Autism, “Stigma,” Disability

A Shifting Historical Terrain

Roy Richard Grinker

Erving Goffman’s 1963 foundational discussion of stigma has been both embraced and critiqued in disability studies and other fields.
In Goffman’s interactional and ahistorical analysis, stigma was presumed to exist as a natural feature of humanity, deflecting attention
away from historical analysis. This article, in contrast, argues that stigma—particularly surrounding “mental illness”—is deeply
embedded in historically contingent structural conditions of modern capitalism and ideologies of individualism that shape ideals of
the modern worker. Specifically, I use the case of autism—and its commodification in the United States—to show how a stigmatized
“mental illness” is intertwined with a range of financial interests that come to depend on the continued production of certain di-
agnoses. For example, an analysis of the “autism industrial complex” in the United States reveals how economic changes set the
conditions for a range of practices that promise to reduce stigma; these include special education, activism/advocacy, and self-
representation. These occur in the context of a transition toward more flexible employment and the increasing value of technological
and artistic skills often associated with neurodiversity. Despite the fact that a capitalist logic continues to define valuations of per-
sonhood, families and autistic self-advocates have been empowered in recent years to use a variety of strategies to decouple stigma and
illness and resist conventional definitions of autism as a syndrome of deficits.

In the time since autism was first identified as a “mental illness,” cient Greek meaning as a mark or branding on the body made
this diagnostic category has undergone remarkable changes. with a sharp instrument. Often associated in its plural form
Once considered exceedingly rare and profoundly debilitating, it (stigmata) with Christ’s crucifixion wounds, it has also come to
is now relatively common; once highly stigmatized, it is increas- connote a flawed psychological or physical state. Stigmatized
ingly accepted under the banner of neurodiversity, invented people are often seen as incompetent, blamed for their suffer-
and promulgated by autistic self-advocates in the United States, ing, and socially marginalized in ways that we might now con-
many of whom identify as part of the American disability rights sider “ableist.”
movement. Indeed, one reason autistic self-advocates chose Experts and advocates decry stigma’s persistence. Former
to represent themselves through the term “neurodiversity” was directors of the National Institute of Mental Health (NIMH),
to claim ownership of and redefine the currently powerful Steven Hyman and Thomas Insel, have repeatedly called stigma
brain-based model. The claiming of a new identity term— an international “public health crisis” (Insel, Collins, and Hy-
“neurodiversity” and its counterpart “neurotypical”—stands as man 2015). Surgeons general have continually declared war
a strategy to disrupt the stigma long associated with “autism-as- on stigma. According to the US Department of Health and
mental-illness.” Assigning this diagnosis a positive social value Human Services, stigma is “the most formidable obstacle to
resembles the strategy of queer, crip, and fat theorists who future progress in the area of mental illness and health”
subverted and disidentified with normative categories and defi- (DHHS 1999, 2001). However, such advocates and institutions
nitions that have subjected them all to stigma for many decades. rarely define stigma, identify its causes, or suggest ways to re-
This article tracks the history of stigma, autism, and “mental duce it beyond improving mental health awareness, education,
illness,” arguing that we cannot understand the emergence of and treatment.
these personhood-shaping categories apart from their long- The scholarly literature on stigma—mainly in the fields of
standing imbrication with the transforming political economy psychology and sociology—draws its inspiration from Erving
of capitalism and its ideologies of labor. Goffman’s classic work Stigma: Notes on the Management
of Spoiled Identity (1963), which conceptualized stigma as
The Intertwined Histories of Stigma interactional and performative. Written before identity poli-
tics, intersectionality, and the social model of disability were
and “Mental Illness”
available constructs, Goffman’s ahistorical analysis focused
Stigma is the unwanted shadow of a person, produced when on individuals living in contexts where stigma’s existence is
society disdains certain human differences, retaining its an- presumed and must be managed. He placed the burden of

Roy Richard Grinker is Professor in the Department of Anthropology of George Washington University (2110 G Street NW, Washington,
DC 20052, USA [[email protected]]). This paper was submitted 11 XI 18, accepted 18 VII 19, and electronically published 22 X 19.
Correction: This article was reposted on November 4, 2019. In the first full paragraph on page S61, the transposition of the terms “syndromic”
and “nonsyndromic” has been corrected.

Current Anthropology, volume 61, supplement 21, February 2020. q 2019 by The Wenner-Gren Foundation for Anthropological Research. All rights reserved.
0011-3204/2020/61S21-0007$10.00. DOI: 10.1086/705748
 S56 Current Anthropology Volume 61, Supplement 21, February 2020

