Autism’s Thirteenth Cousin
A socioanalytic critique of the DSM and "Autism’s Confusing Cousins" by Awais Aftab
Awais Aftab recently wrote an important and fun piece on self-diagnosed autism over at Psychiatry at the Margins.1 It’s worth reading before continuing here. Aftab’s piece is a differential diagnosis. He lines up twelve clinical possibilities, shows how each could produce the surface presentation that gets called “autism,” and shows us that the choice is not between autism or nothing, but between autism and a dozen alternatives—the twelve cousins of autism. It’s rhetorically elegant and clinically careful, achieving exactly what it sets out to do.
The problem
What the piece cannot do is ask whether the twelve alternatives are the correct list to be using in the first place. Every cousin Aftab names is an internal condition of the individual. Schizoid personality, schizotypal, obsessive-compulsive personality, social phobia, borderline, social communication disorder, trauma-related disorder, social awkwardness, etc. He is presenting twelve ways to understand the person in front of him. These are twelve ways the dysfunction could be located inside the skull of the patient.
The issue is that by the time you are choosing between twelve diagnostic categories, you have already conceded that the answer is diagnostic. What if what we need to be looking for is not a syndrome, disorder, or condition? What if we go astray by waiting for a better edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) to give it a billing code. What if what we need to see is instead the structure the patient was formed inside?
The proto-version of this move is in Mark Fisher’s Capitalist Realism (2009). He called it the privatization of stress: what is in fact a collective political problem gets routed through individual therapy and individual medication, where therapy and medication do what they do, which is locate the issue in the person and work on the person. The issue is that the issue is not in the person. Fisher’s frame was applied psychoanalysis—the move Žižek and the Ljubljana school have been making for decades, where concepts forged on the side of a couch in a clinic get extended outward to ideology, politics, and culture.
Fisher could see that something was being privatized, but he could not see the field doing the privatizing. He had no theory of the field of the clinic in relation to the field of education, the field of insurance, the field of pharmaceuticals, the field of the platform economy that delivers the diagnostic memes—and therefore he couldn’t theorize what I’ll present at the end of this piece as the field of de-formation unique to the post-class fractured mass (PCFM). Fisher could see the symptom, but he could not see the field producing the symptom. Socioanalysis is the resource he did not have.2
Self-descriptive symptoms, read through socioanalysis
Aftab opens with eight patient self-descriptions of different symptoms:
Eye contact makes me very uncomfortable.
I suck at small talk.
I have rigid routines.
I hyper-focus on my hobbies.
I am always fidgeting.
Social interaction exhausts me.
I am really bad at making friends.
I don’t fit in; people find me weird.
The first candidate for these phenomena is likely an anxiety disorder. The trained clinician runs the differential and lands on something internal. But what happens when we run a different differential?
When we run the socioanalytic perspective, we ask what fields formed this person? As in, what social spaces with their own implicit and explicit rules for gaining or losing recognition structured what was given as normal? In socioanalytic terms, we cannot ask about the field without asking about the habitus produced within the individual, i.e. what set of durable dispositions, including ways of perceiving and feeling and acting, were acquired by operating inside a given field over time. What did the field encourage or discourage, what was rewarded versus pathologized, and were the incentive structures sending fixed or mixed messaging? Were the inherent dispositions and latent capacities of the individual capable of adapting to that context, and more importantly, how did this individual relate to, and get constituted in relation to, his or her peers in that given context? Genetic predispositions belong in this category: even where they play a role, they remain a substrate the field activates, shapes, or deforms. This is why no blood, spit, or MRI test can yet diagnose autism, even though everyone seems to agree genes play a big part. Finally, we must ask what illusio holds the subject in his or her current position, i.e. what dual libidinal investment for or against the game?3 Instead of asking what is wrong with one’s patients, ask what kind of world they were thrown into and how they formed in relation to others within the social field.
