Overview
The models of disability surveyed elsewhere in this wiki ask what disability is and what should be done about it. A Foucauldian analysis asks a different kind of question: how did we come to think about disability this way in the first place? What systems of power produce the categories of ânormalâ and âabnormal,â and whose interests do those categories serve?
Michel Foucault (1926â1984) never wrote directly about autism or neurodevelopmental conditions. He wrote about madness, medicine, punishment, sexuality, and the state. His relevance to neurodiversity lies in the tools he provides for understanding how societies construct categories of deviance, how those categories are enforced, and how the enforcement becomes invisible by presenting itself as objective knowledge.
Madness and Civilisation: the founding argument
Foucaultâs first major work, Histoire de la folie Ă lââge classique (1961, abridged in English as Madness and Civilization), traces how European societies transformed their relationship with madness between the Middle Ages and the nineteenth century.
In the medieval and Renaissance periods, madness occupied an ambiguous position. The âmadâ were feared but also granted a kind of recognition: in art and literature, the fool possessed dangerous wisdom, a perspective from outside reason that could reveal truths reason preferred to hide. The Ship of Fools was a literary and artistic motif, but it reflected a real social practice in which madness circulated within the community rather than being segregated from it.
The Great Confinement of the mid-seventeenth century changed this. Beginning around 1656 with the founding of the HĂ´pital GĂŠnĂŠral in Paris, a vast network of custodial institutions appeared across Europe. These were not hospitals in any medical sense. They confined the mad alongside the poor, the idle, the criminal, the sexually deviant, and the politically inconvenient. The point was not treatment; it was the removal of âunreasonâ from the social order. Madness was lumped with other forms of social uselessness and moral disorder. The confinement was economic and political before it was medical.
Foucaultâs critical insight is about what happened next. The Enlightenment did not liberate the mad from confinement; it reclassified them. The humanitarian reforms of Philippe Pinel and Samuel Tuke in the late eighteenth and early nineteenth centuries are conventionally told as a story of progress: chains removed, patients treated with kindness. Foucault reads it differently. The asylum replaced physical coercion with moral management. The mad person was no longer chained but was now subject to constant observation, to the imposition of norms of conduct, to the expectation of self-regulation and the internalisation of guilt for failing to meet those norms. The doctor replaced the jailer, and the relationship of power became harder to see precisely because it presented itself as care.
This argument has obvious resonance for anyone familiar with the history of autism intervention. The shift from institutionalisation to community-based âtreatment,â from physical restraint to behavioural modification, from overt control to internalised self-monitoring, follows the trajectory Foucault described. The language changes; the structure of power persists.
The Birth of the Clinic: the medical gaze
Naissance de la clinique (1963, The Birth of the Clinic) examines how modern medicine reorganised itself at the end of the eighteenth century around what Foucault calls the regard mĂŠdical, the clinical gaze. The development of the teaching hospital created a new way of seeing: the patientâs body became an object of systematic observation, classification, and knowledge production. The patientâs own account of their suffering was subordinated to what the clinician could see, measure, and categorise.
The clinical gaze does not simply observe; it constitutes its object. It determines what counts as a symptom, what counts as a disease, and what counts as a body that deviates from the norm. For people with disabilities, the gap between the identity constructed for them by the medical gaze and their own self-conception can be enormous. The clinician sees deficits, diagnostic criteria, functional limitations. The person may experience something quite different.
Applied to autism, the clinical gaze explains the persistent dominance of the medical model even in settings that claim to have moved beyond it. The diagnostic assessment is, structurally, an exercise in the clinical gaze: the clinician observes the person through a framework of predetermined criteria, classifies their behaviour against norms derived from a neurotypical standard, and produces a document (the diagnostic report) that carries institutional authority. The person being assessed may find this process validating, but the structure of the encounter places the clinicianâs categories above the personâs experience. The neuro-affirming practice movement, which attempts to write diagnostic reports that validate rather than pathologise, is in Foucauldian terms an attempt to subvert the gaze from within.
Discipline and Punish: the machinery of normalisation
Surveiller et punir (1975, Discipline and Punish) shifts from medicine to punishment, but the argument is about something broader: the emergence of disciplinary power as the dominant mode of social control in modern societies.
Foucault traces the shift from public, spectacular punishment (the scaffold, the stocks) to the prison, a technology of continuous surveillance, classification, and behavioural modification. The prison does not merely punish; it observes, examines, categorises, and attempts to transform the individual. Foucault draws on Jeremy Benthamâs Panopticon, a prison design in which a single watchman can observe all prisoners without their knowing whether they are being watched at any given moment, to describe how disciplinary power works: not through constant force, but through the knowledge that one might be observed, producing self-regulation.
The concept of the norm is central. Disciplinary institutions (the prison, the school, the hospital, the barracks) do not simply enforce rules; they establish what counts as normal and measure individuals against it. The examination, a technology Foucault traces from its military and educational origins, combines hierarchical observation with normalising judgement: it makes the individual visible, documents them, and compares them to the standard. Those who deviate from the norm are identified, classified, and targeted for correction.
The relevance to neurodevelopmental assessment is direct. The standardised instruments described in Diagnostic pathways, the ADOS-2, the ADI-R, the Sensory Profile, are technologies of examination in precisely Foucaultâs sense. They make the individual visible within a framework of norms, produce a documented record, and sort people into categories that carry institutional consequences. The school occupies a particularly Foucauldian position: it is where children are first systematically observed, measured against developmental norms, and referred for assessment when they deviate. The statement âthis child is not meeting their milestonesâ is a normalising judgement.
