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Towards an Ethics of Autism

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Kristien Hens

Part I: Dimensions of Autism

3. Cognitive Explanations of Autism:

Beyond Theory of Mind

Texte intégral

  • 1 Deborah Barnbaum, The Ethics of Autism: Among Them, But Not of Them (Bloomington: Indiana Universit (...)
  • 2 Nick Pentzell, ‘I Think, Therefore I Am. I Am Verbal, Therefore I Live’, in The Philosophy of Autis (...)

1When I first started to research issues related to autism, way back in 2011, I set out to answer traditional bioethical questions such as ‘is a prenatal diagnosis for autism ethically justified?’. Almost a decade later, I consider the idea that we can even predict autism prenatally, based on genes, naive. However, back then, a logical place to start the investigation was the book The Ethics of Autism, written by Deborah Barnbaum.1 As she wrote the book in 2008, we may excuse the author for taking the then prevailing explanatory model of autism, a deficit in Theory of Mind (ToM), as a starting point for ethical reflection. Less excusable is that she believes that, given this deficit, autistics are ‘among us’ but never truly ‘of us’, to paraphrase the book’s subtitle. Hence the use of reproductive technologies to avoid the birth of a child with autism, she states, is permissible. The book is an illustration and a warning sign of how ontological assumptions about autism profoundly influence the ethical conclusions we draw. Assumptions about empathy and autism have tempted many moral philosophers to use autism as an example in a reflection on the nature of morality in general. The way we explain autism also has repercussions for the people diagnosed with autism. Imagine a scholar who argues that an autistic person can discern emotions neither in themselves nor in fellow human beings. Such a scholar has an entirely different starting point from someone who thinks that a person’s apparently awkward social functioning results from experiencing an overload of sensory input.2 Therefore we must dig deeper into some of these assumptions and their consequences.

  • 3 Pier Jaarsma and Stellan Welin, ‘Autism as a Natural Human Variation: Reflections on the Claims of (...)

2In previous chapters, we have seen how a diagnosis of autism is generally a clinical diagnosis. In consultation with other professionals, in a multidisciplinary team with psychologists and other caregivers, a psychiatrist proposes a diagnosis based on behavioural criteria from the diagnostic manual and based on assessing the person’s functioning. A diagnosis is the starting point for services and support, a clinical presentation based on which clinicians can devise a suitable therapeutic trajectory. However, for many people, autism as a concept also refers to something else, a specific neurological and biological reality, a way of being, a different way of thinking, sensing or feeling. Consider the term ‘neurodiversity’, a name that refers explicitly to a neurologically atypical way of being. Following this, some argue that autism, because it is a neurological or genetic difference, is also a neutral difference or an identity in the same way as homosexuality. Therefore, society should support and accept autistic people rather than try to cure them.3 However, people have also used this emphasis on the neurological basis of autism to defend further research into the genetics and neurology of autism and to look further for medical treatments.

3Explanations of autism take place on different levels. For example, we can explain it by referring to genetic factors, or by neurological and cognitive functioning that causes specific behaviour. Often the influence of physical and social environments on the expression of autistic behaviour is also mentioned. Many models seek to integrate these. However, even in such integrative models, some key questions remain: what is autism, the behaviour or the cognitive explanation? To which extent does our genetic blueprint steer behaviours, and how can mental models explain particular challenges that autistic people face? I shall postpone discussing the genetics of autism to chapter 11, and I will now sketch the explanatory models that have appealed both to the public imagination and to philosophers and ethicists alike.

Why We Need to Talk about Theory of Mind

  • 4 David Premack and Guy Woodruff, ‘Does the Chimpanzee Have a Theory of Mind?’, Behavioural and Brain (...)

4Since Kanner and Asperger, researchers have sought to define the origins of the different behaviour of autistics as a deficit of social capabilities. The most widely known theory is that autistic people have a deficient Theory of Mind (ToM), an idea that was first used in 1978 by David Premack and Guy Woodruff. Theory of Mind refers to the capacity to draw conclusions about the mental states of others.4 The ability to judge what others think typically develops in children around the third year of their lives. Whether a young child has a properly functioning ToM can be tested using the Sally-Anne false-belief test. The investigator shows the child a puppet show with the dolls Sally and Anne, a basket, a box, and a marble. Sally puts the marble in the basket while Anne watches. Sally goes outside, and Anne takes the marble from the basket and puts it in the box, without Sally seeing it. The test taker then asks the child where Sally will look for the marble in the basket or the box.

  • 5 Simon Baron-Cohen, Alan Leslie, and Uta Frith, ‘Does the Autistic Child Have A “Theory of Mind”?’, (...)