Aftab has a caveat at the end of his piece where he shows an awareness that there’s an outside to the DSM:
“Developmental context, response to relationships, and subjective experiences are all very important in looking beyond the surface presentation to understanding the meaning and functions of behaviors.”4
The problem is that this caveat is tacked on at the end, after a long post of different descriptions of different “types” of “disorders,” a frame that de-worlds the subject and then tries to tack the world back on at the end.
Ultimately, if you’re dealing with a patient who is suffering from a set of symptoms that make it difficult to operate in the world, and there are pills or practices you can equip them with that will help them, then the DSM might play an important role; but the DSM has become the new folk astrology. My friends and family who are always diagnosing their friends and family are not psychiatrists, they’re living in our society and reading the kinds of articles, memes, and reels that get passed around in the churn today. What I want to highlight is what gets lost by this kind of approach.
If the patient is a twenty-four-year-old male whose parents both worked full-time jobs they hated, who was dropped off at daycare at eight weeks, warehoused in age-segregated classrooms from five to eighteen, handed screen-crack at six, given unrestricted internet access at ten, absorbed pornography at roughly twelve, never in his life spent sustained time in an intergenerational context, never apprenticed to a master of anything, was never given a task that demanded sustained bodily engagement with a real adult or actually produced meaningful results, has never been formed by a tradition, has never belonged to a congregation, has never had a neighborhood, and has never experienced the rhythm of a day structured by anything other than the school bell or the attention economy — is it really helpful, in the long-term, to just look at the diagnostic manual that puts a label on their behavioral pattern?
Ask what eye contact would mean for that person. Eye contact is an act that presupposes you have been formed as a person who can encounter another person. It presupposes you have been looked at, held, attended to, corrected, dignified, and let be. It presupposes a history of mutual recognition. Strip the history and the act collapses into a sheer demand the person cannot meet. The inability to perform eye contact is not a symptom of autism or schizoid personality or social anxiety. It is the absence of the formation that would have made eye contact a regular human act instead of an ordeal.
Run the same read on the rest of the list. Rigid routines in the absence of intergenerational rhythm. Hyperfocus on hobbies in the absence of vocational apprenticeship. Fidgeting as the body’s refusal to be still in a context where it was never given anything meaningful to do with itself. Social exhaustion as the honest response of a nervous system that was never trained to metabolize social contact. Bad at making friends in a cohort where no one was given the conditions under which friendship actually forms. What Aftab showed us were not twelve internal pathologies sharing a surface presentation. They were descriptions of a single underlying condition: the condition of being formed by nothing in particular.
What thirteen years in the building does
John Taylor Gatto spent three decades teaching in the New York City public school system, got named Teacher of the Year for the state, and then wrote a series of books arguing that the system he worked inside was actively producing most of the things it claimed to be treating. Weapons of Mass Instruction is the distilled form of the argument.5 Compulsory schooling was engineered, not allowed to happen. Its architects were explicit. The goal was a docile industrial workforce. The methods were age-segregation, bell-structured time, disconnection from community, the abolition of autonomous work, the ritual humiliation of boredom, and the replacement of formation by credentialing. The system worked for a while in the sense that it produced what it was asked to produce.
The system no longer has even that telos. The industrial workforce it was built to supply has been offshored, automated, or degraded into gig labor. What remains is the schooling apparatus itself, running on inertia, increasingly functioning as permanent daycare for a society whose adults cannot afford to raise their own children.
Read through Bourdieu, Gatto is describing the field that produces the habitus Aftab’s patients arrive in his clinic with. Thirteen years in the building is not incidental to the symptomatology. It is the formation. The rigid routines, the hyperfocus, the fidgeting, the social exhaustion, the failure to form friendships: these are what you get when you take a human child and put them in that building for thirteen years.
The parents of these patients were themselves schooled in the same system. They then entered an economy that offers most workers neither time nor energy in the sense the timenergy concept specifies. Timenergy is not the same as leisure. It is the substantive condition of possibility for the kinds of activities that form a human being into a capable adult. The reliable, repeatable, energy-infused block of time in which someone can actually make things, teach things, attend to a child, build a garden, hold a conversation that matters, or show up to church.6
Here is where Bourdieu and timenergy meet. Symbolic capital constitutes fields that act as though they are not economic. The academic field, the artistic field, the professional managerial field, all simulate scholē, the Greek word for the leisured contemplative time that is the original root of “school” and the foundational presupposition of theoretical life. The simulation runs on a presumed distance from the necessary labor at the foundations of life. The PMC fields perform as though that distance is real and self-sustaining. It is not. It is borrowed, increasingly on bad terms, increasingly off the backs of the unformed children.
