Feminist Approaches to Cognitive Disability

Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 Feminist Approaches to Cognitive Disability Licia Carlson* Providence College Abstract This essay explores various philosophical approaches to cognitive disability within feminist philosophy. In doing so, it addresses three broad questions: What positive contributions can feminist philosophy make to the philosophy of cognitive disability? How have feminist philosophers critiqued the presence and absence of cognitive disability in philosophy? And what challenges does cognitive disability pose to feminist philosophy itself? The essay begins with definitions and models of disability and then turns to feminist work on cognitive disability in moral and political philosophy, bioethics, and epistemology. It concludes with some methodological considerations. 1. Feminist Approaches to Cognitive Disability The topic of cognitive disability has not traditionally been given significant attention by philosophers. Due in part to advances in the Disability Rights Movement, and critical scholarship in the interdisciplinary field of Disability Studies, however, there is increasing philosophical interest in disability, and feminist philosophers have played a key role in bringing cognitive disability into the foreground. In this essay, I explore various feminist approaches to cognitive disability that, while no means exhaustive, ref lect the breadth and diversity of work in this area. In order to set the stage for these ref lections, it may be useful to identify a number of fields of inquiry that shape and inform these approaches to cognitive disability. First, there is a robust body of scholarship that addresses disability from a feminist standpoint. Scholars in a variety of disciplines have explored the intersections between gender and disability and have revealed the marginalization and omission of women with disabilities from particular analyses of gender injustice and women’s oppression.1 Feminist philosophers2 have joined this conversation and have argued that attention to disability can challenge, reconfigure, and expand debates in feminist philosophy (Hall 2011, 2015a; Kittay, Silvers and Wendell, 2001 and 2002; Kittay, 1999; Tremain, 2013a; Silvers, 1998, 1999; Mahowald, 2008; Shalk, 2013; Wendell 1996). Much of this work is interdisciplinary and ref lects a commitment to intersectionality; thus, disability is theorized not only in relation to gender but also in the context of class, race, age, sexuality, and identity. In bringing disability and feminist theory into dialogue with queer theory and critical race theory, these scholars are challenging dominant assumptions and bringing new modes of analysis to the experience of disability and identity.3 Philosophy of disability is another field of inquiry that has been steadily growing, and within this arena, there are philosophers who have turned their attention specifically to cognitive disability.4 While one can find numerous references to individuals with cognitive disabilities throughout the history of philosophy, it is only in the twentieth century that philosophers began to take up questions of personhood, justice, and rights in relation to people with cognitive disabilities in a more sustained way. In some cases, this has meant examining cognitive disability © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd 542 Feminist Approaches to Cognitive Disability as a marginal case or thought experiment, using “the severely cognitively disabled” to test the boundaries of theories of justice and definitions of personhood.5 These arguments, in turn, have brought challenges from a number of feminist philosophers who have argued that such representations of intellectual disability and the conclusions they lead to are problematic (Carlson, 2010; Kittay, 2010). This philosophical work emerges amidst a broad range of critical perspectives on intellectual and developmental disability (IDD) in fields as diverse as history, theology, anthropology, sociology, political science, and law.6 Philosophers have also turned their attention to other forms of cognitive disability like autism, learning disabilities, and dementia, raising philosophical issues that bear upon central questions in moral and political philosophy, epistemology, the philosophy of mind, and bioethics.7 Increasingly, then, cognitive disability has moved from the margins to the center, and has become the object of philosophical investigation in its own right. Yet just as feminist philosophy comprises a large body of diverse work, there is no single feminist philosophy of cognitive disability but, rather, a rich tapestry of voices and debates. Some of this work is critical, challenging both the presence and absence of cognitive disability within philosophy; other approaches are more generative, opening up new theoretical spaces of inquiry, and transforming and amplifying existing concepts and theories. I will begin with some definitional questions and then examine feminist approaches to cognitive disability in ethics and political theory, bioethics, and epistemology.8 I hope that by highlighting the work being done in these sub-fields of philosophy, it will become clear that a feminist approach to cognitive disability can provide the occasion to ref lect upon some of the most fundamental and pressing philosophical questions, concepts, and problems. 2. Defining Cognitive Disability One of the challenges in addressing cognitive disability in a philosophical context is clarifying its meaning, given the wide range of conditions and classifications covered under this broad designation. Feminist philosophers have focused on a number of different kinds of cognitive disability, including the following: forms of intellectual/developmental disabilities (IDD) that are characterized by both intellectual and behavioral features and with onset typically before the age of 18 (e.g. Down syndrome); late-onset cognitive disabilities caused by traumatic brain injuries or other conditions like dementia and Alzheimer’s; learning disabilities (LD) like dyslexia and ADHD; and the wide range of conditions captured on the autism spectrum, many of which do not involve any form of ‘intellectual disability.’ For the purposes of this discussion, then, the term ‘cognitive disability’ will signify the general category that includes these particular examples, and when appropriate, I will refer to the specific conditions with the relevant abbreviations.9 Some philosophers have focused explicitly on the definitional challenges and theoretical complexities that accompany this heterogeneous classification and have called the very status of disability into question. The various models of disability identified by disability theorists have played a central role in theorizing the meaning of ‘disability’ as a category and an identity. The medical model of disability defines disability as a distinct pathology that is rooted in the individual and that is generally considered objectively harmful and undesirable. In a philosophical context, this model can be found in ethical discussions of personhood, quality of life, and in many bioethical debates regarding issues like reproductive technologies, genetic testing, and euthanasia. Some feminist philosophers challenge the medical model of disability based on its narrow definition of disability in exclusively pathological terms and critique the normative assumption that it constitutes a harmed state that necessarily diminishes an individual’s quality © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 Feminist Approaches to Cognitive Disability 543 of life. Women with disabilities and disability theorists have also taken issue with the ways that feminist philosophers and bioethicists have relied upon the medical and personal tragedy models (where disability is viewed solely in negative terms as a devastating tragedy and burden) in order to make the case for women’s reproductive rights. The social model of disability emerged as a critical response to the medical model and defines disability as the interaction between an individual and his or her environment. Here, then, disability is not an individual pathology; rather, it is a disadvantage that is the result of having an impairment in a specific context. Feminist theorists have drawn parallels with the sex/gender distinction, defining disability as a social construction where the physical or mental impairment is analogous to biological sex, and the disability is akin to gender, an identity that is dynamic and defined by social structures, norms and constraints (Hall, 2011; Garland-Thomson 2011; Wong, 2002; Tremain, 2006). The social model, too, has been called into question from a number of different vantage points. Susan Wendell, for example, challenges the clarity of the impairment/disability distinction, and argues that the biological and the social interact in complex ways that contribute to the construction of disability (Wendell 34–5). Building upon postmodern theories of identity, others have argued that the very concept of impairment must be problematized and viewed as socially constructed. In their view, the social model does not go far enough and like the medical model, is guilty of reifying impairments that are nothing more than departures from a socially defined norm (Tremain 2002, 2006). Cognitive disabilities raise a number of critical questions for both the social and medical models of disability. First, is there a particular impairment that can be identified with a cognitive or intellectual disability? For example, is there a specific genetic anomaly (as in the case of Trisomy 21), trauma, or disease that has affected cognitive function? Or is it a less clear feature like ‘intelligence’ that is considered impaired? The very definition and ontological status of cognitive disability is complicated by the fact that the underlying ‘impairment’ itself may be highly contested, and in many cases, the cause or etiology may be unknown. Definitions of cognitive disability that are based upon the concept of intelligence (e.g. definitions of ‘mental retardation’ that rely upon IQ scores) have been challenged by those who argue that cognitive disability is neither a natural nor a neutral category. The argument that theories of intelligence bear the mark of social norms has been made by feminist theorists who have traced the long, complex history of defining women in terms of their ‘defective’ intellect. There are many historical examples where claims about the inferiority of women and certain racial and ethnic groups have been based upon assumptions about their intellectual and moral deficiencies. In view of this history, philosophers of disability are examining the complex dynamics, whereby attributions of disability intersect with other identities and structures of oppression. For example, I explore the various roles that women (both disabled and non-disabled) played in the emergence of mental retardation as a classification in the late nineteenth and early twentieth centuries (Carlson 2001, 2010a). Stubblefield examines this history through the lens of race and traces patterns and practices, both past and present, through which Black students are consistently classified as ‘cognitively disabled’ at a higher rate than other groups (Stubblefield 2010). Some disability theorists and advocates have introduced the concept of neurodiversity, thereby rejecting traditional categories of cognitive dis-ability based on defect, deficiency, and deviance. For example, there is an increasingly vocal self-advocacy movement that defines autism as a form of neurodiversity, rather than as a pathological departure from the norm of neurotypical function. Reconceiving of autism in this way raises critical questions for the philosophical approaches to autism taken by some philosophers of mind (Barnbaum 2008; O’Donnovan 2013; Yergeau 2013). The significance of focusing on cognitive diversity rather than on © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 544 Feminist Approaches to Cognitive Disability cognitive disability has also been addressed in the context of traumatic brain injuries and learning disabilities (Lindemann 2001). This raises the question of whether the term neurodiversity should be extended to include these conditions, as well as dementia and Alzheimer’s. A broad range of philosophical questions regarding identity, cognition, and f lourishing emerges when there is a shift from devaluing cognitive disability as pathology to valuing cognitive differences. While some have challenged the status of the ‘impairments’ upon which cognitive disability is constructed, other feminist philosophers have argued that it is problematic to view disability solely as a social construction. To say that all forms of cognitive impairments and disabilities are mere constructs may not accurately ref lect the experience of individuals with severe and profound cognitive disabilities. In the case of milder forms of cognitive disabilities like dyslexia or ADHD, Maeve O’Donnovan argues that to deny that these are neuro-processing disorders is to ignore the lived realities of people with learning disabilities and to render their perspectives invisible (O’Donnovan 177). Thus, insofar as the social model denies the corporeal experiences of disability, it runs the risk of marginalizing individuals who rely upon medical technology and services (Kafer, 2013 7).10 Philosophers addressing more severe forms of cognitive disability have also challenged the stark distinction between physical and mental disabilities and have argued that it is not possible to explain certain forms of disablement by appealing to external, social factors alone (Kittay, 1999). There are divergent views on the part of feminist philosophers regarding the very status of cognitive disability as a category and an identity. Some wish to maintain certain medical diagnostic categories for both philosophical and political purposes; others argue that the concept and experience of cognitive disability is socially constructed. Still others, eschewing both the medical and social models of disability, maintain that even concepts of biological impairment, intelligence, and cognitive function must be viewed as socially determined and constructed against dominant norms of species-typical functions. 