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Report on subtyping autism workshop

On the 19th of November 2019 a workshop on subtyping autism was held at LSBU. The hosting organisation was PARC (Participatory Autism Research Collective). With help from individuals from PARC and LSBU, myself (Sam Fellowes), Chloe Farahar and Annette Foster organised this workshop. The workshop lasted two and a half hours. There were five talks, each lasting twenty minutes followed by ten minutes of questions. Some papers argued against subtyping, some argued for subtyping and some looked at specific subtypes (or, in my own case, looked at multiple specific subtypes when I outlined the history of subtyping). I was pleased to see that the workshop was well attended, counting 37 people present at one point on a quick head count.

One aim of the workshop was to obtain the views of autistic people on the question of subtyping. I feel this was a success since some of the speakers identified as autistic whilst there were also autistic individuals in the audience. Some autistic people thought that questions about how to best formulate the diagnosis of autism should be largely determined by autistic people whereas other autistic people felt the views of autistic people should be one of many relevant factors. Either way, I hope this workshop went some way to facilitated autistic people, as well as the non-autistic, in providing views upon this issue.

Quite a number of speakers seemed to share a common vision of what a good psychiatric diagnosis should do, even though they disagreed about whether subtypes would help achieve those goals. In my presentation and in other presentations it was argued that there is more to autistic people than just a broadly defined autism. Rather, it is important to understand the specific ways in which a specific autistic person manifests autism (alongside understanding aspects of them unrelated to their diagnosis). Also, I and others argued that understanding how autistic people can change over time is important. It is also important to understand that different environments can influence how autistic people think, feel and behave. So in this reguard there was a level of shared commonality when it came to questions over what a good diagnostic system should do. Some people (including myself) felt that subtypes would help with understanding these factors whereas other felt this information could be best understood without subtyping autism.

I outlined a history of subtyping. I divided my history into three different areas, the 1930s to the 1970s, the 1980s until recently (around 2010) and finally I discussed the present day. I focused upon Lauretta Bender and Leo Kanner in the first period, then I focused upon DSM-III and Lorna Wing in the second period and finally I focused upon DSM-5 in the final period. I outlined how the subtypes which were employed heavily reflected the values held by psychiatrists in each era. I suggested that DSM-5 is still largely working within the values present in the 1980s even though our values are currently in a process of shifting away from those 1980s values. I then suggested that adopting subtypes would help better reflect the values we are currently moving towards.

The full list of talks was as follows:

Autistic observable and unobservable experiences, and erroneous subtyping: Introducing the Internal and External Autistic Space (Chloe Farahar  & Annette Foster )

Exploring an autistic derived classification of autism (Mary Doherty)

Online discourse on autism does not need autism subtyping (Dafne Zuleima Morgado Ramirez)

An historical overview of subtyping (Sam Fellowes)

Demand Avoidance Phenomena: The circularity, integrity and validity of PDA: a commentary on the PDA Conference held by the National Autistic Society (2018) (Richard Woods)

Workshop on subtyping autism

On the 19th of November (16.30 to 19.00 at London South Bank University (LSBU)) I (Sam Fellowes) am hosting (with collaborators) a workshop on subtyping autism. Below are some reasons why I am interested in this topic and more details on the event (note that these are reasons why I, rather than my collaborators or the presenters, am interested in the topic of subtyping).

My main academic interest is showing that psychiatric diagnoses are in principle scientifically legitimate. I argue that some (though not all) psychiatric diagnoses can be used in a similar way to how models are used in more respectable sciences. They cannot do everything a typical model can do in other sciences. Also, what they can do is usually done with less precision than occurs in other sciences. However, what level of similarity that they do have means that they have significant scientific worth (and this is true even though they typically cover a heterogeneous symptom picture and are causally heterogeneous).

