Download Although autism was first diagnosed by Kanner in 1943 (xx)

Impaired Theory of Mind in Autistic Individuals:
The Cultural Construction of Disability
A Three-field Anthropological Assessment
Robin Freeman
October 22, 2007
Integrating Essay
Anthropology Department
The George Washington University
Two characteristics define what it means to be human: our theory of mind and capacity
for language, yet, we still retain the same body and brain plan as the great apes from which we
diverged 5-8 million years ago. Our similar set of cognitive skills includes the capacity to
remember ‘what’ is ‘where’ in a local environment and categorize objects based on perceptual
similarities. Additionally, both human and non-human primates recognize conspecifics, even
distinguishing hierarchical and affiliative relationships. These social cognitive abilities allow all
primates to engage in some type of social learning and cooperation, to varying degrees of
complexity and abstraction.
Yet, no one would argue that humans and primates are the same; we are different.
Unique brain adaptations, according to many scientists and scholars, permit humans to attribute
mental states such as beliefs, intentions, memories and aspirations to oneself and others. Known
as “theory of mind,” it allows humans to exploit these attributions to understand and predict the
behaviors of others (Shaked 2006) in ways that are far more abstract, conceptual and complex
than other non-human primate species. One method used to detect and test human beings’ theory
of mind is to study children in whom theory of mind appears to be impaired, namely individuals
diagnosed with autism spectrum disorders, in comparison with typically developing children.
This paper assumes theory of mind to be a uniquely human capacity, a physiological
cognitive substrate, upon which human evolves and culture is built. I first trace the evolution of
theory of mind in non-human and human primates. Then, I explore some of the implications of
an impaired theory of mind, as observed in autistic children. From this foundation, I next focus
on how theory of mind articulates with human linguistic practices by comparing ‘normal’ and
autistic individuals. Lastly, I assess how cultural perceptions and normative practices ‘construct’
disability, again through theory of mind deficits in autistic children.
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The literature and research on autism has mushroomed in the past twenty years, from
newspaper articles and talk shows to brain-imaging studies and academic reports. Given the
scope of this paper, a comprehensive review of this broad array is impossible. In addition,
specifically anthropological literature about autism is scarce. Therefore, I will use
anthropological concepts to evaluate the idea of theory of mind across three-fields of
anthropology, focusing on its relevance to autism.
Some background on autism is needed to position and contextualize the illness in a
broader framework. “The cluster of symptoms we now know as autism has probably been
around for a long time, but no one really know for sure” (Grinker, 2007:52), although
‘retroactive’ diagnoses have gone back to accounts from the Middle Ages (ibid). However,
autism was not distilled into a cohesive diagnostic suite of abnormalities until Kanner described
it in 1943 (Grinker, 2007:64). The Diagnostic and Statistical Manual of Mental Disorders
defines autism on the basis of observable symptoms in three behavioral domains: distinctly
impaired or abnormal developments in social interaction; impaired communication; and a
markedly restricted repertoire of activity and interests (DSM-IV). Regardless of geographic
location or cultural milieu, developmental impairments in theory of mind have been strongly
implicated as pivotal causes in the pervasive expression of disabilities in these three domains.
As humans diverged from the great apes, the most dramatic changes occurred in the brain
and muscoskeletal structure. A three-fold increase in brain volume is believed to have occurred
sometime in the past 2 million years, along with a disproportionate increase in the prefrontal
cortex of humans from apes, to 24% from 14% respectively (Povinelli and Preuss, 1995:419).
Povinelli and Preuss assert that the expanded prefrontal region may be related to the evolution of
a specialized neural system that underlies distinctive human cognitive capacities, in which the
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‘normal’ ontogenic development subsumes theory of mind. Their studies of autistic individuals
bolster the hypothesis for ‘locating’ theory of mind. Additionally, they attest that the lack of
insight and introspection found in autistic individuals “is reminiscent of deficits that result from
frontal lesions” (1995:419) observed in individuals with other brain injuries. The authors
additionally posit that theory of mind “is a recent evolutionary innovation” (1995:418), and
claim that this unique advance – in concert with a specific neural organization -- enables humans
to attribute mental states.