Timenergy reduced to labor power is what produces the rest. The house without a home. The family of roommates instead of an intergenerational dependency web. The child who, outside of school, had nothing but social media and pornography for company. The field of the post-class fractured mass (PCFM) is what every person ends up inside when the simulated scholē of the PMC fields has eaten the timenergy that would have made real formation possible at the foundations of life.
Parents with no timenergy cannot form their children, regardless of how much they love them. They can supervise, feed, drive to activities, and absorb the ambient anxiety of modern American parenting. They cannot form. Formation requires presence, attention, boredom, shared work, intergenerational time, and the slow accumulation of ways of being that can only be transmitted through sustained contact. Formation is what gets skipped when both parents work forty or fifty hours, commute, and come home exhausted to screens. The patient who arrives at Aftab’s clinic two decades later is the result.
Castration culture and the eyes
Take one of Aftab’s eight lines by itself. “Eye contact makes me very uncomfortable.” Run the differential on this one through a pair of archetypes that stand in for thousands of other deformation styles.
Consider a young man who first encountered pornography at age ten. By twelve he had a daily habit. By fourteen he had moved through the normal content into whatever algorithmic escalation the platforms serve to retain attention. By sixteen he had spent more hours alone with pornography than he had spent in conversation with his father. By eighteen he had never kissed a girl in real life but had been trained by thousands of hours of explicit content into a scripted, reactive, shame-coded sexuality that he cannot undo. He now presents in your clinic at twenty-four and reports that eye contact makes him very uncomfortable.
Which cousin does this belong to? The first twelve cousins cannot see this young man. They have no room for him. His difficulty with eye contact is not schizoid, not schizotypal, not obsessive-compulsive, not social phobia, not autism. His difficulty with eye contact is that, instead of developing meaningful human relationships and skills that helped him attain a real sense of self-worth and maturity during puberty, he instead gained a porn addiction. Now, instead of a well-adjusted self meeting another, his habitus of de-formation runs on a circuit of shame, defensive pride, and its underlying resentment—the whole cycle saturates his being before, during, and after every encounter with any other. Neurology and the DSM can only see where he stands after that de-formation took place, not the actual genesis through broken down fields in the context of deteriorating institutions and parents who have no timenergy.
Now consider the counterpart. A girl handed Instagram before puberty. By eleven she has been traumatized by exposure to hardcore pornography she did not seek out, along with the fact that all the boys hazing her in middle school are consuming it daily. She knows, before she is ready to know, what the sexual imagination of every boy around her is being shaped by when it turns toward her. While she absorbs that, she is also putting in her own thousand hours orienting herself in reference to hyperreal simulacra of other women on Instagram. Filtered, contoured, cosmetically enhanced, algorithmically selected for engagement. She builds a self under constant comparison to images that do not correspond to any real woman, including the women whose faces and bodies were harvested to build the images. By fourteen she is trying to become one of these simulacra. By twenty-four she is in Aftab’s clinic, and eye contact makes her very uncomfortable.
How much easier will it be for her to make eye contact than for the young man? Not at all. Beneath her conscious ability to assess what’s going on is the fact that her habitus relates to every other face as an audit. Every gaze has been internalized as a comparison she was trained to lose. She cannot look at another woman without ranking, cannot be looked at without feeling measured, cannot meet the eyes of a man without the full weight of the pornographic formation of his generation pressing in on the encounter. The shame has a different somatic texture than his, but it is no less powerful—her unconscious is a product of de-formation fields, neglect, and of being preyed upon by a society that sees her as nothing more than a consumable product to be ranked.
