Neurodiversity, epistemic injustice, and the good human life

Epistemic injustice refers to harms that relate specifically to our status as epistemic agents, whereby our status as knowers, interpreters, and providers of information, is unduly diminished or stifled in a way that undermines the agent's agency and dignity. The concept was defined by Miranda Fricker (2007), who identifies two key forms of epistemic injustice. The first is testimonial injustice, which refers to cases where testimony is unduly dismissed because of prejudiced beliefs regarding minority groups. Hermeneutical injustice refers to cases where a community's shared vocabularies have been structured in a way that unfairly distorts or stifles understanding for, and of, a minority group. In each case, there is an instance of people being harmed specifically in their capacity as knowers: individuals capable of knowing or providing knowledge. Much work on epistemic injustice has identified the operation of negative stereotypes relating to gender and race; for instance, when someone's testimony is dismissed, doubted, or accorded low credibility due to racist or sexist prejudices on the part of the listener (Dotson, 2011; Fricker, 2007; Kidd et al., 2017; Medina, 2013). But in recent years research has drawn attention to epistemic injustice in healthcare generally, and more specifically within psychiatry, pediatrics, and among people with disabilities (Blease et al., 2016; Carel Crichton et al., 2016; Kidd Potter, 2015). What has been revealed is the systematic stifling of the voices and interpretive tools available to both ill and disabled persons: in particular, their information providing, testimonies, and interpretations. These types of epistemic injustice have been associated with the medical deficit model that dominates much of medical and psychiatric discourse (Kidd Carel, 2016, ch. 6). Our interest here is in the possibility that epistemic injustice may stifle forms of flourishing or routes to wellbeing among individuals with neurodivergent disabilities. Here we will focus on one particular disability, namely autism, but we also suggest that this may shed light on the more general issue when it comes to other cognitive, neurodevelopmental, and psycho-social disabilities. In our discussion of the good life we are concerned both with subjective framings that focus on feelings of wellbeing and happiness, as well as more objective framings based on the notion of flourishing or objective goods. As we discuss below, autism is widely taken to be at odds—to varying extents—with both wellbeing and flourishing, and hence incompatible with both objective and subjective conceptions of the good life. While this is one dominant view, it has been challenged by proponents of the neurodiversity conception of autism. This recasts autism as a minority neurocognitive type that is primarily disabled and devalued under current social conditions, instead of it being a medical pathology (Chapman, 2019a; Singer, 1999). In de-pathologising, and instead politicizing, autistic disablement, and distress, this view opens the possibility that rather than autism being inherently at odds with living a good life, autistic wellbeing is impeded by contingent factors. It may even be that we have been rendered ignorant of the possibility of distinctly autistic forms of thriving in certain ways due to interlocking biases, stigma, and prejudice. In what follows we aim to show that epistemic injustice may not only unjustly reduce the credibility accorded to the autistic individual by her listeners, which may marginalize her account of everyday experiences and harms. It may also—despite there being good reason to think that autistic thriving is viable—block our ability to conceive of a good autistic life, as well as to recognize the testimonies of happy autistics as such. In practice, we show how this culminates in a catch-22 paradoxical situation whereby individuals are routinely seen as happy or autistic, but rarely both. This is practically important since it does not just deny recognition to happy autistics—it also means that the actual chances of autistic flourishing are severely diminished, much as any destination will be harder to find if it has not been included on the map. But it is also important for ethical theory more generally since it indicates that minority forms of human flourishing have been blocked from view. In light of this we suggest that a shift toward what's been called the neurodiversity paradigm (Walker, 2012) will place the possibility of autistic—and perhaps other forms of—flourishing on the map, making them visible and moreover salient through acknowledging that we are a neurologically diverse species. Beyond challenging dominant conceptions of normal functioning as it is standardly taken to (Chapman, 2019a; Singer, 1999; Walker, 2012), our argument will serve the further purpose of showing that neurodiversity also challenges us to radically broaden our conceptions of the good human life. On what we call the medical deficit view, autism is classified as a neurodevelopmental disorder, indicating that it is a harmful developmental trajectory that stems from underlying neurological dysfunction. The two key diagnostic traits that distinguish it from other similar classifications are (1) social and communication issues, and (2) restricted and repetitive habits, actions, and routines (APA, 2013, p. 31).1 1 There have been long-standing controversies on the diagnostic status of these categories and the DSM has shifted criteria for many of its disorders but especially for autism and Asperger Syndrome, with the latter being removed from the DSM 5 (Solomon, 2017). We are not uncritically accepting such categories but using them as a starting point for our critical discussion. Autism is also defined as a spectrum condition, with diagnoses being given in terms of its purported severity and correlating support needs. Diagnosis is further accompanied by clarifications regarding both verbal and general intellectual functioning. While the underlying biological mechanisms are complex and heterogenous, medical deficit accounts typically associate autism with empathy deficits alongside general cognitive and sensory processing issues that are in turn taken to have an underlying biological basis (Baron-Cohen, On the medical deficit view autism is also widely taken to be at odds varying on the of the with living a good human life. In widely to autism of of autistic being being or and the more widely to of or autism and in about more as an that be at and as an is a in about and have been for as a and or for of this of autism a of p. autism as and that to be as as p. On the of this may by the in which autism is associated with and low wellbeing Walker, 2012) have the neurodiversity paradigm as an to the dominant of psychiatric and cognitive disabilities. 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