Similarly, Baron-Cohen calls the type of impaired theory of mind observed in autistic
individuals ‘mindblindness’ and notes its essential role in the formation of human culture.
“Without it,” Baron-Cohen asserts, “human society as we know it simply would not exist. It
would either be rigid (like that of ants or bees) or limited to physical interactions and observable
signs of social status and alliances (as in many species of monkeys and apes)” (1997).
In contrast, Hare does not draw such sharp distinctions between humans and
chimpanzees. He notes that chimps share the ability to recognize the emotional states of others
and that they “not only take into account others’ perceptual states but also recognize the
intentions behind other individuals’ behavior” (2007:60). However, Hare asserts a critical
distinction: that chimps do not have the capacity to “flexibly read social cues in cooperativecommunicative contexts” (2007:61) which “seems to have evolved after the hominid split, and
thus may play a role in explaining the unusual behavioral flexibility observed in humans” (ibid).
Understanding intentionality and recognizing others as intentional agents is a critical
cognitive milestone in children that facilitates linguistic acquisition and competence, with
eventual full membership in a given culture (barring other obstacles). In particular, specific joint
attention behaviors, such as gaze following and social referencing, are observable displays of an
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underlying awareness of intentionality, and by extension, theory of mind. In contrast, studies
indicate that no non-human primate species possess this capacity to the same degree (Povinelli
and Preuss, 1995; Tomasello, 1999; Gibson, 2000; Aitchison, 2000) .
Baron-Cohen reiterates how entwined theory of mind is with human biological and
cultural developments. “The ability to make inferences about what other people believe to be the
case in a given situation allows one to predict what they will do” (Baron-Cohen et al, 1985:3).
Baron-Cohen and colleagues argue this ability leads to the human capacity to form second-order
representations, which “is clearly a crucial component of social skills” (1985:39). Tomasello
similarly asserts that “for typically developing children, the ontogeny of these social cognitive
skills begins at the end of the first year of life” (1999:513).
Nevertheless, the vast majority of children diagnosed with autism lack the vital social
cognitive skills to fully engage with cultural artifacts and participate in conventional social
practices around them. This is believed to result from deficits in theory of mind, which is often
tested by assessing ‘false belief’ competency, a particular aspect of theory of mind that usually
develops by a child’s second year of life (Tomasello, 1999). False belief requires individuals to
‘walk in someone else’s shoes’ -- to understand how another person would act if it were known
they had different information (i.e. a ‘false belief’) about a given situation.
In Baron-Cohen’s 1985 study, the researchers asked autistic and normally developing
children ‘belief questions’ regarding where a doll, ‘Sally’, might look for a marble that was
moved after she ‘left’ the room. 16 of 20 autistic children failed the belief question, repeatedly
pointing to the actual location of a marble, even though ‘Sally’ would have no way of knowing
the marble’s location had been changed. Their findings strongly support the hypothesis that
autistic children, as a group, “fail to employ a theory of mind” (Baron-Cohen et al, 1985).
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Accepting theory of mind as a critical component of human cognitive development, what
provoked this crucial change? Based on evidence of accumulated modifications to human
cultural artifacts and traditions over time, Tomasello claims that humans do not operate as
isolated individual cultures. Rather humans pool their cognitive resources to construct collective
products in ever-more complex ways, continually scaffolding upon prior innovations and insights
(Tomasello, 1999). He argues that “the amazing suite of cognitive skills and products… is the
result of some sort of species-unique mode or modes of cultural transmission” (1999:4), and
concludes that this innately biological mechanism triggered the dramatic changes in the last
250,000 years of Homo sapiens evolution (Foley and Lahr, 1997; Klien, 1989; Stringer and
McKie, 1996 in Tomasello, 1999:4).
Schuman writes that “what society values has an impact on how the brain appraises
certain stimuli, and that appraisal determines how the brain acquires and processes certain
information. The brain, in turn, allows societal institutions to work” (2000:3). There exists a
feedback system between brain processing functions and collectivized societal values that gives
humans the ability to read and exploit social cues, particularly in communicative and cooperative
interactions (Tomasello et al, 2003 in Hare, 2007:60). Theory of mind is believed to be a vital
capacity that “paves the way for language, symbolic play, and the acquisition of a number of
other cultural activities and skills during the second year of life” (Hare, 2004:488).