5The expected answer is ‘basket’. Most children pass this test at around age four. Children with a diagnosis of autism succeed at a later age. This finding led autistic researchers to conclude that autistic people may be unaware of the fact that other people also have thoughts and intentions. In particular, the British researcher Simon Baron-Cohen has further examined this theory and popularised it. Autistic people do not readily look others in the eyes. Eyes are, it is said, the window to the soul, and for someone who seemingly has difficulty understanding that there is a soul behind those windows, it makes no sense to look into them.5 If one begins with the idea that autistic people have a deficient ToM, one might readily conclude that these people have no, or at least less, empathy. To have empathy, you have to be able to imagine what another person feels.

  • 6 Adam Smith, ‘The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Em (...)
  • 7 Candida C. Peterson and others, ‘Children with Autism Can Track Others’ Beliefs in a Competitive Ga (...)
  • 8 Eliane Deschrijver & Colin Palmer, ‘Reframing social cognition: Relational versus representational (...)

6Some people have raised critiques of the ToM hypothesis itself, as well as how ToM is tested, and the idea that autistic people have an empathy deficit. Autistic people themselves claim to have empathy. According to the empathy imbalance theory, they may even feel too much, with the result that they have to close themselves off from others.6 Autistic children can pass the Sally-Anne test by researching the correct outcome, if they have the motivation to do so.7 A very recent theory by Eliane Deschrijver and Colin Palmer states that autistics may not have difficulty inferring mental states in others, but in discerning these from their own mental states.8

  • 9 R. Peter Hobson, ‘Against the Theory of “Theory of Mind”’, British Journal of Developmental Psychol (...)
  • 10 Shaun Gallagher, ‘Understanding Interpersonal Problems in Autism: Interaction Theory As an Alternat (...)
  • 11 Yael Kimbi (2014). Theory of mind abilities and deficits in Autism Spectrum Disorders. Topics in La (...)

7Moreover, some researchers claim, autism is something that develops far earlier than their third year, at an age when no child has a functioning ToM.9 A deficit in ToM could merely be the symptom of a development that was atypical far earlier on. In this respect, Shaun Gallagher has stated that the autistic person explicitly reflects on other people’s intentions far more than a typically functioning person. They have missed out on something at a more fundamental developmental level: they did not learn how to understand others instinctively in spontaneous interaction (without theory).10 Moreover, specific research demonstrated that although autistic children might score less on ToM tests than their typically developing peers, they often acquire the skill later.11

Bridging Minds

  • 12 Anne E. McGuire and Rod Michalko, ‘Minds between Us: Autism, Mindblindness, and the Uncertainty of (...)

8Scholars with a background in disability studies and sociology have described autism as a defect that we can localize in the individual or in an individual’s inability to interpret someone else’s mood and behaviour’. A good example is the paper ‘Minds Between Us: Autism, Mindblindness and the Uncertainty of Communication’,12 written by Anne E. McGuire and Rod Michalko. In this paper, the authors challenge the ideas that social and communicative challenges arise from an individual defect. McGuire and Michalko state that people continuously associate autism with mystery. We have to solve a medical puzzle: if we do not understand certain behaviour, we have to explain it by finding a biological origin. If we gather enough knowledge about what autism is, what causes it, we can know it and prevent or cure it. Behavioural therapies can then help to alleviate autistic symptoms and improve the behaviour of the autistic child. According to McGuire and Michalko, this interpretation is wrong. Autism is a complex process that takes place in interactions between people. Autism only has meaning in a relational context, and because of that, autism can teach us something about the interactions between people in general. We can never be entirely sure that what another person means with a specific message is precisely the same as how we have understood it. Communication between people is always partial.

9If we consider autism a problem of communication by the individual, we assume a standard of problem-free communication in which non-autistic people can participate. This is clear in the Sally-Anne test, where we believe that the correct answer is that Sally thinks that her marble is still in the basket. This ‘correct’ answer means that you passed the test. If you give a different answer, then you fail. Nevertheless, this is a denial of what communication is. Readily reading someone’s intentions based on the look in their eyes seems nice in theory but is not how communication works. We do not just read another’s intentions; we must actively work to reconstruct and interpret them, a process that is not always without problems. To go back to the Sally-Anne test: there might be reasons why someone would think that the marble is not in the original place, reasons that do not necessarily relate to reading Sally’s thoughts. For example, Sally may know Anne very well and may think that Anne could have played a joke on her. There is more at stake than purely reading the mind of someone else. Nonetheless, in the standard account of autism, part of the puzzle is deemed to be that autistic people have a deficient Theory of Mind, which we can assess using tests such as Sally-Anne.

  • 13 Tomasello Michael and Carpenter Malinda, ‘Shared Intentionality’, Developmental Science, 10.1 (2006 (...)