Of course, psychiatric diagnoses can vary significantly in their scientific worth. Various ways of formulating them can impact this. The main diagnosis I am interested in is autism and one alternative way of formulating it is to add subtypes. This could alter its scientific worth as well as having many practical impacts outside of the scientific domain. This workshop will hopefully generate interesting discussion about these issues. Also, many speakers and attendees have a diagnosis of autism (or are in the process of being assessed) so lived experience might contribute some insight to both scientific and practical consequences of subtyping. Below is the initial abstract that was part of the call for papers and then the list of speakers.

This was the initial call for papers: Prior to and after the publication of the 2013 DSM there was much controversy over whether Asperger’s syndrome should be removed from the diagnostic manual. Members of the neurodiversity movement made contributions to this debate, drawing upon their lived experience of being autistic and their knowledge of the ways in which being diagnosed can be (or is not) beneficial. This conference aims to consider the question of autism and subtypes more broadly. What benefits or disadvantages are there for autistic people in adding substantive subtypes to autism? It is commonly stated that autistic people can present in many different ways. Might subtypes help add accuracy and nuance to clinical pictures? On the other hand, the boundaries between subtypes are typically vague and they can be placed in multiple places. This raises the danger that they are arbitrary impositions which do not reflect autistic experience. This conference draws upon the experience of autistic people to help resolve these issues. Possible areas for discussion include whether self-understanding for those diagnosed would be increased through being diagnosed with a more specific subtype or if this would unhelpfully impose unnatural constraints? Would the non-autistic be better able to understand different ways autism can manifest if there are significant subtypes, or would it help perpetuate unhelpful stereotypes based on an imposed limited number of ways autism would be proposed to manifest? Would the neurodiversity movement benefit from the subtypes bringing greater focus upon different ways autism can manifest or would this lead to unhelpful fracturing of the autistic community?

These are the papers that are being presented:

Autistic observable and unobservable experiences, and erroneous subtyping: Introducing the Internal and External Autistic Space (Chloe Farahar  & Annette Foster )

Exploring an autistic derived classification of autism (Mary Doherty)

Online discourse on autism does not need autism subtyping (Dafne Zuleima Morgado Ramirez)

An historical overview of subtyping (Sam Fellowes)

Demand Avoidance Phenomena: The circularity, integrity and validity of PDA: a commentary on the PDA Conference held by the National Autistic Society (2018) (Richard Woods)

If you are interested in attending please contact

Podcasts from Philosophy and Psychopathy day


Audio recordings Philosophy and Psychopathy – 21st Sept 2018, Storey Institute, Lancaster

Thomas Schramme (Liverpool) ‘What can we learn from cases of psychopathy for a theory of moral agency?’


Gloria Ayob (UCLAN) ‘Psychopathy as a disorder of valuing: Revisiting Cleckley’s psychopaths’


Rachel Cooper (Lancaster) ‘Problems with cross-cultural conceptions of psychopathy’

Report on Philosophy and Mental Health Workshop

‘Philosophy and Mental Health’ took place at Accrington and Rossendale College on 18 April 2018. The Royal Institute of Philosophy sponsored the event, which was organised by Angela Woods from the college. Sessions were targeted at students studying mental health related courses, but were also open to the public. Rachel Cooper and Sam Fellowes, both from PPR, Lancaster, gave talks.

Rachel Cooper: ‘Mental disorder outside the head’

My aim in this talk was to draw links between contemporary accounts of what it takes to have a mind and accounts of mental disorder. In particular, I aimed to introduce the audience to the idea that our minds can extend beyond our bodies. The ‘extended mind’ thesis was first set out by Andy Clark and David Chalmers in their well-known 1998 paper. I aimed to persuade the audience that normal minds can indeed be extended, and that this implies that some mental disorders might also be located outside of patients’ heads.