management on discredited individuals who need to hide or that stigma emerged out of the structural conditions shaping
mitigate the public exposure of their stigmatizing conditions. capitalism, including ideologies of individualism, personal
Almost all of us, he says, will at some point in time be devalued, responsibility, and the complicated legacies of colonialism.
if not because we have some discrediting attribute, then be- Stigma must be challenged in the context of those conditions,
cause we have social connections to someone who does.1 Due as the recent and successful efforts of autism activists and
to Goffman’s influence, academic works on stigma deflected autistic self-advocates demonstrate. This is not to suggest
attention away from historical and cross-cultural analysis, in- that socialist states or noncapitalist communities do not stig-
stead refining a typology of the concept and describing the matize difference. The idea that a person should be valued for
negative effects of stigma and the cognitive processes involved individual productivity was already in place in communities
with classification and stereotyping. Moreover, historically in- that later embraced other forms of governance.
formed sociological analyses tend to emphasize how stigma Moral judgments about “mental illnesses” reflect what, at
motivates historical change, as opposed to how historical pro- certain times and places, people consider the ideal society
cesses produce particular forms of stigma (see, e.g., Major, and person. The same holds true for physical disabilities when
Dovidio, and Link 2018). communities perceive them as violations of a properly or-
Yet history tells us that stigma—a culturally specific con- dered life (Murphy 1987:29) or as “nature’s mistakes” (Bogdan
cept—is highly variable across time and place (Tyler and Slater 1988:6). The most stigmatized people tend to be those who do
2018). It does not derive solely from ignorance or an indi- not conform to the ideal modern worker: the autonomous, self-
vidual’s failure to navigate the psychological machinations of reliant, individual. Indeed, I argue that the burden of stigma
the presentation of self in everyday life. As Brendan Gleeson changes along with the ideals of the modern worker. At the
puts it, Goffman’s “interactionist fallacy” masks the structural same time, neurodiversity, which was explicitly modeled on the
forces that underwrite personal encounters and their meanings social model of disability (Shakespeare 2010), has become an
(Gleeson 1999:17; Schweik 2014). From its inception, stigma exemplar for how economics can play a role in destigmatiz-
has been bound up with ideas about “mental illness” in Europe ing a previously highly stigmatized condition. New accom-
and North America; I argue that their two histories can be modations and greater accessibility in work and community life
told as one. Mental illnesses became stigmatized as this label have helped many who identify as neurodiverse make claims
was increasingly deployed as a modern category for the idle, on inclusion (Silberman 2015:472–473). As some workplaces
particularly as capitalism developed. Doctors, politicians, and become more flexible, valued twenty-first-century workers—
other “experts” on public health isolated people they deemed including those with autism—might be self-employed, work
economically unproductive. Over the past three centuries, nei- part-time, combine paid work with family care or volunteerism,
ther awareness nor medical and scientific advances have greatly interact virtually rather than in person, and continue to live
affected the ebb and flow of the stigma of the many conditions with their parents after the arbitrary ages of adulthood, such
classified under the rubric of mental illness, whether explained as 18 or 21 years of age. As Rapp and Ginsburg (2011) have
via conventional psychosocial and psychoanalytic frames or the shown, the “difference of disability” reverberates over the life
more recent neurobiological models (see, e.g., Angermeyer and course, creating “new kinship imaginaries” as many families
Matschinger 2005; Pescosolido et al. 2010; Reed et al. 2016). Just learn to accommodate atypical lives. Popular representations of
as ignorance is not wholly to blame for stigma, neither does contemporary autistic imaginaries suggest that young adults
scientific knowledge erase it. Stigma comes from deep struc- with autism can succeed in the workplace not despite their
tural conditions, such as capitalism, ideologies of individualism differences, such as restricted interests in technology and num-
and personal responsibility, and the complicated legacies of bers, but because of them. They might enjoy repetitive ad-
racism and colonialism. Our dynamic conceptions of mental ministrative and technical tasks that neurotypical others es-
illness ride on the waves of broader cultural changes, and when chew, such as filing, inventory management, and animal care.
science or medicine does ameliorate the shame of suffering, it Such flexibility in assessing social and economic worth has
does so as the servant of culture. made it possible for people like my daughter Isabel, who self-
In this article I examine the dynamics of stigma through identifies as autistic, to celebrate forms of difference that were
the tectonic shifts of economic and political structures and once disdained and hidden; they can become valued and visible
accompanying ideologies of exclusion and inclusion. I argue parts of economic and community life to a degree that was
previously impossible.
1. Goffman writes that if one seeks to tabulate the number of people An increasing number of people with disabilities are being
who suffer from stigma, including those related to the stigmatized who offered more accommodations and job support as alternative
experience “courtesy stigma,” the question becomes “not whether a person
work schedules become available to a growing proportion of
has experience with a stigma of his own, because he has, but rather how
workers in the United States, the United Kingdom, and most
many varieties he has had his own experience with” (Goffman 1963:129).
To make this point, Goffman added a passage that many still find dis-
G20 countries (Meager and Higgins 2011). The Organisation
turbing to read: “There is only one complete unblushing male in America: a for Economic Co-operation and Development (OECD) pre-
young, married, white, urban, northern, heterosexual Protestant father of dicts that “such increased flexibility will provide greater op-
college education, fully employed, of good complexion, weight, and height, portunities for underrepresented groups to participate in the
and a recent record in sports” (1963:128). labour market, such as women, senior workers and those with
Grinker Autism and Stigma S57

disabilities” (OECD 2017). The move from factory manufac- commonly blamed autism on supposedly unloving “refrigerator
turing toward flexible production and the democratization of mothers” (Bettelheim 1972) and conceived of autism in the
communication via social media and other digital forms have framework of psychotic disorders (Tustin 1995). In that context,
opened up a degree of community integration that was for- few parents wanted to disclose that they had a child with autism
merly inaccessible for them. Despite those advantages, many (Grinker 2007); growing up, I knew no one with autism. But in
scholars and policy makers consider such flexible work to be the twenty-first century, many parents discuss their children’s
potentially exploitative of workers through “contingent work,” cognitive, emotional, and behavioral diagnoses, medications
given that part-time employees are often denied full benefits and doses, and battles with their school systems, and might even
(Barker and Christensen 1998; Belous 1998; Thomason, Burton, compare them to Bill Gates, Isaac Newton, and Vincent Van
and Hyatt 1998). Yet, more flexible kinds of work schedules Gogh, all mythologized as possibly autistic. Given this dispen-
make it possible for people with physical and mental disabilities sation, most people I meet in my social and professional orbit
to work, resisting norms that prevent them from becoming today personally know several people with autism. We are wit-
integral parts of a community. nessing what Rapp and Ginsburg describe as “the expanding
Research on the trajectories of autistic adults, and employ- arena of public intimacy around the experience of disability”
ment opportunities in particular, lag behind research on chil- (2011:395).
dren and special education (Wehman et al. 2014). Nonetheless, This more flexible sense of personhood or citizenship is ap-
there is a growing body of literature that suggests that peo- parent in almost every aspect of our existence—in the fluidity
ple with autism, while continuing to face discrimination, are of our ethnic, gender, and racial classifications, for example—
capable of succeeding in competitive inclusive employment along with “new kinship imaginaries,” in which “atypicality
(Wehman et al. 2013), especially if they had work experience as is the norm” (Rapp and Ginsburg 2011:406). Our identities
teenagers (Siperstein, Heyman, and Stokes 2014). Workplace are becoming more fluid and negotiable, and this plasticity
changes may valorize those who would previously have been goes well beyond recognizing complex multiethnic, multiracial
denigrated, like the person on the autism spectrum with a talent personhood. Many forces are contributing to these shifts. For
for high technology, more comfortable working and interacting example, globalization encourages forms of personhood con-
with others online. Autistic adults sometimes excel in areas of sonant with borderless markets and claims for universal hu-
significant job growth, such as engineering and other profes- man rights, transcending any particular nation or government
sions that rely heavily on mathematics. The Kessler Founda- (Lewellen 2002). Other influential developments include the
tion’s reports on National Trends in Disability Employment acceptance of transgendered identities and nonbinary sexual
(nTIDE) show increasingly positive trends for employment of preferences, religious or spiritual fluidity, and new kinds of
people with autism,2 although the number of people with cog- sociality that transcend the division of species, as with com-
nitive disabilities employed full- or part-time in the United panion animals such as therapy dogs (Solomon 2010). In short,
States has decreased over the past three decades, even after diverse forms of personhood are generally more accepted and
passage of the 1990 American with Disabilities Act (ADA).3 For considered less threatening today, despite the persistence and
autism, even where employment rates remain stagnant, sala- resurgence of bigotry, racism, anti-Semitism, and discrimina-
ries are improving (Hendricks 2010; see also Feinstein 2018). tory immigration reforms throughout the world.
Psychiatric disorders and developmental disabilities have be- In this context, mental health fields are shifting from con-
come increasingly normalized over the past several decades, a tained diagnostic categories, in which one has this disease or
stunning reversal of a shameful and stigmatized history. In 1944, does not, to a dimensional view; nearly all disorders are now
for example, one of the most celebrated twentieth-century psy- considered to be distributed differentially across the popula-
chologists, Erik Erickson, sent his infant son Neil, born with tion. As a result, researchers, including the authors of the Di-
Down syndrome, to a residential institution and told everyone, agnostic and Statistical Manual of Mental Disorders, fifth edi-
including his other children, that the baby had died at birth tion (DSM-5), have reframed major diagnoses as spectrum
(Friedman 1999). In the 1960s and 1970s, children with autism disorders (e.g., schizophrenia spectrum disorders, bipolar spec-
were often diagnosed with childhood schizophrenia or mental trum disorder, and the depressive spectrum), as happened with
retardation, and schools and employers offered few opportu- autism more than a decade ago. In this new model, clinicians
nities. With no evidence to back up their accusations, clinicians ideally pay more attention to describing the severity of a pa-
tient’s various symptoms than to assessing whether a patient
meets every criterion for a specific disorder.
2. National Trends in Disability Employment (nTIDE), https://www The stigma of “mental illness” is modestly decreasing across
.kesslerfoundation.org/content/ntide-january-2018-jobs-report-americans
many locations, although this is uneven at best. In my field
-disabilities-kick-new-year-sharp-gains-labor-market.
sites in Africa, Asia, and North America, medicalized psy-
3. In fact, there are some economists who argue that the ADA is actually
to blame for a decline in the employment of people with disabilities during
chiatric conditions as well as post-traumatic stress disorder
the 1990s (see, e.g., Stapleton and Burkhauser 2003). But it should also be among survivors of war, natural disasters, and sexual violence
pointed out that such estimates are for what economists refer to as are increasingly accepted as distributed throughout the entire
“measured employment” and not volunteer work or family care (e.g., stay- population (Breslau 2004; Grinker and Cho 2013; Grinker et al.
at-home parents). 2012). Regardless of these steps toward fluidity and flexibility,
 S58 Current Anthropology Volume 61, Supplement 21, February 2020