10According to the ToM theory of autism, it is a condition in which something has gone wrong in the individual’s natural cause of development. McGuire and Michalko also refer to the ideas of Michael Tomasello and others, which situate what is characteristically human in the possibility of shared attention and the development of shared aims.13 Tomasello and colleagues argue that possessing a greater or lesser number of these characteristics is proof of how ‘close to nature’ certain people are: primates and autistic children would, in their view, not be able to participate in activities that require shared attention. According to McGuire and Michalko, however, this assumption neglects the idea that there is a moment in all communication in which one has to make an effort to understand the other in a way that makes sense. They use the ideas of Judith Butler and Emmanuel Levinas to argue that the other is someone who breaks through our barriers and questions us. The other is the other in an absolute way: the other forces us to think about who we are and our relation to that other. We are very close to the other but also infinitely far away. The other can not merely be known or resolved. We can all only guess the true intentions of the other. In this way, autism can teach us something about ourselves and how communication always brings uncertainty.

11This is one of the great merits of McGuire and Michalko’s work. Besides the image of autism as a medical puzzle to be solved, it is also often associated with something completely unusual. Often, images of Martians and other aliens are used to stress this otherness, even by people who have a diagnosis themselves. An unbridgeable gap is thus created between the ‘neurotypical’ and the ‘autistic’. If we follow McGuire and Michalko and conceive of autism as something that unavoidably takes place within communication, it allows us to understand the autistic other better. We can all imagine situations when we have understood something completely differently from how it was intended or when we did not understand a joke. This fact does not preclude the notion that autistic people suffer from such instances more frequently or intensely, but it allows us to understand each other better.

Beyond the Theory of Mind

  • 14 Simon Baron-Cohen, ‘The Extreme Male Brain Theory of Autism’, Trends in Cognitive Sciences, 6.6 (20 (...)

12Simon Baron-Cohen has championed the association of autism with both a deficit in ToM and with less empathy. Baron-Cohen has sympathy for autistic persons and stresses the talents that these people often have. In his later research, he elaborates on the idea of the extreme male brain.14 According to this theory, specific characteristics that we primarily associate with men are amplified in autism. Autistic people primarily systemise and analyse, in contrast to the more socially interested empathisers. Therefore they have more insight into details. The association of autism with some characteristics that we primarily associate with men looks straightforward: even today, three-fourths of those diagnosed with autism are male.

  • 15 STEM is an abbreviation of Science, Technology, Engineering & Mathematics.
  • 16 Simon Baron-Cohen, ‘Is Asperger Syndrome/High-Functioning Autism Necessarily a Disability?’, Develo (...)

13Moreover, Baron-Cohen gives an additional biological explanation for the origins of autism by linking it to increased exposure to testosterone in the uterus. Anyone who has read up on gender studies intuits that we can contest this theory on several grounds, not in the least the way it is named. Associating specific characteristics with being male or female seems outdated. Moreover, what about autistic girls and women? Do we say that girls in STEM or girls who prefer activities that are not necessarily related to caring have more ‘male characteristics’?15 This illustrates that scientists should take care when using specific terms. Still, Baron-Cohen is a big proponent of the idea of neurodiversity: being autistic has certain advantages. For example, it can significantly improve your performance in certain professions to be an analytic thinker and to focus primarily on details. Baron-Cohen has proposed that we should no longer speak of Autism Spectrum Disorder but Autism Spectrum Condition, to stress that we should not always consider the characteristics of autistic people a disorder.16

  • 17 Uta Frith, Autism: Explaining the Enigma, 2nd ed. (Malden, MA: Blackwell Pub, 2003).

14With the idea of hyper-systemizing — primarily paying attention to analysis and details rather than to interpersonal aspects — we approach the next explanatory model of autism. For Uta Frith and others, the fundamental deficit that can explain the behaviour of autistic people is weak central coherence.17 Central coherence is the ability to integrate different sensory and informational perceptions in a whole. For autistic people, it is a challenge to tie together all these different sensations and feelings into a sensible whole. People with autism get stuck on the details. As such, weak central coherence also explains other challenges that autistic people experience. A focus on details could make it difficult to perceive other people as whole beings with their own thoughts and selves, explaining why autistic children sometimes fail false-belief tests such as the Sally-Anne test. It would also explain why autistic people sometimes have different sensory experiences. Uta Frith and other proponents of this theory would claim that it is not the case that autistic people, for example, perceive certain sounds as louder. Because they cannot integrate them into a greater whole, they only seem louder to them. We should, therefore, take the accounts of autistic people about their sensory perceptions with a grain of salt. Here we also arrive at the most problematic part of her theory: not only do autistic people have a deficient ToM in relation to other people, but also in relation to themselves.

