The field of educating individuals with Autism Spectrum Disorder has ever been rife with controversy regarding issues ranging from etiology and causation to effective intervention and education options. One such basis for controversy has been between humanism, and humanistic philosophical concepts, and its fundamental differences with behaviorism, and behavioristic philosophical concepts. These differences have long been debated, and the belief that the two orientations are generally mutually exclusive has been largely maintained. Recently, however, there has been some resurgence of interest in reconciling some of the fundamental humanistic and behavioristic tenets. Most of these discussions, however, center on specific interventional methodologies as its basis without delving more deeply into the underlying philosophical issues. This article will explore some fundamental humanistic concepts that ought to be reconciled in order for behaviorism to be considered a humanistic practice. While the notion that the possibility of reconciliation is maintained, the central argument maintains that much work needs to be done on the part of behaviorism both philosophically and methodologically in order for such reconciliation to be achieved.
The field of educating individuals with Autism Spectrum Disorder (ASD) has a rich history of practical controversy, contradictory claims of dominant territoriality and effectiveness of intervention, as well as competition for dominance over the accepted conceptualization of the condition itself. One such interventional model, known most commonly as applied behavior analysis (ABA) or intensive behavior therapy (IBT), among a variety of other monikers, is often argued to be the most effective intervention for individuals with ASD based on its ability to replace or reduce inappropriate, non-contextual, or dysfunctional behaviors with those that are more appropriate, contextual, or functional. Additionally, such interventions have been claimed to be capable of progressing the individual with ASD toward, or in some cases even attaining, “normal” social and intellectual functioning (Foxx, 2008; Howard, Stanislaw, Green, Sparkman, & Cohen, 2014: Reichow, 2012). The success of the ABA approach in attaining practical and clinical acclaim is unsurprising given the dominance of both the positivistic paradigm and the medical model across many areas of social science and human services, including the therapeutic and educational fields (Fisher & Goodley, 2007). However, closer scrutiny reveals that there are a number of humanistic problems created when the centricity of the medical model of disability is maintained by ABA in the area of educating individuals with ASD.
For quite some time, there has been ongoing debate regarding the relationship between humanism and behaviorism, and a question as to whether the two philosophical orientations are inherently diametric. The basic critique of behaviorism, as regarded from a humanistic lens, suggests that behavioral methodologies are generally mechanistic, absolutist, symptom-focused, and oriented principally around external motivation (Hayes, 2012; Ryan & Deci, 1996; Ryan & Deci, 2000). Humanistic approaches, rather, can be regarded as more adaptable, person-centered, relativist, holistic, and oriented around both internal and external motivation (Buhler, 1971; Schneider, Pierson, Bugental, 2014).
Indeed, while there were some historical attempts at reconciling some of the seemingly fundamental differences between humanism and behaviorism, many of these were generally dismissed and relegated to the margins of the dominant mainstream discourse (Hayes, 2012). While such issues and attempts at reconciliation have experienced a resurgence over the last decade or so, especially through the increased research presence of fields such as cognitive behavior therapy (CBT) and acceptance and commitment therapy (ACT), to name but two examples, there still exists a dearth of discussion that occurs between fields extending specific interventional practices and focusing on deeper philosophical underpinnings of those practices.
Principal among the contemporary philosophical issues raised is the central role that “normality” plays in the philosophy and practice of ABA. Framed within the largely positivist and absolutist medical model of disability, maintaining an outcome goal of attaining normality or some approximation of it, in intellectual, social and/or behavioral functioning, is the main treatment goal, as such a model treats a condition such as ASD as a medical problem that interferes with “normal” functioning. However, a concerning by-product of this type of approach is the propagation of the dichotomous structure between normal and abnormal, with abnormality being seen as both an undesired and potentially even tragic state. Connecting abnormality with ASD as its cause risks making tragic both the condition itself and, in a very real sense, the individual who possesses it, relegating the most effective and sensible therapies as those that will minimize, if not eliminate the “autistic symptomatology,” therefore bringing the individual closer to normality. An extension of this conceptualization is the notion of ableism, or the idea that those who are “more able” are “more includable” into mainstream educational environments as well as greater society. From this perspective, the goal of any therapy should be to increase one's chances at inclusion based on their ability to meet the acceptable standards of normality.