I started the talk by considering the Identity Theory of mind; a view that was developed in the 1950s (notably by Smart and Place) but that remains popular today. The identity theory claims that the mind just is the brain, and that any particular type of mental state (pain say) is identical with some particular type of brain state (maybe, C-fibres being simulated). The identity theorists take the claim that the mind is the brain to be a claim of the same type as the claim that water is identical to H20. ‘Mind’ and ‘brain’ are taken to be two labels for the same thing, in the same sort of way that water and H2O is the same stuff. The identity theory seems especially plausible when one considers the images that are nowadays produced by various types of brain scanning study. It’s very plausible to suppose that the images show the mind/brain engaged in different types of thinking.

There is, however, one big problem for the identity theory: The identity theory claims that what it is to have a mind is to have a brain, and that what it is to have any particular type of mental state is to have some particular type of brain state. An implication of such claims is that only beings very like typical humans can possibly have mental states. And to many this seems an implausible claim. The worry is that we can’t rule out the possibility that there might be minded-beings that don’t have brains like us. Maybe somewhere out there in the galaxy there are intelligent aliens, with heads full of green gunk. Or, at some point in the future, maybe we will develop a computer that can really think. If one supposes that it is possible that there might be a minded, but non-brained, being then one has to reject the identity theory – it can’t be true that having a mind is just having a brain of the right type.

Functionalism is an account of mind that was developed to allow for the possibility that creatures that don’t have brains like ours might think. The functionalist allows that there might be minded-beings that are made of electronics, or green gunk, or whatever. On the functionalist account, mental states should be characterised in terms of their characteristic functional roles. In the same sort of way that what it is for something to be a mousetrap is that it’s a device for catching mice, what it is for a state to be a pain is that it plays the right sort of causal role. Pains have characteristic causes – such as tissue damage. They lead to characteristic types of behavior – like screaming, and they connect in characteristic ways with other mental states, for example, pains typically trigger desires for pain killers. On the functionalist account, anything that fulfils the appropriate role counts as a pain, it doesn’t matter whether it’s brain activity, or electronics, or green alien gunk that does the work.

Of course, mental health professionals have enough trouble dealing with human patients, and there may seem to be little point in them concerning themselves with accounts of mind that are designed to accommodate aliens and robots. However, it’s quite plausible that even if one restricts one’s attention to human beings, an identity account, which claims that any particular type of mental state is identical with some particular type of brain state, may be overly restrictive. Many of us have unusual brains – we may have recovered from a stroke, or have been dropped as children. It seems plausible that even amongst human beings there can be variation in the types of brain activity that are associated with particular types of thought (indeed Blasi et al 2002 demonstrates as much). As such, even those who are solely interested in humans should accept functionalism over the identity theory.

If one adopts functionalism about the mind then this has implications for how we should think about certain types of mental disorder. David Papineau (1994) has argued that functionalism about the mind implies that some types of mental disorder will not be reducible to brain disorders. Papineau’s paper is highly recommended, but in the talk I didn’t have time to talk much about the implications of functionalism for psychiatry. I wanted to press on to talk about the implications of the idea that the mind can be extended.

The functionalist claims that it doesn’t matter what physical stuff a mind is made of. If one adds to this the claim that it also doesn’t matter where the physical stuff is located (inside or outside of heads) then one ends up with the claim that minds can extend outside of bodies. In their seminal paper, Clark and Chalmers (1998) discuss a character called Otto. Otto has suffered brain damage and his organic memory has been destroyed. But Otto has found a new way to remember – he writes notes in a book that he carries everywhere. Clark and Chalmers claim that Otto’s notebook fulfils the functions that are more typically fulfilled by an organic brain-based memory. They thus conclude that Otto’s notebook is his memory – and of course his notebook is outside of his head.

If one accepts that Otto’s notebook is his memory then the conclusion that mental disorders can be located outside of patients’ heads quickly follows. If Otto’s notebook is his memory, then burning his notebook can destroy his memory. Here we have a memory-disorder that is located outside of Otto’s head. Or, as another example, consider the case of a child who carries a teddy everywhere and strokes the teddy to calm themselves down. If the teddy is lost, their ability to regulate their emotions may be destroyed. In such a case the emotion-regulation disorder is located outside of their head. If minds extend beyond heads, then mental disorders do too.

