MINDFUL SUBJECTS: CLASSIFICATION AND COGNITIVE DISABILITY Angela Licia Carlson A Thesis submitted in conformity with the requirements for the degree of Ph.D. Graduate Department of Philosophy University of Toronto O Copyright by Angela Licia Carlson 1998 191 National Library Bibliothèque nationale ,,,fo du Canada Acquisitions and Acquisitions et Bibliographie Services services bibliographiques 395 Wellington Street 395. rue Wellington Ottawa ON K1A ON4 Ottawa ON K1A ON4 Canada Canada The author has granted a non- L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant a la National Library of Canada to Bibliothèque nationale du Canada de reproduce, loan, distribute or sell reproduire, prêter, distribuer ou copies of this thesis in microfom, vendre des copies de cette thèse sous paper or electronic formats. la fome de microfiche/nlm, de reproduction sur papier ou sur format électronique. The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts fiom it Ni la thèse ni des extraits substantiels may be printed or otherwise de celle-ci ne doivent être imprimés reproduced without the author's ou autrement reproduits sans son permission. autorisation. MINDFUL SUBJECTS: CLASSIFICATION AND COGNITIVE DISABILITY Ph.D. 1998 Angela Licia Carlson Philosophy Department, University of Toronto This dissertation is a cal1 for a philosophical reorientation regarding a particular classification of human beings: mental retardation. Generally, individuals with mental retardation are only discussed in philosophy as moral problems to be solved: are they persons? do they have rights? how ought they be treated? 1 depart from the traditional approach, and ask a different set of questions about the nature of classification, the effects it has on classified subjects, and the power relations involved in the process of classiQing. This project operates at three theoretical levels: it is at once a philosophical study of classification, an alternative history of mental retardation, and a discussion about the modes and effects of power. In the second and third chapters, 1 analyze the development of mental retardation as an object of knowledge, and outline a theoretical framework from which to discuss classification general!~.A feminist re-examination of this history exposes the power dynamics involved in definitions and practices associated with mental retardation. In identiQing five roles that women piayed in this history, it becomes evident that the development of this classific ation was inextricably bound with social and political factors, and involved multiple layea of oppression. In th: final chapter, I present a critique of philosophical discourse about cognitive disability. The preceding historical analysis serves as an important backdrop to understand current discussions about the "mental [y retarded", and reveals that many philosophers neither address this history, nor have they escaped it In applying the analytic approach to classification and power relations developed in earlier chapten, it becomes apparent that many moral philosophers do not address the socially and historically determined nature of mental retardation as a classification. Rather, they assume a medical mode1 which views it as an unproblematic "natural kind. After addressing the problem of philosophical language and definitions, I tum to one argument in particular: the case against speciesism. I argue that the treatment of persons with cognitive disabilities in arguments conceming the rnora 1 status of animals relies upon a kind of discrimination I cal1 "cognitive ableism". 1 conclude by exploring future directions for philosophical work on cognitive disabilities. 1 would like to thank my supervisor, [an Hacking, for the challenging and illurninating conversations which allowed this project to take shape, and for his endless support and encouragement. I thank Kathryn Morgan, my advisor, for her valuable input and her shared enthusiasm for the subject I have chosen. 1 am also grateful for the Connaught Fellowships and the Ontario Graduate Scholanhip that gave me the opportunity and time to complete my work. To my devoted friends and dearest family, 1 thank you for your inspiration, your patience, and the many words and silences which have sustained me. Finally, it is to the persons who are both present and absent in these pages, and whose lives have directly and indirectly touched my own, that 1 offer my deepest gratitude and respect. TABLE OF CONTENTS CHAPTER ONE: INTRODUCTION The Status of Mental Retardation. ......... ............................................. 2 ,... The Historical World of Mental Retardation. ................................................. 9 . . ( 1) Oppositional Analysis. .......................~.~~.~~..........................1..0.. ...... . . (2) Feminist Analysis. ......................................................................... 12 The Problem of Power. .................................................................................... 13 CHAPTER TWO: MENTAL RETARDATION AS AN OBJECT OF KNOWLEDGE ............................................................................................................ 17 Institutional Discourse: Preliminary Remarks. ................................................ 30 The Institutional World of Mental Retardation: An Analysis of Three Tensions. ...................................................................... 22 ( 1) Qualitative and Quantitative Difference. ........................................ 