از کلینیک تا فرهنگ: تحلیل انتقادی شکلگیری و دگردیسی مفهوم اتیسم در گفتمان‌های پزشکی، فرهنگی و نهادی جهان و ایران

Purpose: This study aims to conduct a critical historical analysis of the concept of autism within the framework of medical anthropology and social sciences, examining its formation, redefinition, and evolution across socio-cultural and institutional contexts. The research seeks to address two key questions: 1) How has the historical process of autism’s social construction unfolded globally and in Iran? 2) In what ways have social processes, cultural frameworks, institutional structures, and power discourses contributed to shaping autism as either a 'disorder' or a 'difference'? Moving beyond dominant pathological approaches, this paper endeavors to uncover the tensions between scientific and social discourses in defining autism.

Methodology: This study was conducted within the framework of critical disability studies, employing a qualitative methodology. Data were collected through library research and critical analysis of historical texts, psychiatric documents (such as various editions of the DSM), educational-support policy documents, and social science literature related to autism. By combining documentary methods with critical disability studies approaches, this research examines power relations and dominant discourses in the meaning-making processes surrounding autism. The analysis focuses on three layers: 1) Dominant Discourses: Tracing the evolution of medical definitions from Kanner’s "childhood schizophrenia" to the "autism spectrum" in DSM-5, alongside the role of institutions like the American Psychiatric Association. 2) Institutional Constructs: Examining how educational systems, rehabilitation programs, and legal frameworks shape "normativity" and socially manage autism through diagnostic thresholds, treatment guidelines, and resource allocation policies. 3) Discursive Confrontations: Analyzing social resistance (e.g., the neurodiversity movement) against medicalization and efforts to redefine autism as a form of "neurological diversity."

Findings: The results are organized into three themes: Autisim historical studies: The conceptualization of autism has shifted significantly over time. Initially framed as a "rare disorder" centered on communication deficits in the 1940s, it expanded into a "spectrum" by the late 20th century, driven by genetic research and advocacy for educational access. This redefinition responded not only to scientific advances but also to institutional demands (e.g., service provision) and evolving social norms (e.g., reframing disability as a social issue). Institutional Matrix: Diagnosis and management of autism are mediated by institutions (medical, educational, insurance) that regulate social identity through mechanisms like diagnostic criteria (e.g., DSM-5’s elimination of Asperger’s syndrome) and resource policies, directly impacting access to support.

Paradigmatic Ambiguities: Persistent contradictions—such as blurred boundaries between the "autism spectrum" and "individual differences," tensions between "treatment-focused" and "neurodiversity-affirming" discourses, and debates over biological versus social causality—reveal the concept’s inherently political and discursive nature, rooted in normative frameworks and power relations.

Conclusion: This study argues that autism is not a fixed biological phenomenon but a dynamic construct shaped at the intersection of scientific discourses, institutional imperatives, and social struggles. The long-standing dominance of medical discourse, by reducing autism to an "individual disorder," has marginalized lived experiences, reinforced stigma, and restricted autistic individuals’ agency in defining their identities. The research advocates for an interdisciplinary shift away from pathological paradigms toward approaches that prioritize three principles: centering self-advocacy narratives, recognizing autism as a form of neuro-cultural diversity, and critiquing institutional mechanisms that reproduce structural inequalities through normative definitions of "normalcy." Such a perspective could reorient mental health policies and disability studies toward social justice.