Sam Fellowes: ‘Lessons for today from the history of autism’

The first half of my presentation was largely a re-cap of my previous criticism of Neurotribes ( In this book Silberman (2015) argues Leo Kanner’s original description of autism (1943) was of a disorder that was “vanishingly rare” and “monolithic by definition”. Silberman argues that Kanner’s ‘autism’ was quite unlike the condition described as autism today. He claims that modern notions of autism have a significantly better scientific foundation and are much more suitable for neurodiversity than Kanner’s approach was.

However, in this paper I argued that when properly understood Kanner’s autism is much more like the autism that is described today than Silberman acknowledges. I argue that it is crucial to appreciate that Kanner considered autism to be a subtype of childhood schizophrenia (Kanner 1969). I argue Kanner thought it was only vanishingly rare in the sense of it being a rare subtype of the fairly common childhood schizophrenia. I accept that Kanner’s autism did have quite restrictive symptoms (even if it was not monolithic) but I situated it as being a subtype of a much less monolithic childhood schizophrenia which shared many symptoms of Kanner’s autism but did not require the stringent diagnostic criteria. Silberman claims that adherence to Kanner’s views prevented the full autistic spectrum being recognised for many decades but, if you consider Kanner’s views on childhood schizophrenia, it looks like Kanner endorses a position quite like a spectrum.

In the second half of my presentation I discuss some of my more recent research. I outlined Lauretta Bender’s (1956) approach to childhood schizophrenia and considered how elements of her approach fit modern psychiatric evidence surprisingly well. Additionally, they could be used to formulate alternative approaches to neurodiversity, one based around meaningful subtypes with nuanced inter-relationships between them, rather than an account of neurodiversity based around the DSM-5 spectrum which lacks subtypes.

As far as I was aware, none of the audience were professional historians or philosophers. I found it positive to deliver my work to a wider audience, getting the findings of my research out to a wider audience. Some of that audience were mental health professionals or training to become mental health professionals, thus some are or would be interacting with autistic people regularly in their line of work. As a historian and philosopher my work often can be a bit removed from actual practise, thus it was good to be speaking to and opening dialogue with individuals who have much practical hands on experience of working with autistic individuals. The audience were engaged and asked interesting questions. These included questions about alternative ways of thinking about diagnosis, what the value of diagnosis was, how to keep in focus the aspects of the individual not covered by the diagnosis and even if diagnoses were needed at all. I think these are all important questions and it was good to see questions about them. Overall, I feel that academics often do not engage sufficiently with the world outside academia. It was very encouraging to attend a talk which was so well attended by an audience who asked engaging questions so I feel the whole process was very much a worthwhile experience.


Bender, Lauretta. 1956. Childhood Schizophrenia Symposium. American Journal of Orthopsychiatry, 26 (3), pp.449-506.

Blasi, V., Young, A.C., Tansy, A.P., Petersen, S.E., Snyder, A.Z. and Corbetta, M., 2002. Word retrieval learning modulates right frontal cortex in patients with left frontal damage. Neuron, 36(1), pp.159-170.

Clark, A. and Chalmers, D., 1998. The extended mind. Analysis, 58(1), pp.7-19.

Kanner, L. 1943. Autistic Disturbance of Affective Contact. Nervous Child 2, pp.217-250.

Kanner, L. 1969. The Children Haven’t Read Those Books, reflection on differential diagnosis. Acta Paedopsychiatrica 36, p.2-11.

Papineau, D., 1994. Mental disorder, illness and biological disfunction. Royal Institute of Philosophy Supplements, 37, pp.73-82.

Place, U. T. (1956). Is consciousness a brain process? British Journal of Psychology 47:44-50.

Silberman, Steve. (2015) Neurotribes. (London: Atlantic Books).