My two chosen figures are archetypical metonyms.7 They are the legible cases, chosen because the deformation-line from input to presentation is short enough to trace in a paragraph. The PCFM teenage subject can be deformed in a thousand other shapes. The boy whose father was working two jobs and whose mother was medicated into compliance. The girl raised by a stepfather she could never quite relax around. The kid passed through four schools before age ten. The one whose first sustained intimate experience was with a chatbot. The one whose friend group migrated from the neighborhood to the Discord server and never came back. The one whose older brother was radicalized in the manosphere and brought it home. The one whose older sister was pulled into the trans identity pipeline and pulled her along. On and on. Every one of these produces a distinct developmental signature, and every one of them presents to Aftab as something close to one of the twelve cousins without being any of them.
This is the underside of what Castration Culture is tracking. The symptomatology the DSM codes as one thing or another is often the somatic and relational signature of fake sex, introduced into children before their capacity for real sex had any chance to develop, in any one of a thousand variants. The clinical frame will never include this variable, because the clinical frame was built in a period that could not yet see pornographic formation as a mass intervention on a generation’s sexual architecture.
The Field of the PCFM
Aftab gave us twelve cousins inside the DSM frame. Cousins, by definition, cannot share a parent. They can share a grandparent, though. If the twelve cousins look alike, it’s because they trace back to the same grandparent, not because they came from the same parent. So do the genealogy. Find the parents of these cousins. The parents are the specific deformation lineages: pornographic formation, school as warehouse, atomized parenting, screen-mediated puberty, and the timenergy-poor household. Each is a sibling of the others. What makes them siblings is that they all came from the same grandparent.
The grandparent is a field, in the technical sense Pierre Bourdieu gave that word: a structured social space with its own rules, internal positions, and logic, which forms the people who live inside it whether or not they consent to the formation. The grandparent to our generation’s symptoms is the fractal-field of the post-class fractured mass (PCFM) that replaced the older interlocking institutional apparatus through which modern societies used to hand children off from infancy-to-adulthood and produce, at the end of the process, a specific kind of “well-adjusted” person. Babies still go in one end of that institutional pipeline, to never see figurative daylight until their eventual end in a senior care facility—the difference now is that the kind of “successful” formation that could be achieved in the 20th century has become increasingly rare.
The fractal-field of the post-class fractured mass is one of de-formation at the intersection of all the other fields colliding and breaking down after fifty plus years of capital hollowing out the institutions, by what tends to get called “neoliberalism,” a specific mitigating response to the tendency for the rate of profit to fall (TRPF).8 By “institutions” we are referring to the disciplinary and educational apparatuses (which Althusser called “repressive state” or “ideological state” apparatuses), i.e. the prison, the mental hospital, the borders, the halls of government, the media, the compulsory schooling K-12 system.9
In the 20th century, all of these institutions became seemingly too big to fail and successfully displaced older and more localized institutions like the parish, the trade, the neighborhood, the extended family networks of embedded intergenerational dependence, the union of workers and their independent associations, the agrarian commons, and the school back when schools tried to make citizens rather than warehouse workers and the PMC (professional managerial class).
Consider how, in 1928, Edward Bernays described the average man’s civic involvement: “John Jones, besides being a Rotarian, is member of a church, of a fraternal order, of a political party, of a charitable organization, of a professional association, of a local chamber of commerce, of a league for or against prohibition or of a society for or against lowering the tariff, and of a golf club….”10 After the mid-20th century, John Jones got replaced with the guy Chomsky called “Joe Six-pack.”
“There are other media too whose basic social role is quite different. It’s diversion. There’s the real mass media, the kinds that are aimed at the guys who… Joe Six-pack. That kind. The purpose of those media is just to dull people’s brains.”11
This is the man who, outside of work, has only engagement with his television screen, investment in a football team, who is involved with politics the way he is with wrestling. Neil Postman saw this and wrote the book Amusing Ourselves To Death about it.12
None of the old forms disappeared cleanly, for every Joe Six-pack there’s another person who tries to get involved with community through Meetup.com. Simulations of each of the old civic involvements have been commodified and sold back to us in a way that, rather than serving our needs, instead scratch at the itching wounds that keep us addicted to the lack. All of these fields keep operating in fragmented forms, still producing some of their prior effects on some of the people some of the time. Increasing numbers of people are falling through its cracks.
