From Clinic to Culture: A Critical Analysis of the Formation and Transformation of the Concept of Autism in Medical, Cultural, and Institutional Discourses in Global and Iranian Contexts

Document Type : Research Paper

Author

Assistant Professor, Handicraft Department, Humanities Faculty, University of Hormozgan, Bandar Abbas, Iran.

10.22059/ijar.2025.395777.459920

Abstract

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.

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References

Aali, H., Rakhsha, I., Beygi, B., & Banafsheh. (2016). Examining Autism Spectrum Disorder in Urban Culture, Sociology, and Psychology and its Relationship with Architectural Design [Paper presentation]. The Second       International Conference on Civil Engineering, Architecture, Urban Environment, and Urban Management, Tehran, Iran. (in Persian).
Ahmadnia, S., Sherafat, S., Taghikhan, K. and Tavakoli, S. (2017). The Experience of Social Stigma and the Spoiled Identity of Mothers with Autistic Children. Journal of Social Problems of Iran, 8(1), 103-117. (in Persian).
Angell, A. M., & Solomon, O. (2017). ‘If I was a different ethnicity, would she treat me the same?’: Latino parents’ experiences obtaining autism services. Disability & society, 32(8), 1142-1164.
Bagatell, N. (2010). From Cure to Community: Transforming Notions of Autism. Ethos 38(1):34–58.
Cascio, M. Ariel (2014). New Directions in the Social Study of the Autism Spectrum: A Review Essay. Culture, Medicine, and Psychiatry, 38(2), 306–311.
Chamak, B. (2008). Autism and social movements: French parents’ associations and international autistic individuals’ organisations. Sociology of Health & Illness, 30(1), 76-96
Daley, T. C. (2002). The Need for Cross-Cultural Research on the Pervasive Developmental Disorders. Transcultural Psychiatry, 39(4), 531–550.
Davidson, J., & Orsini, M. (Eds.). (2013). Worlds of autism: Across the spectrum of neurological difference. University of Minnesota Press.
Evans, B. (2017). The Metamorphosis of Autism A History of Child Development in Britain. Manchester University Press.
Eyal, G., Hart, B., Oncular, E., Oren, N. and Rossi, N. (2011). the Autism Matrix: The Social Origins of the    Autism Epidemic. Cambridge.
Farhadi Langroudi, F., & Ghasemzadeh, B. (2019). Content Analysis of the Television Series "Atypical" Regarding the Presentation of Issues Related to Autism Spectrum Disorder [Conference presentation]. Conference on
      Family, Autism Spectrum Disorder, and Associated Challenges, Tehran, Iran. (in Persian).
Fatemi, A., Khodayari, L. & Stewart, A. (2015), Counseling in Iran: History, current status, and future trends, Journal of Counseling and Development, 93(1), 105–13.
Feinstein, A. (2010), A History of Autism: Conversations with the Pioneers. Oxford: Wiley- Blackwell.
Foucault, Michel (2012). Care and Punishment, The Birth of Prison, Translators: Niko Sarkhosh, Afshin Jahandideh, Tehran: Ney Publishing House, 10th edition. (in Persian).
Gabriels, L. R., Gaffey, J. L. (2012). Art Therapy with Children on the Autism  Spectrum. In C. Malchiodi (Ed.), Handbook of art therapy, New York, NY:  Guilford Press.
Gibson, M. F., & Douglas, P. (2018). Disturbing behaviours: Ole Ivar Lovaas and the queer history of autism science. Catalyst: Feminism, Theory, Technoscience, 4(2), 1-28.
Goodley, Dan; Lawthom, Rebecca; Liddiard, Kirsty; Runswick-Cole, Katherine (2019). Provocations for Critical Disability Studies. Disability & Society, 34(6), 972–997.
Goodley, D. (2014). Dis/ability studies: Theorising disablism and ableism. Routledge.
Grinker, R. (2010). Commentary: On Being Autistic, and Social. Ethos, 38(1):176–83.
 Grinker, R. R. (2008). Unstrange Minds: Remapping the World of Autism.  New York: Basic Books.
Hacking, I. (1999). The Social Construction of What? Cambridge, Harvard University Press.
Harbour C.K, Maulik P.K. (2013). Epidemiology of Intellectual Disability. In: JH Stone, M Blouin, editors.  International Encyclopedia of  Rehabilitation.
Hess, P. (2019). Autism prevalence estimates for Catalonia, Iran highlight gaps in data, Autism Research News/ https://www.spectrumnews.org.