From a more humanistic vantage, the emerging concept of neurodiversity, or the idea that ASD (among other potential neurological differences) is overly-conceptualized as pathological by the medical community, whose focus has become disproportionate to the area of rehabilitation or even cure rather than acceptance and value of diversity plays a central role in the discussion (Kapp, Gillespie-Lynch, Sherman, & Hutman, 2013). While to a number of people neurodiversity is regarded as a misguided concept aimed at minimizing genuine struggles or over-romanticizing the notion of acceptance, this radical idea represents a positive step forward in the area of humanistic thought at a greater social level, and calls the medical model's focus on intervention and outcome directly into question.
Analytic Framework and Structure
Because this argument is largely conceptual in nature, it is necessary to establish a framework within which its foundations will be based. There are two main groundings for the argument: disability studies in education (DSE) and critical discourse analysis (CDA). DSE, the general philosophical framework for the argument can largely be framed as a perspective that regards “disability” as a social phenomenon that interacts with the educational environment in a number of culturally, socially, and politically relevant ways, essentially rejecting the medical model of disability. As such, conceptualizations and arguments proffered from within a DSE framework are to be approached in a pluralistic manner including social constructivist, interpretivist, postmoderninst, poststructuralist, among others (Baglieri, Valle, Connor, & Gallagher, 2011; Taylor, 2006).
CDA, the methodological framework employed interprets the specific use of language in research and theory within a social-theoretical frame, especially involving notions of power, control, and dominance. Essentially, CDA employs analysis of instances of social interaction in both linguistic and practical form, with especial regard to the relationship between language and society, as well as between the analysis itself and the practice being analyzed (Blommaert & Bulcaen, 2000). Therefore, in order to maintain fidelity to the CDA methodology, the current paper will intentionally employ more frequent use of extended quotes despite such practice being generally avoided in APA (6th edition) styled papers.
While it is inaccurate and imprudent to suggest that ABA/IBT is the sole methodological framework for ASD intervention that employs the medical model of disability as a fundamental (indeed, other approaches such as Defeat Autism Now as well as many interventional projects within socio-developmental framework do as well), it is prudent to claim that it is the field whose advocates tout its interventional capabilities and achievements most boldly (Eikeseth, Smith, Jahr, & Eldevik, 2002; Eikeseth, Smith, Jahr, & Eldevik, 2007; Eldevik, Eikeseth, Jahr, & Smith, 2006; Fava et al., 2011; Foxx, 2008; Howard et al., 2014; Howard, Sparkman, Cohen, Green, & Stanislaw, 2005). Therefore, the purpose of this article is to be a contribution to the ongoing and ever-important contemporary discussion of humanism and behaviorism, and is intended to evoke discussion and response from critical behaviorists who believe in the necessity of such a dimension to the discourse, much of which has become unilaterally focused on intervention and outcome at the expense of philosophy. It is explicitly not intended as denigration, or as an affront to behavior analysts as practitioners, researchers, or philosophers.
This article will proffer the following arguments:
The general framework of applied behavior analysis, including resulting therapeutic and interventional methodologies, are generally centered on the medical model of disability.
Inherent to the medical model of disability is the role of power between “clinician/therapist/teacher” and “patient/client/student.” Framing applied behavior analysis and its resulting methodologies within the context of power situates autism spectrum disorder (as well as those with ASD) as a form of “enemy” (as per Broderick, 2010).
The maintenance of the social metaphor of ASD as “enemy” leads the greater field to address the efficacy of “therapeutic treatment” of ASD in terms of achieving (or approaching) normality.