Many scholars, including anthropologists, attest that language is a primary linking and
mediating force between human cognitive capabilities and culture. Aitchison notes that language
is a defining feature of human beings and that it is an “extraordinary system [that] allows us to
communicate about anything whatsoever, whether it is present, absent, or even non-existent”
(Aitchison, 1996:3). A smoothly functioning system requires theory of mind, manifested by, and
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through, language and is, in fact, “so closely coupled with the development of communication
and language that we often do not recognize their interdependence” (Miller, 2006:142). As
Bakhtin writes, “language enters life through concrete utterances (which manifest language) and
life enters language through concrete utterances as well” (1987:63).
Yet, studies indicate that for autistic individuals, an impaired theory of mind is tightly
aligned with linguistic and communication defects, a key diagnostic criterion for autism (DSMIV). This broad category includes faulty semantic processing and impeded pragmatic
processing, which has been identified as a specific, universal characteristic among autistics
(Järvinen-Pasley, 2007). It should be foregrounded that the diagnosis of autism, or any illness
for that matter, is entrenched in culturally agreed upon, discursively communicated, conventions
of what constitutes ‘normal’ and ‘abnormal’ (Grinker, 2007; Mehan, 1998; Mehan, 1996; Ochs,
2005; Wisniewski et al, 1992).
The underlying assumption equates linguistic competency, social aptitude, and selfawareness with normalcy, as the price of full-admission to a given society. What are the
implications for autistic individuals whose deficits in language capacities and cognitive
competencies are legendary? Throughout history, autistic individuals have been
institutionalized, abandoned, or believed to be possessed (Grinker, 2007). Among ultraorthodox
Jews in Israel, mothers of autistic children believe it is some kind of signal from God, often
distinguishing “between the children’s damaged brain and their soul” (Shaked and Bilu,
2006:14).
To understand how entangled language is with cognition, let us revisit the basic
progression of language. Language starts with letters, arbitrary symbolic representations of
potential sounds, which combine to form phonemes, are then united into words, and finally into
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sentences (Culler, 1986). Earlier stages are inextricable from later ones in constructing a
linguistic system in which each layer simultaneously indexes multiple meanings. Silverstein
asserts that the “linguistic – and dependent cultural – texts project (index) the metaphorically
‘surrounding’ contexts in which they by degrees ‘appropriately’ occur, as well as project (index)
the contexts that, by their occurrence, they have ‘effectively’ brought into being” (1988:73).
Consequently, for an individual to comprehend the full meaning and intention of an utterance,
she/he must be both linguistically and culturally competent. And in order to attain that
competency, one must understand the concept of intentionality and that others are intentional
agents.
Bakhtin opines that successful communication means “real and integral understanding”
(1987:69) predicated on active interplay between speaker and listener. The speaker must
convey the meanings and intentions of their utterances; likewise the listener must perceive and
understand these various, and often hierarchically embedded, meanings (Bakhtin, 1987). As
“mental states are unobservable” (Miller, 2006:145), the crucial role theory of mind in
developing linguistic competence is again reinforced.
The ‘what’ and ‘how’ of an utterance can be classified into two domains, the segmental
and suprasegmental (Paul et al, 2005:861). The segmental focuses on word sequence, merging
Saussure’s distinct conceptions of the syntagmatic and paradigmatic, whereby the ‘horizontal’
and ‘vertical’ selection of words both determines and constrains successive choices and
meanings. In regards to theory of mind, participants engaged in a communicative moment must
be aware of multiple potentially different perspectival and semantic intentions and connotations.
For example, there are numerous ways to convey the same thought: “I broke the bat” versus
“The bat was splintered.” Choosing one word, tense or sequencing rather than another indicates
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ability to reason, and the capacity to unify knowledge about situational context, (self)awareness
of desired outcome, and understanding about other participants (Grinker, 2007; Tomasello, 1999;
Culler, 1986).
