Infantilisation in Care, Community & Cognitive Disability

My Master of Research thesis is now available to read and download via the Cork Open Research Archive (CORA), at this link:

Here I’m sharing the introduction to the thesis, which sets out what it aims to do (a concept and theory of infantilisation) and how it goes about it (conceptual analysis, empirical data, testimony of infantilized adults).

For reading time: the introduction copied here is about 1600 words (roughly three or four A4 pages). The full thesis is 25,000 words (around 90 pages, including references).

Follow the link to the full document if you want any of the references mentioned in the introduction.

Big thanks to Don Ross at UCC for supervision, and to Robert Wilson and Kian Mintz-Woo for the assessment (and extremely constructive feedback).

Infantilisation in Care, Community & Cognitive Disability : Introduction

This thesis presents a concept and theory of infantilisation, which can be summarized as follows: Infantilisation involves conceiving of an adult as having the subjectivity or personhood of a child and treating them on that basis. This treatment has four distinguishing features: ‘baby talk’, infantilizing activities and environments, desexualisation, and stasis. Infantilised adults are presumed to have some level of cognitive impairment, denied personal autonomy, and experience limits on their liberty and mobility. These treatments stem from and are motivated by the conceptual root of infantilisation.

This project was undertaken in response to a gap in the philosophical literature. My original intention – to examine whether infantilisation is a form of dehumanization – had to be modified when I found that no existing concept or philosophical theory of infantilisation was available. The term ‘infantilisation’ has occasionally been used descriptively but otherwise left largely unexamined within philosophy. In other disciplines, where it has sporadically been the subject of some research for fifty years, the term has been used to refer primarily to linguistic phenomena (namely, ‘baby talk’), although more recent work has uncovered a network of non-linguistic treatments and structures which are now seen as part of infantilisation (Dolinsky, 1984; Hepworth, 1996; Cassidy, 1997; Salari, 2006; Brady, et al., 2014; Capri & Swartz, 2017; Jongsma & Schweda, 2018). Additionally, research on attitudes towards disabled and elderly people has brought out the conceptual background to infantilisation (Dorozenko, et al., 2015; Robey, et al., 2006; Nario‐ Redmond, et al., 2019). Still, infantilisation has so far primarily been discussed and studied as a way of treating people. Its conceptual foundations have been essentially unexplored.  

I dedicate Chapter 1 of this thesis to these conceptual foundations, focusing on how people are conceived of when they are infantilized. I argue that they are conceived of as being children in the bodies of adults: as adult bodies with the subjectivities or personhood of children. Understanding this conceptual basis is crucial in understanding the treatments which stem from it. It is also crucial in separating infantilisation from paternalism, especially as infantilisation seems to occur most often in situations where some level of paternalism may be appropriate. I argue that infantilisation is conceptually distinct from paternalism, and that clarity on this is necessary if the ensuing treatments are to be properly understood. The concept ‘child’ cannot be applied to an adult without conflict.

In Chapter 2 I develop a theory of infantilisation. I show how infantilisation is enacted. To do this, I draw on research from multiple disciplines and geographical regions. I use this research to show four distinguishing features of infantilisation: ‘baby talk’, infantilizing activities and environments, desexualisation, and stasis. These features result directly from the conceptual foundation of infantilisation just outlined, they are not found even in cases of severe paternalism, and they reflect the conflict which occurs when the concept ‘child’ is applied to an adult. Methodologically, it is important to note the following two points:

  • In developing a concept and theory of infantilisation, I have not imagined what it might consist in and then looked for evidence to support my claims. The concept and theory are developed from empirical research, the self-advocacy of infantilized adults, informal conversations with people affected, and personal experience. I have not attempted to invent a concept and theory and then apply it to the real world; I have observed a problem with how people are thought of and treated and aimed to both clarify the conceptual foundation of the problem and provide a theory with accurate explanatory potential. The four features which I propose are distinct to infantilisation were found in the empirical research. In using these features to build a theory of infantilisation, and clarifying the conceptual root from which they stem, I have aimed to provide definition for a distinct phenomenon which I believe requires dedicated attention and intervention.
  • In reviewing empirical research on infantilisation, I included any material which was available. I aimed to attain the broadest possible picture of the term in theoretical and practical use. This has included research in multiple disciplines and from multiple geographical regions (although I have been restricted to English language publications). In collating research from different regions and contexts, it has not been my intention to flatten or disregard cultural or geographical differences between them, but rather to include the widest possible range in a project of limited scale. Of course, differences in the practice and conceptual strength of infantilisation vary in different contexts, and these differences require further study. Given the range of contexts examined, however, it is notable that the four distinguishing features of infantilisation were vividly consistent throughout. That is why they are foundational to this theory.