The Medical Model and Pathological Orientation of Disability in Applied Behavior Analysis
The framework of social science regarding disability from the beginning of the 20th century has been conceptualized almost entirely within the medical model. At its core, the medical model of disability is centered on the dichotomous categories of “disabled” and “non-disabled” in order to frame acceptable levels of intellectual, behavioral, and social functioning, as well as determines which individuals should be required to receive “treatment” in order to ameliorate the consequences of their disability. From the medical model perspective, the locus of the disability itself lies within the person, leaving the need for treatment to come from an external counteractive source. It follows, then, that the focus of treatment from the medical model perspective must be on either rehabilitating such difficulties that are caused by the disability or curing the individual of that disabling condition in order to attain, or approach, normality (Areheart, 2008).
Just under the surface of the “disabled” and “non-disabled” dichotomy, then, is a deeper and more socially relevant dichotomy: that of “normal” versus “abnormal.” Out of this conception emerges a seemingly axiomatic version of what one “ought to be,” able-minded and able-bodied, while any aberration from this standard is to be considered abnormal and disadvantageous, making treatment and rehabilitation of the utmost importance (Shyman, 2013).
The medical model, then, sets boundaries as to who does the curing (and, ipso facto decides and designs the “treatment” regimen) and who needs the curing (or who receives the “treatment”), allowing for a hierarchical and potentially inequitable relationship between clinician/therapist/teacher and patient/individual/student. Suffused throughout the functioning of the medical model is the focus on a pathological orientation of thought: a perspective that seeks to isolate a set of particular “facts” or indices of disability, usually in the form of definable physical or intellectual characteristics, which separates those for whom “normal functioning” is attainable without treatment and those for whom it is not. The pathological model, then, is centered on the notion of diagnosis and categorization whose existence is likely to lead to a particular type of treatment: one that is best suited to rehabilitate, relieve, or even cure the individual of the ills caused by the disability (or disease) (Hodge, 2005; Rogers & Pilgrim, 2002).
This notion has received attention in the behavior analytic community historically. As Goldiamond (1974) suggests in his now classic paper Toward a Constructional Approach to Social Problems, the pathological orientation is affected by both pessimistic views of abnormality and optimistic views of rehabilitation. Indicative of this framework is the consequences that are apt to ensue from avoiding treatment for a pathological condition; one that is likely to result only in crisis and hopelessness for a once treatable but now largely debilitating condition.
It is squarely within this framework that ABA is situated, and from this perspective that both its rhetorical and research basis is drawn. By regarding ASD as a pathological condition that stems from particular neurological, biomedical and/or genetic dysfunction, which results in both disabling and abnormal behavior, the clinical goals (and, in many cases, promises) of behavior analytic intervention build directly upon the notion of rehabilitating the individual with ASD. Thus, this treatment can be responsible for not only relieving him or her from the dysfunctional consequences of ASD (couched in terms of the behavior itself) but also delivering him or her to having the ability to behave in a more functional and normal, and thus socially acceptable manner. It is the justification of the pathological model that permits this frame of thought: without intervention a pathological condition cannot be rehabilitated or cured. By virtue of the fact that a pathological condition is, in terms of cultural definition, harmful, an intervention that has been shown to be eliminative or at least reductive of such consequences is best suited for implementation.
The Role of the Medical Model of Disability in Establishing ASD as “Enemy”
Maintaining the frame that ABA is centered on the framework of the medical model of disability, it follows that a discussion of how the medical model is applied in the treatment environment (clinic, classroom, or therapeutic home program) for ASD is necessary. Endemic to the medical model is the concept of power, and, more importantly, the role that power plays in an individual's, or a group of individuals' ability to dictate what is to be regarded as normal versus abnormal, and to ultimately enact intervention upon members of the populous who appear to stray from this standard in order to evoke normal behavior through any number of means. According to Goldiamond (1974):
…the “idea whose time has come,” that is, which begins to have social or scientific impact and to exert an influence over behavior which has hitherto been lacking, derives its onset of power from changes in social or scientific contingencies. These exert new behavioral requirements, and the ideologies and models which rationalize these behaviors and the contingencies of which they are a part now seem invincible (p. 117-118).
