If relying on the Diagnostic and Statistical Manual- 5 (DSM-5) to diagnose Autism Spectrum Disorder (ASD) the triad of impairment that featured in past versions of the DSM as the structure for the diagnosis has collapsed to a dyad. Restricted, repetitive patterns of behavior, interests or activities remained as the second part of the new 'Dyad of Impairment'. This part of the dyad has received relatively little research attention, despite the centrality to diagnosis and experience of living with ASD. This paper discusses the work of Soren Kierkegaard in his 1843 book Repetition and the link to understanding the nature of repetition in human experience universally and in particular for those with ASD. The work of Martin Heidegger in being and Time 1946 is discussed, to elucidate further the nature of autism associated with repetition in the ontological project of being. The understanding of repetition in eastern thought through the work of Bhadantacariya Buddhaghosa in 412 is also briefly considered to balance the western philosophical view and inform issues of mindfulness. The impossibility of repetition, outside spiritual endeavors is highlighted in a society constructed by neurotypical beings. The anaesthetizing role of habit is exposed.
Autism spectrum disorder, Kierkegaard, Repetition, Restricted and repetitive behaviours, Anxiety, Autism, Communication habits
While central to the diagnosis of and experience of living with ASD, there is a paucity of research in the domain of restricted and repetitive patterns of behavior, interests or activities [1]. This paucity is in the context of less than two percent of ASD research funds being invested on research on and with, adults with ASD [2]. The obvious impact of this domain in terms of impairment may plausibly be more progressively noticeable with ageing. ASD is often viewed by the community as a disorder of childhood and much effort has been placed into early intervention, however it is clear that ASD is a lifelong disorder and despite the obvious benefits of early intervention impairment continues into the adult part of life, the place where the majority of years are lived by people with ASD [3]. The focus in early intervention has been working on the communicative and social skills needed to enter schooling. Outcomes in terms of employment, intimate relationships and independent living are over all poor for adults with ASD [4]. Research and thinking are needed to understand the impact of ASD across all domains and across the lifespan. Understanding behavioural flexibility is important to allow development of supports to promote adaptation.
Through parent response questionnaires the link between intensity of anxiety and intrusiveness of restricted and repetitive behaviors in those with autism has been demonstrated [5]. The function of repetition for those with ASD and the mechanism of the relationship with anxiety are still being explored. The importance of this thinking cannot be underestimated. Once established restrictive and repetitive behaviors in the form of habits, either of behavior, communication or thought (obsessions), are not easily disrupted and are intrusive to the point of potentially having developmental consequences [6]. Restricted and repetitive approaches to the world limit adaptation and appear to significantly contribute to reduced potential in obtaining and maintaining employment, intimate relationships and independence for adults living with ASD [7].
The books Repetition, Being and Time and The Path of Purification are reviewed to determine what insights are provided into repetition and its place in human being. In addition a search of the databases Academic Search Elite, Medline, PsycINFo, Cinahl and Eric was conducted with the terms Kierkegaard, repetition and autism at title and abstract level.
The search of the peer-reviewed literature produced no returns at title or abstract level.
In 1843 Soren Kierkegaard published repetition. This book he labeled as a "venture in experimental philosophy" [8]. Through the use of pseudonyms a story is presented that contrasts jests and despair to portray, interpret and illuminate the function of repetition in life. The conclusion reached is that, "in the individual then, repetition appears as a task for freedom in which the question becomes that of saving one's personality from being volatilized and, so to speak in pawn of events" [8]. Before expanding on the conclusion, it is fruitful to look at the exception presented to that of neurotypical being (the way of human being that is not characterized by autism).
In explaining the use of exception to form the basis of jest and contrast Kierkegaard eloquently preempted the way ASD is used in contemporary education in courses aimed at learning outcomes that are based on understanding neurotypical behavior. "Consequently, the exception explains the universal and himself and if only one really wants to study the universal, one only needs to look around for a legitimate exception; he (sic) dissolves everything far more clearly than the universal itself. The legitimate exception is reconciled in the universal; basically, the universal is polemical toward the exception and it will not betray its partiality before the exception forces it, as it were to acknowledge it" [8]. The exception is presented through the voice of the character Constantin Constantius, whose intention was to act as a ministering spirit to a young man experiencing a romantic crisis. Constantin portrayed himself as a disciplined person who views people objectively. The exception presented, although pre-dating the conceptualization of autism by 100 years, rings true to contemporary accounts of ASD. This is very useful as the function of repetition in the exception is exposed in contrast to the universal, giving clues to the existential structure and lived impact of restricted and repetitive thoughts, communication and behaviors (repetition) for those with ASD.
