Three Distinct Problematic Points of the Medical Model and the Misinterpretation of “Levels”
🇬🇷 Ελληνικά
1. Overall disease framework, with gradations of mild and severe
• In contrast to the Neurodiversity Paradigm, in which there are natural human neurological variations.
Within the medical model, “autism” is framed as a disease, with gradations—mild, severe. That is the error from the outset. This must be made clear. If from the beginning one views “autism” as a disease, one is already operating within the wrong framework.
As I say in the video Deconstructing Camouflage – Autistic Journals S2Ep1, the word “autistic” is being redefined today within a different framework. In this framework, we speak of a mode of functioning; there are no gradations or levels within it—levels in relation to what? This does not negate any support that an Autistic person may need. All it tells you is that the person “is Autistic”, they do not “have autism”, because it is not a disease.
(Common Misconceptions About Autism Levels – What It Really Means)
• Definition of normality and health.
• Projection of traumatic and inaccessible environments and systems as inherent pathology and deficits.
2. Eugenic and sexist origins of the “functioning” divide
This divide is linked to ideas of “high intelligence”, the “male brain”, and perceptions of disability as a measure of the value of human life. From this emerged the notion of “levels” as two extremes — “high-functioning” and “low-functioning.” These ideas have influenced the medical model throughout its historical continuity and have shaped perceptions and stereotypes that continue to permeate society.
I have also come to understand that this distinction never clearly existed in the DSM as “functioning”, yet it has historically been conveyed informally through medical-model approaches.
As long as these perceptions are not clearly addressed, the “levels” of the medical model take on such connotations, and this is a serious problem.
The problem, therefore, lies primarily in dominant perceptions which, formally or informally, have historically been perpetuated through medical-model approaches and their prevalence.
(Common Misconceptions About Autism Levels – What It Really Means)
• Eliminationist views regarding so-called “low functioning” are still expressed today. Temple Grandin, a highly privileged Autistic with access to Harvard, has expressed such views and considers that only “high-functioning” Autistics should be born.
• “Intelligence” as a comparative measure and criterion of value.
• Ideas of “productivity”, “usefulness” of people in society, and of “sociality”, as defined (also) in National Socialism as an inherent characteristic and its deficit (Gemüt).
• The origins of diagnosis within the historical context of National Socialism and the child psychiatry that prevailed as its continuation. Asperger’s separation of certain white Autistic boys who met criteria, and the extermination of all the rest, including all the girls. The impact is evident in the predominance of diagnosis in boys and socially in the stereotype of the white Autistic boy with “high intelligence”.
Recently, extensive historical evidence about the context of diagnosis has come to light, including in Edith Sheffer’s book Asperger’s Children: The Origins of Autism in Nazi Vienna (2018). This article offers a concise and helpful review of the book: https://dsq-sds.org/article/id/864/
3. Perception of functionality as behavior based on allistic functioning
This is reflected in ideas about “camouflage”. The erasure and denial of the real difference in functioning. From this emerges the idea of “levels” as, on the one hand, pathologized “autism”, and on the other, the non-recognition of difference (and what that entails), reframed instead as a “personality type”. The behavioralization and psychologization of difference in functioning.
Masking may also have a personality dimension. But that is only one dimension, and in my experience not the most important one. Perhaps it is the first one someone becomes aware of. I first became aware of this. But there is more to it. It is not actually about personality.
(Masking is not an indication of “functionality”; it is an indication of greater oppression. It is an indication of suppression.)
This perception relates more to “camouflage” as “functioning”, turns functioning into behavior, and attempts to eliminate it as “behavior”, while denying the real difference between autistic and allistic functioning. Informally, this creates a division between a level of pathologized “autism” and another level that is not recognized and is interpreted as a personality type.
This view is so dominant that it has affected us ourselves. The perceptions that we ourselves often hold about “camouflage” reflect a view of “personality”, or the behavioralization and psychologization of functioning. This denial of difference is also reflected in the idea that “everyone masks”, which I discussed in the post We are not talking about “cost.” “We are able” = “we are able”. They do not care.
(Common Misconceptions About Autism Levels – What It Really Means)
The fundamental error in the perception of the medical model
The problem begins with a fundamental error in the way the medical model perceives things as a whole: it denies functional difference and instead sees a single line of functionality. Everything else is derived from this perception. It does not accept that there might be another mode of functioning. There is only allistic functioning.