The emergence of Goldiamond's (1974) as well as Wexler's (1973) arguments must be contextualized within the true beginnings of behavior analytic interventions, which were applied in more captive hospital or institutional settings in the 1950s and 1960s. Accordingly, these authors suggest a number of constitutional and ethical concerns regarding the increased use of what was then termed “behavior modification,” almost all of which remain relevant today despite the widespread use of behavior analytic approaches outside of such captive environments.
The role of power between the “therapist” and the “patient” remains of central importance in such constitutional designs that are applied in contingency-based arrangements. That is, behavior replacement and reduction plans center on the implementation of reinforcement and punishment, which is provided or withdrawn at the discretion of the therapist. Indeed, though there is likely the existence of an “operational definition” that guides such decisions, the ultimate power of provision remains in the hands of the therapist. Therefore, while the goal of treatment itself is clear and well-suited to the methodology, the constitutionality, humanistic value, and perhaps even ethicality of the behavior replacement therapeutic process is called earnestly into question.
Therapeutic interactions such as those found in clinics, home-based therapeutic programs, and specific classrooms within schools (be they specialized for students with ASD or programs within greater public school systems and buildings) may likely pose the same threats to a consensual democratic system despite the elimination of physical captivity. That is, through the application of a behavioral contingency, an essential element of behavior analytic interventions, the treated must behave in a particular way or comply with a particular expectation in order to be given access to a reinforcer (either self-chosen or compelled), or reward for such compliance, doled by the therapist (or the treater) at the therapist's discretion. Through this system near-total (if not total) power of the therapist is maintained. It is not necessarily required that the individual consent to the behavior plan in any way. (It is imperative to acknowledge that some plans for individuals who are able to consent are devised mutually and methods such as person-centered planning attempt to extend this practice even to individuals with more severe communicative challenges). In such situations of non-consent, if the “clinical team” deems the plan ethical and necessary it is not required that consent be acquired from the individual under contingency, either to the plan itself or even the basic assumptions of the paradigm from which the plan is derived; one which holds their naturally chosen behaviors as inappropriate and dysfunctional and the synthetic replacement behaviors decided by the clinical team as appropriate and functional. At best, this can be seen as passive consent, or assumed consent in the absence of explicit dissent. Essentially, behavior analytic interventions may risk converting what may very well be rightful activities and provisions (such as access to recreation, food, and leisure activities) into privileges to be earned based on compliance with a set of rules.
But for what reason should a social system derive a need to control something like ASD? A potential explanation lies in Broderick's (2010) notion of “ASD as enemy” in which she states that both scientific and popular discourse has effectively framed the function of autism in two threatening ways: ASD as abductor and ASD as epidemic. Taken together, these two functions warrant an urgent response to eliminate, or at least minimize the symptomatology of ASD, allowing for the approach that does so in the most efficient and apparent manner to gain dominance. Since, as it stands in the current state of positivistic empirical research, there is insufficient biological or neurological understanding of ASD, at least enough in order to warrant a clear psychopharmacological or biological treatment regimen, the mode of positivistic research that is most highly associated with “outcomes-based” and “normalizing” evidence is ABA.