  • 18 Markus Gabriel, I Am Not a Brain: Philosophy of Mind for the 21st Century (Hoboken: Wiley, 2017).
  • 19 David Williams, ‘Theory of Own Mind in Autism Evidence of a Specific Deficit in Self-Awareness?’, A (...)

15We can represent our self as a little man, a homunculus that is the integrated sum of our experiences. This unified self-experience is thus deficient or fragmented in autistic people. Because of this deficient ‘self’, we should be cautious when we interpret the experiences that autistic people tell us they have, and we should double-check these with their caregivers. I immediately want to express some concerns here. First, we can contest the idea of the self as a homunculus.18 Philosophers of consciousness disagree about what it means to have a self. It is therefore misguided to deny certain people the ability to speak authoritatively about their own experiences based on this assumption. Moreover, empirical research seems to suggest that autistic people do have a strong sense of self and often question what it means to have a self.19 This self may be less spontaneous or less subconscious than in an average person. However, we could also state that this is precisely because autistic people are excellent witnesses of their own experiences. In chapter six, I shall return to the problem of epistemic injustice and who can speak for whom.

  • 20 R. Peter Hobson, ‘Against the Theory of “Theory of Mind”’, British Journal of Developmental Psychol (...)
  • 21 Francesco Craig and others, ‘A Review of Executive Function Deficits in Autism Spectrum Disorder an (...)
  • 22 James Russell, Autism as an Executive Disorder (Oxford: Oxford University Press, 1997).

16Ideas about a deficient ToM assume that autism is a problem at a social level in the first place. Competing theories are based on this as well. For example, Peter Hobson has stated that during the early years of autistic children, even before there is any development of ToM, something atypical happens as they learn spontaneous and atheoretical social interaction. These children are, from birth, focused on others to a lesser degree than neurotypical children.20 However, if we look at the DSM-5 definition of ASD, we notice that social-communicative problems are only one part of the dyad. Repetitive or stereotypical behaviour is the other part. More recently, theories have been developed that assume that autism is a problem with information processing or sensory processing in the first place, and that social challenges are the result of this, rather than the other way around. For a long time, it has been known that autistic people have problems with executive functioning. Cognitive science defines executive functions as those that play a role in planning, concentration, and working memory. Because autistic people have difficulties with their executive functions, they experience challenges in planning and being attentive to different things simultaneously.21 Therefore, they have a preference for repetitive actions, which also explains the well-known insistence of sameness, an aversion to change.22 If you are unsure of how to take the next step, it is safer if everything remains the same. Explanations that refer to executive functions have an advantage in that they are close to what autistic people tell themselves. They could also explain the overlap of autism with ADHD. Nonetheless, we can still wonder whether a deficit in executive functioning is an explanatory model in itself, or the result of a difference on a more fundamental level of information processing.

Beyond Deficit Models of Autism

  • 23 Henry Markram, Tania Rinaldi, and Kamila Markram, ‘The Intense World Syndrome — an Alternative Hypo (...)
  • 24 Nick Pentzell, ‘I Think, Therefore I Am. I Am Verbal, Therefore I Live’, in The Philosophy of Autis (...)

17In the last decade, scholars have developed theories that explicitly take into account the experiences of autistic persons. In a 2007 paper, Henry Markram, Tania Rinaldi, and Kamila Markram describe their Intense World theory.23 The problems and challenges that autistic people face, they claim, can be explained by sensory perceptions being experienced much more intensely. They argue that this is because local neuronal circuits in autistic people are hyperreactive and hyperplastic, something the authors have studied in mice. This theory has been much acclaimed by autistic people because it is close to what they experience as their primary challenge. For example, Nick Pentzell, who is autistic himself, writes that this overload explains why children fail the Sally-Anne test. During this test, these children are so busy attempting to maintain their equilibrium while experiencing an overflow of sensory input that everything else becomes a side issue: ‘sensory overload inhibits anyone from thinking about much more than surviving its barrage’.24

  • 25 Laurent Mottron and others, ‘Enhanced Perceptual Functioning in Autism: An Update, and Eight Princi (...)
  • 26 Laurent Mottron, L’intervention précoce pour enfants autistes: Nouveaux principes pour soutenir une (...)

18Laurent Mottron is a psychiatrist working at the University of Montréal. He is originally from France and has rejected the psychoanalytic assumptions about autism that are prevalent there. His theory is called Enhanced Perceptual Functioning.25 For Mottron, who also intensively collaborates with autistic researchers (amongst others Michelle Dawson), autism is a different form of intelligence. In his book on early detection, he stresses that autistic people can see wholes and not only details, despite what other theories may suggest.26 They just arrive via a different route to the whole. Therefore one should not try to force an autistic child with a delayed language development to learn a language. Autistic children firstly develop a good visual intelligence, which is apparent in the fact that at a young age they can often already read letters (‘hyperlexia’). Only after that do they acquire oral language. We should not try to force them to follow more typical development pathways; this might even be considered unethical.

