Alicia A. Broderick (2022). The Autism Industrial Complex: How Branding, Marketing, and Capital Investment Turned Autism into Big Business. Maine, USA: Myers Education Press, LLC. ISBN 978-1-9755-0185-3
Reviewed by Ryan B. Collis
Faculty of Education
Alicia Broderick’s (2022) The Autism Industrial Complex: How Branding, Marketing, and Capital Investment Turned Autism into Big Business traces the history of the diagnostic and intervention industries that have sprung up since autism emerged as an ontological category in 1943. The book is divided into four sections: the manufacturing of the autistic person as a potential commodity (1943-1987); the way autism was rebranded through rhetorical use of hope and fear to create markets (1987-present); the forming of the intervention and prevention markets (1998-present); and applying the concept of biocapital to both the history and the future of the autism industrial complex.
The first section, “Forging The Autism Industrial Complex: Manufacturing Foundational Commodities (1943-1987)” is composed of two chapters. The first, a version of which was previously published, introduces Broderick’s titular Autism Industrial Complex (AIC), which she credits to Anne McGuire (2013, 2016) who wrote the forward to this book. By analysing the intersections of ideology, rhetoric, and discourse with neoliberal capitalist institutions such as education and medicine, Broderick seeks to deploy the AIC as a heuristic device to open the black boxes of autism intervention, diagnosis, and prevention. She argues that while there is profit to be made in goods and services around autism, that is only a side effect of the AIC; the real commodity is autism itself, which is the “first central ideological product manufactured and consumed in the AIC” (Broderick, 2022, p. 15). Broderick describes how the second central ideological product is the result of the merger of the ideology of operant behaviourism and the ideology of neoliberalism: “the cultural logic of (behavioral) intervention” (Broderick, 2022, p. 16, emphasis in original). She specifically notes the role that applied behavioural analysis (ABA) played in extracting commercial profit from autistic people over the past 75 years. While other authors have looked at the many concerns with ABA’s effectiveness (Rodgers et al., 2020; Sandbank et al., 2020; The Department of Defense Comprehensive Autism Care Demonstration Annual Report, 2019; The Department of Defense Comprehensive Autism Care Demonstration Annual Report, 2020), ethics (Wilkenfeld & McCarthy, 2020), conflicts of interest (Bottema-Beutel & Crowley, 2021), abuse (Sandoval-Norton & Shkedy, 2019), and risk of PTSD (Kupferstein, 2018), Broderick focuses on how the founder of ABA, Ivar Lovaas, was able to rebrand autism as a social problem that could be addressed through the institutional response of behavioural intervention. This led to the cultural logic of intervention as a response to autism: the unquestioned assumption that autistic people required operant behavioural conditioning. ABA was in place to profit off of this market.
The second section of the book looks at the interconnected groups that make up the “foundational plutocrats of the AIC,” by participating “in the commodification of autism and autistic people” and enlarging the market through the production of interventionist and preventionist logics (Broderick, 2022, p. 49). These include academic behaviourists, nonautistic parents, the board that certifies ABA practitioners (the BACB®), and Autism Speaks. It was primarily through the work of behaviourists and parents that autism and the AIC were rebranded and marketed through the cultural politics of hope, truth, and fear. Lovaas’ use of the rhetoric of recovery in his claim that his method offered to “return” an autistic child to “normalcy” combined with the publication of Catherine Maurice’s autobiography (who claimed Lovaas’ ABA cured her two children) marketed ABA as the “only” “scientific” intervention for young autistics (Broderick, 2022, pp. 56–57, quotation marks for emphasis in the original). Broderick emphasises that the results of Lovaas’ Young Autism Project (YAP) were not especially impressive in a scientific sense, but through his use of the rhetoric framing (rebranding) of recovery from autism (emphasis in original) his work still resonates 35 years later. This is the largest section of the book, comprised of four chapters, with a chapter dedicated to each of the politics of hope, truth, and fear. The politics of hope (a previous version of the chapter was published in 2009) continues to look at how ABA marketed itself as intrinsically linked to the hope of “recovery [to normalcy]” (Broderick, 2022, p. 81, brackets in original). In the next chapter, Broderick looks at how ABA rebranded itself as scientific in the late 1980s and 1990s through the rhetoric of scientism. Using the six signs of scientism described by Haack (2012) she finds the use of all six red flags. As a result, “[a] foundational working assumption of the conceptional apparatus successfully advanced to this point is that (of course) autism requires intervention, and scientism is deployed in a rhetorical power play to assert the authority of one particular intervention methodology (ABA) as the only suitable or warranted intervention” (Broderick, 2022, p. 107, emphasis in original). In her chapter about the politics of fear, Broderick argues that, following “Hunter’s (1991) assertion about culture war conflicts” an enemy is required, and autism became that enemy (Broderick, 2022, p. 132). To increase the number of consumers for the AIC, a crisis was needed, and this was provided by Autism Speaks’ rhetoric around the “autism epidemic” as a “national public health emergency.” This framing justified the “aggressive, even militaristic” approaches to intervention and prevention, which Broderick frames as “eliminating the potential future existence of autistic people” (Broderick, 2022, p. 137). This approach, pushed by capitalists hoping to profit off of the AIC, involves “rhetorically create[ing] a cultural enemy, declar[ing] a ‘war’ on it, and lobby[ing] the government to dedicate federal dollars to combating the egregious societal ill you’ve identified” (Broderick, 2022, p. 138).