3. Moral and Political Theory To find examples of cognitive disability in philosophical discussions of personhood, justice, and rights is not uncommon. While philosophical analyses of the very meaning of cognitive disability like those outlined in the previous section are relatively recent, there are many instances where ‘the cognitively disabled’ have been brought up as marginal cases in moral philosophy and in theories of justice. Feminist contributions to moral and political philosophy are varied and extensive, as are the ways that feminist philosophers in both analytic and Continental traditions address cognitive disability. Some philosophers argue that the ways that ‘the cognitively disabled’ have been depicted in moral philosophy are both inaccurate and problematic. This may be because they rely upon stereotypes regarding disability (like the assumption individuals with cognitive disabilities necessarily experience a diminished quality of life), they construct hypothetical cases that bear little or no resemblance to actual individuals with disabilities, or through repeated associations and comparisons with non-human animals, they animalize and dehumanize individuals with cognitive disabilities (Carlson 2007, 2010a; Kittay 2005 and 2010a). These arguments point to one of the central philosophical questions that have shaped discussions of cognitive disability: the question of moral personhood. Debates regarding the definitions and boundaries of personhood loom large here, as there are profound ethical, political, and personal implications for the lives of those labeled ‘cognitively disabled.’ It is also important to note that these philosophical arguments emerge amidst a very powerful advocacy movement – the People First movement (www.peoplefirst.org) – that has asserted the importance of recognizing the © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 Feminist Approaches to Cognitive Disability 545 humanity and personhood of individuals with IDD. The category of personhood not only bears upon discussions of individuals with severe or profound IDD, but it is relevant to ethical and bioethical arguments regarding people with dementia and those who are deemed ‘formerly competent.’11 Feminist philosophers have generated theories of justice, personhood, and the good that squarely address cognitive disability. Eva Kittay’s work is seminal in this regard, as she has explored the relationship between dependency, care, and justice explicitly in relation to cognitive disability (Kittay, 1999, 2001, 2012, 2015.) Martha Nussbaum extends her capabilities approach to incorporate the rights and status of persons with cognitive disabilities (Nussbaum, 2007) and argues that a number of practical conclusions follow from this, including the claim that people with cognitive disabilities should have the right to vote (Nussbaum, 2010). Anita Silvers and Leslie Francis explore the ways that individuals with cognitive disabilities might define and pursue particular conceptions of the good and consider what conditions are necessary to realize these aims (Francis and Silvers, 2010). In cases of individuals with severe or profound cognitive disabilities who may be non-verbal, this may involve articulating particular enabling conditions required for them to f lourish (Wong 2010) and addressing the nature and practical implications of guardianship and trusteeship (Kittay, 1999, 2001, 2012, 2015.) The roles of guardians and trustees point to another related area in feminist ethics: critiques of traditional conceptions of agency and autonomy. The question of autonomy for people with cognitive disabilities is a complex one for many reasons. First, there is a long history of depriving people with disabilities of the right to self-determination. In some cases, this has included profound violations in the form of involuntary segregation and sterilization and the denial of fundamental liberties and opportunities. Second, within this broad category and even within specific forms of cognitive disabilities (IDD, LD, late onset disabilities), people exhibit vastly different capacities for self-determination and agency. Finally, conceptions of agency are often intertwined with ableist assumptions, and thus claims and arguments about the autonomy (or lack thereof ) of people with cognitive disabilities require close scrutiny. Here, feminist challenges to the atomistic, independent, autonomous individual can be particularly fruitful to consider. In response to this traditional view, they have argued that vulnerability, dependency, and interdependency must be acknowledged and have proposed alternate, relational accounts of autonomy. Insofar as some individuals with cognitive disabilities do not conform to traditional concepts of agency and autonomy, and may be vulnerable and dependent in specific ways, they have become the focus of philosophical attention (Purcell, 2013). In the case of both children and adults with IDD, philosophers have raised questions about how best to recognize and respond to an individual’s degree of agency and have considered how gender norms play into both the experience of disability and the roles assigned to their caregivers (Wong 2002; Cushing and Lewis 2002; Back, 2015; Davy, 2015). Moreover, the very concept of caring for has been critically revisited in the context of caring for individuals with disabilities. For example, Eva Kittay enlarges the concept of care to include the complex relationships between herself, her daughter Sesha, and Sesha’s caregivers, arguing that any ethics of care must include caring for caregivers (Kittay 1999). In speaking about the philosophical questions posed by late-onset disability due to traumatic brain injury, Kate Lindemann points out that in focusing exclusively on care-giving, theories of care have not paid sufficient attention to the act of receiving care (Lindemann 