25 (2) OrganicNon-Organic " Idiocy" ....................................................... 31 (3) Static and Dynamic Definitions. .................................................... 34 (4) Treatment and the Static/Dynamic Opposition. ............................ 41 Docile Bodies, Docile Minds ...............,..... ............................................. 49 ..., . . . . Visibility and Invisibility: The IQ Test .......................................................... 51 . . . . (1) Social Visibility. .......................................................................... 52 (2) Individual Visibility. ...................................................................... 53 . . . . . 3 Etiological Visibility. ..................................................................... 56 (3) CHAPTER THREE: PHILOSOPHICAL FEATURES OF CLASSIFICATION: AN ANALYTIC iNTERLUDE .............................................. 59 Heterogeneity ................................................................................................... 59 Prototype Effects. ........... .. ........................................................................... 65 CHAPTER FOUR: MENTAL RETARDATION AS A GENDERED CLASSIFICATION. ........................~....................................... 69 Social Groups and Modes of Power ............................................................... 71 Five Groups of Women: (1) "Feeblerninded" Women: A Prototype Effect. .......................................... 75 (2) Institutional Caregivers: The Paradox of Inmate Labor .............................. 83 (3) Women As Mothers: The Role of Etiology. .......... .. ............................. 91 (4) Female Researchers: Pedigree Studies as Woman's Work .......................... 98 (5) Female Refomists: Lady Bountiful and the "Dawn of Womanhood" ............................................................................................. 101 Conclusion ....................................................................................................... 108 CHAPTER FIVE: THE PHILOSOPHICAL WORLD OF MENTAL RETARDATION. ....................................................................... 111 The Language of Moral Philosophy: "Idiocy" Revisited. ................................. 113 . . The ProbIem of Definitron ................................................................................ 120 ( 1) Extemal Heterogeneity : The Excuse for Slim Definitions. ...................................................... 121 (2) Reification ........................................... .... ................................. 135 3 Prototype Effects. ............................................................................ 131 (3) Distinctness of Kind: Our Philosophical Pets .... ............... ........................ 134 . . ( 1 ) Qualitatrve Difference. ..................................................................... 136 (2) Animais and the "Mentally Retarded": Analogous or Identical?. ................................................................... 138 (3) The Case Against Speciesism: Peter Singer's Animal Liberu~ior.z.. ... 141 i . How the "Cognitively Disabled Help Prove the Case ........... 142 ii . Why Choose the "Severely Cognitively Disabled?. .............. 146 (4) Cognitive Ableism vs . Speciesism: A Necessary Choice? ................ 155 CONCL USION ..................~........................................................................................... 167 Bioethics and the Politics of Prevention .......................................................... 172 . . . . Genetic Visibility and Prenatal Prototypes ........................................................ 174 Sel f-Advocacy and Reverse-Discou r.se. ..... ................................................... 179 REFERENCES. ............ CHAPTER ONE INTRODUCTION "Mental retardation.. .i s a serious condition, one that any reasonable person would rather not have. In Our terms, the disvalue is objective. This means that we cannot cope with the problem of stigma simply by Qing to re-educate people into thinking the condition is not inherently bad. Retardation is not like race or gender stigma. Even the most dedicated and sympathetic advocate for the retarded acknowledges that it is a serious problern ....T he problem is real. It is so cleariy a bad thing to have that we can act as if it were objectively a bad condition. " -Robert M. Veatch ( 1986) "If we had to choose to Save the life of a normal human being or an intellectually disabled human being, we would probably choose to Save the life of a normal human king. ... When we consider members of our own species who lack the characteristics of normal humans we can no longer Say that their lives are always to be preferred to those of other animals. As long as we remember that we should give the same respect to the lives of animals as we give to the lives of those humans at a similar mental Ievel, we shall not go far wrong."2 -Peter Singer ( 1995) This project is a cal1 for a philosophical reorientation with respect to a particular classification of human beings: mental retardation. Most philosophical discourse about persons with cognitive disabilities3 has been restncted to questions about their moral status (how do they differ from animals? persons?) and how they ought to be treated. As the above quotes suggest, philosophes also make value judçments about the condition itself and the worth of those whom fhey consider "cognitively disabled. 