As demonstrated earlier in the argument, the framework of ABA is a well-suited fit for the medical model of disability. Therefore, it stands to reason that it would also be a well-suited fit for the medical-model based approach for treatment centering on eliminating the symptoms of ASD and allowing momentum of the individual toward normality. Because both the methodological framework of ABA fits the medical model of disability in terms of treatment, and the philosophical perspective of ABA fits the social and cultural metaphor of “ASD as enemy,” it follows that it has become the approach to dominate the policy and practice of an ever positivistic educational system. As Lakoff and Johnson (2003, as cited by Broderick, 2010) suggest:
Metaphors may create realities for us, especially social realities. A metaphor may thus be a guide for future action. Such actions will, of course, fit the metaphor. This will, in turn, reinforce the power of the metaphor to make experience coherent. In this sense metaphors can be self-fulfilling prophecies (p. 156).
Indeed, the positivistic notions of operational variables (those that are observable and measurable) and its centricity in ABA play a dominant role in the “visual” power of such interventions. If one can literally “see” and “measure” an “abnormal” behavior decrease and a “normal” behavior increase in its place, then from a strictly positivistic viewpoint there is little more evidence needed for such an approach's effectiveness. Not only is the phenomenon observable clinically and without the necessity of specialized training, but it is desirable socially, allowing the individual to progress toward normality. Thus, both the scientific and the social metaphors are placated within one clear-cut methodology. With the deep acceptance of the “ASD as enemy” metaphor, it would seem foolish, if not outright abusive for parents or caretakers to choose away from an interventional modality that not only moves an individual toward normality, but can demonstrate its effectiveness in clear, quantitative, positivistic terms.
Metaphorical Power of Applied Behavior Analysis in Approaching or Attaining Normality
The medical model of disability propagates a powerful social and scientific narrative within which one is to regard ASD as a disease, indeed, an enemy, that is to be treated or even cured in order to provide a basis for a person to attain normality. By situating ASD in this way, the powerful rhetorical tool of “treatment” as “rehabilitation” or even “cure” becomes an obvious end goal. This sentiment is quite powerfully demonstrated in the philosophical and rhetorical underpinnings of ABA as a treatment for ASD. One of the most demonstrative instances of this perspective was a catalyzing article in the Summer 2002 newsletter of the Association for Science in Autism Treatment (ASAT), a largely behaviorally-based organization, in which Catherine Maurice, a mother of two children with autism and author of the now canonized book Let Me Hear Your Voice (1994) proposes that the purpose of treatment for individuals with ASD should be, ultimately, cure, but in the absence of such possibility the goal then becomes to “…maximize the patient's potential” (Maurice, 2002, p. 3). In a bolder modality of thinking and employing a highly powerful metaphor, Maurice then analogizes ABA as a treatment for ASD to chemotherapy as a treatment for cancer. As she suggests:
Just substitute the word “cancer” for “autism” and any “lay person” could detect a slightly subversive note: Are there ethical issues associated with recovery from cancer? What is the economic implication of wide scale attempts to recover people from cancer?...Why would we not attempt to recover anyone from cancer, or autism? No, we cannot guarantee [italics in original] cure for anyone, but is that sufficient reason to lower the bar? Do we start deciding how many people should have access to science-based treatments to cancer? Do we start deciding how many children should have access to ABA? (p. 4)
While there are multiple problems with the underlying logic, as well as the veracity of this line of reasoning, the most evident problem is the comparison itself between ASD and cancer. Cancer is a biologically based, definitively diagnosable disease, which can be legitimately recovered from once cancer cells are no longer present in the body. Attaining quantitative measures to validate the absence of cancer can be facilitated through medically-based and largely trustworthy tests. ASD, conversely, while widely thought to be biological and neurological in nature based on strong emerging research from various fields, cannot be definitively biologically identified or measured. The diagnosis and existence of ASD is, and has always been, diagnosed as a means of behavioral interpretation based on clinical best estimate: that is, a qualified clinician's best judgment based on a variety of imperfect and questionably suited behavioral assessments (Lord et al., 2006). The comparison, then, between chemotherapy and ABA serves only a rhetorical function to enhance the scientific credibility of ABA by analogy and reinforce the “autism as enemy” metaphor, likening its existence to cancer. That is, if ABA is to ASD what chemotherapy is to cancer, the connection, especially by emotionally vulnerable parents seeking help for their child will play a significant role in “buy-in.” This perspective is not unlike that critiqued by Sontag (1978) in her catalyzing book Illness as Metaphor. However, to truly compare the nature of ABA research and practice with that of cancer pushes both rhetorical and ethical bounds.