Repetition is posited in the exaggerated sense as the ideal. "Repetitions love is in truth the only happy love. Like recollection's love, it does not have the restlessness of hope, the uneasy adventurousness of discovery, but neither does it have the sadness of recollection- it has the blissful security of the moment. Hope is a new garment, stiff and starched and lustrous, but it has never been tried on, and therefore one does not know how becoming it will be or how it will fit. Recollection is a discarded garment that does not fit, however beautiful it is, for one has outgrown it. Repetition is an indestructible garment that fits closely and tenderly, neither binds nor sags" [8]. This is further expounded in, "one never grows weary of the old, and when one has that, one is happy" [8].
Constantin described his belief that it, "is always certain and true that by being inflexible and also by dulling one's powers of observation a person can achieve a sameness that has a far more anesthetic power than most whimsical amusements and that like a magic formulary in the course of time also becomes more and more powerful" [8]. The observation of more powerful akin to what is at times seen in ASD as inflexible behavior, communication, and thought becomes more entrenched as the individual needs to increase the investment of will to guard against anxiety generated by increasing noise in their environment demanding adaptation and change. In the provision of behavioural description Constantin wrote, "I have always strongly mistrusted all upheavals, yes, to the extent that for this reason I even hate any sort of housecleaning, especially floor scrubbing with soap" [8]. It is written with regard to Constantin, "in the excavation of Herculaneum and Pompeii, everything was found in its place just as the respective owners left it. If I had lived at that time, the archeologists, perhaps to their amazement, would have come upon a man who walked with measured pace up and down the floor. To maintain this established and enduring order, I made use of every possible expedient. At certain times like Emperor Domitian, I even walked around the room armed with a flyswatter, pursuing every revolutionary fly. Three flies however, were preserved to fly buzzing through at specified times. Thus I did love forgetting the world" [8].
Constantin through his experimentation in the book and the associated despair came to the realization that the ideal repetition is not possible in neurotypical society. "My discovery was not significant, and yet it was curious, for I had discovered that there is simply no repetition and had verified it by having it repeated in every possible way" [8]. The only possible repletion was that of the spirit in the form of atonement and refinement occurring through repeated opportunities to act virtuously in presented situations. Repetition was a development task, and as noted earlier through development a task of freedom, freedom from merely reaction to life events. The quest for sameness, often characteristic of what we now conceptualize to be ASD was doomed to fail. "In reality as such, there is no repetition. This is not because everything is different, not at all. If everything in the world were completely identical, in reality there would be no repetition, because reality is only in the moment. If the world, instead of being beauty, were nothing but equally large unvariegated boulders, there would still be no repetition. I would see a boulder, but there would be no question as to whether or not it was the same one I had seen before" [8]. In the context of impossibility of repetition outside of the quest for spiritual development and hence freedom, habit is described as utilized for its anesthetic effect. Habit is described as the, "disappearance of self-awareness" [8]. Habit of thought behavior and communication is posited as the opposite of genuine repetition, in the form of spiritual development, which is acquired originality through earnestness and requires adoption of novel approaches.
The understanding of repetition as illuminated by Kierkegaard for the universal, in the spirit of exception has important implications for the understanding of the way of being in the world characterized by ASD. The function of behavioural repetition, repetition of thought (obsession) and communication is akin to habit, and hence of the purpose to anaesthetize or dull the experience of self-awareness (in the form of awareness of anxiety characteristic of the human existence) which is the driver to spiritual/personal development. As repetition other than in the spiritual sense is not possible, it is plausible that energy invested in habits needs to increase, to keep the demand to develop originality imposed by the world as part of being human, at bay. This gives clues to the origins of vicious cycles driven by anxiety, or increasingly entrenched habit at times when change is demanded to adapt, observed in people with ASD [9].
Martin Heidegger published being and time just over 100 years after Repetition was published. Heidegger on an ontological quest to expose the structures of being had at his disposal the works of Kierkegaard and referenced them. Heidegger attempted to move beyond theology, the realm in which Kierkegaard's work could plausibly be partially assigned, as the atonement was viewed within the lens afforded by the Christian faith. "Theology is seeking a more primordial interpretation of man's being towards God, prescribed by the meaning of faith itself and remaining within it" [10]. Heidegger had an interest in authentic being, in the thrown context in which a person exists. "Dasein is authentically itself only to the extent that, as careful Being alongside and solicitous Being-with, it projects itself upon its own most potentiality for Being rather than upon the possibility of the theyself" [10]. At first look this would appear to suit the way of being that characterizes the experience of ASD as impaired social skills and communication may lessen the attraction of group think and the hence pull towards the theyself. However, authentic being requires care. Care involves self-awareness, the very aspect of being identified by Kierkegaard to be dulled by habit. This dulling habit as discussed is characteristic of the restricted and repetitive behavior, thought and communication that form a conceptual pillar and half of the diagnostic dyad of impairment in ASD. "Only the particular Dasein decides its existence, whether it does so by taking hold or neglecting" [10]. A lack of focused self-awareness leads to neglect or inauthentic being. Inauthentic being representing the neglecting described by Heidegger.
