Research in Nursing & Health, 2010, 33, 265271

A Modified Hermeneutic
Phenomenological Approach
Toward Individuals
Who Have Autism
Claire Newman,1* Andrew Cashin,2** Cheryl D. Waters3{

1
Faculty of Nursing Midwifery & Health, University of Technology Sydney and New South Wales Justice
Health, Professorial Unit, Suite 302 Level 2, Westfield Office Tower, 152 Bunnerong Rd, Eastgardens,
Sydney, New South Wales 2036, Australia
2
School of Health & Human Science, Southern Cross University, Lismore, Australia
3
Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Sydney, Australia
Accepted 23 March 2010

Abstract: Individuals with autism have a unique cognitive processing style

characterized by impaired abstraction, impaired theory of mind, and visual
as opposed to linguistic processing of information. A consequence of this
unique cognitive processing style is that traditional ways of hermeneutical
phenomenological examination may be inadequate to achieve the kind
of understanding of experience toward which this method is directed. In
order to stay true to Heideggers hermeneutic phenomenology, we needed to
develop modifications to this research methodology, which include the use of
visual aids to promote participant engagement and access the eidetic
memory of a participant with autism, so as to elicit concrete descriptors of
an experience. 2010 Wiley Periodicals, Inc. Res Nurs Health 33:265271, 2010

Keywords: hermeneutic phenomenology; autism; Martin Heidegger

Because individuals with autism have rarely
participated in qualitative research, there are
likely aspects of their experiences that remain
unexplored. A consequence of this is that an
opportunity may be lost to acquire the kind of
knowledge needed to tailor nursing practice to the
unique needs of these persons. Yet, in the unique
cognitive processing style of persons with autism
may lay the reason for their relative lack of
participation in qualitative studies. In this paper,
we consider the use of Heideggerian hermeneutic
phenomenology with individuals who have autism
and the modifications needed to traditional ways
of conducting this kind of research that would
better fit their cognitive processing style.
AN OVERVIEW OF AUTISM
Autism is a developmental disorder that affects
between 0.6% and 1.6% of the population world-
wide (Baron-Cohen et al. 2009; Centers for
Disease Control and Prevention, 2007; MacDer-
mott, Williams, Ridley, Glasson, & Wray, 2007).
Extensive research in the neurobiology of autism
has resulted in a number of prenatal and genetic

Correspondence to Claire Newman

No financial or other support was received for this paper.
*Research Nurse.
**Professor of Nursing.
{
Senior Lecturer.
Published online 7 May 2010 in Wiley InterScience
(www.interscience.wiley.com). DOI: 10.1002/nur.20382

