The Paradoxical Place of Psychiatry in the Administration of Disability: Dealing with the Reframing of Autism from a Psychiatric to an Educative Issue in the Concrete Making of a Target Public

Abstract

Disability studies were founded on a transition from a « medical model », in which disability is mostly thought based on individual deficiencies, to a « social model », in which disability is conceived as a relational reality in a given environment. This chapter proposes to question the translation of that transition in the French administration of disability through the case of autism. Parents’ organizations have contributed since the end of the 1980’s to a reframing of autism, in redefining autistic disorders as being a behavioral instead of a psychological problem, and in claiming a right to an educative care as opposed to a psychiatric one. Parents use the existing “disabled child education allowance” to finance alternative care arrangements that resort to private health professionals and “ordinary” schooling. This reframing of autism has generated a malaise in the administration of disability regarding the allocation of this benefit to parents of children diagnosed with autism. This malaise is structured by two key issues: How should the relevance of an alternative care arrangement be assessed? How should the notion of education be delimited? The emerging right to an educative care for children diagnosed with autism questions both the definition terms and the boundaries of the target public. This chapter first explores the ways the administration deals with these uncertainties, especially in asking for psychiatric expertise. It also shows how parents’ organizations make alliances with psychiatrists to secure the right to an educative care in an institutional setting characterized by medical assessment of deficiencies. Based on an ethnographic study of the administrative assessment of disability rights for children diagnosed with autism, this analysis allows underlining the paradoxical place of psychiatry in the definition of a public eligible to a non-psychiatric care, and more generally, the limits of the actual transition from a medical to a social model of disability.