whose interests they serve, or whether the systems they operate within are appropriate. Indeed, questioning the system may itself be treated as a problem.

This is where the issue of autism becomes especially important. Autistic people do not necessarily experience the world in the ways that these systems presume. They may process information differently, communicate differently, experience sensory environments differently, or place different values on the social conventions that others take for granted. Some may find particular forms of social interaction exhausting. Others may question rules that appear arbitrary, resist expectations that seem irrational, or require explanations for things that other people simply accept.

These are not universal autistic characteristics, because no such things exist (in itself a cause of neoliberal confusion on the issue when it assumes the world is uniform), and their consequences vary enormously between individuals. Nor should the substantial disabilities experienced by some autistic people be overlooked. But the underlying issue remains. What happens when people whose lived experience differs from the assumed norm are required to conform to a system that has little tolerance for difference?

The individual is not the problem 

The answer, too often, is that the individual is identified as the problem. The person who cannot tolerate a noisy workplace is considered difficult. The person who questions an apparently irrational instruction is considered uncooperative. The person who cannot sustain the social performance expected of them is considered inadequate. The person who requires different working arrangements is considered less productive. And the person who becomes exhausted by constantly adapting to these demands is expected to find a way to cope.

This is where the concept of masking, the existence and nature of which Frith challenges in an interview noted in Harris's article, becomes particularly interesting. Whatever questions exist about its precise scientific definition and measurement, the experiences described by people who say they mask raise a fundamental social question. Why should anyone have to devote so much effort to appearing to be someone they are not simply to participate in ordinary economic and social life?

That question is not necessarily confined to autistic people. It is possible that neurotypical people might also experience pressure to conform. They, too, are expected to suppress their preferences, conceal their difficulties, perform socially acceptable roles and meet demands that may have little relationship to their actual abilities or needs. They, too, may as a result experience exhaustion, anxiety, alienation and a sense that their lives are being organised around objectives they might never have chosen.

The difference is that autistic and other neurodivergent people may experience these pressures in particularly intense ways because the assumptions built into our institutions are often especially poorly suited to them. In that sense, their experiences can reveal something about the system that might otherwise remain hidden.

Society is harming human wellbeing

The problem is not necessarily that autistic people are unable to meet the requirements of society. It may also be that society has constructed requirements that are unnecessarily restrictive, intolerant and sometimes damaging to human wellbeing.

This does not mean that autism is simply a social construction or that all autistic disabilities would disappear if society were organised differently. That would plainly be wrong. Some autistic people have profound support needs that would exist under any conceivable economic system. Their needs must be recognised and met. But it does mean that we should distinguish between difficulties arising from a person's neurological characteristics and those created or intensified by the environments in which they are required to live.

That distinction is crucial. Consider education. An education system increasingly organised around standardised testing, measurable performance, competition and conformity will inevitably struggle to accommodate children who learn, communicate or respond to their surroundings differently. The resulting difficulties may then be attributed to the child rather than to the structure of the educational system.

The same is true of employment. A workplace that values constant social interaction, uninterrupted attendance, rigid working practices and unquestioning compliance may exclude people who could make substantial contributions if their work were organised differently. The issue is not necessarily their capacity to contribute. It is the narrow definition of acceptable contribution.

And the same problem arises in public services, where standardised procedures may be administratively convenient but fail to recognise the different circumstances of the people they are supposed to serve. These are not exclusively questions about autism. They are questions about how we organise society and whose needs we choose to recognise.

Holding the system to account

That brings us back to the controversy Harris describes. If we accept the neoliberal assumption that people must adapt themselves to the demands of existing economic institutions, then differences in their capacity to do so become individual problems requiring diagnosis, treatment or correction. The system itself escapes examination.

But if we begin from a different assumption, that economic and social institutions exist to serve people rather than the other way around, the questions change. We would no longer ask only why some people struggle to conform. We would ask why conformity is required, whether the expectations imposed on people are reasonable, whether institutions could operate differently, and whether the diversity of human experience might be something to accommodate and respect rather than something to eliminate.

This also changes how we should think about the apparent competition for support between different groups of autistic people. Harris is right to take seriously the concern that people with profound disabilities might be overlooked as the definition of autism expands. But another question needs asking. Why should recognising one group's needs threaten the support available to another?

That is not an inevitable consequence of recognising human diversity. It is a consequence of organising public provision around supposedly financially constrained resources, eligibility thresholds and competition between people with different needs. When support is treated primarily as a cost to be minimised, every expansion in recognised need becomes a potential threat to those already receiving assistance.

People are then encouraged to compete for recognition and resources. Those requiring extensive support may fear that their needs will be displaced by those whose disabilities are less visible. Those diagnosed later in life may fear that their experiences will be dismissed because they appear too capable. Both groups have legitimate concerns, but their interests need not be opposed.

Meeting need

The alternative is to recognise that people have different needs, that those needs should be assessed appropriately, and that public services should be organised to meet them. This requires resources, but it also requires a willingness to design services around people rather than expecting people to fit the administrative convenience of services. Most importantly, it requires a different understanding of the relationship between individuals and society.

I think that is what is missing from much of the debate about autism. We are discussing the boundaries of a diagnostic category without sufficiently questioning the social and economic assumptions that make those boundaries so consequential.

We are asking who qualifies as different without asking why difference is so difficult to accommodate. And we are debating who deserves support without adequately questioning why support should be treated as a scarce privilege rather than a normal feature of a society organised around human need.

That means that there is a deeper philosophical issue here. I am suggesting that human beings are not interchangeable units of production. We are individuals with different abilities, limitations, experiences, relationships and aspirations. We do not all understand the world in the same way. We do not all communicate in the same way. We do not all respond to the same environments or find satisfaction in the same activities. Nor, absolutely vitally in my opinion, should we be expected to.

Our relationships with one another are not simply competitive. They are also reciprocal. We depend upon each other, contribute to each other's wellbeing and create society through those relationships. An economic system that fails to recognise this misunderstands something fundamental about human existence.

That matters for neurotypical people as much as it does for autistic people. The demand for constant productivity, competition, adaptability and conformity can diminish everyone's capacity to live a fulfilling life. Autistic people may expose the consequences of those demands particularly clearly, but the underlying problem is shared.

This is why I think the debate Harris describes should be understood in a much wider context. The scientific questions about autism are important. We need credible diagnoses, better research in some areas, greater understanding of individual differences and appropriate support for people whose needs vary enormously. But we also need to recognise that diagnosis takes place within a society whose expectations are not neutral. Those expectations reflect pre-disposed political and economic choices. They can be changed.

The fundamental question

That then brings me to what I think is the fundamental question. Should human beings be required to adapt themselves to the needs of an economic system, or should the economic system be organised to meet the needs of human beings?

Neoliberalism has tended to prioritise the former. I believe we should prioritise the latter.

That does not mean denying disability, dismissing scientific evidence or pretending that every difference can be accommodated without difficulty. It means recognising that the purpose of an economy is to enable people to live well, with dignity, security, opportunity and respect for their differences. It also means accepting that no single model of human behaviour can adequately describe the diversity of people who make up society.

Harris concludes his article by quoting Francesca Happé's hope that the debate might become one in which people assume goodwill and are willing to listen to those with whom they disagree. I agree with her, but I would go further.

We need not only to listen to people whose experiences differ from our own. We need to create an economy and society in which those differences are recognised as an ordinary part of being human.

That is not simply an issue for autistic people. It is an issue for everyone. And it is, ultimately, a question about the kind of society we want to create.

Jacqueline Murphy contributed to my thinking on this issue. 

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