in some parts of the world people with cognitive disabilities are italism. In every era, there were people who were seriously
imprisoned in their own homes or in state institutions. Nu- depressed, who had delusions and hallucinations, whose moods
merous conditions have lost stigma, but other disorders such swung wildly; there were people who could not speak or, if they
as schizophrenia and addictions remain in stigma’s shadow. did, spoke mostly to themselves, who purposefully injured
In the United States, Alcoholics Anonymous remains anony- themselves, who were unable to take care of their daily needs
mous. The very phrase “mental health” is designed to avoid the (Dols 1984, 1987). But only during the first industrial revolu-
connotations of sickness. Even the National Institute of Mental tion did the person addicted to alcohol become an alcoholic, the
Health, the leading federal agency for research on mental ill- person who hears voices become a schizophrenic, and so on.
ness, does not call itself an institute of mental illness, though the Before psychiatry began as a discipline in the late eighteenth
other national institutes are named for diseases (e.g., the Na- century, mental illness was not a category distinct from physical
tional Cancer Institute). illness (Foucault 1998 [1965]; Hacking 2004). Mental illness—
Nonetheless, greater recognition of developmental disorders, the notion of a distinct group of abnormalities of thought and
even in low- and middle-income countries, has catalyzed early behavior—is a distinctly modern invention, appearing in Eu-
intervention programs and special education (Grinker, Yeargin- rope and the African colonies in the early nineteenth century,
Allsopp, and Doyle 2011). Celebrities no longer hide their and then in East Asia by the late nineteenth century, as the
mental health challenges; they shine a light on them.4 We have result of European influence (Gilman 1982; McCulloch 1995;
not been able to put it into words, but most of us can sense Scull 1979; Swartz 1995; Yoo 2016). The unseemly history of
that something positive is happening. One need only listen mental illness, including the growth of horrific asylums, illus-
to the way millennials speak more openly about their mental trates the vital role classification played in the simultaneous
suffering. A student in one of my classes described her struggle emergence of mental illness and stigma.
to find treatment for attention deficit/hyperactivity disorder Most European asylums during the eighteenth and much
(ADHD) when she was in high school. Her father told her she of the nineteenth century were populated by prostitutes, crim-
did not have ADHD and that she simply was not working hard inals, drunkards, heretics, and the homeless, often undifferen-
enough to get good grades. She begged to see a psychiatrist tiated, lumped together as one because they were considered
but had to wait until she went to college to act on her own. to have one thing in common: lack of reason. Insanity or mad-
“Getting diagnosed with ADHD,” she told our class, “was one of ness was just one kind of unreason. Commenting on the 1656
the best days of my freshman year because someone actually opening of the Hôpital Général in Paris for the poor and idle
saw that I wasn’t stupid or lazy, that I just needed treatment to (including those later classified as insane), Foucault says of
help me do better.” Another student even wore a T-shirt that these heterogeneous residents that “there must have existed a
read “I hate normal people.” In fact, the contemporary term unity which justified its urgency” (Foucault 1998 [1965]:45,
for normal that comes from the neurodiversity movement, 2006). Far before the invention of psychiatry, that unity con-
“neurotypical,” does not really mean normal. It refers, critically, sisted of people defined not in terms of their individuality
to people who conform to society’s definition of the normal. but through their “unreasonable” relationship to work and to
While such acceptance and visibility reflect a change in the economy in the city. As historian Andrew Scull writes, the
awareness and education, I would argue that they are epiphe- relationship between urbanization and asylums may not have
nomenal, masking deeper structural and historical forces. been simple, but it was certainly constitutive. Rather than at-
tribute the growth of the psy-professions to advances in knowl-
Reframing Mental Illness: From Asylums edge, “the main driving force behind the rise of a segregative
response to madness (and other forms of deviance) can much
to Consumer Activism
more plausibly be asserted to the effects of a mature capitalist
Capitalism did not cause psychological impairments; rather, market economy” (Scull 2005:29). The market prompted the
psychological impairments acquired new meanings under cap- “abandonment of long-established techniques for coping with
the poor and troublesome (including troublesome members of
4. Lady Gaga and Prince William have disclosed their emotional the more affluent classes)” (Scull 2005:29). At the same time,
struggles, she with post-traumatic stress from an assault, he from de- secularization in Europe and North America led to a new
pression. David Letterman’s psychiatrist joined him onstage in 2017 emphasis on individual agency and self-reliance. The chari-
when he received the Kennedy Center’s Mark Twain Prize for American table work of the Christian churches gradually waned too, as,
Humor. Positive autistic characters are present in children’s and adult in Marcel Mauss’s words, everyone “was now one’s own priest”
television. There is an autistic Sesame Street character, an autistic Power
with an “inner God” (Mauss 1985 [1938]).
Ranger, and other protagonists with obvious autistic traits in the films
Importantly, as Foucault showed, the asylum did not directly
Mary and Max and Adam and in television shows such as The Good
Doctor, The Big Bang Theory, Silicon Valley, Community, Hannibal, The
impose new subjectivities but provided a kind of technology
Bridge, Sherlock, House, Mr. Robot, and The Walking Dead, among that enabled the imposition of the identity of pauper—a new
others. The Tony Award–winning plays Dear Evan Hansen and Curious and shameful category of being. In the secular world of science
Incident of the Dog in the Nighttime featured characters with severe social and medicine, mental illnesses became diseases of the mind—
anxiety and autism, respectively. evidence of the moral and cognitive failure to regulate oneself.
Grinker Autism and Stigma S59