In contrast, suprasegmental “refers to all other aspects of the speech signal that modulate
meaning and give each speaker unique identity” (Paul et al, 2005:861). Among individuals with
autism, it is usually their atypical vocal and expressive communication behaviors that “most
immediately creates an impression of oddness” (ibid). Their striking speech patterns primarily
include prosodic distortions and irregularites, vocal quality (too loud/too soft), perseveration, and
echolalia (Järvinen-Pasley et al, 2007; Paul et al, 2005; Ochs and Solomon, 2005; Constantino et
al, 2006; Stiegler, 2007). Paul’s study indicates that prosodic processing is ‘somewhat’
independent of semantics and syntax (Paul et al, 2005), yet the erratic prosody of autistic
individuals creates very real obstacles for full cultural integration.
Language does far more than convey information. It describes, defines and constitutes
disability, plus function as a discursive platform to talk about disabilities through concepts like
ideology and genre. Heath defines ideology as the “self-evident ideas and objectives a group
holds concerning roles of language in the social experiences of members as s/he contribute to the
expression of the group” (Heath, 1989:53 in Woolard, 1998). In discursive practices, language is
an expression of normative standards based on stages of biological development and the cultural
views of individuals who do not measure up to them – linguistically creating disability. The
underlying cultural paradigms equate societal aptitude and membership with language
competency. As such, the language used to describe disability, regardless of cause,
automatically positions that individual outside normative societal boundaries; a proverbial
‘abnormal Them’ in opposition to a ‘normative Us’.
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McDermott and Varenne note that “disabilities are less the property of persons than they
are moments in a cultural focus” and that “their definition, their ascription, and their ties to social
structure raise ultimate questions about cultural life” (McDermott et al, 1995:326). Utterances
act as gatekeepers, through which both language and culture must be channeled. Consequently,
language becomes one of the fundamental mechanisms that create culture, while simultaneously
revealing it. Accordingly, speech genres become an ‘architectural’ framework that guides the
organization and interpretation from the “interplay between systems of social value, linguistic
convention, and the world portrayed” (Hanks, 1987:671). While the dominant cultural group
operationalizes linguistic ideologies and genres through a discourse of disability, the disabled
themselves or those associated with disabled individuals must also exploit the same tools of
language and communication to express ideologies from their perspective. For individuals with
autism, the developmental and cognitive impairments associated with a defective theory of mind
make it extraordinarily difficult for them to communicate their own mental states (Grinker, 2007;
Tomasello, 1999; Beth Zivic, special education teacher, personal communication).
Another essential function of language is to socialize members into conventional cultural
practices. Ochs and Schieffelin emphasize that “the process of becoming a competent member
of society is realized to a large extent through language, by acquiring knowledge of its functions,
social distribution, and interpretations in and across socially defined situations” (Ochs et al,
1984:264). Thus schools are principal “institutions of socialization” whose mandate is to
“tighten the fit” between metadiscourse and textual practice (Silverstein et al, 1996: 10). In the
socialization of autistic children, language is simultaneously an instrument by which mainstream
cultural norms and beliefs are conveyed, and a mechanism that compels adherence to them (Ochs
and Solomon, 2005; Noens et al, 2005; Hale and Tager-Flusberg, 2005; Grinker, 2007). For
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example, a special education teacher often articulates specific behavioral rules regarding
‘personal space’ when people converse. Language is also used to try to teach theory of mind –
for instance, when an autistic child ‘memorizes’ the ‘rule’ that friends play gently and do not hit
each other. At minimum, these types of lessons may provide a cognitive ‘template’ on which
they rely in myriad real-life situations in their struggle to make sense of and adhere to normative
values when interacting with the ‘wider world’ (Grinker, 2007; Ochs and Solomon, 2005;
Constantino, 2006). By attaining linguistic competency, individuals with autism can potentially
increase their level of independent functioning, which is why “developing competence in
different generic frameworks is a major focus of educational systems.” (Bauman and Briggs,
1992:161).
Culture is defined by most contemporary anthropologists as a “socially constructed,
learned communicative code based on a shared system of meaningful signs” (Marshall,
1996:249). To learn one’s respective culture and achieve competency, people rely primarily on
aural and oral capacities. Marshall contends that around the world, humans perceive anything
that interferes with “the development or maintenance of normal speech is threatening because it
inhibits or even prevents cultural transmission” (1996:249). He describes these individuals as
“without culture” and “genuinely disabled” (ibid). Autistic individuals clearly fit this category.