The Abnormal: three figures
In his 1974â75 lectures at the Collège de France, published as Les anormaux (Abnormal), Foucault traces the genealogy of the category of âthe abnormalâ back to three earlier figures: the human monster (the person whose very existence violates natural and social law), the incorrigible individual (who resists all attempts at correction), and the masturbator (the universal figure of childhood deviance whose body becomes the site of parental and medical surveillance).
These three figures, Foucault argues, were merged in the nineteenth century into a single category: the abnormal individual, subject to a new form of power that combined juridical authority with medical knowledge. The psychiatric expert witness in the courtroom, called upon to pronounce not on what the accused did but on what they are, epitomises this merger. The question shifts from âdid this person commit this act?â to âwhat kind of person is this?â The answer carries the authority of science but operates as a judgement of character, of normality, of the fundamental nature of the individual.
For neurodiversity, the Abnormal lectures illuminate how diagnostic categories function as more than clinical descriptions. To be diagnosed autistic is not merely to be identified as having certain traits; it is to be constituted as a certain kind of person, with institutional consequences that follow from that constitution. The diagnostic report, like the psychiatric expert testimony Foucault describes, speaks with the authority of objective knowledge about who the person fundamentally is.
Biopower and the management of populations
Across these works and in the first volume of The History of Sexuality (1976), Foucault develops the concept of biopower: the management of life itself as a political project. Where sovereign power operated through the right to take life (the kingâs power to execute), biopower operates through the regulation of living populations: their health, their reproduction, their productivity, their normality.
Diagnostic systems, clinical categories, and intervention programmes are, in this reading, technologies of biopower. They do not simply describe reality; they produce it. The DSM does not discover that autism is a disorder; it constitutes autism as a disorder through an act of classification that carries institutional force. Prevalence statistics, genetic studies, early intervention programmes, cost-of-disability analyses: all participate in making autism visible as a population-level phenomenon to be managed.
Contemporary extensions
Anders (2013) traces Foucaultâs logic from technologies of normalisation to contemporary societies of control, arguing that the management of deviance has shifted from overt institutional discipline (the asylum, the special school) to distributed systems of monitoring and intervention that operate through diagnosis, medication, and behavioural management in everyday settings. The ABA therapist in the family home, the SENCO tracking behavioural targets, the diagnostic pathway with its standardised instruments: these are all sites where normalising power operates, now dispersed into the fabric of daily life rather than concentrated in institutions.
Nguyen (2015) extends this analysis to global governance, showing how the World Health Organisationâs Global Burden of Disease framework constructs disability as a measurable cost to be reduced, embedding a medical-economic logic that treats disabled lives as inherently less valuable. The politics of âinclusionâ in international development frameworks can function as a more sophisticated form of normalisation: bringing disabled people into systems designed around non-disabled norms rather than transforming those systems.
Relevance to neurodiversity
This perspective is uncomfortable but illuminating. Each of Foucaultâs major concepts maps onto the contemporary neurodiversity landscape:
The Great Confinement finds its echo in the history of institutionalisation of autistic people and people with intellectual disabilities, a history that is not as distant as it might seem. The clinical gaze structures every diagnostic encounter, regardless of how affirming the clinician intends to be. Disciplinary power operates through the school system, the behavioural intervention, the IEP, the target chart. The examination is literally the central technology of diagnostic assessment. Biopower frames autism as a population-level phenomenon to be tracked, measured, and managed.
The diagnostic pathway is simultaneously a route to self-understanding and support and a technology of classification that sorts people into categories carrying institutional consequences. The neuro-affirming practice movement (see NAITâs 2024 guidance on diagnostic reports) can be read as an attempt to use the diagnostic apparatus while resisting its normalising logic, writing reports that validate rather than pathologise. Whether this resistance can succeed within the diagnostic system, or whether the systemâs structure always reasserts itself, is an open question.
The Foucauldian critique does not replace other models of disability. It adds a layer of analysis that helps explain why, despite decades of advocacy, the medical model persists; why âinclusionâ can coexist with exclusion; and why diagnostic categories carry such weight even when the biology they claim to describe is heterogeneous and contested (see Genetic heterogeneity in autism).
Key sources
- Foucault, M. (1961/1965). Madness and Civilization: A History of Insanity in the Age of Reason. New York: Pantheon. [Abridged translation of Histoire de la folie Ă lââge classique.]
- Foucault, M. (1963/1973). The Birth of the Clinic: An Archaeology of Medical Perception. London: Tavistock.
- Foucault, M. (1975/1977). Discipline and Punish: The Birth of the Prison. London: Allen Lane.
- Foucault, M. (1976/1978). The History of Sexuality, Volume 1: The Will to Knowledge. London: Penguin.
- Foucault, M. (1999/2003). Abnormal: Lectures at the Collège de France, 1974â1975. London: Verso.
- Anders, A.D. (2013). Foucault and âthe right to lifeâ: from technologies of normalization to societies of control. Foucault Studies.
- Nguyen, X-T. (2015). Genealogies of disability in global governance: a Foucauldian critique of disability and development. Foucault Studies, 19, 67â83.