The asylum was not a hospital for treating illness but a separate The invention of the female was part of the same process of
world of discipline in which administrators used whatever tools modern classification as was mental illness. In both France and
they needed—chains, stakes, cages, for example—to subdue England, scientists now saw women as defined by their bodies,
and control the “unreasonable” and, to some extent, inhuman, as beings tied more closely to nature than men. Describing
since reason was considered the essence of humanity. The the stigma of being female in the early nineteenth century,
people represented as “the insane” in many European paintings one historian notes, “In moral discourse there was hardly any
before the nineteenth century (Gilman 1982, 1988) included overlap between the active, rational, resolute male and the
those defined by their failure to become proper members of the emotional, nurturing, malleable female. The two sexes were
working class, a definition that persisted in the United States essentialized, and woman was constructed as ‘other’ in a more
well into the twentieth century. Even as recently as 1960, doc- absolute sense than ever before” (Tosh 2005:336). This sepa-
tors framed the lobotomy, a drastic measure for discipline and ration made it even easier for experts to fix stereotypes of fe-
control, in economic terms: as disability studies scholar Jenell maleness, including a tendency to equate women with mental
Johnson notes, “the ultimate indicator of a lobotomy’s suc- illness. It was just a short step to associating mental illness with
cess was its ability to return patients to gainful employment” women through the “nature” of their sex (Chilcoat 1998:13), a
(Johnson 2011:194). Today, the World Health Organization still development that led to the creation of hysteria as a mental
includes “productive” work in its definition of mental health.5 illness category, as well as the development of a pathological
Historians have criticized Foucault for providing too lit- model of human sexuality.6
tle evidence for a “great confinement” or for its uniformity Well into the twentieth century, the association of mental
throughout Europe (see, e.g., Midelfort 1980). But the critique illness with idleness extended to people believed to be inher-
misses the point since the numbers are irrelevant (Porter 1990). ently inferior, especially the members of colonized populations.
Exclusion was just as powerful as an idea since the concept of During World War I, instead of using the stigmatizing term
confinement was salient. In London’s oldest asylum, Bethlem “hysteria” for officers suffering emotional or unexplained
(Bedlam), there were generally only about three dozen inmates, bodily distress, British physicians used the less stigmatizing
yet Bedlam figured prominently as an imaginary in art and term “shell shock,” whether the soldier saw combat or not. The
literature, in parents’ admonitions to their children, in threats term denoted an appropriate, understandable male response to
to the disorderly (see Cross 2012; Torrey and Miller 2001:11). stress, rather than anything inherent in the individual (Mosse
Even the humanitarian reform known as “moral treatment” 2000:101–102). But doctors retained the feminizing term “hys-
was guided by a capitalist imperative. “Moral” for doctors such teria” to describe mental illnesses among working-class soldiers,
as Philippe Pinel (1745–1826) meant “psychological,” not ma- Jews, the Irish, and colonial subjects, most of whom seldom re-
terial or physical, a kind of tough love to be exercised in the ceived treatment (Bogacz 1989:230). Doctors in Germany con-
service of potential liberation and employment of the idle. Folie sidered non-elites untreatable because they were considered
(madness), Pinel wrote, was alienation from the social order inherently inferior, weak, and “work-shy,” by virtue of their
caused by primitive, as opposed to civilized, impulses. An ex- birth and upbringing (Lerner 2003). Emotional distress was
pert on eighteenth-century Francophone literature notes “Folie, proof of their nature; the diagnosis reinforced their inferior
which until the latter half of the eighteenth century had been position in a gendered hierarchical system of social classification.
understood as the general incapacité . . . à suivre les rythmes de In the United States the stigma of the most commonly di-
la vie collective [inability to follow the rhythms of social life], agnosed mental illnesses (such as anxiety, affective disorders,
became through Pinel the bona fide medical condition known and war trauma) waxed and waned through the first half of the
as aliénation mentale” (Chilcoat 1998:12). This psychological twentieth century in relation to World War I, World War II,
definition was a major break from the past because, in a sense, and the Korean War.7 Stigma tended to decrease when the
a specifically “mental” illness had been born.
The emergence of these seemingly objective concepts in 6. For Emil Kraepelin, the great classifier of psychoses, “symptoms of
Western Europe was paralleled by another development no mental illness could be seen not only in women but in undeveloped ‘wild
less crucial to the stigma of mental illness, in which scientists tribal people’ with their demonic and magical beliefs, in children, with
sought to create stable categories of being and difference: the their ‘spineless submission,’ and in women with their propensity for
invention of the female. Just as there were no mental illnesses extremes of excitement, their volatile mood, and lack of self-control”
before the advent of psychiatry, neither were there females, (Barrett 1996:211).
since scientists believed, as they had for centuries, that men 7. In their book War Neuroses in North Africa (1943), which was
known as the “bible” of military psychiatry (Jaffe 2014:139; Shephard
and women were part of a single sex—male—of which women
2000:213), Roy Grinker and John Spiegel, in effect, normalized mental
were just imperfect men (Laqueur 1990). But by 1800, scientists
illnesses for a time. For them, the more interesting question was not why
divided men and women into incommensurable, fixed cate- these soldiers became sick but why so many didn’t become sick. Stigma
gories, a categorization that was essential for social order in an was reserved for those who failed to enlist or were incarcerated for crimes
increasingly industrialized Europe. and severe mental illnesses, including sexual pathology. The New York
Times (Laurence 1944:36) prematurely claimed that Grinker and Spiegel
5. http://www.who.int/features/factfiles/mental_health/en/. eliminated the stigma of mental illness.
 S60 Current Anthropology Volume 61, Supplement 21, February 2020