This is how what is informally referred to as “high functioning” is understood: as something that approaches—so it is perceived—allistic functioning, which is taken to be the only functioning that exists. Whatever appears to approximate this mode of functioning is placed higher on this line, with “low functioning” positioned at its lower pole.
This also explains the linear understanding of the word “spectrum” as it is used within the diagnostic framing of the disorder. Informally, this is likewise taken to mean that there is no real differentiation between autistic and allistic functioning. There is, overall, a single functional continuum for everyone; allistic functioning occupies the upper pole, and whatever appears to approach it is placed higher on that line. In this way, the boundaries of autistic functioning itself become blurred. Some are then led to the seemingly reasonable conclusion that “everyone is autistic,” to some degree or another—thus erasing real difference.
This is the fundamental error of this perception: a linearity that does not exist in reality. Within the Neurodiversity Paradigm, we can instead understand different modes of functioning, rather than a single line against which everything is measured in reference to allistic functioning as superior and positioned at the top.
From this fundamental error, the entire problem begins.
Masking as ability and functioning
From this fundamental error, an impression is created that some Autistic people are able to mask—as though this were some kind of ability they possess. And this is then taken to indicate functionality. This happens because everything is viewed in terms of behavior based on allistic functioning. That line is interpreted as behavior.
So when a person is perceived as “being able to”—in quotation marks—display behavior that appears to pass as allistic, this creates the impression of functionality. The entire framework is misplaced from the outset. This is not how things actually are.
The separation of behavior as performance
This external observation perceives something called “autistic behavior”—which does not exist. What they call “autistic behavior” is simply human behavior. That is how they perceive things. They see everything as behavior.
The “neurotypical persona”
The impression is sometimes given that we construct a supposedly neurotypical—or, I would say, allistic—persona. But, as I say here, we do not even know what that is. Just as we do not know what the environmental demands are, we also do not know what this neurotypical persona is. We, too, only have an impression of how allistic people function, based on what we observe.
What needs to be understood is that we are talking about a different mode of functioning. This is not playing a character, as an actor would. These are not characters. So what exactly is this neurotypical persona? And in terms of systemic access, what does it achieve—and how?
(Deconstructing Camouflage – Autistic Journals S2Ep1)
• This is also expressed in the idea of “therapy”, behaviorism, and the behavioral practice “ABA,” aiming to change “behavior” and eliminate so-called “Autistic behavior”. If the person themselves “achieves” camouflage, they supposedly do not need anything; they are normal. Or they have mental health issues, trauma, personality disorders, and other diagnoses for which they must seek therapy or “manage” individually. The aim is the elimination of Autistic existence through “behaviorism” — elimination they call treatment — or invisibility.
They just can’t accept that we can be Autistic, because for them it’s a condition that 3-year-old boys have, and not adult women. If they accept it, they will still see it as a “mild case” according to the medical model, because for them it is divided into “mild” and “severe,” so “severe” is the issue (again, for 3-year-old boys).
So for them, an undiagnosed adult Autistic woman is basically allistic with some “difficulties” that can be worked through in therapy, as with any allistic.
The medical model is very damaging.
(Notes and Comments)
• Allistic functioning as a measure of comparison and a criterion of value, health, and normality.
• Symptoms of distress and trauma interpreted as symptoms of “autism”.
• Framing the issue as “learning social skills”, “foreign languages,” or “acting skills”.
• This point, too, is intertwined with and deeply rooted in the historical context of diagnosis — as are ABA, its ties to “conversion therapies,” and its founder, Ivar Lovaas.
• Projection of traumatic, antisocial, hostile, and inaccessible environments and systems as inherent deficits in “sociality” and “empathy”, as pathologized or negative “traits,” and as “behavior problems.”
• Victim-blaming. Mechanisms of rationalization and enabling of exclusion and abuse.
Related post
Συνηθισμένες Παρανοήσεις για τα «Επίπεδα Αυτισμού» (Ελληνικά - Πρωτότυπη ανάρτηση)
Common Misconceptions About Autism Levels – What It Really Means (English text)
Videos
Common Misconceptions About Autism Levels – What It Really Means
Deconstructing Camouflage – Autistic Journals S2Ep1
Read on the blog
We are not talking about “cost”. “We are able” = “we are able”. THEY DO NOT CARE.
Autistics who "mask" are not "high-functioning", they are supposed to not exist.
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