The Pathogen and the Package
This chapter charts a “neurodevelopmental turn” in psychiatric diagnosis away from an understanding of mental illnesses as discrete disease categories and toward the assessment and remediation of capacities, assumed to be both neural and universal and arrayed along a spectrum, for perception, memory, attention, learning, and sociality. In this time of paradigm shift, multiple diagnostic entities are produced that coexist under the same name. Different traditions in contemporary biomedicine—one focused on detecting and eliminating discrete disease entities and the other seeking to map and modulate comprehensive “connectomic” systems—produce different but overlapping “autisms”: a “pathogen model” of autism as separable, exclusively negative, and damaging to the self, on one hand, and a “package model” of autism that is an inseparable and constitutive element of personhood with both valued and troubling aspects, on the other. Through a process referred to here as “divided medicalization,” the former is misrepresented as the latter: complex, multivalent neurodevelopmental conditions are produced and then reduced to fit within a preexisting, disease-oriented clinical paradigm. Through divided medicalization, the former comes to stand in for the latter, allowing for the occlusion and potentially the suppression of autism’s multivalent, aesthetic, and identitarian dimensions.