military created terms like “shell shock” or “war neurosis” and The Case of Autism
used the dubious strategy of delaying psychiatric diagnosis and
Doctors once considered psychiatric nosology of little concern
treatment to keep soldiers in combat. The stigma of mental ill-
to the public at large. As one of the editors of the DSM-IV and
ness then increased postwar when the economic costs of chronic
DSM-5 told me, “The DSM used to be just for doctors.” After
sickness strained government budgets. Despite more than a
publication of the DSM-III in 1980—the first diagnostic
century of concerted attempts by advocates (such as Dorothea
manual to define mental illnesses constitutive of the person and
Dix during the nineteenth century) and ex-psychiatric patients
in terms of chronicity rather than as temporary reactions to
(like Clifford Beers and Rachel Grant-Smith in the early twen-
environmental stressors—psychiatric classification became an
tieth century) to resist dominant discourses on mental disability,
integral part of psychiatric training, research, and care. DSM
mental health advocacy emerged in earnest only during the
categories became essential to a range of practices, such as
1960s, along with other kinds of civil rights advocacy. By 1973
advocacy and lobbying, global health outreach, pharmaceutical
gay rights and veterans’ rights leaders, along with ex-patients
advertising, and of course, insurance reimbursement for clin-
and young, progressive psychiatrists, were able to persuade the
ical care and other services (Kutchins and Kirk 1997). Just as
American Psychiatric Association to remove homosexuality
importantly, the DSM began to resemble a dictionary that
from its list of mental disorders and to begin serious consid-
provided the public at large with a language of seemingly le-
eration of a new concept of post-traumatic stress disorder
gitimate and objective mental illness categories.
(Borus 1975; Haley 1974; Kutchins and Kirk 1997; Young
The extraordinary growth in the number of psychiatric di-
2008).8 But with the exception of those two groups—homosex-
agnoses in the United States and throughout the world resulted
uals and veterans—the so-called mentally ill were still relatively
in an apparent “epidemic” not only of autism but other con-
silenced. The experts still assumed that suffering individuals
ditions as well, most of which are linked to extensive financial
could not speak for themselves about stigma and discrimina-
interests. Insanity in the nineteenth century was a financial
tion. This assumption was especially salient for individuals with
matter largely for churches and government, but in the twenty-
physical disabilities (Epstein 2007; Funk et al. 2006).
first century the private business income generated by mental
Working within the framework of the market, patients
illnesses exceeds $135 billion a year, about one-quarter of that
adopted an economic language by calling themselves “con-
amount in prescription drug fees. Mental health care costs
sumers” or “consumer/survivors” (Tomes 2006) and appealing
constitute about 20% of all spending for physician and clinical
for the right to be heard less on the basis of their rights to health
services in the United States.9 The US Centers for Disease
care as citizens than as consumer-citizens. Patients, conde-
Control and Prevention (2005) estimates that approximately
scended to and feeling disempowered by the medical profes-
11% of the 51 million children ages 4–17 years in the United
sions (and by what was sometimes referred to as the medical
States have at one time been diagnosed with ADHD and that
industrial complex), aimed to resist medical paternalism by
half of those individuals have at one time taken stimulants as a
appropriating the discourse of the market. In the consumer
treatment (e.g., Ritalin). The number of ADHD diagnoses and
narrative, doctors should not only heal but use their resources
prescriptions of stimulants is increasing outside the United
rationally; patients should be able to shop not only for doctors
States as well (Polanczyk et al. 2007). Sales of stimulants for the
but also for providers who practice outside the medical estab-
treatment of ADHD produce more than $12 billion in income
lishment—those providers that physicians want to marginalize
for pharmaceutical companies. A similar pattern can be found
from the medical marketplace. Government protections for
for adults. At least 9% of Americans have depression, for ex-
the patient increasingly came not from constitutional law but
ample, in any given year, and 10% of Americans are taking
from consumer regulation protections (Tomes 2006:86–87).
antidepressant medications, the same proportion of Americans
Patient advocacy and federal laws to protect the “mentally
who take statins, the medicines that lower cholesterol. The
disabled” (e.g., the 1963 and 1965 Community Mental Health
point is not that children and adults are being overdiagnosed
Centers Acts) together posed a serious threat to psychiatrists’
and overtreated—that is a subjective judgment open to a range
monopoly on mental health care. Patients who had once been
of interpretations—but that a particular diagnosis became
characterized as passive (literally “patient”) and irrational, in
embedded in a financial system that has come to depend on
contrast to the active, rational doctor, were now not only
that diagnosis for its sustainability and growth. For example,
wise shoppers but people who could represent themselves
the FDA recently approved Roche’s drug balovaptan for fast-
(Halpern 2004).
track clinical trials as a treatment for social communication
impairments; other companies are banking on finding break-
through medications in the near future. Given the absence of
any medical intervention, autism is a dream frontier for the
8. There is a similar push today by transgender advocates to eradicate pharmaceutical industry.
any category of gender identity disorder from the DSM, though it is un-
likely to be successful since removing it would eliminate the possibility for 9. US Centers for Medicare and Medicaid Services, https://www.cms.gov
transgendered individuals to get access to reimbursable medical services, /Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/National
such as hormone therapy and surgery (Byne et al. 2012; Reed et al. 2016). HealthExpendData/downloads/highlights.pdf.
Grinker Autism and Stigma S61