1 intend to move out of the realm of moral discourse and ask a different set of questions, not only because 1 . - - - - - - - - - - I Robert M. Veatch, The Forrrrdatiom of Jmtice: Why Ihe Retorded mici the Rest of UTH ave CIaims fo EpaIiiy (New York: Oxford University Press, 1986), 197. 2~eteSri nger, Animai Liberatio~t( London: Pimlico, 1995), 20- 1. '~hou~mhy focus is on "mental retardation" as a particular classification, 1 will use the tems "cognitively disabled" and "cognitive disability" to refer to the gened group of persons and disorders traditionaiiy associated with "mental deficiency". 1 use this more general term because philosophers often refer to different conditions without qualification, that al1 involve some kind of cognitive impairment. Thus, the term cognitive disability includes individuals referred to as "brain-damased", "intellechially disabled", and "mentally retarded". 1 use quotation marks to indicate that when 1 refer to the "cognitively disabled", I mean individuais who have been labeled as such. 1 do not view these categoritions of persons as seff- evideat or unproblematic. find them philosophically interesting, but in an attempt to explain why some philosophen deal with the issue of cognitive disability in the ways that they do. There are numerous questions that can be asked about mental retardation: 1s mental retardation "real"? How is it defined, and by whom? What kinds of individuals does it pick out? Does it refer to some "natural kind"? 1s it simply a category created for specific political purposes, grouping together individuals who are deviant and undesirable? How is it that mental retardation became a unified category in the fint place? What practices contributed to the constitution of the classification and classified subjects? In what follows, 1 present a philosophical analysis of these questions, organized into four chapters. Chapter Two analyzes the historical emergence of mental retardation as an object of knowledge. From the philosophical analysis of this history, 1 develop a framework in which to discuss the nature of classification generally, which is outlined in Chapter Three. After this analytic interlude, 1 re-esamine the history of mental retardation as a classification from a feminist perspective in Chapter Four. The final chapter moves into the contemporary philosophical world, and examines the consequences of ignorinç questions about the nature of mental retardation as a classification and its classified subjects. More generally, this dissertation operates at three theoretical levels: it is at once a philosophical study of classification, a history of mental retardation, and a discussion about the modes and effects ofpower. 1 will briefly discuss each. The Status of Mental Retardation At one level, the answer to the question " 1s mental retardation real?" seems obvious. There are clearly real people who have been labeled "mentally retarded" and whose lives have ken directly affected by that label. There are individuals who have certain intellectual limitations, some as a result of endogenous biological or genetic causes, others caused by extemal factors (e.g. poverty, deprivation, pre- or post-natal trauma), and some for which there is no identifiable cause. There are persons who face significant social barriers, institutionalization, and violence because of their limitations, andior because of the fact that they are labeled mentally retarded. 1 do not wish to dispute any of these claims. However, the status of mental retardation as a "natural kind" is still in question. To what extent does "mental retardation" pick out some real deficit or feature of human existence independent of the social, historical and political context? Moral philosophers and theorists of disabilityd (especially those who espouse what 1 will cal1 the "social construction" position) have very dif5erent responses to this questions. Anita Silvers observes that much philosophical work on disability still adheres to the medical mode1 of disability, which "conceptualizes the disabled as biologically inferior, and in so conceiving contines such individuals to the role of recipients of benevolence, rather than as persons with social and moral agency."5 Chapter Five will confimi that many philosophers, in discussing the "mentally retarded", assume that there is an identifiable, pathological condition which the tenn "mental retardation" picks out. Operating under this assumption, they go on to discuss whether or not individuals with mental retardation qualiQ as "persons", what moral status they possess, and how we might solve certain moral, political, and bioethical dilemmas that individuais with this condition pose. Throughout, mental retardation is assumed to be a "natural kind"; its socially and historically detennined nature is rarely addressed, and it is taken as an unproblematic "kind". Many theorists discussing the social construction of disability, on the other hand, maintain that there is a more complicated story to be told than the medical mode1 would have us believe, and argue that the very nature of "disability" is problematic. They cal1 for the abandonment of the individual/pathological/personalt ragedy models of disability do not mean to suggest that moral philosophers cannot be theorists of disability; however. there is linle J~ crossover in the approaches of the two groups that 1 examine. jhita Silvers, "(Tn)Equality, (Ab)Normality, and the Arnericans With Disabilities Act," 7ne JmtrnaI of Medicirre curd Philosophy 2 1 ( 1996): 2 f 0.