2001). The challenges of theorizing the relationship between autonomy and dependency also arise in the case of aging and dementia and have generated philosophical discussion regarding how best to reconcile a respect for agency with the necessity for care and assistance (Silvers, 2015; Lindemann, 2010.) This points to the need for further examination of how the discourse surrounding aging and dementia intersect with assumptions about class, race, and gender. © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 546 Feminist Approaches to Cognitive Disability There is also room to extend feminist discussions of care and justice to specific forms of oppression, marginalization, and violence experienced by people with cognitive disabilities. Individuals with cognitive disabilities have been victims of a horrible array of abuses and sexual violence. Those living in group home or institutional settings, for example, may be especially vulnerable and disenfranchised. These injustices, which have received relatively little attention from feminist philosophers, demand a response and raise many important questions regarding the nature of vulnerability and violence, and the possibility of resistance and solidarity (Carlson 2010a; Kittay, 2001). They also speak to the importance of developing what Nirmala Erevelles has called a materialist standpoint within Disability Studies that addresses structural forms of oppression and exposes the material conditions that exacerbate them (Erevelles, 2013). While individuals with cognitive disabilities may be targets of sexual exploitation by virtue of their disabilities and the conditions in which they live, feminist work on disability has highlighted the ways in which people with disabilities are simultaneously viewed as childlike and asexual. Many feminist critiques of the sexual objectification of women and the gendered expectations and norms that govern reproduction, parenting, and sexuality do not, in fact, apply to women with disabilities (Finger, 1988, 1992; Fine and Asch, 1988; Morris, 1996; Smith and Hutchinson, 2004; Garland-Thompson, 1997, 2011; Linton, 1998; Scully, 2008; Silvers 1999). In this vein, it is especially important to attend to the specific ways in which particular norms and ableist assumptions affect women with cognitive and intellectual disabilities. For instance, how have reproductive rights and sexual freedom granted or denied to people with cognitive disabilities? Answering this question might involve: critically examining the assumption that people with IDD cannot and should not be sexual beings who engage in sexual relationships; considering freedom of sexual expression in institutional settings (e.g. for people with IDD or dementia); and addressing the issue of reproductive rights for individuals with cognitive disabilities. 4. Bioethics The field of feminist bioethics incorporates many topics directly related to cognitive disability. In addition to the considerations of reproductive rights mentioned above, bioethical work on cognitive disability includes analyses of how particular medical and scientific practices affect individuals with IDD and cognitive disabilities (e.g. in research ethics, genetic screening, and medical decision-making); a consideration of how technologies like prenatal testing, genetic screening, selective abortion, and enhancement impact societal views and practices surrounding the prevention of cognitive disability; and an evaluation of how normative assumptions regarding cognitive disability shape debates regarding quality of life and end of life decision-making. It is important to note that feminist bioethicists do not speak univocally in these areas, and they represent a plurality of positions and approaches. For example, in assessing the impact of practices like genetic screening, prenatal testing, and selective abortion intended to prevent the birth of people with cognitive disabilities, one finds very different responses. Some argue that such technologies are ultimately beneficial (and even morally obligatory to use) insofar as they promote well being, minimize harms, and enhance women’s reproductive autonomy (Purdy 1995). In response, feminist disability scholars have challenged the underlying assumptions about disability and quality of life upon which such arguments are made and maintain that these widespread practices perpetuate harmful assumptions and devalue disabled lives (Silvers, 1999; Parens and Asch, 2000; Asch, 2000; Carlson, 2002; Saxton, 2000 and 2013; Garland-Thomson, 2012; Hubbard, 2013; Bérubé, 2013). Feminist analyses of disability also explore the significance of embodiment and the experience of living within a body that does not conform to certain social, scientific and © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 Feminist Approaches to Cognitive Disability 547 philosophical norms (Scully 2008; Garland-Thomson, 1997, 2012). To turn attention to ‘cognitive’ or ‘mental’ disability is not, however, to leave the body aside; rather, a feminist approach to cognitive disability must consider the interaction between mind and body and explore the ways in which practices and norms that govern bodies and cognitive abilities inf luence the meaning and experience of having a cognitive or intellectual disability.12 One example of the ways in which both minds and bodies are interpreted as disabled and deviating from an accepted norm can be found in attempts to normalize particular physical features associated with cognitive disability through various cosmetic and medical procedures. Practices like surgery to correct the eyelids of children with Down syndrome have been critiqued for perpetuating certain ableist and racist norms and simultaneously devaluing these forms of cognitive disability (Goering 2003). One of the most public and morally fraught examples was the case of Ashley X, a young girl who had significant physical and intellectual disabilities and was given growth attenuation therapy (which included the removal of her breast buds, a hysterectomy, and hormone therapy) to prevent her from growing into a fully formed adult. This case garnered a broad range of feminist responses, many of which argued that the decision to subject Ashley to these extreme forms of therapy was based upon problematic assumptions regarding the embodiment, development, and sexuality of people with severe physical and intellectual disabilities (Kittay 2010b, 2011; Hall 2011; Lindemann and Nelson 2008). Cases like this one raise particularly difficult questions about decision-making and epistemic authority in relation to parental roles and the medical establishment, questions that feminist philosophers have taken up in a number of ways. 5. Knowledge and Authority The ways in