Philosophy, Psychiatry, & Psychology

Is autism a condition internal to the person that causes problems in social interaction? Or should we conceive of autism primarily at the level of interaction, as a “two-way” phenomenon (Krueger & Maiese, 2018) that develops in the relation between the person with autism and her social-material environment? Over the last decade or so, this issue has increasingly gained interest, not only in academia, but also in the field of mental health care and in the wider public domain.

Much is at stake here. Framing autism as an internal deficit or rather as an interaction phenomenon has far-reaching implications for scientific research and clinical practice. It steers the focus of autism research by determining the kind of research questions we deem scientifically and clinically relevant. In mental health care, it influences the way in which we conceive of the problems people with autism struggle with and seek help for. Are the social difficulties that people with autism experience to be framed in terms of their lack of “theory of mind” (e.g., Baron Cohen, 2000)? Or should we rather start our clinical inquiry with the acknowledgment of a “double empathy problem” (Milton, 2012) that shapes the social interaction between the autistic individual and non-autistic people, health care professionals included? More generally, are the problems experienced by people with autism to be explained with reference to internal mental dysfunction? Or should rather we take as our primary diagnostic unit of analysis the structural mismatch in needs, interests, experienced salience and perceived possibilities between the person with autism and the wider social world? These background assumptions regarding the nature of autism shape diagnostic case formulations, guide treatment interventions and determine the tone of the therapeutic relationship. Beyond scientific and clinical interests, the issue also has wider societal implications. Framing autism as a difference rather than a disorder, voices in the recovery and (neuro) diversity movement have suggested that the problems experienced by people with autism are first and foremost social—or rather societal—problems originating from a failure of society to make room for autistic forms of life (cf. Silberman, 2015). [End Page 213]

I think it is important to keep these wider issues in mind when reading Boldsen’s paper. First, as Boldsen herself makes clear, her inquiry into the role of material objects in the immediate environment in shaping social interaction for people with autism is motivated by phenomenological, enactivist and externalist conceptions of mind and cognitive science. These philosophical views argue against the internalist understanding of mind and mental (dys)functioning still prevalent in mainstream autism research and treatment programs. These philosophical views explicitly endorse a relational view of mind, thereby making room for a relational view of autism (e.g., De Haan, 2020; De Jaegher, 2013; Fuchs, 2018; Gallagher & Varga, 2015). Second, Boldsen’s study is one of few empirical attempts to take seriously the idea that the material environment plays an important role in shaping social interaction for people with autism. Straddling the divide between the “social” and “non-social” characteristics of autism, this idea has significant potential for both research and clinical practice. Scientifically, it opens up a whole new range of empirical questions as to how (shared) engagement with material objects enables people with autism to regulate their sensory, affective and cognitive attunement within the social world. Clinically, it motivates both health-care professionals and service users to take even more seriously the possibility that the shaping of the physical environment and the handling of material objects in social situations might play an important role in facilitating attunement and synchronization and reducing social stress and overstimulation. And as Boldsen highlights at the end of her paper, these considerations also point toward broader societal questions regarding the shaping of material niches that afford autistic ways of social life.

Interpreting the qualitative data of her field-work study, Boldsen suggests two ways in which material things can sustain and facilitate social interaction for people with autism: first, material things solicit sensory engagement for the persons with autism in virtue of their sensible qualities...