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Theses Doctoral

Making an Autism World in Morocco: Parent Activism, Therapeutic Practice, and the Proliferation of a Diagnosis

Hart, Brendan Gerard

This dissertation examines the relationship between a clinical classification (autism) and the sociocultural and institutional contexts of its application. Historically in Morocco, as in many other global contexts, the autism label has not been widely used, and the professional disciplines typically charged with diagnosing and treating it (i.e., child psychiatry and special education) are relatively new there. Children have long been described and treated as majnun (“possessed”), mo’aq (“disabled”), hmaq (“crazy”), f shkel (“weird”) – but not typically as tawahhudi (“autistic”). Beginning in the 1980s, and then intensifying after 2000, Moroccan parent-activists have been working together with foreign and local experts to change that. Drawing on an Anglo-American neurocognitive behavioral model of autism diagnosis and treatment – in direct opposition to a French psychoanalytic one – they have been training a new cadre of experts, raising autism awareness, lobbying government agencies, and constructing an infrastructure to identify and educate children as autistic. This dissertation follows the category autism as it circulates with increasing speed and intensity across Morocco by way of nongovernmental parent associations operating special classrooms for disabled children and adolescents. It tracks the ways the category – as well as its attendant practices and concepts – reshapes local moral worlds and everyday domestic life. Drawing on philosopher Ian Hacking’s work on “making up people” and “the looping effect of human kinds” (2007), it seeks to understand how and to what extent activists and experts are making autism into a viable category, and thus a viable way to be a person in Morocco. In other words, what makes the category “stick” – or not? How does it gain traction in local worlds? How does it become alive and meaningful to Moroccan families? And in turn, how does the label autism itself – its meanings, definitions, uses, enactments – change and respond to complex processes initiated by its introduction to quotidian contexts of Moroccan social life? Through 26 months of fieldwork in family homes, a child psychiatry clinic in a public hospital, a parent-run classroom for disabled adolescents, 17 autism associations across the country, as well as several sites of vernacular healing, this dissertation provides an important ethnographic complement to Hacking’s work and extends his theoretical insights by focusing on the everyday practice of autism therapies. The first half of the dissertation examines the consequences of autism activism for the category itself. It shows how the histories of local institutions for the disabled, lexicons of disorder, and colonial encounters all shaped the prototypical image of the autistic child in Morocco. Further, it shows how novels institutional forms and mundane therapeutics practices lend the category a certain sense and vitality for parents. Drawing on life histories, it also demonstrates how the diagnosis “stick” (or become a durable identity) – or not – for a variety of economic, pragmatic, and sometimes idiosyncratic reasons. The second half of the dissertation examines the consequences of autism activism for the people involved. It shows how new styles of parenting circulate along with the category and it identifies a particular style of prosaic activism through which parents work to reframe understandings of autism by becoming experts on their own children and building “prosthetic environments” for them (Holmes 1990). Further, it situates autism activism in relation to highly publicized neoliberal development projects, showing how a complex triangulation between the Moroccan monarchy, state, and civil society creates novel expectations, aspirations, and exclusions. Through a close analysis of one family’s experience of attempting to implement autism behavioral therapies in their home, it also demonstrates the tensions internal to autism activism and examines struggles over the ethics of autism therapies. By detailing the dynamic ways in which the category autism interacts with and responds to the social, political, and institutional contexts of its application, this dissertation offers a novel perspective on international health activism and the globalization of psychiatric categories.

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Academic Units
Sociomedical Sciences
Thesis Advisors
Sharp, Lesley Alexandra
Degree
Ph.D., Columbia University
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