What collapsed in the last fifty-or-so years is the capacity of the institutional fields to do the formation work that they did for the parents of our grandparents—they no longer function as a single interlocking apparatus. We are the third generation of the breakdown of the institutional matrix, living in the ruins of something that was able to maintain itself as a seeming organic whole for the generations of Talcott Parsons and Pierre Bourdieu (1950s — 1960s). It’s a world most of our parents still believe exists.
The post-class fractured mass is what fills the space where that apparatus used to be. Inside it you do not develop the kind of person an intact field would have produced. You develop the somatic and relational signatures of formation that did not happen, registered later in your nervous system, your social capacity, your sexual architecture, all the way down to your inability to look someone in the eye. The patient arriving at the clinic with self-diagnosed autism is more often than not giving accurate testimony about that field, in the only vocabulary the culture has given them to speak. The DSM is forced to read their symptoms as disorders, because the DSM has no category for the absence of formation and its consequent de-formation. The disorders are the only vocabulary the manual has, and it’s a frame that puts the focus onto the individual rather than the social fields and their formation work.
If Aftab’s patient actually gets the diagnosis notarized, they might just feel “seen” for the first time, but the fact is, they still haven’t experienced any form of mutual recognition. That would require something that would have had to happen organically in more primordial human involvements. My short example: Joel Salatin, the most famous popularizer of regenerative agriculture in the U.S., says that genuine confidence comes from the accomplishment of meaningful tasks.
“This is not a psychology book, but my experience drives me to make an observation: we learn our self-worth through doing. We don’t feel valuable because a focus group or self-help group made us feel valuable. Who we are is a direct result of what we do…. When children can’t, won’t, or don’t have project and ownership responsibilities, they see themselves as worthless. Feeling needed and contributing to the good of family and society is the foundation for developing self-worth…. Here is my completely unscientific anecdotal old geezer observational hypothesis: accomplishment drives worthiness.”13
I would add that meaningful tasks are done under the tutelage of someone worthy of respect who has time to get to know you, in the context of the kind of work that serves the foundations of life — that’s meaningful competence that transfers into confidence. That child grows up knowing how to look a person in the eyes, without the help of pills, CBT, two decades of psychoanalysis, or positive affirmations from someone paid to say them.
Bourdieu developed the toolkit for socioanalysis forty years ago, but he has been buried due to how inconvenient his approach is for today’s crumbling institutional order. A part of my project is to use it for the self-defense purposes he envisioned, while still taking it beyond where he left off. I’m writing a book about it, but for the time being will just say that “socioanalysis” is mysteriously absent from the theory scene. I think that’s a situation that needs to be remedied. Bourdieu is the first step for re-grounding Baudrillard’s reading of simulation in the field of cultural production rather than in a free-floating semiotics, and it sets me up to go beyond them both by theorizing the primordial grounds that their theories bracketed. That is for the book. For now, the move is this: next time some new constellation of suffering surfaces and the diagnostic class starts looking for its thirteenth cousin, do the genealogy instead. Find the parents of the cousins. Find the grandparent of the parents. The grandparent is always a field, and the field is the thing that has to change.
Thanks for reading.
To read some of my other socioanalytic work, check out Socioanalyzing Analytic Philosophy.
Also, if you’re interested in getting involved with the behind-the-scenes discussions, lectures, and my ongoing research seminar at Theory Underground, you can become a member here. Do so in the next week and you’ll be able to join Matthew Stanley’s guest lecture course on the history and theory of the Deep State.14
Notes
Awais Aftab, “Autism’s Confusing Cousins: A Differential Diagnosis for the Weird and the Awkward,” Psychiatry at the Margins (Substack), December 5, 2025, https://www.psychiatrymargins.com/p/autisms-confusing-cousins.