Because autism is a childhood-onset condition, it falls within fessional identity. In 2013, 20% of the pediatric caseload of
the domain of school systems, where the diagnosis thus has had private speech and language pathology practitioners was with
the most financial significance. Between the 2000–2001 and patients with a diagnosis of autism, and the percentage of
2010–2011 school years, autism classifications in the American those receiving services within schools is probably even higher
public school system rose by 331%, but the proportion of (ASHA 2012; Brook 2013). Child psychiatrists also perform a
children in special education programs in the public schools crucial function since some school systems require a diagno-
remained static (Polyak, Kubina, and Girirajan 2015). A static sis from a board-certified child psychiatrist before agreeing
special education rate and an increase in autism can occur only to deliver autism services. There are currently 8,500 board-
if other classifications drop. Indeed, numerous classifications certified psychiatrists in the United States, and no state in the
that parents have found uncomfortable if not stigmatizing, United States meets the standard (one child psychiatrist per
such as intellectual disability and specific learning disability, 2,127 children) suggested by the American Academy for Child
declined as autism became a more common, less frightening, and Adolescent Psychiatry. If one is lucky enough to get an
and less shameful diagnosis. The expansion of autism into a appointment with a child psychiatrist, the fees can be as high as
spectrum, the decline of mother blame, and the temporary $600 per hour.
inclusion in the DSM of Asperger’s Disorder as a way to de- Medical costs for autism interventions involve not only direct
scribe people with autism who were intelligent and educable expenses incurred from conventional care but also comple-
(1994–2013) all reduced stigma and made autism increasingly mentary and alternative therapies, many of which are not re-
desirable as a replacement for other diagnoses, especially for imbursable by insurance. These include chelation, hyperbaric
children with identifiable genetic syndromes in which autistic oxygen chambers, nutritional therapies, and other treatments
features were one part of the syndrome. Some clinicians and based on unproven ideas, such as the hypothesis that autism is
researchers now distinguish between nonsyndromic autism caused by chronic bacterial or viral infections, yeast infections, or
(idiopathic) and syndromic autism. For example, syndromic mercury poisoning (Fitzpatrick 2008). Menus of “biomedical”
autism is increasingly a term of clinical utility for individuals treatment plans can be found throughout the internet and
with Down, Angelman, Cohen, Williams, fragile X, Rett, Cornelia sometimes include daily regimens of items such as horsetail
de Lange, 22q11 deletion, and Prader Willi syndromes (Gillberg grass, Ora-Placenta, gold salts, grapeseed extract, fenugreek,
and Coleman 2000). milk thistle, and a range of amino acids (Fitzpatrick 2008).
Passage of the Individuals with Disabilities Education Act Additional costs include hippotherapy, communication devices,
(IDEA) is often credited with expanding educational oppor- and countless trademarked therapies (e.g., SCERTS, Son-Rise,
tunities for children with special needs, especially children who Floortime, etc.). Thirty-one percent of children with ASD use
reside in areas of the United States with lower access to care some sort of non-school-based service such as academic tutors,
(Losen and Orfield 2002). But the distribution of resources has applied behavioral analysis, legal aid, and school observation
perpetuated inequalities by race and class and has also led to an services and consultants (Lavelle et al. 2014). Buescher et al.
imbalance in autism diagnoses across diverse communities. (2014) estimate that for the United Kingdom, the average life-
Autism-related services can sometimes cost twice as much as time cost of care for a person with autism is $1.4 million; Leigh
those for other classifications. In some public schools, autism and Du (2015) estimate that by the year 2025 the total national
has increased as a primary diagnosis for children who reside in cost in the United States for caring for people with autism will
states in which these costly services are provided. Fiscal in- exceed $461 billion per year.
centives and disincentives play an important role in the number Recognizing the potential for the increase in diagnoses of
of school diagnoses of autism: the more diagnoses, the more autism to bring financial revenue, universities now offer on
money the school receives (Sigafoos et al. 2010). In Texas and campus and online graduate degrees in education or psychology
California, for example, the provision of financial support for with certification in clinical treatments of autism. There are new
children with autism spectrum disorder (ASD) led to signifi- PhD programs on autism, programs focusing on autism and
cant increases in special education classifications and autism in play therapy and social skills, and master’s degrees in applied
particular (Cullen 2003). On the flip side, autism rates fell when behavior analysis, most of which justify their existence as a
those resources were removed (Kwak 2010). Parents fight- necessary response to the increased prevalence of autism. More-
ing for autism-related services often find themselves in a legal over, the nonprofit sector for autism continues to grow, espe-
quagmire, depending on the availability of support in their cially in terms of awareness promotion, the area of philan-
districts. Those who can afford it seek legal support for special thropic activity designed specifically to increase the visibility
education litigation. This also contributes to the profitable legal of the symptoms of autism and available services. In 2013, ac-
business in autism, as the rate of autism-related suits is dis- cording to tax returns filed with the IRS and available through
proportionate to enrollment of students with autism in special a GuideStar search,10 the wealthiest 100 nonprofits devoted
education programs in the United States (Zirkel 2011).
From classroom aides to speech and language pathologists, 10. GuideStar is a well-regarded source of information and evaluation
child psychiatrists, and vocational trainers, an increasing num- on nonprofit organizations. https://www.guidestar.org/ (accessed June 24,
ber of workers now rely on autism for their income and pro- 2019).
 S62 Current Anthropology Volume 61, Supplement 21, February 2020

to autism were worth close to $1 billion in assets and income we return to work: the ultimate sign of an individual’s inde-
(e.g., Autism Speaks, the Anderson Center for Autism, and Eden pendence. For many disabled people employment is unat-
Autism Services). All these developments bespeak the chal- tainable. We often simply make inefficient workers, and in-
lenges and struggles that parents face as they seek to find ser- efficient is the antithesis of what a good worker should be. For
vices and social supports that will enable their diagnosed chil- this reason, we are discriminated against by employers. We
dren to be educated and launched into the neurotypical world. require what may be pricey adaptations and priceless un-
derstanding. Western culture has a very limited idea of what
being useful to society is. . . . Disabled people have to find
Autism Goes to Work
meaning in other aspects of their lives and this meaning is
One of the current professional goals of interventions for people threatening to our culture’s value system. . . . The same rule
with autism is “independent living,” a term first coined in the that often excludes the impaired from the traditional work-
1960s by disability rights activists in the United States, launching place also exploits the able-bodied who have no other choice
a “philosophy and a movement of people with disabilities who but to participate. The right not to work is an ideal worthy of
work for self-determination, equal opportunities and self-respect” the impaired and able-bodied alike. (Taylor 2004)
(www.independentliving.org). The goal is also for people with
Similar critiques of the commodification of autism serve as
disabilities to “show the solutions we want, be in charge of our
cautionary tales about how categories can be taken up under
lives, think and speak for ourselves” (www.independentliving
capitalism in ways that challenge the more inclusive imaginary
.org).11 The language of the Independent Living Movement in-
proposed by activist scholars such as Taylor. For example,
fluenced the United Nations Convention on the Rights of Per-
Anne McGuire writes of the “autism industrial complex,”12
sons with Disabilities, which states that its goal is “to enable
a phrase she uses to characterize the complex infrastructure
persons with disabilities to live independently.”
for autism, and to criticize the capitalist valuation of the per-
The Independent Living Movement, motivated by a foun-
son (McGuire 2013, 2016). The vital economic role of autism
dational commitment to self-determination, continues to an-
is evident in websites like the Autism Speaks Marketplace or
imate disability activism worldwide; yet at times its language
Autismthings.com, where autism is branded and commodified
has been co-opted and reduced under late capitalism as a hall-
and emblazoned on T-shirts, coffee mugs, and other objects. A
mark of successful neoliberal existence, a gloss on economic
handful of movie and Broadway theaters are now marketing
self-sufficiency. This appropriation of “independent living”
directly to autistic people and their families, advertising their
both embraces and contradicts the original and ongoing mean-
occasional subsidized “autism-friendly,” “sensory-friendly” per-
ing of the Independent Living Movement. On the one hand,
formances; for example, the use of strobe lights and pyrotechnics
few would argue against expanding opportunities for mean-
is limited, and quiet spaces with “fidget toys” are provided. Such
ingful work, a sense of purpose, and integration into commu-
shows offer a rare welcome for those on the spectrum and their
nity life for all people with disabilities. The more they are able
families and allies, accommodating a wide range of autistic
to gain access to the same kinds of practices open to people
behaviors like stimming and vocalizing, with actors prepared
without disabilities, the easier it will be to reduce stigma. On
for lively if unruly audience participation (Ginsburg and Rapp
the other hand, taken too far in certain contexts, this expec-
2015; Silberman 2015:472).
tation might suggest that a meaningful life is impossible for
As Ian Hacking and others have so lucidly described, once
someone who is not economically productive or able to live on
a diagnosis takes hold and serves as the hub around which so
their own, a far cry from the intentions of the activists who
much wealth, so many people, and activities coalesce, it takes
catalyzed the Independent Living Movement over a half cen-
on a life of its own as an authentic, naturalized classification
tury ago. Disability activist and scholar Sunaura Taylor of-
(Hacking 2000). This category, in turn, provides an incentive
fers a cogent critique in her landmark 2004 essay “The Right
for manufacturing people with the diagnosis of autism whose
Not to Work: Power and Disability.” She writes:
presence and needs support this financial infrastructure. The
The fact is that impairment reveals our interdependence and autistic person becomes increasingly defined in the terms of
threatens our belief in our own autonomy. And this is where capital. McGuire notes:
The Starbucks cup, World Autism Awareness Day and the
11. As activist Adolf Ratzka explains: “Independent Living does not sheer breadth of the “autism industrial complex” all gesture
mean that we want to do everything by ourselves, do not need anybody or
like to live in isolation. Independent Living means that we demand the same 12. The concept comes from former US President Dwight Eisenhower,
choices and control in our every-day lives that our non-disabled brothers who after leaving office in 1961 expressed concern about the “military in-
and sisters, neighbors and friends take for granted. We want to grow up in dustrial complex,” the symbiotic relationship between American industry
our families, go to the neighborhood school, use the same bus as our and military. That symbiosis insulated the military and its corporate
neighbors, work in jobs that are in line with our education and interests, partners from the normal operations of the competitive market, since that
and raise families of our own. We are profoundly ordinary people shar- relationship was to a great extent shielded by the government and shielded
ing the same need to feel included, recognized and loved.” https://www from the actions and interests of the wider American public (Ledbetter
.independentliving.org/. 2011).
Grinker Autism and Stigma S63