What is legitimately implied by Maurice's statements, however, is the deep notion that is undoubtedly (and understandably) shared by many parents and other stakeholders involved with individuals with ASD: that the goal for any “treatment” should be a reduction in disabling behaviors (those that are symptomatic of ASD) and an increase in functional behaviors (those that allow the individual with ASD act “less autistic” and “more normal”). As a result, the preponderance of studies that have been used to evidence the effectiveness of ABA as a treatment for ASD grounds its claims squarely within the context of normalization and, in other extreme cases, recovery. Indeed, this goal is explicitly stated in a guidance document by the Behavior Analyst Certification Board (BACB, 2012), which is the governing body of credentialing behavior analysts. This document states that “…the goal of treatment is to bring the client's functioning to levels typical for that chronological age or maximize independence in multiple areas” (p. 23). While there is no humanistic or philosophical issue with working toward independence in multiple areas for an individual with a variety of challenges, the problem is encountered in the context of “typicality” and “normality.”
The likely root of the connection between behavior analytic approaches and the attainment of normality can be traced to a seminal but significant study published by Lovaas (1987), which is generally regarded as the first systematic study of the application of behavior analytic principles in the intervention for children with ASD. Attempting to contextualize his results as clinically significant Lovaas (1987) claims:
This article reports the results of intensive behavioral treatment for young autistic children. Pretreatment measures revealed no significant differences between the intensively treated experimental group and the minimally treated control groups. At follow-up, experimental group subjects did significantly better than control group subjects. For example, 47% of the experimental group achieved normal intellectual and educational functioning in contrast to only 2% of the control group subjects (p. 3).
Though hailed by many in the growing field of behavior analysis, Lovaas' bold claims did not go undisputed by many others in the field of ASD (see particularly Schopler, 1987).
Despite the critical reception by many notable researchers, the notion that behavior analytic intervention can lead to “recovery,” “cure,” or at least “approximations of” normality for children with ASD became an indelible part of the behavior analytic narrative, and continues to play a deeply important role in the appeal and adaptation of behavior analytic interventions for children with ASD. This idea can be evidenced by the propagation of such claims over the last several decades since Lovaas (1987). According to Jacobson, Mulick, and Green (1998):
Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD-NOS can attain intellectual, academic, communication, social, and daily living skills within the normal range (p. 201).
Harris and Delmolino (2002) similarly suggests:
The techniques of applied behavior analysis (ABA) are effective in altering the developmental trajectory of some very young children with autism. This research suggests that early, intensive treatment using the methods of ABA enables a significant number of children to enter the educational mainstream and achieve normal intellectual functioning (p. 11).
Reichow (2012) suggests, based on his overview of meta-analyses that “[Early Intensive Behavioral Intervention] can be a powerful intervention capable of producing large gains in IQ and/or adaptive behavior for many young children with ASDs.” (p. 517). While these claims represent only a sample, there is a rich history of similar claims evident in the extant literature over the last three decades (Foxx, 2008; McEachin, Smith, & Lovaas, 1993; Howard et al., 2014; Peters-Scheffer, Didden, Korzilius, & Sturmey, 2011; Sallows & Graupner, 2005; Smith & Lovaas, 1988; Smith, Eikeseth, Klevstrand, & Lovaas, 1997; Smith, 1999).