which people with cognitive disabilities are knowing subjects have been explored by philosophers in a number of fields. Philosophers of mind have been particularly intrigued by autism and the theory that autistic individuals lack a theory of mind. Neuroscientists and cognitive scientists are interested in the ways that certain cognitive impairments affect cognition and identity. For example, the case of individuals with Williams syndrome, a disability that affects certain cognitive abilities and that is often characterized by a deep responsiveness to music, has attracted the attention of scientists and philosophers interested in music and the brain. And the experiences of memory loss that accompany certain brain traumas and conditions like dementia and Alzheimer’s provide much fodder for philosophical ref lections on the complex relationship between memory, cognition, and personal identity. Feminist philosophers have pointed out that much of this work remains within a medical model of disability, however, and have called some of these approaches into question. Drawing upon work in feminist epistemology and feminist philosophy of science, they have introduced a distinct set of questions regarding identity, standpoint epistemology, authority, and responsibility (Wendell, 1996; Kittay, 2005, 2010a; Carlson, 2009, 2010; Ho 2008,2011; Lindemann, 2001). Susan Wendell, in The Rejected Body, explores the meaning of a standpoint epistemology for people with disabilities (Wendell 69–73). What might this mean in the context of IDD, learning disabilities, and other forms of cognitive disabilities? Given the vast differences between these disabilities (e.g. between late onset dementia or brain injury, a person with profound IDD, and someone on the autism spectrum), is there a meaningful way in which one might define a standpoint based on cognitive disability? Additional questions emerge from feminist work regarding the nature and production of knowledge. For example, how do particular forms of IDD and LD rely upon alternate modes of learning and knowing? In what ways might philosophical attention to disability expand definitions and theories of knowledge, rather than © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 548 Feminist Approaches to Cognitive Disability simply applying existing theories to measure the extent to which individuals with “cognitive impairments” fail to conform to normal ways of knowing? Kate Lindemann, for example, speaks about her experience of doing philosophy after a traumatic brain injury and argues that late-onset disability presents a distinct set of questions regarding identity, memory, cognitive ability, and the relationship between mind and body (Lindemann 2001). In the case of both IDD and autism, there are robust self-advocacy movements that present a rich area for feminist inquiry regarding political advocacy, solidarity, and the conditions for articulating a distinctive standpoint and making epistemic and political claims. It is important to engage with these movements and voices in order to assess the extent to which feminist philosophy, itself, is exclusionary, and to consider what is needed to include and value these voices and perspectives. This can be especially challenging when individuals cannot communicate verbally, yet new possibilities can emerge as alternate means of communication, perhaps even through artistic expression, are sought (Wong 2010; Carlson 2013; Vorhaus, 2015). These questions inevitably raise the issue of what kind of epistemic authority is granted to and claimed by particular subjects. Exploring the ways and extent to which people with cognitive disabilities can be granted such authority demands an interdisciplinary approach, and one that includes the voices of these individuals and, when appropriate, those who are in close relation to them. The question of the epistemic status of parental perspectives and testimony has been a central focus in bioethical literature, particularly in cases of IDD where children or adults may not be able to speak for themselves. In the clinical context, feminist philosophers have addressed the ways that both patient and parental authority have been discounted in cases of people with cognitive disabilities and examine the gate-keeping role that genetic counselors and other clinicians play in presenting information about disability to prospective parents (Ho 2008, 2011; Parens and Asch 2000). They have also mounted more systemic, structural critiques, examining the ways that disability and impairment (both pre- and post-natally) are constructed and governed within the medical establishment (Tremain 2006). These same critical questions must be asked of philosophy itself (and of feminist philosophy) in view of the ways that particular perspectives and voices have been doubted, dismissed, or silenced in philosophical discourse about cognitive disability. 6. Conclusion Incorporating cognitive disability into philosophical research in any of the areas discussed here raises methodological questions that can benefit from the contributions of feminist philosophers. For example, how can one speak with, rather than for others? How can one engage in responsible philosophical scholarship about individuals who, in some cases, may not be able to speak for themselves? And what does it mean to do so with epistemic humility and responsibility? Finally, insofar as philosophical work on cognitive disability must be interdisciplinary, the area of feminist philosophy is a valuable place to look for discussions of methodology and self-critical ref lections on the value and the challenges of engaging in interdisciplinary dialogue. Recognizing the complex intersections between race, class, gender identity, age, and sexuality, and institutionalized systems of oppression and discrimination is crucial to generating philosophical work on disability that ref lects the complex lived realities and material conditions of people with intellectual and cognitive disabilities. Finally, in view of the marginalization of disability and disabled philosophers within philosophy itself (Tremain, 2013), the dynamics of inclusion and exclusion that govern the profession must be addressed. Philosophers of disability can play a significant role in developing broader conceptions of intellectual diversity, accommodation, and justice that can make philosophy itself more diverse, hospitable, and inclusive. © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 Feminist Approaches to Cognitive Disability 549 I have only provided a brief overview of the ways in which feminist approaches to cognitive disability can inform the philosophy of disability. Equally important, however, are the ways that attending to cognitive disability