towards the cultural fact that, under neoliberal rule, social and/ Z. Brown, Deej Savarese, and Amanda/Mel Baggs, to name just
or economic investment in the untimely autistic child is not a few leaders in the neurodiversity movement—researchers are
just an investment in the realization of the “future-citizen- seeking to find a balance between the depersonalized knowl-
worker” but in the potential for its realization. In one un- edge constructed by science and individual claims for knowl-
broken—and clearly very lucrative—move, our market-driven edge that had been previously silenced or dismissed as an-
times, at once, produce and regulate, create and constrain ecdotes. As Jenell Johnson writes (2011), the person with a
conducts that are beyond the norm. (2016:124) mental illness used to be almost completely without voice or
volition. And if the person spoke or wrote—memoir, fiction,
British autism researcher Bonnie Evans (2017a, 2017b) and poetry—what she said was often valued only as evidence
offers a new twist on autism diagnosis in the context of capi- of the illness, as when doctors analyze the writings of a patient
talism in the United Kingdom. She suggests that the govern- with schizophrenia, looking only for examples of irrationality
ment promoted autism diagnoses not just to facilitate service and disorder. “To be disabled mentally,” disability scholar
delivery but because these diagnoses provided a way to justify Catherine Prendergast notes, “is to be disabled rhetorically,”
the absence of certain kinds of individuals from the workforce not because one inherently lacks the ability due to the disease
as governments were dismantling social welfare programs— but because it has been taken away by society (Prendergast
that is, the state could argue that autism, and not government 2001:45). It is as if when you have a disability you can no
policies, was to blame for much of the unemployment in En- longer mean what you say.13 Clearly, times have changed.
gland. She draws on Nikolas Rose’s characterization of neo- Technologies have made new forms of sociality possible for
liberalism as involving the shifting focus of government action many who in the past may have been isolated; verbal and
from society to individuals (Rose 1998). Autism, Evans says, nonverbal individuals can now use technology to build and
“grew up as a kind of resistance to a neoliberal agenda, a tool for maintain meaningful relationships and even new social iden-
sheltering certain people” who might otherwise fall through the tities. Beyond social media and online chat groups are new
cracks (2017a). kinds of employment that require extraordinary memory for
A more persuasive argument for the increased popularity of details about narrow topics and the ability to detect visual and
autism, however, is that at least some autistic individuals now mathematical patterns. Such skills are highly advantageous
fit better with our economy and society than ever before. for computer programming, software development, and other
Advocates, especially parents, may have motivated the delivery areas of basic science. For this reason, Temple Grandin once
of government-funded services, but far from separating and described NASA as the largest sheltered workshop in the coun-
sheltering autistic people from the economy, the services have try. This same argument has led some to wonder if autistic
in many cases served to integrate people with autism and other people are responsible for more than we ever imagined. As one
disabilities into it, the goal of many activists. In places where journalist wrote, paraphrasing an earlier comment by Grandin,
autistic people used to be hidden away, like India, Korea, and “For all we know, the first tools on earth might have been de-
South Africa, people with autistic children are now publicly veloped by a loner sitting at the back of the cave, chipping
insisting on their rights to be full citizens. Increasingly, autism at thousands of rocks to find the one that made the sharpest
is understood less in terms of lack and more as distinctiveness spear, while the neurotypicals chattered away in the firelight”
or eccentricity, if not talent and genius. (Silberman 2001:5). In addition, in response to the tireless
In large part the result of the writings of autistic individuals, efforts of families and self-advocates, employers and schools
many of them activists (see, e.g., the works of Temple Grandin now offer varied environments for disabled workers, including
and Donna Williams), scholars are chipping away at the as- the neurodiverse, most of them created in response to parent
sumptions of deficit by identifying rationality, coherence, logic, and autistic self-advocacy efforts. These include sensory-friendly
creativity, and metaphor where these were assumed to be ab- environments, telecommuting, and autism-friendly performances
sent (Costa and Grinker 2018; Draaisma 2009; Savarese 2018).
Following Biklen (2005), Hacking (2009), and others (see Osteen
2008), Costa and Grinker (2018), for example, draw on phe- 13. Echoing Prendergast, autistic self-advocate and founder of the
nomenology and philosophy of mind in an analysis of first- Autistic Self-Advocacy Network (ASAN), Ari Ne’eman, tells the story of
person accounts of autism by Sean Barron (Barron and Barron his organization’s interviews with the media to describe their anger over the
2002), Lucy Blackman (Blackman 2001), Carly Fleischmann New York University Child Study Center “Ransom Notes” ads. The ads
(Fleischmann 2012), Naoki Higashida (Higashida 2013), Tito suggested that autism and other conditions were criminals who had kid-
napped children from their parents (Kras 2010). Journalists had a difficult
Mukhopadhyay (Mukhopadhyay 2011), Stephen Shore (Shore
time comprehending that Ne’eman and his colleagues were actually au-
2003), and Daniel Tammet (Tammet 2006) to challenge long-
tistic, since they were representing themselves. One writer who reported on
standing assumptions about the nature of autistic cognitive im- her interview with Ne’eman and ASAN filed a story on UPI under the title
pairment. In psychology and allied disciplines, researchers are “Ads Anger Parents of Autistic Children”—but neither Ne’eman nor the
detailing new kinds of sociality (Frith 1989; Happé, Briskman, other interviewees were parents of autistic children, let alone parents (R. R.
and Frith 2001; Hobson 2014). By listening to the voices of Grinker interview with Ne’eman, August 1, 2018). See “Ads Anger Parents
people with autism—Temple Grandin, Ari Ne’eman, Lydia X. of Autistic Children,” United Press International, December 14, 2007.
 S64 Current Anthropology Volume 61, Supplement 21, February 2020

