I was recently invited to provide a guest blog post to the Cortical Chauvinism blog where I outlined some of my concerns with Silberman’s Neurotribes. It gives brief overview of some of the concerns which I have written about in various publications. Here is the link.
Back in April I presented alongside Rachel Cooper at an event set up by Accrington and Rossendale College. I wrote this blog post for the Lancaster University Bioethics and Philosophy of Medicine Blog but I thought I would reproduce it here since I mainly spoke about the History of Autism. Details on Rachel’s talk can be found on the Blog post.
My talk was entitled Lessons for today from the history of autism. The first half of my presentation was largely a re-cap of my previous criticism of Neurotribes (https://www.sciencedirect.com/science/article/pii/S1369848616300954). In this book Silberman (2015) argues Leo Kanner’s original description of autism (1943) was of a disorder that was “vanishingly rare” and “monolithic by definition”. Silberman argues that Kanner’s ‘autism’ was quite unlike the condition described as autism today. He claims that modern notions of autism have a significantly better scientific foundation and are much more suitable for neurodiversity than Kanner’s approach was.
However, in this paper I argued that when properly understood Kanner’s autism is much more like the autism that is described today than Silberman acknowledges. I argue that it is crucial to appreciate that Kanner considered autism to be a subtype of childhood schizophrenia (Kanner 1969). I argue Kanner thought it was only vanishingly rare in the sense of it being a rare subtype of the fairly common childhood schizophrenia. I accept that Kanner’s autism did have quite restrictive symptoms (even if it was not monolithic) but I situated it as being a subtype of a much less monolithic childhood schizophrenia which shared many symptoms of Kanner’s autism but did not require the stringent diagnostic criteria. Silberman claims that adherence to Kanner’s views prevented the full autistic spectrum being recognised for many decades but, if you consider Kanner’s views on childhood schizophrenia, it looks like Kanner endorses a position quite like a spectrum.
In the second half of my presentation I discuss some of my more recent research. I outlined Lauretta Bender’s (1956) approach to childhood schizophrenia and considered how elements of her approach fit modern psychiatric evidence surprisingly well. Additionally, they could be used to formulate alternative approaches to neurodiversity, one based around meaningful subtypes with nuanced inter-relationships between them, rather than an account of neurodiversity based around the DSM-5 spectrum which lacks subtypes.
As far as I was aware, none of the audience were professional historians or philosophers. I found it positive to deliver my work to a wider audience, getting the findings of my research out to a wider audience. Some of that audience were mental health professionals or training to become mental health professionals, thus some are or would be interacting with autistic people regularly in their line of work. As a historian and philosopher my work often can be a bit removed from actual practise, thus it was good to be speaking to and opening dialogue with individuals who have much practical hands on experience of working with autistic individuals. The audience were engaged and asked interesting questions. These included questions about alternative ways of thinking about diagnosis, what the value of diagnosis was, how to keep in focus the aspects of the individual not covered by the diagnosis and even if diagnoses were needed at all. I think these are all important questions and it was good to see questions about them. Overall, I feel that academics often do not engage sufficiently with the world outside academia. It was very encouraging to attend a talk which was so well attended by an audience who asked engaging questions so I feel the whole process was very much a worthwhile experience.
A new article by Dan Olmsted and Mark Blaxill has just been published which partly responds to my own article. They intend their article as an objection to my claims but I believe it broadly supports what I say.
I argued Leo Kanner conceptualised an initial idea of autism after reading Louise Despert’s 1938 article. Her article effectively is a bridge between 1930s notions of childhood schizophrenia and Kanner’s 1943 notion of autism. 1930s childhood schizophrenia made a set of claims, Despert’s 1938 paper partly modified them in ways which was quite close to Kanner’s 1943 autism and then Kanner made further modification to conceptualise his notion of autism. As I said in my article, Kanner built on Despert. Olmsted and Blaxill’s article has very helpfully found in the archives some letters written between Despert and Kanner. Written in 1943, just after Kanner’s publication on autism, Despert praises Kanner’s paper but objects to his claim to have discovered something new. She appears to think she has already described something like autism. Kanner, in a letter sent a few days later, praises Despert’s work but argues his own paper contains an important additional claim – the children showed the symptoms from birth, whereas Despert’s children only showed some symptoms from birth. As I wrote, Kanner’s “innovation was realising that actually no onset took place, all symptoms were presentfrom birth. Generally, it was believed all symptoms of all childhood schizophrenia occurred after a period of normality, but then Despert claimed some childhood schizophrenics had some symptoms present from birth, and finally Kanner claimed some childhood schizophrenics had all symptoms present from birth, renaming those childhood schizophrenics as autistic.” (2275-2276).
At this point we need ask, what does it mean to describe something first? Kanner’s autism has also undergone major modifications by later psychiatrists, so in a sense you could say that Lorna Wing really discovered autism, since her notion seems closest to our own (but then Wing’s notion has undergone minor modification). This is why I concluded by saying “Who wrote the original account of autism? This is not a helpful question. Kanner and other child psychiatrists worked within scientific communities, engaging in a mutual process of borrowing and expanding ideas” (2276). I think the archival material Olmsted and Blaxill have produced nicely show this borrowing and expanding process, a process that does not easily fit notions of “who first described something”.
I have just finished a major update to Kanner’s bibliography:
Kanner’s In Defense of Mothers arrived last week, having been ordered from America. It was published in 1941, two years before he developed his notion of autism. This books is very different in focus to most his writings, unusually being primarily about children who did not see psychiatrists.
The message is primarily ‘let children be children’, and to a lesser degree ‘let mothers be mothers’. He seemingly has a notion of natural mothering and believes this is distorted through bad advice given by various sources of supposed experts on mothering. He tells mothers not to insist on rigid diets, not to overburden the children with work, not to interfere dramatically in the child’s social life (i.e not decide who their friends can be), trying to counter various cultural sources who insist the mother must perfectly raise children lest the child ends up neurotic and delinquent. He thinks society should just let mothers be mothers, which would mean mothers would let children be children, a good route to healthy children in Kanner’s view.
There was very little about psychoanalysis in the book. The specific claim that poor mothering causes mental illness (such as childhood schizophrenia) was not really discussed (there were some ambiguous passages related to this but much more moderate than what came later). Whilst such claims really took off around 1950, it seems they were of little significance in the early 1940s.
The guiding principle throughout the book was ‘put the child in context’. If the child does something bizarre then there probably is good reason for this, talk to the child, try to understand what is happening with their life, but do not take this as a sign of some ominous symptom that must be immediately countered. This looks like Kanner taking a Meyerian approach, emphasising the individual as a whole who must be understood contextually, rather than more common approaches of just interpreting everything under one pet theory, something some child psychaitrists did and Kanner hated.
It was interesting to see Kanner would often describe the family in political terms, outlining a democracy as an ideal family where the child was an active member who was listened to. This contrasted with totalitarian families where the exact path the child must take was laid out in advance by the parents. Written in 1941, using such political terminology was understandable.
Overall, I’d put In Defense of Mothers as Kanner’s least valuable book to read, measured by all those published since he became a child psychiatrist. It does not particularly illuminate Kanner’s views, at least not more so than his 1935 text book, which goes into much more detail. It does give some nice social history though, giving a good feel for early 1940s American approaches to childhood.