can challenge and transform feminism and philosophy (Garland-Thomson 2011; Hall, 2011, 2015b). As developments in science, technology, and clinical medicine continue to shape definitions of disability and impact the lives of people with cognitive disabilities, and as the Disability Rights movement and the interdisciplinary scholarship on disability expand, feminist philosophy of cognitive disability can make distinctive contributions to the goals of greater inclusion, justice, and f lourishing for all persons with disabilities. Short Biography Licia Carlson is an associate professor of philosophy at Providence College in Rhode Island. The primary focus of her research has been on philosophy and intellectual disability, and she has published numerous articles on disability in the context of bioethics, feminist philosophy, phenomenology, and the work of Michel Foucault. She is the author of The Faces of Intellectual Disability: Philosophical Ref lections (Indiana University Press, 2010) and co-editor of Cognitive Disability and Its Challenge to Moral Philosophy (Wiley-Blackwell, 2010) and Phenomenology and the Arts (Lexington Books, forthcoming). She is currently writing a book on music, philosophy, and intellectual disability. Notes * Correspondence: Philosophy, Providence College, Providence, RI, USA. Email: [email protected] 1 See Finger, 1988; Fine and Asch, 1988; Morris, 1996; Smith and Hutchinson, 2004; Garland-Thompson, 1997, 2011; Linton, 1998; Scully, 2008; Kafer, 2013. 2 In speaking about ‘feminist philosophers’ separately, I do not mean to suggest that they do not also identify as disability theorists and/or activists. Given the interdisciplinary nature of this work, and the aim of this article to highlight philosophical approaches to cognitive disability, I am separating these sources so readers can easily identify work done by philosophers and work in other disciplines. 3 See McRuer, 2006; Hall, 2011; Kafer, 2013; Braswell, 2015; Johnson, 2015; Thomsen, 2015; Stubblefield, 2010; Erevelles, 2013. 4 See the essays in Kittay and Carlson, 2010; Kittay, 1999, 2005, 2010a; Carlson, 2005, 2009, 2010a, 2010b, 2010c; Silvers, 2015, Wong, 2002, 2010; Back, 2015; O’Donnovan, 2010; Vorhaus, 2015. Note that not all of this work approaches cognitive disability from a feminist perspective. For collections addressing philosophy and disability more generally, see Silvers, Wasserman, Mahowald, 2008; Tremain 2013b and 2015; Kristiansen, Vehemas and Shakespeare, 2009. 5 For some examples of this, see McMahan, 2002; Singer, 2010; McMahan, 2010. For an extended critique of these examples, see Carlson, 2010; Kittay, 2005, 2010. 6 For a few examples, see Bérubé, 1996; Carey, 2013 and 2010; Reinders, 2000 and 2008; Trent, 1994; Herr, Gostin and Koh, 2003; Goodey, 2011. Obviously, there is a vast literature on cognitive disability in the fields of medicine, psychology, special education, and rehabilitation sciences as well. 7 For some examples, see Carlson 2010a; Kittay, 2005, 2010; O’Donnovan, 2010; Lindemann 2010; Jaworska, 2010; McGeer 2010; Hacking 2010; Silvers 2015; Barnbaum 2008; Nussbaum 2007, 2010; Kristiansen, 2000; Vorhaus 2007 and 2013. 8 The choice of these areas is not entirely arbitrary, as they are fields in which one finds a critical mass of work on cognitive disability from a feminist standpoint specifically. © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 550 Feminist Approaches to Cognitive Disability 9 In The Faces of Intellectual Disability (Carlson 2010a), I defend the use of the term ‘intellectual disability’ because the book is focused on the constellation of conditions that once fell under the umbrella of ‘mental retardation’ (and are now defined in a referred to as intellectual and developmental disabilities.) However, because the various works discussed here encompass a broader range of conditions, classifications, and identities, cognitive disability casts a broader net and allows me to specify when speaking about what are now called ‘intellectual and developmental disabilities’ specifically (see Kittay and Carlson, 2010, 2.) However, I recognize that ‘cognitive disability’ is not a unproblematic, neutral term, though time will not permit a fuller discussion of this issue here. Margaret Price makes the case for an even broader term, ‘mental disability,’ which includes the conditions I have mentioned as well as mental illness, psychiatric disorders, and m/Madness, but I have chosen not to adopt this since my focus in this article is not on this latter group of conditions (Price, 2011, 2015). 10 In her book Feminist, Queer, Crip, Allison Kafer proposes an alternative to the medical and social models that she calls the political–relational model, which focuses on the political experience of disablement and brings together work in feminist, queer and disability theory (Kafer 2013). 11 See the exchange between Eva Kittay, Jeff McMahan and Peter Singer in Kittay and Carlson, 2010; Kittay 2007 and 2010. See also Carlson, 2010a; Taylor, 2013; Wong, 2010. 12 In her discussion of mental disability, Margaret Price introduces the concept of ‘bodymind’ as a way to resist this dualism (Price, 2015). Works Cited Back, Laura. “Private Dependence, Public Personhood: Rethining Nested Obligations.” Hypatia, Vol. 30, no. 1, 2015. Barnbaum, Deborah. The Ethics of Autism: Among Them but not of Them. Bloomington: Indiana University Press, 2008. Bérubé, Michael. “Disability, Democracy and the New Genetics,” in ed. Lennard Davis, The Disability Studies Reader. New York: Routledge, 2013. ——. Life As We Know It. New York: Vintage, 1996. Braswell, Harold. My Two Moms: Disability, Queer Kinship, and the Maternal Subject. Hypatia, Vol. 30, no. 1, 2015: 234–50. Carey, Alison. On the Margins of Citizenship: Intellectual Disability and Civil Rights in Twentieth Century America. Philadelphia: Temple University Press, 2010. ——. ‘The Sociopolitical Contexts of Passing and ID.’ Disability and Passing: Blurring the Lines of Identity. Eds. Jeffrey Brune and Daniel Wislon. Philadelphia: Temple University Press, 2013. Carlson, Licia. “Research Ethics and Intellectual Disability: Broadening the Debates,” Yale Journal of Biology and Medicine, 86(3): 303–313, 2013. ——. Faces of Intellectual Disability: Philosophical Reflections. Bloomington: Indiana University Press, 2010a. ——. ‘Philosophers of Intellectual Disability: A Taxonomy.’ Cognitive Disability and its Challenge to Moral Philosophy. Eds. Eva Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010b. ——. ‘Who’s the Expert? Rethinking Authority in Light of Intellectual Disability.’ Journal of Intellectual Disability Research. Vol, 54, Supp. 1. 