19Interestingly, Mottron makes a distinction between ‘real’ autism and syndromic autism. The latter is autistic behaviour that we can entirely explain by an underlying syndrome such as Fragile-X, a condition with a localizable genetic cause that is associated with autistic behaviours. Although it is possibly correct that different biological causes of autism lead to different types of autism, it seems that the distinction between autism-as-the-result-of-a-syndrome and autism-as-visual-intelligence is artificial and undesirable. Autistic people with a known syndrome behave a certain way because of specific reasons, and they can also have qualities related to their autism. For these people, it is vital that we try to understand their behaviours and not merely explain them via genes.

20Moreover, and I think this is a valid criticism of all explanatory models, it seems impossible to find one explanatory model that covers all autistic behaviours. There will be people diagnosed with autism who do not experience much empathy or who score poorly on the visual parts of an IQ test. Autism as a diagnosis connects these people in a way that often makes sense, based on shared experiences. A vision of autism that tries to reduce it to one explanatory model carries the risk that some people will not fit that model, and that we therefore deny them the benefits of identifying and being identified as autistic. We can conclude, however, that we should reject a theory in which no one with a diagnosis recognizes themselves, and which is purely based on speculation about how brains work.

  • 27 Sander Van de Cruys and others, ‘Precise Minds in Uncertain Worlds: Predictive Coding in Autism’, P (...)

21More recent models of autism assume the Bayesian model of predictive coding, the idea that our brain continually generates statistical models of reality and adjusts these based on new information. The High, Inflexible Precision of Prediction Errors in Autism (HIPPEA) theory by KU Leuven researcher Sander Van de Cruys states that autism is related to difficulties in evaluating the weight of prediction errors.27 Our brains build a model based on our observations, and this model is adjusted based on mistakes in our prediction. However, not every prediction error is relevant: some are noise or not appropriate for a specific task. Autistic people’s brains put too much weight on all mistakes and do not filter out the noise. Therefore it is more challenging to come to specific predictions, and the brain considers every new situation to be entirely new. This model allows us to view autism not merely as a deficiency. In tasks where the context could lead to mistakes in typically functioning people, for example, in visual illusions, autistic participants often score better.

The Ethical Import of Ontological Assumptions about Autism

  • 28 Jeanette Kennett, ‘Autism, Empathy and Moral Agency’, Philosophical Quarterly, 52: 208 (2002), 340– (...)

22Let us, for the moment, set aside the discussion about the explanatory models of autism and look at their relevance for ethics. A branch of ethics in which autism has flourished, for example, is that of meta-ethics. Autism has inspired some philosophers to speculate about the question of why and how we are moral beings. An example of this is the discussion between Victoria McGeer and Jeanette Kennett. In her article ‘Autism, Empathy and Moral Agency’, Kennett tries to tackle the age-old question about whether David Hume or Immanuel Kant is correct regarding the role of emotions in morality. Autistic people, especially those Kennett describes as ‘high-functioning’, have a sense of duty and justice. Kennett takes Kant’s side: emotions can play a role in morality, but they do not have to. There are other ways to arrive at moral action. According to her, autistic people are Kantians par excellence. Because they do not have direct access to the intuitions and feelings of others, they come to moral insight through reasoning about what is good. She refers to Oliver Sacks and Temple Grandin’s meetings, where the latter stated that she would consider for herself how people behaved and what to learn from this. Kennett concludes that, driven by the desire to do good, autistic people use reason to arrive at what is good. Hence, she concludes that although empathy may play a practical role in moral development, it is not a precondition to be a moral actor.28

  • 29 Victoria McGeer, ‘Varieties of Moral Agency: Lessons From Autism (and Psychopathy)’, in Moral Psych (...)

23Victoria McGeer explains the moral actions of autistic people differently in her text, Varieties of Moral Agency.29 She points out that autistic people are often prone to describe themselves and others in terms of moral duties. From autobiographies, she deduces that autistic people often have difficulties predicting others’ behaviour, leading to anxiety. They, therefore, need structure and order. Their desire for just rules might be more related to their passion for a structured world rather than intrinsically moral. As McGeer points out herself, it is difficult to draw a distinction between following rules as a protective mechanism and honestly acting morally in the way Kant would have wanted. Next, McGeer states that the necessity to create order to deal with the environment contributes to the fact that autistic people are very passionate about their desire for order. Therefore it is not only reason that drives their moral action but also their strong underlying feelings about order and structure that make autistic people use rationality to arrive at this order. Rationality is the means to acquire the passionately sought-after aim: order and structure.