In the third section of the book, Broderick looks at the two main industrial branches of the AIC: interventions and preventions. While she has written at some length on the issues with ABA as intervention, in this chapter she examines how two non-profits, the Behavior Analyst Certification Board (BACB) and Autism Speaks, engaged in lobbying (only to the limits of the law, of course) to ensure that state and insurance dollars would flow to ABA practitioners and the AIC. This led to increased profits, interest from investors, and expansion to fill a need that the AIC created. On the prevention front, Broderick, speaking for the AIC, asks “[h]ow do we commodify not only the bodies of existing autistic people, but also the abstract possibility of future others like them?” (Broderick, 2022, p. 211). While a genetic test for autism would be far more complex than the test for Down syndrome, already she reports on a small, for-profit start-up company using “very preliminary and small and uncertain and as-yet unvalidated datasets” raising millions of dollars in venture capital (Broderick, 2022, p. 214). Over decades, billions of dollars of both public and private money have gone to genetic autism research, with the US federal government alone planning to spend $1.8 billion from 2020-2024 through the National Institute of Health on “developmental, behavioral, clinical psychology, in addition to … neurobiology, genetics, and genomics of autism” (Broderick, 2022, p. 218).
The final section of the book analyses the history of AIC as a project of biocapital. Broderick argues that the AIC constructs autistic people as “infinitely indebted, and, therefore, as a commodity with nearly infinite possibilities for extraction.” (Broderick, 2022, p. 263). She notes that neoliberalism blurs the line between the state and private interests, and so an autistic child becomes a ripe target for expropriation – biocapitalist value extraction – through “diagnosis, referral for services, consultation, interventions, therapies, etc.” (Broderick, 2022, p. 263). Often the funding for these services come from tax dollars which are then harvested as private profits. Broderick’s final chapter closes with a reminder that the futures advanced by the AIC are “quite literally existential threats to autistic people, futurities that leverage the explicit threat (marketed as ‘hope’ to nonautistic consumers) of a ‘world in which autism doesn’t exist.’ And never forget that a world without autism is in fact a world without autistic people.” (Broderick, 2022, pp. 278–279). She concludes with a look at the possible futures that could be brought into existence, where collective assemblages actively subvert capitalism to resist the AIC.
Overall, Broderick’s book is an excellent depiction of how an industry developed to “treat” autistics, without, at any point, involving autistics in a discussion of the ethics, efficacy, or effects of behavioural conditioning. ABA is still widely popular with parents despite the fact that its reputation is based on a study that has never been replicated and involved the use of physical punishments on children (Broderick, 2022, p. 164). In a 2004 case where parents appealed to the Ontario Special Education Tribunal to force the use of behavioural conditioning, the tribunal wrote that behaviourism is not necessarily good pedagogy (see M. W. and A. W. v. Simcoe County District School Board, 2004, p. 37). In many jurisdictions, however, ABA is the only form of treatment that is funded or insured, and this book is a strong argument as to why that has to change.