2010 Wiley Periodicals, Inc.

266 RESEARCH IN NURSING & HEALTH
conditions being suggested as causes for autism
(Baird, Cass, & Slonims, 2003). Yet, with no
definitive cause known for autism and in the
absence of biological markers, diagnosis is based
on behavioral characteristics (Huws & Jones,
2008). Autism is characterized by impairments in
the areas of communication, social skills, and
behavioral flexibility, also known as the triad of
impairment (Gillberg, 1998).
Current diagnostic criteria, as presented in
the Diagnostic and Statistical Manual of Mental
Diseases of the American Psychiatric Association
(1994), list three diagnostic entities that constitute
autism: Autistic Disorder, Aspergers Disorder,
and Pervasive Developmental Disorder not other-
wise specified (PDDnos). PDDnos has been
differentiated from the other two diagnostic
entities as the triad of impairment is evident at
the sub-threshold level. Arguably there are no
characteristics that differentiate Autistic from
Aspergers Disorder. To meet the criteria of
Aspergers Disorder, intelligence must be average
or above or the person must have developed
speech in a chronologically expected manner. A
conundrum exists for clinicians and the public
that, if the criteria for Autistic Disorder are met,
then this is to be the diagnosis (American
Psychiatric Association). It has become apparent
with the increased recognition that autism may or
may not co-exist with intellectual disability in the
last decade, that in fact, if the DSM criteria
are adhered to, a diagnosis of Aspergers Disorder
is not possible (Cashin, 2006). Removal of the
diagnostic classification of Aspergers Disorder
from future editions of the DSM is the only
logical step. At this time acknowledgement of the
conundrum is necessary in any publication related
to autism.
Contemporary understanding of the behavioral
manifestations of autism and resultant diagnostic
constructs is based on the work of pioneers in
the field, including Leo Kanner (18941981),
a Baltimore psychiatrist, and Hans Asperger
(19061980), a Viennese pediatrician. In
recent years, the focus has shifted from the
behavioral manifestations of autism to the origin
of the impairments associated with a unique
cognitive processing style (Dodd, 2005). This
cognitive processing style is characterized by
impaired abstraction, impaired theory of mind,
and visual as opposed to linguistic processing of
information (Cashin, 2005). Individuals with
autism have an inability to form a unified centrally
coherent base of knowledge about the world
through constructionist learning and have a
marked deficit in empathy (Cashin, 2005). For
Research in Nursing & Health
the researcher intending to conduct qualitative
research with individuals who have autism,
consideration needs to be given to the impact of
this unique cognitive processing style on research
methods employed.
AUTISTIC PERSONS AND
RESEARCH PARTICIPATION
Due to the variable nature of the degree of
impairments that characterize autism and the
possibility of a co-existing intellectual disability,
some individuals with autism may be unable to
understand the purpose of a research study and to
offer insights into their experiences (Barnbaum,
2008). In the absence of a co-existing intellectual
disability and with consideration of the cognitive
processing style of those with autism, however,
there is no reason why individuals with autism
cannot make the informed choice to consent to
participate in a research study, to articulate their
experiences, and to share their perspective on the
topic being studied. This has been demonstrated
in the few qualitative studies conducted with
individuals with autism. For example, Muller,
Schuler, and Yates (2008) recruited and inter-
viewed 18 adults with Aspergers Disorder or
high-functioning autism to describe their experi-
ences of navigating their social worlds. A further
example of qualitative research involving indi-
viduals with autism is the study conducted by
Hurlbutt and Chalmers (2002), who examined
the life experiences of three adults with high-
functioning autism through analysis of partici-
pants narratives in interview transcripts and
material written by the participants.
Individuals with autism hold the key to provid-
ing others with insight or an understanding into
their experiences as demonstrated by individual
accounts such as those from the renowned Temple
Grandin (Grandin & Georget, 2000) who was
able to articulate her personal experiences of
living with autism. A research methodology that is
focused on examining human experiences as
they are lived, such as phenomenology, may add
another dimension to build on these individual
accounts.
WHAT IS PHENOMENOLOGY?
For Martin Heidegger (18891976), the focus of
phenomenology was ontological; it concerned
understanding the situated meaning of a human
in the world (Annells, 1996; Dreyfus, 1991).
 HERMENEUTIC PHENOMENOLOGY AND AUTISM / NEWMAN, CASHIN, AND WATERS
Heidegger was influenced by the work of Wilhelm
Dilthey (18331911), from his view of experience
existing before subject and object, created
the ontological dimensions of hermeneutic
philosophy (Geanellos, 1998). Hermeneutics was
originally a method for the study of sacred and
biblical texts. The word hermeneutics is of Greek
origin, derived from the Greek God Hermes who
was responsible for making clear, or interpreting,
messages between the Gods; roughly translated, it
means to interpret (Lopez & Willis, 2004, approaches that are congruent with and operation-
p.728). The aim of interpretation is to bring to
light, or to make clear, that which is hidden or
fragmented (Geanellos). Heidegger referred to
phenomenology as an interpretative conceptual
and methodological approach to the understand-
ing of a persons experience of existing (Mackey,
2005). Hermeneutic phenomenology therefore
involves bringing to light the lived experience
through the interpretation of meaning acquired in
text created from the narratives of those being
studied.