Indeed, the contextualization of attaining normality as a goal for intervention may seem innocuous, if not entirely sensible at face value. Why would a parent, clinician, or even individual with ASD not want to gain ground toward being normal when normality is the standard of acceptance in a society? The harm of such a perspective is revealed, however, by the tacit diametric though simultaneous message. The first danger is the language of deficit that is carefully employed by such conceptualizations of ASD. Endemic in the vast majority of the behavioral studies cited, whether explicitly stated or not, is an acceptance of the legitimacy of the medical model of disability as applied to ASD. That is, that ASD as a condition, as well as its “symptoms” are negative and denigrating, and must be treated and reduced in order to increase one's quality of life. Though this is, to be sure, a widely accepted, if not axiomatic frame of thought in behavior analytic research (as well as greater positivistic medical research), it has not, in any way, been validated or even suggested by quantitative or qualitative research. Therefore, it cannot be seen, by any standards of veracity, as a point of fact, but rather a widely accepted though potentially erroneous presumption that has grown out of the medical model of disability.
The message of this line of thinking is clear: the more normal students become (as evidenced, in a large way, by whether they “qualify” for general education placement), the more effective and valuable a treatment is (and therefore, worthy of monetary investment) (Chasson, Harris, & Neely, 2007; Jacobson et al., 1998). This is also, essentially, the message of the medical model. Parents and caregivers are then faced with a choice: they can choose an “intervention methodology” that is most likely to maximize an individual's mobility toward normality (in which there is “hope”) as supported by “science” (comprising both the dominant social and medical message) or they can choose less evidence-based (or, in some cases “unproven”) intervention methodologies that do not. When distilled, this choice, adamantly proclaimed by proponents of the field of ABA, amounts to not only choosing effectiveness over ineffectiveness, or “real science” over “faith,” but choosing hope versus hopelessness.
It is thus argued that ABA, through the scientific lens of humanistically decontextualized outcomes-based evidence-basis, harnesses a powerful rhetorical device by offering parents not a choice between a happy child or an unhappy child, but rather a hopeless abnormal child, or a hopeful normal one. As a result, the legitimacy of the medical model of disability is both preserved and propagated, situated squarely as the frame upon which parents are implored to make decisions about the “treatment” of their children. From the behavior analytic perspective, such decisions must not be based on emotional thinking, clearly connoted as unclear and unsound from a positivistic perspective, but rather on systematic, objective, and scientific decision-making. As Catherine Maurice (1993) suggests in Let Me Hear Your Voice:
After gamely agreeing to look at beloved works of poetry and fiction through the diverse lenses of structuralism, poststructuralism, phenomenology, feminist criticism, deconstruction, I pounced on medicine like some poor fact-starved rat. I was tired of truth as a relative term, a shift of one's perspective, a way of seeing. Information was what I wanted to try on for size. Science. A corpus of knowledge validated by whether its data held together empirically, not by whether its practitioners had the gift of gab (p. 16).
Clearly Maurice is suggesting that emotional input into clinical decision making serves not only a distracting, but more so a destructive purpose that disallows parents and caregivers to make clear decisions based on fact while they are bamboozled by their own emotional investments and lack of rational clarity, thus needing to rely on the more objective and less emotionally invested clinical professionals (an analogous outplay of the power dynamic demonstrated previously). Essentially, Maurice implies that what one regards emotionally as “hope” can really be best defined as a craving for rational thinking and action. According to Danforth (1997):
From this [modernist] perspective, hope lies in the gradual, scientific production of improved approximations of “truth” and the development of intervention technologies, practices, programs, and instruments “that work” according to the truth-clarifying research (p. 94).
Broderick (2009) sets ABA squarely within this framework by suggesting:
In the context of the ongoing reproduction of ABA discourse…as inherently tragic, catastrophic, and hopeless—the concept of hope for recovery stands in stark contrast to this dominant picture of hopelessness and despair and is presented as the only hopeful vision available, or at least, as the only real hope [italics added]. Recovery thus becomes almost synonymous with hope itself—in the apparent absence of other visions of hope, hope for recovery may be welcomed by those who insist on embracing hopeful visions of futures for young children labeled with autism in spite of the dire prognoses traditionally offered (p. 271).