The cultural construction of a disability is usually accomplished through the application
of labels to those judged impaired. Wisniewski and Sedlak assert that handicaps are identified as
such when an individual is faced with an “environmental demand” beyond their capabilities or
which their peers can normally perform. In specific situations that demand communicative and
linguistic competency, and comprehension, people who do not reach an arbitrary normative
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standard established by the dominant group are marked as “learning disabled” (Wisniewski et al,
1992).
McDermott and Varenne advance three models of how culture shapes disability. Their
deprivation approach recognizes that people in various groups adhere to different measurable
milestones tied to biologically-grounded stages of development. Cultural norms are mapped
onto these physiological steps. Individuals that ‘lag’ are deprived of benefits because they
cannot demonstrate proficiency. Over a lifetime, advantages or disadvantages accumulate that
directly index the individual’s positionality and status within a given society. The second, or
difference approach, tracks Boas’ theory of cultural relativity, stating that people invariably
develop in ways that are highly attuned to their own culture. Therefore, disabled individuals
cannot be judged by a ‘universal’ standard. Their third paradigm, culture-as-disability, is a spin
on Bourdieu’s concept of habitus (1977), positing that people create idealizations of what their
cultural members should be and systems of measuring those who fall short. It is a collectively
produced system that “marks off those who are to be noticed, handled, mistreated and remediated
for falling short” (McDermott et al, 1995:336).
In a two decade psychiatric study, Higgins and colleagues used an ethnographic approach
emphasizing emic perspectives to understand and describe their participants’ self-acceptance of
being labeled ‘learning disabled’. Participants almost uniformly partitioned “the day-to-day
technical problems of the disability from the stigma attached to it by their culture” (Higgins et al,
2002:7). They outline five stages of ‘acceptance’ as participants came to terms with the
“social/emotional impact of being labeled” (ibid, 8): a) awareness of their ‘differentness’; b) the
labeling event; c) understanding their limitations and negotiating with service providers; d)
compartmentalizing their learning disability; and e) transforming their negative attitude into
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appreciation. The study’s participants had the self-awareness and cognitive capacities to
recognize differences between themselves and their fellow students. The stages documented in
this study may not be cognized as readily, or at all, by autistic individuals themselves, but may
be applicable to parents and siblings of autistic children. Another key finding from Higgins’
research is the necessary adjustment of cultural expectations for future achievements of those
with disabilities.
While culture may be a system of learned, shared beliefs and behaviors, it is “not so
much a product of sharing as a product of people hammering each other into shape” (McDermott
and Varenne, 1995:326). The image of ‘hammering’ someone into culturally constructed
pigeonholes leaves little room to maneuver. Clearly “autism, like all disorders, does not exist
outside of culture. It is culture that sees something as abnormal or wrong, names it, and does
something about it” (Grinker, 2007:11-12). A brief inventory of vocabulary used in the cultural
construction of disability proves the point: disabled, abnormal, atypical, impaired, irregular,
defective, deficient …and the list continues. This language concurrently buttresses a culture’s
normative standards and reinforces the exclusion of a disabled person from the group. All the
participants in Higgins’ study were profoundly impacted by these negative and damaging labels.
Likewise, one has to wonder whether and how labeling process impacts the emotional and
intellectual well-being of autistic individuals. Of note here is that labels index cultural
assumptions and bind associated practices to these assumptions.
Grinker optimistically challenges that although “autism is a terrible, lifelong disorder …
it’s a better time than ever to be autistic … since there is much less stigma attached to autism
than there once was” (Grinker, 2007:6). Furthermore, it is a disability to be “accommodated” as
a “variation of human existence” (ibid). In this paper, I first outlined the development of theory
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of mind in human and non-human primates. Through a selection of literature on autism and
theory of mind deficits, I then demonstrated how theory of mind (impaired or normal), linguistic
practices, and cultural norms intersect. Lastly, I have explored the implications of how discourse
and normative cultural values simultaneously create and construct disability, specifically in
regards to autism.
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