Central to Heideggers thinking was that a
person is situated in the world without an element
of choice, or thrownness (Heidegger, 1927/ were discovering a different way of being human,
1962, p. 135), as one is born into a given culture,
language, and values. The person is therefore
understood as being-in-the-world (Heidegger, severe social deficits and unusual behaviors. At the
1927/1962, p. 53), meaning that a researcher can
interpret or understand the experiences of a
participant only within a given situational and
historical context. Heidegger (1927/1962) stated
that interpretation will be founded essentially
upon fore-having, fore-sight, and fore-conception.
An interpretation is never a presuppositionless
apprehending of something presented to us
(p. 150). Ultimately, this means that researchers
are required to identify from their own world their
prior knowledge, including past experiences, that
make interpretation possible (fore-having), and
their socio-cultural background that carries with it
both the viewpoint from which an interpretation
is made (fore-sight) and also the expectation
of what might be found in an investigation (fore-
conception; Wojnar & Swanson, 2007).
Furthermore, there is an epistemological
assumption underlying hermeneutic phenomeno-
logy that language is integral to understanding
experience. As Gadamer (1960/1989) observed,
language is the universal medium in which
understanding occurs. Understanding occurs in
interpreting (p. 389). This linguistic process
existing in people is the way of being-in-the-world
that Heidegger (1971/1975, p. 189) was thinking
about when he stated that: Man [sic] is said to
have language by nature. It is held that man, in
Research in Nursing & Health
267
distinction from plant and animal, is the living
being capable of speech. . . .It is as one who speaks
that man-is-man. Holroyd (2007) noted too that
people develop meanings of their experiences
primarily through language.
Fidelity to the philosophy of hermeneutic
phenomenology is made difficult by the absence
of a given method for conducting hermeneutic
phenomenological research. The researcher
is therefore required to use methodological
alize the philosophical underpinnings of herme-
neutic phenomenology. What follows is how
hermeneutic phenomenology may be used to
examine the lived experiences of those with
autism.
CONDUCTING A
PHENOMENOLOGICAL STUDY
WITH PERSONS WITH AUTISM
While Heidegger was asserting that to be human is
to be linguistic, Leo Kanner and Hans Asperger
that is, of being-in-the-world. In a seminal paper,
Kanner (1943) described children who displayed
same time, Asperger (1944) was submitting his
thesis on Autistic Psychopathy in Childhood, in
which he described a set of characteristics present
in children that were deemed abnormal. These
children experienced being human in a way
different from the human experience Heidegger
described, or what Gray and Attwood (1999)
referred to as not neurotypical. Humans process
information, including information relating to
how they experience phenomena, primarily in
two ways: neurotypically (i.e., those without
autism) or non-neurotypically (i.e., those with
autism).
Like other individuals who do not have autism,
the researcher will process thought and informa-
tion neurotypically through the use of a linguistic
process. Neurotypical individuals have the
capacity to abstract information that is stored
using a linguistic code in a manner that creates a
unified base of knowledge about the world
(Cashin, 2005). Neurotypical individuals are
therefore able to construct meaning of their
experiences by retrieving and expanding on
previously stored knowledge.
Individuals with autism, however, have a
cognitive processing style that is not neurotypical
and therefore potentially at odds with the episte-
mological assumption underlying hermeneutic
268 RESEARCH IN NURSING & HEALTH
phenomenology that language is integral to
understanding experience. For persons with
autism, information is processed visually, as
opposed to linguistically. Thoughts about the
world, or about experiences, are stored chronolo-
gically as discrete chunks of visually coded
information, as opposed to linguistically coded
and stored with similar concepts or experiences
(Cashin, 2005). Neurologist Oliver Sacks (1986)
captured this unique cognitive processing style
when he wrote about twins with autism who had a
savant gift with numbers. As he observed:
If you ask them how they can hold so much
in their mindsa three-hundred-figure
digit, or the trillion events of four decades
they say, very simply, we see it. And
seeingvisualizingof extraordinary p. 67), is required of the researcher and must be
intensity, limitless range, and perfect fide-
lity, seems to be the key to this. (p. 199)
The impaired abstraction ability, and sub-
sequent concrete thinking of those with autism,
calls into question how and even whether such
individuals can engage with the researcher to
make meaning of their lived experiences;
the objective of hermeneutic phenomenology.
We found two reports of studies designated as
phenomenological involving participants with
autism. In the first study, Humphrey and Lewis
(2008) used interpretative phenomenological
analysis (p. 23) of narratives generated from
semi-structured interviews with students with
Aspergers Disorder to understand how they
viewed and experienced secondary school. There
was no discussion, however, of whether the lack of
abstraction ability characteristic of Aspergers
Disorder impeded the students ability to confirm
that the interpretations made were reflective of
their experiences. In the second study, Huws and
Jones (2008) also used interpretative phenom-
enological analysis (p. 99) to understand the
perceptions of their diagnosis of nine college
students between 16- and 21-year old with high-
functioning autism. Although the researchers
considered the influence of their own thinking
and understanding, and showed recognition of