It should be noted that my definition of infantilisation excludes some instances where the term has previously been applied. First, I am not concerned with self-infantilisation or performative infantilisation. Second, in Chapter 1, I note instances sometimes referred to as infantilisation: the treatment of women in some patriarchal contexts, and the treatment of some colonized populations and racialized groups by colonial powers and/or white supremacist authorities. I show that these cases are not, by my definition, examples of infantilisation. In order to pick out the specific wrongs and harms of a phenomenon, that phenomenon requires definition. The concept and theory I propose in this thesis is intended to accurately identify instances where adults are conceptually infantilized and point to the specific pattern of harms which stem from this concept. It is therefore necessarily more narrowly defined than the word ‘infantilisation’ is in general use.

As noted, this is especially urgent as infantilisation seems to occur most often where people have additional support needs and in instances where some level of paternalism may be appropriate. With infantilisation, it is presumed that the target has some level of cognitive impairment or is cognitively disabled. With paternalism also, it is assumed that the target is, to some degree, cognitively incapable of making sensible decisions in their own best interest. Yet an adult can be assisted with decision making and day-to-day living needs without their being conceived of as a child. The infantilized adult is considered not only cognitively impaired in some specific respect; their subjectivity or personhood is understood globally as that of a child. In this thesis, I consider somewhat separately the infantilisation of elderly and physically disabled people (those with no marked cognitive impairment) and the infantilisation of cognitively disabled adults. I do this because I believe a common response to my argument will be that infantilisation is clearly wrong in the former case, but appropriate and justifiable in the latter. Therefore, I provide a brief history of mental age theory and demonstrate the sociohistorical contingency of diagnoses and psychological testing. I do not, however, argue that there are special reasons why cognitively disabled people should not be infantilized. They should not be infantilized for the same reasons that apply with everyone else: because infantilisation is demonstrably harmful to the health and well-being of the affected adult, disregards their life narrative, and erases their actual subjectivity.

It is necessary to specifically address the infantilisation of cognitively disabled adults in this thesis, but it is not my intention to present cognitively disabled people as a qualified exception or marginal case. I do not use the term ‘cognitively disabled’ as an ontological sortal. I use it to refer to people who have been classified as cognitively, intellectually, or developmentally impaired or disabled, fully acknowledging that these classifications are historically and socially contingent and linguistically problematic. Likewise, and in counterpoint, I use the term ‘statistically typical cognitive functioning’ to refer to people who are not classified as cognitively disabled; fully recognizing that population statistics on intelligence and cognitive ability are historically bonded to eugenics and continue to be skewed by racialized discrimination and geographical privilege. The terms ‘cognitively disabled’ and ‘statistically typical cognitive functioning’ act as contingent (and no doubt imperfect) designators for how different people are classified according to perceived or actual cognitive functioning. Where adults are infantilized, they are assumed to have not only the cognitive capacities of children, but to actually be children in the bodies of adults. I argue that this assumption is rooted in discriminatory biases about disability and old age, not on unbiased, ahistorical or apolitical judgements about the actual cognitive abilities of the adult in question. Even if an objector were to argue that infantilisation is appropriate and justified with cognitively disabled people (but wrongful with those not so classified), that objector would need a clean, precise, a-contextual definition of what it means to be cognitively disabled. I am skeptical that any such definition could be produced.

Nonetheless, my short definition of infantilisation – conceiving of an adult as having the subjectivity or personhood of a child and treating them on that basis – is intentionally normatively neutral. This is a methodological choice intended to leave space for others to engage with this theory without its being normatively pre-determined. For my part, however, I argue that infantilisation is both conceptually wrongful and demonstrably harmful, and as such, should be urgently avoided. In Chapter 3, I examine this wrongfulness and harmfulness in detail, and assess where blame, if any, might lie. I propose a graded approach to blame, with strong epistemic conditions, which centers the infantilized adults who are wronged and harmed by infantilisation while maintaining a pointed consideration of the difficult and unjust working conditions of many carers. I conclude that the infantilisation of adults – cognitively disabled or not – is both a social injustice and a conceptual failure.