  • 30 Indrajeet Patil and others, ‘Divergent Roles of Autistic and Alexithymic Traits in Utilitarian Mora (...)

24Furthermore, so McGeer concludes, it is precisely because autistic people have these passions that many of them develop into true moral actors. Kennett and McGeer wrote their works in 2002 and 2008. More than ten years later, we still do not agree on the core explanation of autism, and the idea that autistic people have an empathy deficit needs revision. Experiences and scientific studies demonstrate that autistic people are not by definition less empathic than others.30 Philosophers and ethicists ought to study the experiences of many different autistic people. Perhaps as for morality, the same is true for autism: it may make more sense to study the phenomenon in its multiplicity, rather than reduce it to a single explanatory model.

  • 31 Kenneth Richman and Raya Bidshahri, ‘Autism, Theory of Mind, and the Reactive Attitudes’, Bioethics(...)
  • 32 Peter Frederick Strawson, ‘Freedom and Resentment’, Proceedings of the British Academy, 48 (1962), (...)

25The explanatory model of autism that one adopts effects how autism can be used to illustrate specific ideas about the role of empathy in morality. It also has consequences for how we think about the moral responsibility of autistic people themselves. Can autism be used to excuse the transgression of particular social, ethical, or legal norms? It is this question that Ken Richman and Raya Bidshahri tackle in their paper ‘Autism, Theory of Mind and the Reactive Attitudes’.31 Reactive attitudes are feelings of approval and disapproval as a response to specific deeds. As Peter Strawson (1919–2006) has argued in his seminal paper ‘Freedom and Resentment’,32 they play a role in how we think about moral responsibility. Reactive attitudes are feelings of approval, disapproval, and praise as a response to specific deeds. If we think about whether an act is good or bad, we also think about the effects that this deed potentially has on ourselves and others. If we are responsible for our deeds, we will have to be able to estimate the reactive attitudes that these deeds can cause. We require a minimum of empathy for this. Richman states that there is no reason to assume that autistic people cannot participate in the moral community: they make moral judgements and give reasons for them. Members of the moral community can do things that are not right as well. We cannot, however, blame autistic people for all their transgressions. Suppose it is so that autistic people cannot properly judge reactive attitudes because they have a deficient Theory of Mind. In that case, if they perform a particular moral transgression, they are not responsible for it. Richman and Bidshahri do not claim that a deficient ToM is the correct explanation for autism, or that the idea of reactive attitudes is the proper way to look at morality. They demonstrate that, should these two approaches be correct, this could have consequences for the extent to which autistic people are responsible for their behaviour. If we cannot understand which reactions our actions will evoke in others, how are we responsible? Moreover, Richman and Bidshahri raise an important point: to what extent is it the duty of the autistic person to put more effort into trying to understand others? Should non-autistic persons demonstrate more understanding for their autistic fellow human beings, explain the context of specific reactions of theirs, and try to come to mutual understanding?

26I would also argue that being responsible and being held accountable are not the same. Holding someone responsible and having reactive attitudes also imply seeing the other as a human being capable of learning. I usually give the somewhat autobiographical example of pathological clumsiness. Imagine an utterly clumsy person, to the extent that, throughout their life, they have broken many glasses of wine, spilt coffee, and ruined people’s clothes to a far greater degree than is acceptable. This person regrets this profoundly but cannot help their behaviour. Does this mean that their partner has no reason at all to be grumpy, perhaps even a bit angry when they once again spill the last glass in the bottle of wine? Is a cheerful ‘oh that is fine, you cannot help it’ always an appropriate reaction? Grumpiness may not be related to the other person’s capacity to have done otherwise, as much as it is a sign that the other is considered a completely autonomous, but, in some respects, flawed human.

27Reactive attitudes also serve a pedagogical aim. Even if we know that a particular faux pas was beyond the control of a given person, complete indifference is not the proper reaction. It assumes that the person doing the transgression is beyond any learning. In my experience, autistic people want acknowledgement of the fact that they do some things because they do not understand the effects on others, and they did not intend any harm. Nevertheless, they also like to learn and receive feedback and explanations. This does not mean forcing them to conform to certain norms, but it can be part of the mutual understanding described above.

28To conclude this chapter, I would like to give the floor to M. Remi Yergeau and Bryce Huebner. In an article they wrote as a dialogue, they challenge the use of ToM arguments in philosophy. They state that all ethicists and philosophers who take this approach make the same mistake: they assume that a social deficit is the basis of autism. This way of thinking has dehumanized autistic people and has directly impacted their lives. Yergeau talks about how certain philosophers use autobiographies of autistic people to demonstrate that they have a deficient emotional experience rather than as a way to gain access to this emotional life. Such philosophers hunt for symptoms to illustrate the lack of ToM. This endeavour is an example of a deficiency in Theory of the Autistic Mind that belongs to the autism researchers themselves. They do not put much effort into engaging autistic people in their research, and they do not check certain presumptions for their empirical truth. Yergeau summarizes this as follows:

  • 33 Melanie Yergeau and Bryce Huebner, ‘Minding Theory of Mind’, Journal of Social Philosophy, 48: 3 (2 (...)