2010c: 58–65. ——. “The Human as Just an Other Animal: Madness, Disability and Foucault’s Bestiary” in eds. Christian Lotz and Corinne Painter, Phenomenology and the Non-Human Animal, Springer, 2007: 117-133. ——. “Docile Bodies, Docile Minds: Foucauldian Reflections on Mental Retardation.” in Foucault and the Government of Disability, ed. Shelley Tremain. Ann Arbor: University of Michigan Press, 2005. ——. “The Morality of Prenatal Testing and Selective Abortion: Clarifying the Expressivist Objection” in ed. Lisa Parker and 2002. Cushing, Pamela and Tanya Lewis. ‘Negotiating Mutuality and Agency in Care-giving Relationships with Women with Intellectual Disabilities’ Hypatia 17, no. 3 (2002): 173–193. Davy, Laura. Philosophical Inclusive Design: Intellectual Disability and the Limits of Individual Autonomy in Moral and Political Theory. Hypatia, Vol. 30, no. 1, 2015: 132–148. Erevelles, Nirmala. ‘(Im)material Citizens: Cognitive Disability, Race, and the Politics of Citizenship.’ Foundations of Disability Studies. Eds. Matthew Wappett and Katrina Arndt. Palgrave Macmillan. 2013. ——Fine, Michelle and Adrienne Asch, eds. Women with Disabilities: Essays in Psychology, Culture, and Politics. Philadelphia: Temple University Press, 1988. Finger, Anne. “Claiming All Our Bodies: Reproductive Rights and Disabilities” in With the Power of Each Breath: A Disabled Women’s Anthology. Eds. Susan Browne, Debra Connors, and Nanci Stern. San Francisco: Cleis. 1988. 292–307. ——. ‘Forbidden Fruit.’ New Internationalist 233 (1992): 8–10. Francis, Leslie and Anita Silvers. ‘Thinking about the Good: Reconfiguring Liberal Metaphysics (Or Not) For People with Cognitive Disabilities.’ Cognitive Disability and its Challenge to Moral Philosophy. Eds. Eva Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010. 237–259. © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 Feminist Approaches to Cognitive Disability 551 Garland-Thomson, Rosemarie. ‘Integrating Disability, Transforming Feminist Theory.’ ‘Disability Feminist Disability Studies. Ed. Kim Hall. Bloomington: Indiana University Press, 2011. 13–47. ——. ‘The Case for Conserving Disability.’ Journal of Bioethical Inquiry 9 (2012): 339–55. ——. Extraordinary Bodies: Figuring Disability in American Culture and Literature. New York: Columbia University Press, 1997. Goering, Sara. ‘Conformity Through Cosmetic Surgery: The Medical Erasure of Race and Disability.’ Science and Other Cultures. Eds. Robert Figueroa and Sandra Harding. New York: Routledge, 2003. Goodey, C. F. A History of Intelligence and "Intellectual Disability: The Shaping of Psychology in Early Modern Europe. Surrey: Ashgate, 2011. Hall, Kim. ‘Reimagining Disability and Gender Through Feminist Studies: An Introduction.’ Feminist Disability Studies. Ed. Kim Hall. Bloomington: Indiana University Press, 2011. ——Hall, Kim. Ed. Special Issue: New Conversations in Feminist Disability Studies. Hypatia 30, no. 1 (2015a). ——. “Editor’s Introduction” in Special Issue: New Conversations in Feminist Disability Studies. Hypatia 30, no. 1 2015b Herr, Stanley, Lawrence O. Gostin and Harold Hongju Koh, eds. The Human Rights of Persons with Intellectual Disabilities. Oxford: Oxford University Press, 2003. Ho, Anita. ‘Autonomy and the Challenge of Disability.’ Bioethical Inquiry 5 (2008): 193–207. ——. ‘Trusting Experts and Epistemic Humility in Disability.’ The International Journal of Feminist Approaches to Bioethics. 4, no. 2 (2011): 102–123. Hubbard, Ruth. “Abortion and Disability: Who Should and Should Not Inhabit the World?” in ed. Lennard Davis, The Disability Studies Reader. New York: Routledge, 2013. Jaworska, Agnieszka. ‘Caring and Full Moral Standing Redux.’ Cognitive Disability and Its Challenge to Moral Philosophy. Eds. Eva Feder Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010. 369–392. Johnson, Merri Lisa. ‘Bad Romance: A Crip Feminist Critique of Queer Failure.’ Hypatia 30, no. 1, Winter 2015. 251–267. Kafer, Alison. Feminist, Queer, Crip. Bloomington: Indiana University Press, 2013. Kittay, Eva and Licia Carlson. Cognitive Disability and Its Challenge to Moral Philosophy. Malden, MA: Wiley-Blackwell, 2010. Kittay, Eva, Anita Silvers and Susan Wendell, eds. ‘Special Issue: Feminism and Disability Part I’ Hypatia 16 no. 4 (2001). Kittay, Eva. ‘Special Issue: Feminism and Disability, Part II.’ Hypatia 17 no. 3 (2002) ——. ‘At the Margins of Moral Personhood.’ Ethics 116 (2005): 100–131. ——. ‘Forever Small: The Strange Case of Ashley X.’ Hypatia 26 no. 3 (2011): 610–631. ——. ‘Ideal Theory Bioethics and the Exclusion of People with Severe Cognitive Disabilities’ in Naturalized Bioethics: Toward Responsible Knowing and Practice. Cambridge: Cambridge University Press, 2009. ——. Love’s Labor: Essays on Women, Equality, and Dependency. New York: Routledge, 1999. ——. ‘The Personal is Philosophical is Political: A Philosopher and Mother of a Cognitively Disabled Person Sends Notes from the Battlefield.’ Eds. Eva Kittay and Licia Carlson. Cognitive Disability and its Challenge to Moral Philosophy. Malden, MA: Wiley-Blackwell, 2010a (a). 393–413. ——. ‘They Don’t Know the Difference Anyway’: Dissenting from the Seattle Growth Attenuation and Ethics Working Group’s Compromise Position.” Hastings Center Report, November 2010b (b). ——. ‘Centering Justice on Dependency and Recovering Freedom.’ Hypatia, Vol 30 No. 1, Winter 2015: 285–291. ——. ‘Getting from Here to There: Claiming Justice for People with Severe Cognitive Disabilities.’ Medicine and Social Justice: Essays on the Distribution of Health Care, 2nd ed. Eds. Rosamund Rhodes, Margaret P. Battin, and Anita Silvers. New York: Oxford University Press, 2012. 313–324. ——.“When Care is Just and Justice is Caring: The Case of the Care for the Mentally Retarded.” Public Culture, vol. 13, no. 3, Special issue "The Critical Limits of Embodiment: Reflections on Disability Criticism." September 2001. pp. 557–579. Kristiansen, Kristjana, Simo Vehemas, and Tom Shakespeare. Arguing About Disability: Philosophical Perspectives. New York: Routledge, 2009. Kristiansen, Kristjana. "At Home with My Daughter: Reflections on Olmstead v. L. C. and E. W." In Americans with Disabilities: Exploring Implications of the Law for Individuals and Institutions, eds. Leslie Francis and Anita Silvers. New York: Routledge, 2000. Lindemann, Hilde. ‘Holding One Another (Well, Wrongly, Clumsily) in a Time of Dementia.’ Cognitive Disability and its Challenge to Moral Philosophy. Eds. Eva Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010. 161–169. ——. and James Lindemann Nelson, "The Romance of the Family," Hastings Center Report 38, no. 4 (2008): 19–21. Lindemann, Kate. ‘Persons with Adult-Onset Head Injury: A Critical Resource for Feminist Philosophers.’ Hypatia 16 no. 4 (2001): 105–123. Linton, Simi. Claiming Disability: Knowledge and Identity. New York: New York University Press, 1998. Mahowald, Mary. “A Feminist Standpoint.” In Disability, Difference, Discrimination: Perspectives on Justice in Bioethics and Public Policy, eds. Anita Silvers, David Wasserman and Mary Mahowald. Lanham: Rowman & Littlefield, 2008. 209–251. McGeer, Victoria. “The Thought and Talk of Individuals with Autism: Reflections on Ian Hacking.” In Cognitive Disability and Its Challenge to Moral Philosophy, eds. Eva Feder Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010, 279–292. © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 552 Feminist Approaches to Cognitive Disability McMahan, Jeff. The Ethics of Killing: Problems at the Margins of Life. New York: Oxford University Press, 2002. ——. “Cognitive Disability and Cognitive Enhancement” in eds. Eva Kittay and Licia Carlson, Cognitive Disability and Its Challenge to Moral Philosophy. Malden, MA: Wiley-Blackwell, 2010 345–367. McRuer, Robert. Crip Theory: Cultural Signs of Queerness and Disability. New York: New York University Press, 2006. ——Morris, Jenny, ed. Encounters with Strangers: Feminism and Disability. London: The Women’s Press, Ltd, 1996. Nussbaum, Martha. ‘The Capabilities of People with Cognitive Disabilities.’ Cognitive Disability and its Challenge to Moral Philosophy. Eds. Eva Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010. 75–95. ——. Frontiers of Justice: Disability. Nationality: Species Membership. Belknap Press, 2007. O’Donnovan, Maeve. “Feminism, Disability and Evolutionary Psychology: What’s Missing?.” Disability Studies Quarterly 33 no.4, 2013. ——. ‘Cognitive Diversity in the Global Academy: Why the Voices of Persons with Cognitive Disabilities are Vital to Intellectual Diversity.’ Journal of Academic Ethics 8 (2010): 171–185. ——Parens, Erik and Adrienne Asch, eds. Prenatal Testing and Disability Rights. Washington. D.C: Georgetown University Press, 2000. Price, Margaret. Mad at School: Rhetorics of Mental Disability and Academic Life. Ann Arbor: University of Michigan Press, 2011. ——. “The Bodymind Problem and the Possibilities of Pain.” Hypatia, Vol. 30, No. 1, Winter 2015. Purcell, Elizabeth. ‘Narrative Ethics and Vulnerability: Kristeva and Ricoeur on Interdependence.’ Journal of French and Francophone Philosophy, XXI, No. 1 (2013): 43–59. Purdy, Laura. ‘Loving Future People.’ Reproduction, Ethics, and the Law: Feminist Perspectives. Ed. Joan C. Callahan. Bloomington: Indiana University Press, 1995. 300–327. Reinders, Hans. The Future of the Disbled in Liberal Society. Notre Dame: University of Notre Dame Press, 2000. Saxton, Marsha. “Disability Rights and Selective Abortion” in ed. Lennard Davis, The Disability Studies Reader. New York: Routledge, 2013. ——. ‘Why Members of the Disability Community Oppose Prenatal Diagnosis and Selective Abortion.’ Prenatal Testing and Disability Rights. Eds. Erik Parens and Adrienne Asch. Washington, D.C: Georgetown University Press, 2000. 147–164. Schalk, Sami. “Metaphorically Speaking: Ableist Metaphors in Feminist Writing. Disability Studies Quarterly, Vol, 33, no. 4. 2013. Scully, Jackie Leah. Disability Bioethics. Lanham, PA: Rowman and Littlefield, 2008. Silvers, Anita, David Wasserman, and Mary Mahowald, eds. Disability, Difference, Discrimination: Perspectives on Justice in Bioethics and Public Policy. Lanham: Rowman & Littlefield Publishers Inc, 1998. Silvers, Anita. Becoming Mrs. Mayberry: Dependency and Recovering Freedom. Hypatia, Vol. 30, no. 1, 2015: 292–299. ——. ‘Reconciling equality to difference: Caring (f )or justice for people with disabilities.’ Hypatia 10.35 (1995): 30–55. ——. “Formal Justice” in eds. Silvers, Wasserman, Mahowald. Disability, Difference, Discrimination, 1998. ——. “On Not Iterating Women’s Disability: A Crossover Perspective on Genetic Dilemmas” in eds. Anne Donchin and Laura Purdy, Embodying Bioethics, Lanham, MD: Rowman & Littlefield, 1999: 177–202. Singer, Peter. “Speciesism and Moral Status.” In eds. Eva Kittay and Licia Carlson, Cognitive Disability and its Challenge to Moral Philosophy. Malden, MA: Wiley-Blackwell, 2010 ——Smith, Bonnie G. and Beth Hutchison, eds. Gendering Disability. New Brunswick: Rutgers University Press, 2004. Stubblefield, Anna. ‘The Entanglement of Race and Cognitive Disability.’ Cognitive Disability and its Challenge to Moral Philosophy. Eds. Eva Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010. 293–313. Taylor, Ashley. “Lives Worth Living: Theorizing Moral Status and Expressions of Human Life.” Disability Studies Quarterly, Vol. 33, no 4, 2013. Thomsen, Carly. The Post-Raciality and Post-Spatiality of Calls for LGBTQ and Disability Visability. Hypatia, Vol. 30, no. 1, 2015: 149–166. Tremain, Shelley. ‘Introducing Feminist Philosophy of Disability.’ Disability Studies Quarterly 33 no. 4 2013a. ——. ed. ‘Special Issue: Improving Feminist Philosophy and Theory By Taking Account of Disability.’ Disability Studies Quarterly 33, no. 4 (2013b). ——. Foucault and the Government of Disability. Ann Arbor: University of Michigan Press, 2015. ——. “On the Government of Disability: Foucault, Power, and the Subject of Impairment” in The Disability Studies Reader, ed. Lennard Davis. New York: Routledge, 2006. 185–196. ——. ‘On the Subject of Impairment.’ Disability/Postmodernity: Embodying Disability Theory. Eds. Mairian Corker and Tom Shakespeare. Bloomsbury Academic, 2002. ——. ‘Reproductive Freedom, Self-regulation, and the Government of Impairment in Utero.’ Hypatia: A Journal of Feminist Philosophy 21, no. 1 (2006): 35–53. Trent, James W. Jr. Inventing the Feeble Mind: A History of Mental Retardation. Berkeley: University of California Press, 1994. Vorhaus, John. ‘Capability, Freedom and Profound Disability.’ Disability and Society 28.8 (2013): 1047–1058. ——. Disability, dependency and indebtedness, Journal of Philosophy of Education, 41, no. 1, (2007): 29–44. ——. Giving Voice to Profound Disability: Dignity, Dependence and Human Capabilities. London: Routledge, 2015. © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350 Feminist Approaches to Cognitive Disability 553 Wendell, Susan. The Rejected Body: Feminist Philosophical Reflections on Disability. New York: Routledge, 1996. Wong, Sophia. ‘At Home with Gender and Down Syndrome.’ Hypatia 17 no. 3 (2002): 89–117. ——. ‘Duties of Justice to Citizens with Cognitive Disabilities.’ Cognitive Disability and its Challenge to Moral Philosophy. Eds. Eva Kittay and Licia Carlson. Malden, MA: Wiley-Blackwell, 2010. 127–146. Yergeau, Melanie. ‘Clinically Significant Disturbance: On Theorists Who Theorize Theory of Mind.’ Disability Studies Quarterly 33, no. 4 (2013). © 2016 The Author(s) Philosophy Compass © 2016 John Wiley & Sons Ltd Philosophy Compass 11/10 (2016): 541–553, 10.1111/phc3.12350