Legault, M., Bourdon, J. N., & Poirier, P. (2019). Neurocognitive variety in neurotypical environments: The source of “deficit” in autism. Journal of  Behavioral and Brain Science, 9(06), 246.
McGuire, Anne. (2016). War on Autism: On the Cultural Logic of Normative Violence. ‎ University of Michigan Press.
Meekosha, H., & Shuttleworth, R. (2009). What's so ‘critical’about critical disability studies?. Australian Journal of Human Rights, 15(1), 47-75.
Milton, D. E. (2014). Autistic expertise: A critical reflection on the production of knowledge in autism studies. Autism, 18(7), 794-802.
Milton, D. E. M. (2012). On the ontological status of autism: the “double empathy problem.” Disability & Society, 27(6), 883–887.
Moradi, Z., Keshavarz Afshar, M. and Afhami, R. (2024). Explaining the Intersection of Art and Disability in Dealing with People on the Autism Spectrum. Glory of Art (Jelve-y Honar) Alzahra Scientific Quarterly
     Journal, 16(2), 89-105. (in Persian).
Murray, S. (2008). Representing Autism: Culture, Narrative, Fascination. Liverpool: Liverpool University Press.
Nadesan, M. H. (2010). Constructing autism: A brief Genealogy. In Autism and representation (pp. 86-104). Routledge.
Nadesan, M.H. (2005). Constructing Autism: Unravelling the “Truth” and Understanding the Social. Abingdon:   Routledge.
Nikookholgh, A., Saffariyan Toosi, M. R., Nejat, H. and Zendedel, A. (2018). Comparison of the Effectiveness of Pivotal Response Treatment model and the Therapeutic-Educational model with Emphasis on sensory  integration on clinical Syndrome of Students with Autism Spectrum  Disorder. Medical Journal of Mashhad university of Medical Sciences, 61(3), 1036-1049.
O’Dell, L., Bertilsdotter Rosqvist, H., Ortega, F., Brownlow, C., & Orsini, M. (2016). Critical autism studies: exploring epistemic dialogues and  intersections, challenging dominant understandings of autism. Disability &    Society, 31(2), 166-179.
Pouretemad, H. R., & Eskandari, B. (2019). Autism in Seven Mirrors: Seven Parental Narratives on the Successful Treatment Process of Their Children with Autism. Tehran, Iran: Elm-e Tamaddon Publications. (in Persian).
Pouretemad, H. Khoushabi, K. (2008). Investigating the effectiveness of  intensive behavioral therapy on children with autism, Journal of Psychology, 11(2), 198-215. (in Persian).
Reaume, G. (2014). Understanding critical disability studies. Canadian Medical Association Journal, 186(16), 1248–1249.
Samadi, S. A., & McConkey, R. (2013). Indicators of Autism in Iranian   children. In Recent Advances in Autism Spectrum Disorders-Volume I. IntechOpen, 29-48.
Shakespeare, T. (2017). Disability: the basics. Routledge.
Silberman, S. (2017). Neurotribes: The legacy of autism and how to think smarter about people who think Differently. Atlantic Books.
Silverman C & Brosco J. (2007). Understanding autism: parents and pediatricians in historical perspective. Arch.   Pediatr. Adolesc. Med. 161(4):392–98
Skubby, D. (2012). A history of Medical Practices in the Case of Autism: A Foucauldian Analysis Using Archaeology and Genealogy, The University of Akron.
Solomon, O. (2010). Sense and the Senses: Anthropology and the Study of Autism. Annual Review of Anthropology, 39: 241–259.
Szasz, T. S. (2010). The myth of mental illness: Foundations of a Theory of Personal Conduct, Toronto: Harper Collins.
Titchkosky, T. (2007). Reading and writing disability differently: The textured life of embodiment. University of Toronto Press. 
Vakirtzi, E. (2010). The archaeology of autism and the emergence of the autistic subject, the University of Exeter as a thesis for the degree of doctor of Philosophy in Education.
Walkerdine, V. (2009). Developmental Psychology and the Study of  Childhood. An Introduction to Childhood Studies, 2, 112-123.
Waltz, M. (2013). Autism: A Social and Medical History. Springer.
Woodhead, M. (2006). Changing perspectives on early childhood: theory, Research and policy, 4: 2: 1-43.
Woods, Richard. Milton, Damian, Larry Arnold & Steve Graby (2018), Redefining Critical Autism Studies: a more inclusive interpretation, Disability & Society, 33:6, 974-979.
Iranian Journal of Anthropological Research
Volume 15, Issue 2 - Serial Number 28
Indexing Databases
December 2025
Pages 89-106

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