Doing Abstraction: Autism, Diagnosis, and Social Theory

Abstract

Recent decades have witnessed a dramatic upsurge in the prevalence of autism spectrum disorder (ASD). As researchers have investigated the responsible sociohistorical conditions, they have neglected how clinicians determine the diagnosis in local encounters in the first place. Articulating a position “between Foucault and Goffman,” we ask how the interaction order of the clinic articulates with larger-scale historical forces affecting the definition and distribution of ASD. First, we show how the diagnostic process has a narrative structure. Second, case data from three decades show how narrative practices accommodate to different periods in the history of the disorder, including changing diagnostic nomenclatures. Third, we show how two different forms of abstraction—Type A, which is categorical, and Type B, which is concrete and particular—inhabit the diagnostic process. Our analysis contributes to the sociology of autism, the sociology of diagnosis, the sociology of abstraction, and social theory.

Narrative Methods for Differential Diagnosis in a Case of Autism

“…In sum, our findings, in line with recent cognate scholarship (Maynard and Turowetz , ; Timmermans and Buchbinder ; Turowetz , ), establish the importance of narrative in differential diagnosis, and suggest new avenues for further inquiry focusing on the practices by which clinicians accomplish diagnosis in clinical settings. Such investigations contribute to the sociology of diagnosis, and can also shed light on larger diagnostic trends, inasmuch as these ultimately depend on locally accomplished decision‐making through talk and social interaction.…”

“…Moreover, they are often generalizable across time periods as well, forming the stable background against which historical changes occur. With regard to the present study, a close comparison of the 1985 and 2011 to 2015 data (see Maynard and Turowetz ) makes us confident that the practices we are examining—specifically the narrative way in which clinicians interpret diagnostic evidence—did not change appreciably during this period, even though the criteria for autism did (Eyal et al ). Thus, we selected the case that best exemplified the phenomenon under analysis, rather than the most contemporary one(s) .…”

“…In this paper, which draws on our previous research (Maynard and Turowetz , ), we demonstrated the narrative organization of diagnostic deliberation. Narrative is not discussed in official diagnostic manuals or test protocols.…”

“…Along with the diagnostic criteria for autism, the general public's attitude toward, and understanding of, the condition have gone through several transformations, as reflected not only in clinicians' stories, but those of parents, too. While such changes are not our focus in this paper (but see Maynard and Turowetz ), they constitute the substance—the “whats” in Holstein and Gubrium's () terms—of the diagnostic stories organized through the narrative sequence.…”

“…Parents' increasing involvement in the diagnostic process represents a change that has occurred since 1985. Thus, while the narrative organization of diagnosis has not changed appreciably, the behavior of the relevant parties has changed in a way that we describe as “context‐sensitive” (see Maynard and Turowetz ).…”