This characterization leads one to the conclusion that absolutism is not only the epistemological frame within which ABA is situated, but the very means by which its claims can (and should) be substantiated. When one can see their child progress toward normality by replacing their “asocial” or “dysfunctional” behavior with “prosocial” or “functional” behavior, the promise of hope itself is reinforced, and with human perception favoring linear organization and sensory-based evidence, the caregiver becomes convinced of the effectiveness of an intervention that can quite literally be “demonstrated” to minimize (or eliminate) that which is “autistic” and replacing it with that which is “normal.” With this replacement come also all of its social trappings, such as “qualifying” for more inclusive educational environments, participation in mainstream society, and a more acceptable form of a social life. As Fitch (2010) explains:
This practice, grounded in scientific positivist assumptions and the biomedical model of disability, continues to legitimate segregation and inequality and justify a dual system of special education. Demonstrating the socially constructed nature of difference/deviance, labeling deviance theory has played a crucial role in challenging this orientation, serving as one of the key conceptual foundations for the disability and inclusive movements. (p. 18).
It is upon this foundation that the concept of ableism is directly reinforced by not only the medical model of disability in general, but the preoccupation with ABA for individuals with ASD.
It is important to add, however, that there are counter-narratives present from parents which demonstrate a clear rejection of the notion of regarding the attainment of normality as the optimal result for intervention, or for their children to begin with. But one example is from Kephart (1998) who relates:
What, in the end, are you fighting for: Normal? Is normal possible? Can it be defined? Is it best achieved by holding up in the offices of therapists, in special classrooms, in isolated exercises, in simulating living, while everyday “normal” happens casually on the other side of the wall? AND is normal superior to what the child inherently is, to what he aspires to, fights to become, every second of his day? Normal in terms of what, and by what sacrifice? (p. 11)
Limitations of the Argument, Future Directions, and Conclusion
The current argument aimed to contribute to the resurgent dialogue regarding the differences between fundamental concepts in humanism and behaviorism. In attempt to add to Hayes' (2012) article encouraging the continuation of such discourse, the current argument focused on elements of underlying philosophy and fundamental assumptions as opposed to specific interventional and methodological practices and outcomes. As a result, the argument employed a critical and conceptual dialogical and dialectical style. There are, however, some considerations that need to be made in order for such a discussion to continue in a productive way.
First, the current discussion offered an argument that was, in some essential ways, binary, risking adding to the notion that there is a real distinction between humanism and behaviorism that must be maintained. While possibly true, this approach was instituted more aptly to frame the fundamental humanistic issues of behaviorism as clearly and as concretely as possible. Future dimensions of the discussions should seek to expand this conceptualization beyond binary distinctions. Second, and along the same lines, the argument situated the difference between the “medical model” and the “interactionist” model as a bifurcated distinction. It is important to note, however, that emerging research and thought in the area of disability studies in education specifically suggest rethinking this dichotomous approach. Third, the inclusion of the notion of neurodiversity as a component to humanistic functioning needs to be further explored and analyzed, especially given how such a concept applies to individuals with varying degrees of severity. Finally, the field of ABA has, indeed become more nuanced, and the means by which different methodologies that fall under the auspice of ABA address these particular humanistic issues (such as pivotal response training, positive behavior support and person-centered planning) must be more deliberately addressed.
Ultimately, however, it is suggested that the current argument revealed some important philosophical humanistic issues that must be addressed by critical members of the field of ABA should any such reconciliation with humanism be accomplished. There is, indeed, a deep possibility for humanistic behavioral approaches that are as strong in outcome as they are humanistic in approach, though earnest conversation only will fully provide means. It is hoped that this piece provides some productive contribution to this discourse.
This work was not supported by any grants, nor are there any conflicts of interest nor are any disclosures necessary.