participants contextual and cultural background,
they too did not directly address issues relating to
the cognitive style of the participants.
Neurotypical individuals interpret their world
through language. The neurotypical mind recalls
memories and past experiences using thought that
consists of words, which are then expressed,
or externalized, through language. As Heidegger
(1971/1975) observed, as soon as man [sic] looks
thoughtfully about himself at what is, he quickly
Research in Nursing & Health
hits upon language too, so as to define it by
standard reference to its overt aspects (p. 189). If
individuals with autism do not experience
memories linguistically and if externalizing their
thoughts and feelings through spoken words is not
a natural process for them, it is uncertain whether
their lived experiences can be examined via a
hermeneutic phenomenological approach: that is,
whether they can express their experiences to the
researcher who in turn is required to language
them.
The researchers historically situated thinking
(fore-having; Heidegger, 1927/1962, p. 150)
has led them to seek access to an experience
pertaining to that individual. This concentrated
attention, or willing (Heidegger, 1971/1975,
shared with the participant in order for the
meaning attributed to the experience in question
to be brought to light. Heidegger (1971/1975)
stated:
He [sic] who truly knows what is, knows
what he wills to do in the midst of what is.
. . .knowing that remains a willing, and a
willing that remains a knowing, is the
existing human beings entrance into and
compliance with the unconcealedness of
Being. (p. 67)
For neurotypical individuals, this shared will-
ing, or jointly focused attention by the researcher
and participant on an experience, may be achieved
through basic rapport building and agreement to
focus subsequent discussion on the experience in
question. Yet, this willing may be more difficult to
achieve because of the non-neurotypical cognitive
processing style characteristic of autism. In order
for a shared willing between a researcher and
participant with autism to be achieved, researchers
will need to ensure that the language they use
when talking to participants promotes clarity
about the process, as this is essential for under-
standing to be achieved that is faithful to
experience. An individual with autism is more
likely to achieve clarity if superfluous words and
jargon are excluded from speech. The use of visual
aids, something that can visually represent some-
thing such as photographs or drawings, is likely to
be useful here.
One visual aid particularly suited to achieving a
shared willing is a comic strip conversation.
Created by Gray (1994) as an aid to teach
conversation skills to students with autism, comic
strip conversations provide a visual representation
of a conversation in the form of simple
drawings. For example, a researcher meets with
 HERMENEUTIC PHENOMENOLOGY AND AUTISM / NEWMAN, CASHIN, AND WATERS
an imprisoned individual who has autism to
examine how that individual experiences incar-
ceration. A suitable comic strip conversation in
this instance may show someone outside a prison
looking in on a figure with the thought bubble I
have autism while the figure outside of the prison
has the thought bubble I wonder what it is like to
have autism and be in prison. The comic strip
visually represents that toward which the
researcher wants participants to will their atten-
tion, that is, their experience of having autism and
being incarcerated. Following the achievement
of a shared willingness, the challenge for the
researcher is to elicit from participants their
expression of the experience.
In order to elicit non-neurotypical participants
expressions of an experience, the researcher is
required to adopt an approach different from that
used with neurotypical individuals. In conducting
hermeneutic phenomenology with neurotypical
participants, the researcher has to drill down
beyond individual interpretation to get to the
primordial interpretation, or telling, which is more
complete, in-depth, and unified (Dreyfus, 1991).
Individual interpretation is when a being, through
thematic assertions, uses words/speech to point
things out in a shared situation: that is, to tell of
something jointly, to show to one another what that
which is claimed in the speaking says in the
speaking, and what it, of itself, brings to light
(Heidegger, 1959/1971, p. 122). This form of
interpretative language is used within a context to
point out characteristics of an entity, or experi-
ence, within a shared world to another being. At
the stage of pointing out, language becomes
impoverished; that is, words in our language
(are) mostly (used) in a disparaging sense
(Heidegger, 1959/1971, p. 123). Words lose their
original meanings and the beings intentional
states reflect conscious subjects relating to objects
through disclosure of their beliefs, desires, and
perceptions (Dreyfus). This stage therefore does
not enable primordial understanding as, according
to Heidegger (1927/1962):
We do not so much understand the entities
which are talked about; we already are
listening only to what is said-in-the-talk as
such. What is said-in-the-talk gets under-
stood; but what the talk is about is under-
stood only approximately and superficially.
(p. 212)
This stage, however, presupposes a more
fundamental way of being-in-the-world that
cannot be understood in subject/object terms
(Dreyfus, 1991, p. 5); it is the pointing out of the
Research in Nursing & Health
269
pointable and the saying of the sayable that
enables primordial telling to become concrete as
linguistic telling (Dreyfus).
In investigating the lived experience, a
researcher may elicit such linguistic telling
through guiding the participant to communicate
through language concrete examples of the
experience in question. Once stimulated, the
concrete telling of the experience for people with
autism will often be free from the individuals
personal interpretation. Sacks (1986) highlighted
