The faces of intellectual disability. Philosophical reflections, by Licia Carlson, Bloomington, Indiana University Press, 2010, 266 pp., £47.50 (hardback), ISBN 978-0-2533-5421-1

In this book Licia Carlson gives us a thorough analysis of the different faces of intellectual disability. She does this by following two paths. First in the spirit of Foucault, she explores the ways that intellectual disability in its various forms was constituted as an object of knowledge between the mid-nineteenth century and the early decades of the twentieth century. The purpose of this historical journey is to give a theoretical framework for addressing the complexities of this category, so as to ground the philosophical conversation about intellectual disability in the historical context (13). The second objective of the book is to uncover certain features of contemporary philosophical discourse about intellectually disabled. Using the analytical tools developed in part 1 Carlson unmasks in part 2 four faces in contemporary philosophical discussions about intellectual disability: the face of authority, the face of the beast, the face of suffering and the face of the mirror (13).

Drawing on Ian Hackings use of the word unmasking, she does not seek to refute the ideas found in contemporary philosophical conversation about intellectual disability, but to undermine them by exposing the function they serve. The intention of the unmasking is that once one sees the ‘extra-theoretical function’ of an idea it will lose its ‘practical effectiveness’ (13). Carlson's objective is not to provide a theory or the doctrine that should be used in philosophizing about intellectual disability. Rather, she is engaged in a venture akin to Foucault's historical ontology adopting to a ‘historical–critical’ attitude.

Following the idea of critical ontology Carlson develops her research question along the three axes suggested by Foucault – knowledge, power and ethics. Her examination of intellectual disability in both the historical and the philosophical worlds moves along these axes (15).

Being faithful to Foucault she investigates power in terms of existence, by addressing specific modes of power as they occur in history of intellectual disability examining certain forms of disciplinary and psychiatric power in the first chapter, and complex gendered power relations in the second. In part 2 she investigates the power relations between the philosopher-expert, her objects of knowledge, and other voices that have been left out of the conversation (16).

The intent of Carlson's investigation is a reorientation with respect to intellectual disability. Carlson's call is to rethink certain philosophical attitudes, and to confront the ‘ethos’, in Foucault's sense of the term that is embedded in the practice of philosophy (17).

Outlining these perspectives in the introduction Carlson really gives the reader anticipations especially to the analytical tool that she has foreshadowed for a philosophical reorientation with respect to intellectual disability.

In her review of the history of intellectual disability addressing specific modes of power in chapter one and two she draws on many contributions written about intellectual disability. This historical window is according to Carlson not exhaustive, but reveals certain tensions and dynamics, and I agree. However, there are some references that I am a bit surprised that she does not use. For example Paul's (1998) important book on The politics of heredity: essays on eugenics, biomedicine, and the nature-nurture debate. Instead, she refers to a book by Paul from 1995. Points Carlson makes in her contribution Paul pointed out in her 1998-book. Similarly in part 2 Carlson does not enter into the discussions between bioethicists and disability theorists about concepts of disability (Newell 1999; Harris 2000; Reindal 2000; Cox-White and Boxall 2009) just to mention some. That would have been an interesting follow up and contribution to the ongoing debate. However, to Carlson's defence I should add that these discussions do not discuss intellectually disabled in particular but disability in general. Still the same logic is being used and it would have been interesting to have her contribution into this discussion. Also when it comes to her account of disability in the introduction I am a bit surprised that she just distinguishes between what she calls ‘the traditional approach’ found in ethical and bioethical literature, and a critical disability approach found in both ethics and bioethics, as well as in other areas of philosophy and disability theory (9). I would have liked that she had a bit more nuanced account of the different positions of disability, for example using Priestley's (1998) analytical framework as often the critique from bioethicists to a critical disability approach is a shallow understanding of the social model demonstrated for example by Richards (2002) and Cox-White and Boxall (2009). When these minor remarks are mentioned I will applaud Carlson for her thorough review of the literature in order to make her argument and development of the analytical tool.

What I particularly liked was the short but very important chapter Analytical interlude. Departing from the distinction between social construction with regard to disability as the process of construction and the interpretation of a particular condition, Carlson uses Hackings series of distinctions in order to tease out the multiple meanings of the phrase ‘social construction’ in the context of mental retardation as the product of construction.

Drawing on Hackings broad categories of things that can be socially constructed: objects (things in the world), ideas (conceptions, concepts, beliefs, attitudes, theories), and elevator words (higher-level concepts like truth, reality, and knowledge) she concludes that while one could say that persons with cognitive limitations have existed throughout history, the definition of mental retardation need not have developed in the way that it has (89). Having shown that the notion mental retardation is a social construct, she uses Hackings observations that all social constructionists share the following precondition: ‘in the present state of affairs, x is taken for granted; x appears to be inevitable’ (Hacking 1999, 12 in Carlson 2010, 90). Hence she makes her announcement that it is against this preconceived inevitability of mental retardation, not as a condition but as a classification, that many historians of mental retardation, disability theorists, and philosophers like Carlson are arguing (90).

In an effort to recast social constructionist discourse and to challenge certain kind of philosophizing about intellectual disability, she proposes that intellectual disability can be analysed in terms of the following concepts: heterogeneity, instability, prototype effects, and power relations (91). When the false dichotomy between ‘natural kind’ and ‘socially constructed kind’ is rejected, a new array of philosophical questions emerges according to Carlson (91).

And it is here that her contribution really is very promising. Using this analytical tool she among other important analytical discussions, investigates Peter Singers (1974) argument of speciesism that he first presented in his groundbreaking book Animal liberation (137). In this book Singer defines speciesism as ‘a prejudice or attitude of bias in favor of the interest of members of one's own species and against those of members of other species’ (Singer 1995, 6 in Carlson 2010, 137). In elaborating the issue of speciesism Singer presents an example of an infant born with ‘massive and irreparable brain damage’ in Singers word a ‘human vegetable’ (Singer 1995, 17 in Carlson 2010, 137).He then asks whether, if asked by the child's parents, the doctor should kill the infant. Why we react to the killing of disabled infants and not to other non-human animal with higher cognitive skills, is according to Singer our speciesist bias. Singer argues that our offence of the killing of disabled infants is founded on an arbitrary value placed on species membership.

Singer uses the severely cognitively disabled to serve to illustrate a bias towards our own species which according to Singer, is both inappropriate and arbitrary. By applying the analytical tool developed in the first part using the concepts: heterogeneity, instability, prototype effects, and power relations Carlson develops an eloquent refutation of Singers argument by exposing his assumptions. I will not make a brief summary of this argument as it deserves to be read in its lengths. In response Carlson shows how severely intellectually disabled can be recognized in a shared humanity without making these claims being a speciesist.

Hereby the book is warmly recommend and it shall be interesting to see how Singer will comply with this critique Carlson offers of his position as well as other philosophers within bioethics building on Singers well-known argument.

Solveig Magnus Reindal

NLA University College, Bergen, Norway

© 2011, Solveig Magnus Reindal