What can a diagnosis do? The case of the "genetization" of autism

The loose condition of "autism" is undergoing through a broad process of (re)definition under the aegis of genomic medicine, which promises to find (epi)genetic causes to autism, or at least to some forms of the Autism Spectrum Disorder. What is at stake is a scientific controversy about the very definition of the condition, i.e. the diagnosis itself. Whether it is considered primarily as a psychopathology or as a genetic disorder has consequences. It has implications regarding who would have the authority to diagnose the condition but also about the ways of taking care of persons with autism. In this paper, we depart from the paradox that some patients' organizations claim for a "geneticization" of the condition, so as to get rid of any sort of "psy-" related dimensions. It seems paradoxical because if the causes of autism are to be found in the genes, and hereby partly determined, it would seem to imply that the margins for effective therapy are narrowing down. We want to test the hypothesis that the more objective, "naturalized" a diagnosis is, the more it opens up possibilities for broadening the therapeutic reach outside the autist bodies, questioning the "milieu" of the disorder — the environment through which it is produced and the wealth of linkages and relationships through which living with autism could be eased. In other words, stressing that the diagnosis is a site to explore these contested dimensions of autism, its "geneticization" could lead to more active uptakes in patients care, whereas blurry diagnosis could not afford a similar reach. Following a pragmatic stance of an "art of consequences" (I. Stengers), we investigate the tensions raised by a genetic diagnosis which tends to "objectify" or "naturalize" the causes of the condition with respect to the lived experiences of persones with autism and their relatives, following some of the contested dimensions of a "politics of diagnosis" in their effects on affected autistic bodies and minds. To unfold those issues, our ongoing inquiry considers the interactions between various persons and institutions involved in the debate in Belgium.