this interpretation-free recall of memory in his
description of how his patients with autism
recalled memories. As he noted:
One is dealing with memories that seem of a
documentary kind, in which there is no
personal reference, no personal relation, no
living center whatever. . . .It might be said
that personal involvement, emotion, has
been edited out of these memories. (p. 198)
Sacks described this as characteristic of eidetic
memory. To be able to tap into documented
memories will reveal the experience as lived, as
opposed to the neurotypical individual interpreta-
tion of the experience represented through
impoverished language or as appropriated
through language using Heideggers nomen-
clature: human is indeed in its nature given to
speech. . .being human has been brought into its
own by language, so that it remains given over
or appropriated to the nature of language
(Heidegger, 1971/1975, p. 208). This is suggestive
that the researcher may well need to be less
rigorous in the drilling down beyond individual
interpretation (the participants interpretation
expressed through impoverished language) as the
telling will consist of concrete descriptors, or
chunk recall of the experience. Stimulation of the
telling, or eliciting the chunk recall, becomes the
challenge as opposed to drilling beyond the in-
dividual interpretation to get to concrete examples.
Individuals with autism tend to process infor-
mation visually, as opposed to linguistically.
Despite this, language remains a medium for
which things manifest as the way in which telling
gets expressed is language (Heidegger, 1927/
1962, p. 204). Individuals with autism will be less
able to express through language their interpreta-
tion of an experience, as this would require a level
of abstraction ability. Researchers can, however,
elicit a concrete telling. To stimulate such a
telling, the researcher would seek to go straight to
obtaining concrete examples of the experience.
These concrete tellings manifest in chunk form,
require little or no abstraction ability from the
270 RESEARCH IN NURSING & HEALTH
participant, and therefore are especially suitable
for the non-neurotypical cognitive processing
style of individuals with autism.
Linguistic expression of concrete tellings is
assisted through the use of visual cues. The use of
visual cues in the education of people with autism
is well established as a method to augment
instruction and promote understanding (Scott,
Clark, & Brady, 2000). Such visual cues may
include keeping a diary or drawing pictures of
experiences. Grounding questions (questions
focused on externalizing the experience giving it
a concrete entity) may be required to focus the
participants attention on a particular experience.
The aim of the researcher is not to interpret a
drawing of an experience; it is the act of drawing
the experience and seeing their interpretation of
their experiences in their drawings that can tap into
eidetic memory, as Sacks (1986) showed in his
example of the twins. The researcher offers
guidance by asking participants for their (verbal)
description of what they have drawn.
To return to the example used previously of a
researcher examining the experience of incarcera-
tion for an individual with autism, the researcher
will begin by asking participants to tell what being
in prison yesterday was like. If participants are
verbally unable to respond to this question, the
researcher will offer them an opportunity to draw
different things that happened to them yesterday.
Generic photos relating to aspects of their daily
routine, such as a photo of a prison guard or inmate
in the same prison uniform as their own, may cue
participants eidetic memory from which they
will be able to draw to express experience. The
researcher may then ask participants to verbally
describe what they have drawn. Visual images of
an experience turn the abstract concept of the past
into something concrete that individuals with
autism can talk about thereby creating concrete
tellings. These concrete tellings will enable the
researcher to develop a primordial understanding
of participants way of being-in-the-world.
CONCLUSION
In healthcare research, knowledge of patients
lived experiences will favorably influence service
provision and development. For those with autism,
this knowledge has been limited to accounts by a
few highly articulate individuals. Hermeneutic
phenomenology as a research methodology ena-
bles the examination of the lived experience and
has the potential to add another dimension to build
on these individual accounts. Hermeneutic phe-
Research in Nursing & Health
nomenology enables the examination of the lived
experience through a circular interpretative proc-
ess involving the narratives of those being studied.
The narratives of individuals who do not
have autism typically reflect linguistic thought
processing and contain abstracted and constructed
meanings about experiences expressed through
self-interpretative language. The researcher of
the phenomena will seek to drill down beyond
such individual interpretation in order to get to a
more complete and in-depth primordial telling
that is expressed by informants in concrete
examples of the experience. Language is
therefore integral to understanding in hermeneutic
phenomenology.
Individuals with autism, however, process
information visually as opposed to linguistically
and thinking is concrete. On first glance, this style
appears epistemologically incongruent with the
cognitive processing style required to participate
in phenomenological studies. The lack of abstrac-
tion and the chunk style processing may, however,
when cued from the researcher, lead to less
evaluated/impoverished chunks of recall related
to lived experience. This may be the thing itself
of which Heidegger (1927/1962, p. 49) wrote. The
challenge of digging becomes one of eliciting.
The goal becomes accessibility, as opposed to
impoverishment.
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