ToM is both a rhetorical and philosophical problem: it impoverishes not only our notions of what it means to have a body mind, to exist, to cogitate, or to participate, but it also reduces how we interrelate or think about interrelating. The idea of others outside oneself is both rhetorically and philosophically complicated (understatement of the year)-but, with so much irony, ToM collapses all of this complicatedness and difference in such a way as to deny the rhetoricity, symbolicity, and empathic potentialities of numerous kinds of minds.33

  • 34 Damian Milton, ‘On the ontological status of autism: the “double empathy problem”’, Disability & So (...)

29This quote is also reminiscent of what sociologist Damian Milton has described in his paper on the double empathy problem. In this paper, he states that rather than localizing a lack of empathy in the autistic person, we need to acknowledge that people with very different experiences of the world will have difficulties in empathizing with each other. It is unfair to think that this is merely a problem of autistic people not empathizing with non-autistic people: the opposite is equally the case, perhaps even more so.34 As ethicists, we must guard against locating deficiencies in other people too quickly, especially if they are different from us.

  • 35 Francesca Happé, Angelica Ronald, and Robert Plomin, ‘Time to give up on a single explanation for a (...)

30In this chapter, I sketched some of the explanatory models of autism and their relevance to the ethics of autism. I have described how autism has been used as an example in meta-ethics, and how specific theories have harmed autistic people. I have focused on critiques of the deficiency in Theory of Mind theory, because the theory and the critique have gained much attention during recent decades. It is possible that, in the upcoming years, the other theories will also receive critique or perhaps praise. Perhaps there is not one thing called autism, and we should not explain the origins of autism by looking at neurology but at the historical context in which it arose. The idea that autistic behaviour should correlate with a neurological and cognitive essence that is different from typical functioning seems straightforward. However, autistic researchers themselves think more and more that there is no one definitive explanation for the differences between autistic and non-autistic functioning and that there may be ‘many autisms’.35 Perhaps some of the theories are only applicable to a subset of people diagnosed with autism. In that respect, it is helpful to look at the historical and cultural context in which autism as a concept arose. This is the topic of the next chapter, in which I discuss social-constructivist explanations of autism.

Notes

1 Deborah Barnbaum, The Ethics of Autism: Among Them, But Not of Them (Bloomington: Indiana University Press, 2008).

2 Nick Pentzell, ‘I Think, Therefore I Am. I Am Verbal, Therefore I Live’, in The Philosophy of Autism, ed. by Jami L. Anderson and Simon Cushing (Lanham: Rowman & Littlefield, 2013), pp. 103–8.

3 Pier Jaarsma and Stellan Welin, ‘Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement’, Health Care Analysis, 20.1 (2012), pp. 20–30.

4 David Premack and Guy Woodruff, ‘Does the Chimpanzee Have a Theory of Mind?’, Behavioural and Brain Sciences, 4.4 (1978), 515–629.

5 Simon Baron-Cohen, Alan Leslie, and Uta Frith, ‘Does the Autistic Child Have A “Theory of Mind”?’, Cognition, 21.1 (1985), 37–46; Simon Baron-Cohen, Mindblindness: An Essay on Autism and Theory of Mind (Cambridge, MA: MIT Press, 1997).

6 Adam Smith, ‘The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development’, Psychological Record, 59.2 (2009), pp. 273–94.

7 Candida C. Peterson and others, ‘Children with Autism Can Track Others’ Beliefs in a Competitive Game’, Developmental Science, 16.3 (2013), 443–50, https://doi.org/10.1111/desc.12040

8 Eliane Deschrijver & Colin Palmer, ‘Reframing social cognition: Relational versus representational mentalizing, ’ Psychological Bulletin, 146: 11 (2020), pp 941–69.

9 R. Peter Hobson, ‘Against the Theory of “Theory of Mind”’, British Journal of Developmental Psychology, 9.1 (1991), 33–51, https://doi.org/10.1111/j.2044-835X.1991.tb00860.x

10 Shaun Gallagher, ‘Understanding Interpersonal Problems in Autism: Interaction Theory As an Alternative to Theory of Mind’, Philosophy, Psychiatry, and Psychology, 11.3 (2004), pp. 199–217.

11 Yael Kimbi (2014). Theory of mind abilities and deficits in Autism Spectrum Disorders. Topics in Language Disorders, 34 (4), 329–43.