Inauthentic being, lead to by a lack of self-awareness and care, leads to anxiety. They anxiety is of the magnitude of fear. "Fear is anxiety, fallen into the world, inauthentic, and, as such, hidden from itself" [10]. This is not only experienced in the now moment, but also projected into the future. "As care, Dasein is essentially ahead of itself. Proximally and for the most part, concernful Being-in-the-world understands itself in terms of that with which it is concerned. Inauthentic understanding projects itself upon that with which one can concern oneself, or upon what is feasible, urgent or indispensable in our everyday business" [10]. This future projection was described as anticipation. By extension the projection of anxiety into the future is what we understand in contemporary nomenclature to be anticipatory anxiety. Or from the insights revealed in the work of Heidegger for those with ASD perhaps better termed anticipatory fear. Anticipatory fear leads to entrenched habit of thought, behavior and communication, as fear experienced in the moment is compounded by the anticipation of fear yet to come.
The eastern thought on repetition as expressed by Bhadantacariya Buddhaghosa in the Buddhist work on the Path of Purification, written approximately 1400 years before Kierkegaard's book repetition, was also focused on spiritual refinement. "Preceding profitable states are a condition, as repetition condition, for succeeding profitable states" [11]. Repetition within and across lives provided the foundation for development. "As he repeats, develops and cultivates the equanimity about formations his faith becomes more resolute, his energy better exerted, his mindfulness better established, his mind better concentrated, while his equanimity about formations grows more refined" [11]. This understanding is almost identical to the conclusion arrived at by Kierkegaard. The differences largely being the religious lens/understandings that formed the ground upon which the conclusions were reached and articulated. In this sense repetition to be profitable required a high degree of self-awareness/mindfulness and earnestness. The profitable condition of repetition posed to lead to spiritual development, with the reverse of the unprofitable or inauthentic condition of repetition (moving away from self-awareness, the anesthetic type), leading to ongoing samsara/distress.
Through the use of exception Kierkegaard in his book Repetition sought to illuminate the place of repetition in the human condition. The exception presented to neurotypical being, or the universal, bears striking similarities to the way of being characteristic of ASD. This makes a lot of sense, as although predating the conceptual use of autism by Kanner [12] as a diagnostic category by a century, based on thinking structures ASD is the only other, thus far identified, way of being in the world [13-15]. Heidegger further extends the understanding generated of the universal way of being as he went about moving away from a theological position and further laying bare the existential structures. The combined works provide insight into the structure of habit and positioning of awareness to detect and anesthetize the individual from anxiety/fear. Habit becomes entrenched, as repetition in the behavioural sense is not possible. The fear of each moment is lived and compounded by anticipation, or fear projected into the future. Development cannot occur, as self-awareness is lost. Theological work in the east, much earlier than the writings of Kierkegaard and Heidegger, interpreted through Buddhist precepts, rested on similar conclusion of the place of repetition. In the place of self-awareness the term mindfulness is employed.
The exception used to illuminate universal structures has also allowed a new understanding of the structures of the experience of the exception, in this case ASD. Understanding the existential structure of habit for those with ASD and the nature of anxiety/fear is of critical importance. Although the experience of anxiety is universal, in ASD it is experienced in a far higher proportion than in those without ASD, to the point of meeting criteria for disorder [16]. There as yet are no established understandings related to the causative biological mechanisms of ASD or the high degree the comorbid mental ill health [17]. In the absence of such understandings the value of the understandings generated in philosophy are immense. These understandings of the function of repetition in alleviating anxiety and the subsequent consequence of failure to adapt resulting in vicious cycles informs the target of needed intervention and gives a clue to the form of intervention. Intervention to support people with autism in managing anxiety and providing a scaffold that facilitates adaptive behaviour is indicated across the lifespan.
The function of habit in dulling the awareness of the demands of the world to adapt through novel approaches, and anesthetizing the individual from anxiety/fear have been revealed in the existential structures laid bare. Focus of the individual is on alleviation of fear, as opposed to their existence, representing the opposite of mindfulness. The fear in the present is compounded by fear generated through anticipation, or projected into the future. The need for increasing doses of anesthetic (seen as entrenchment of habit), leads to a vicious cycle. It would appear from the lack of identified peer review publications related to Kierkegaard's work Repetition and the link to ASD that this is a quarry of understanding related to autism that remains to be mined in understanding the function of behaviour that forms half of the diagnostic dyad.
No funding was received for this paper.
There are no identified conflicts of interest to declare.