Mark Fisher, Capitalist Realism: Is There No Alternative? (Winchester, UK: Zero Books, 2009), 21–25, 35–38. On reflexive impotence, see also pp. 21–24.
The socioanalytic toolkit invoked here, including field, habitus, and illusio, is from Pierre Bourdieu, Habitus and Field: General Sociology, Volume 2 (Lectures at the Collège de France, 1982–1983), trans. Peter Collier (Cambridge: Polity Press, 2020); and Pierre Bourdieu, Classification Struggles: General Sociology, Volume 1 (Lectures at the Collège de France, 1981–1982), trans. Peter Collier (Cambridge: Polity Press, 2019). Those two seminars are phenomenal and I can’t recommend reading them enough. Bourdieu introduces the term “socioanalysis” directly in Habitus and Field, p. 15, but the canonical habitus formula is in Outline of a Theory of Practice, trans. Richard Nice (Cambridge: Cambridge University Press, 1977), 72.
Aftab, “Autism’s Confusing Cousins.”
John Taylor Gatto, Weapons of Mass Instruction: A Schoolteacher’s Journey Through the Dark World of Compulsory Schooling (Gabriola Island, BC: New Society Publishers, 2008).
David McKerracher, Timenergy: Why You Have No Time or Energy, foreword by Slavoj Žižek (Theory Underground, 2023). For the earlier development, see also McKerracher, Waypoint: Timenergy, Critical Media Theory, and Culture War (2021).
"Archetypical metonym" here names a figure that is both typical (an archetype, a recurring pattern that organizes a domain) and substitutive (a metonym, a part that stands in for a larger whole). The pornographically-formed young man and the Instagram-formed young woman are not statistical averages or composite case studies. They are legible patterns whose developmental logic can be traced quickly from cause to effect, and which therefore stand in for the much larger and messier set of formation pathways the PCFM produces. With these two figures I hope to give the reader two clear lines from input to outcome, so that the thousand more obscure variants gestured at in the following paragraph can be held in mind without each requiring its own narrative reconstruction. Also important to note, I’m borrowing the term from rhetorical theory rather than the Jungian register: archetype in the older sense of arche-typos, the original mold or pattern, joined to metonymy as the figure of substitution by contiguity rather than by resemblance.
Karl Marx, Capital: A Critique of Political Economy, Volume III, trans. David Fernbach (London: Penguin Classics, 1991), part 3, “The Law of the Tendential Fall in the Rate of Profit”; Henryk Grossman, The Law of Accumulation and Breakdown of the Capitalist System: Being also a Theory of Crises, trans. Jairus Banaji (1929; London: Pluto Press, 1992); Ted Reese, The End of Capitalism: The Thought of Henryk Grossman (Winchester, UK: Zero Books, 2022).
Louis Althusser, “Ideology and Ideological State Apparatuses (Notes towards an Investigation),” in Lenin and Philosophy and Other Essays, trans. Ben Brewster (New York: Monthly Review Press, 1971), 127–86. Originally published 1970.
Edward L. Bernays, Propaganda (New York: Horace Liveright, 1928), 110. The passage appears in Bernays’ chapter on propaganda and political leadership.
Noam Chomsky, in Manufacturing Consent: Noam Chomsky and the Media, directed by Mark Achbar and Peter Wintonick (1992; Montreal: Necessary Illusions Productions), film. Distinct from the 1988 book of the same name, co-authored by Chomsky and Edward S. Herman. It’s worth mentioning that Chomsky’s over-simplification really misses WHAT happened in the 20th century with the major historical formations and shifts what’s possible for a worker living under the structural stultification of timenergy.
Neil Postman, Amusing Ourselves to Death: Public Discourse in the Age of Show Business (New York: Viking, 1985).
Joel Salatin, Homestead Tsunami: Good for Country, Critters, and Kids (Swoope, VA: Polyface, 2023), 91–92. By the way, I use “confidence” in my formulation while he is using worthiness. He uses confidence in his earlier formulations, but the mature Salatin uses worthiness. I get my expressed formulation from him, but put it in a way that I think is more memorable, even though I do prefer where he has taken it in his most recent work.