12 Anne E. McGuire and Rod Michalko, ‘Minds between Us: Autism, Mindblindness, and the Uncertainty of Communication’, Educational Philosophy and Theory, 43.2 (2011), pp. 162–77.

13 Tomasello Michael and Carpenter Malinda, ‘Shared Intentionality’, Developmental Science, 10.1 (2006), 121–25, https://doi.org/10.1111/j.1467-7687.2007.00573.x

14 Simon Baron-Cohen, ‘The Extreme Male Brain Theory of Autism’, Trends in Cognitive Sciences, 6.6 (2002), 248–54.

15 STEM is an abbreviation of Science, Technology, Engineering & Mathematics.

16 Simon Baron-Cohen, ‘Is Asperger Syndrome/High-Functioning Autism Necessarily a Disability?’, Development and Psychopathology, null.03 (2000), 489–500, https://doi.org/null; Simon Baron-Cohen, ‘Editorial Perspective: Neurodiversity — a Revolutionary Concept for Autism and Psychiatry’, Journal of Child Psychology and Psychiatry, 58.6 (2017), 744–47, https://doi.org/10.1111/jcpp.12703

17 Uta Frith, Autism: Explaining the Enigma, 2nd ed. (Malden, MA: Blackwell Pub, 2003).

18 Markus Gabriel, I Am Not a Brain: Philosophy of Mind for the 21st Century (Hoboken: Wiley, 2017).

19 David Williams, ‘Theory of Own Mind in Autism Evidence of a Specific Deficit in Self-Awareness?’, Autism, 14.5 (2010), 474–94, https://doi.org/10.1177/1362361310366314

20 R. Peter Hobson, ‘Against the Theory of “Theory of Mind”’, British Journal of Developmental Psychology, 9.1 (1991), 33–51, https://doi.org/10.1111/j.2044-835X.1991.tb00860.x

21 Francesco Craig and others, ‘A Review of Executive Function Deficits in Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder’, Neuropsychiatric Disease and Treatment, 12 (2016), 1191–202, https://doi.org/10.2147/NDT.S104620

22 James Russell, Autism as an Executive Disorder (Oxford: Oxford University Press, 1997).

23 Henry Markram, Tania Rinaldi, and Kamila Markram, ‘The Intense World Syndrome — an Alternative Hypothesis for Autism’, Frontiers in Neuroscience, 1: 1 (2007), 77–96, https://doi.org/10.3389/neuro.01.1.1.006.2007

24 Nick Pentzell, ‘I Think, Therefore I Am. I Am Verbal, Therefore I Live’, in The Philosophy of Autism, ed. by Jami L. Anderson and Simon Cushing (Lanham: Rowman & Littlefield, 2013), pp. 103–8.

25 Laurent Mottron and others, ‘Enhanced Perceptual Functioning in Autism: An Update, and Eight Principles of Autistic Perception’, Journal of Autism and Developmental Disorders, 36: 1 (2006), 27–43, https://doi.org/10.1007/s10803-005-0040-7

26 Laurent Mottron, L’intervention précoce pour enfants autistes: Nouveaux principes pour soutenir une autre intelligence (Brussels: Editions Mardaga, 2016).

27 Sander Van de Cruys and others, ‘Precise Minds in Uncertain Worlds: Predictive Coding in Autism’, Psychological Review, 121: 4 (2014), 649–75, https://doi.org/10.1037/a0037665

28 Jeanette Kennett, ‘Autism, Empathy and Moral Agency’, Philosophical Quarterly, 52: 208 (2002), 340–57.

29 Victoria McGeer, ‘Varieties of Moral Agency: Lessons From Autism (and Psychopathy)’, in Moral Psychology, Volume 3, ed. by Walter Sinnott-Armstrong (Cambridge, MA: MIT Press, 2008).

30 Indrajeet Patil and others, ‘Divergent Roles of Autistic and Alexithymic Traits in Utilitarian Moral Judgments in Adults with Autism’, Scientific Reports, 6 (2016), 23637, https://doi.org/10.1038/srep23637

31 Kenneth Richman and Raya Bidshahri, ‘Autism, Theory of Mind, and the Reactive Attitudes’, Bioethics, 2017.

32 Peter Frederick Strawson, ‘Freedom and Resentment’, Proceedings of the British Academy, 48 (1962), 1–25.

33 Melanie Yergeau and Bryce Huebner, ‘Minding Theory of Mind’, Journal of Social Philosophy, 48: 3 (2017), 273–96.

34 Damian Milton, ‘On the ontological status of autism: the “double empathy problem”’, Disability & Society, 27: 6 (2012), 883–87.

35 Francesca Happé, Angelica Ronald, and Robert Plomin, ‘Time to give up on a single explanation for autism’, Nature Neuroscience, 9 (2006), 1218–20.

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