of theater and films. Nonetheless, people on the spectrum are eliminated prematurely in the interview process. As Mahoney
imagined to be consumers of a booming industry of “geek put it, “An interviewer might write that the applicant was
culture” such as memorabilia and literature related to Star socially awkward, made poor eye contact, and gave long and
Trek, Dr. Who, Star Wars, computer or hand-drawn animation rambling answers, and then end the interview without ever
(anime), and activities like Comicon and Cosplay. Of course, discovering that the person is an incredible Java coder.”15
this comes with a risk of stereotyping. It is important to re- The majority of the workforce at Rising Tide, a car wash
member the now widely circulated sobriquet: “If you’ve met company in Miami cleaning approximately 160,000 cars a
one person with autism, you’ve met one person with autism” year, is autistic. My daughter has found a job she loves caring
(interview with Shore [Lime Connect 2019]). for laboratory animals in research settings. At both Rising Tide
In April 2017, 50 large corporations such as JP Morgan, and in the laboratory where my daughter works, the highly
Ford Motor Company, Ernst and Young, and numerous high- repetitive tasks are well suited to many autistic persons’ skills
tech businesses met in Silicon Valley to talk about ways to and enjoyment. Autism can become an exemplar of how work
hire more adults with autism. A German software company, and productivity can decrease social exclusion and increase
SAP, hosted the event and talked about how over the past social interactions, but only if we can reconfigure our expec-
5 years it had hired 128 people on the autism spectrum. The tations about what constitutes a valuable life under capitalism.
initiatives were launched not only at the request of employees
who have family members with autism but by those who have
Conclusion
other disabilities, for example, executives such as Jim Sinocchi
at JP Morgan Chase, who is a wheelchair user, and Jenny Lay- As the case of autism suggests, stigma decreases when a con-
Flurrie at Microsoft, who is deaf. Both JP Morgan Chase and dition affects us all, when we all exist on a spectrum, with
Microsoft have programs to hire autistic workers, and some more or less of a certain set of features. With autism, as with
smaller companies are following suit.14 The executives I in- many medical diagnoses—like hypertension and obesity—the
terviewed following the meeting insist this new openness to boundary lines are drawn more by culture than by nature. A
inclusion and support of neurodiversity is not a rejection of the spectrum simultaneously presents an opportunity for people to
capitalist sink-or-swim ideology. Nor do they see their role as negotiate their subjectivities more freely and to challenge the
a replacement for government services or interventions. Sim- diagnostic stability and chronicity that so often characterizes
ply put, they are competing for labor. stigma. The spectrum is also an invitation. It asks us to join the
Michael Fieldhouse, an executive at DXS, a cybersecurity rest of the world on a continuum of suffering. It asks us to say,
offshoot of Hewlett-Packard, told me, “I’ve talked to col- along with neurodiversity advocates, that both normality and
leagues at places like Marks and Spencer, the food company abnormality are fictional lands no one actually inhabits. This
in England, mining executives from BHK in Canada looking was Freud’s great hope: that by showing that we are all neurotic
for people with good visualization skills, and the leaders at we might understand that we are all afflicted in some way. To
Freddie Mac, and we all agreed that the demand and supply his credit, Goffman attempted to do this when he said that the
equations were out of whack in some talent pools, especially so-called normal have little more than a shaky advantage since
those we needed at DXC.” James Mahoney, who directs the everyone has some form of difference to be protected from
Autism at Work Program at JP Morgan Chase, insists the social approbation. This new condition of normality may be
initiative was not born of sentiments like compassion and the one Andrew Solomon describes in his book Far from the
generosity. “We never said, ‘Let’s do the right thing and be Tree: it is difference, not homogeneity, that unites us. While
charitable.’” For Mahoney, fighting stigma certainly has noth- writing about schizophrenia, autism, deafness, and dwarfism,
ing to do with pity, which is simply stigma clothed as com- among other conditions, Solomon realized something impor-
passion. “We never said we had jobs for people on the autism tant about himself—that as a gay man with a history of serious
spectrum. We said, ‘We want talented people and maybe there depression and suicidality, he is more normal than abnormal.
is a group of talented people we’re not hiring.’” For both Field- “The exceptional is ubiquitous,” he writes. “To be entirely
house and Mahoney, the “normalization” of autism in the typical is the rare and lonely state” (Solomon 2013:4). Solomon’s
economy is a response to the labor market. Inspired by the perspective may help people to become more empathic and
Danish company Specialisterne, which was founded specifi- may motivate broader participation in conversations about
cally in order to hire autistic software engineers, Mahoney mental health and disability rights. For example, in autism re-
created a separate autism recruiting track that focuses more on search, scientists have shown that mild symptoms of autism are
job skills so that people with social skills deficits do not get common in the general population and that family members
of a child with autism often exhibit isolated and subtle autistic
14. See, e.g., “The Growing Acceptance of Autism in the Workplace,” traits. With these insights in mind, where might stigma begin
CBS News, https://www.cbsnews.com/news/the-growing-acceptance-of and end?
-autism-in-the-workplace/, and also “These Major Tech Companies Are
Making Autism Hiring a Priority,” Monster.com, https://www.monster.com 15. Interviews with Michael Fieldhouse (May 8, 2019) and James
/career-advice/article/autism-hiring-initiatives-tech. Mahoney (September 28, 2018).
Grinker Autism and Stigma S65

Conventional wisdom holds that stigma is universal— Bogdan, Robert. 1988. Freak show: presenting human oddities for amusement
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Wenner-Gren conference “Disability Worlds” at which an Draaisma, Douwe. 2009. Stereotypes of autism. Philosophical Transactions of
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the conference participants for their insightful criticisms and Epstein, Steven. 2007. Inclusion: the politics of difference in medical research.
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