Smart, J. J. C. (1959). Sensations and brain processes. Philosophical Review 68:141-56.

Phenomenology and Mental Disorder – podcasts available

The workshop on phenomenology and mental disorder took place in Lancaster on 15th February 2018, and was sponsored by the Royal Institute of Philosophy.

Podcasts from of the talks are available below:

Matthew Ratcliffe (Vienna) – Is schizophrenia a self-disorder?

Joel Krueger (Exeter) – Affective disturbances and the scaffolded self

Moujan Mirdamadi (Lancaster) – Depression in Iran: how culture shapes experiences of illness

Wellcome Research Fellowship for Sam Fellowes

Sam Fellowes has been awarded a Research Fellowship by the Wellcome Trust. Sam will be based in the department of Politics, Philosophy and Religion at Lancaster throughout his three year project.

Sam’s project aims to develop a neo-Kantian framework for psychiatry: Empirical research has not been able to find specific causes for many mental disorders. Instead massive causal heterogeneity has been uncovered within the domain of psychiatry. This has led to a crisis of confidence concerning psychiatric diagnoses. Sam will develop a new account of what makes a psychiatric diagnosis legitimate, which draws on an approach in the philosophy of science called ‘neo-Kantianism’. This approach emphasises the role played by theories and values when scientists model the world. On this new approach a legitimate psychiatric diagnosis does not need to have a specific underlying cause, and so current concerns regarding the validity of psychiatric diagnoses can be alleviated. Sam will use the history of autism to look at alternative theories and values to assess if psychiatry could improve the theories and values it employs.

Does the philosophy of psychiatry need metaphysics? – podcasts available

Posted by Rachel Cooper

“Does philosophy of psychiatry need metaphysics?” was a conference held in Lancaster in June 2016 (with sponsorship from the British Society for the Philosophy of Science, and Lancaster University). It’s taken a while, but podcasts of the talks have now been edited and are available below. In some cases the introductions to the talks are quite hard to hear on the podcasts – but keep listening because the talks themselves are fine.

I organized the conference because it seemed to me that philosophers of psychiatry spend a lot of time writing and arguing about metaphysics. Many recent books in the philosophy of psychiatry have presupposed some metaphysical framework or other. Peter Zachar’s important book, A Metaphysics for Psychopathology (2014), explicitly sets out to develop a metaphysical framework, and argues for a pragmatist approach. Tim Thornton’s Essential Philosophy of Psychiatry (2007) adopts a McDowellian view. My Classifying Madness (2005) assumed a scientific realism. In Mind, Meaning and Mental Disorder (1996) Jonathan Hill and Derek Bolton argue from a Wittgensteinian perspective. In all of these works, discussions of metaphysics play a key role.

Although philosophers of psychiatry have spent a lot of time disagreeing on questions of basic metaphysics, it wasn’t clear to me how much useful work the metaphysical discussions were really doing. The conference brought together Derek Bolton, Tim Thornton, Peter Zachar and me. Each of us considered whether our key claims about psychiatry and mental disorder could have been made without making use of the controversial metaphysical assumptions that we in fact employed in our books. John O’Neill also gave a commentary.

You can get the podcasts here:

Peter Zachar (University of Auburn at Montgomery) ‘Empiricism, pragmatist metaphysics and the philosophy of psychiatry’

Rachel Cooper (University of Lancaster) ‘Classification: Realism versus pragmatism’

Derek Bolton (Kings College London & Institute for Psychiatry) ‘Localising metaphysics: continuities with science and culture’

Tim Thornton (University of Central Lancashire) ‘The manifest metaphysics of Essential Philosophy of Psychiatry’

The 2017 volume of the Bulletin of the Association for the Advancement of Philosophy and Psychiatry may also be of interest. It’s devoted to discussion of Peter Zachar’s book, and includes commentaries by me and Tim Thornton (my commentary is a written version of my conference talk).