Autism: A Social and Medical History

Citation

Petri, G. (2016), "Autism: A Social and Medical History", Tizard Learning Disability Review, Vol. 21 No. 4, pp. 228-230. https://doi.org/10.1108/TLDR-01-2016-0005

Autism: A Social and Medical History is a chronological overview of the history of autism spectrum conditions, mostly from social and medical perspectives. Although many other books have attempted to present readers with “a history” of autism, Waltz’s book stands out in a number of ways. It is richly referenced but uses an accessible language, and its concise size makes it ideal for those interested in the topic but not willing to start longer volumes. Also, books on autism often focus on therapies, interventions or they claim to give us a new and “evidence-based” perspective, using the disciplines of psychology, psychiatry or neurology. Most of these books put societal issues on the margin. Mitzi Waltz’s book is different: it locates autism in a socio-cultural context and attempts to develop a narrative that treats diagnostic changes, medical categories and trends in services provision as integrally related to this wider context.

The book starts with the story of Ralph Sedgwick, a two-and-a-half-year-old boy, whose family brought him to Great Ormond Street Hospital in London, in 1877.The story of Ralph is not only captivatingly interesting, but also true: the details were obtained from the Hospital’s archives. This chapter catches the reader’s attention with colourful details about the Victorian age and how working class families lived in London. We get information about the wards of the hospital as well as available treatments, medical notes and the staff.

Chapter 2 is the start of the chronological presentation: it takes us through the eras prior to and after the enlightenment. We learn about how disease and impairment were seen in ancient Greek and Roman societies. Religious notions of illness are presented along with relevant notes from available sources: Christianity, Islam and Judaism are all referred to here. The stories of “changelings” featured in literature, for example, in tales by the Brothers Grimm, are put into the context of medieval societies. Waltz discusses pre-industrial notions of disability and madness, based on authors like twentieth century philosopher Michel Foucault and enlightenment thinker Jean-Marc Gaspard Itard.

In Chapter 3 we read about the rise of psychiatry but we get more details than just pure data on the history of a medical profession. Waltz manages to connect the spread of asylums and other forms of early institutions to the changes in production in nineteenth century societies. The evolving industrial capitalism required a larger workforce, while technological advancement resulted in urbanisation and changes in trade and food production alike – and all these impacted families’ lives seriously. This important detail – the power of wider societal and economic issues over disabled people’s lives – is often missing from autism studies, and it is this book’s real merit to bring this issue back to the discussion.

The following two chapters are particularly interesting for clinical practitioners. The groundbreaking work of Leo Kanner is discussed in detail, and the author gives a critical analysis of Kanner’s case studies. Kanner’s clinical case studies were taken at face value for decades by influential experts in the field of autism, but the book presents us with literary theories that shed light on weaknesses in Kanner’s work. These thought-provoking chapters feature Waltz’s ability to remain critical even when approaching fundamental works in the history of autism. Autism was not only established as a medical diagnosis, but was also socially constructed. The social construction of the diagnostic label had an important impact on the lived realities of families, for example, through the parent-blaming that was prevalent for decades: “refrigerator mothers” were believed to be the cause of their child’s autism (Chapter 5). The roots of twentieth century scientific mother-blaming are found in the Victorian era which shows how outdated views of previous periods are often recycled by societies, including by professionals and academics throughout history.

Chapter 6 on “bedlam and behaviourism” – similarly to Chapter 1 – begins with a detailed case study: Jimmy Jones, a severely disabled man living in the Ely Hospital in the USA in the 1960s, is a composite of different real-life cases. Details of Jimmy’s life are not surprising to those who know institutional culture, but may astonish readers who have never seen such a place. Later in this chapter Ivar Lovaas’s work using ABA, Eric Schopler and the TEACCH methods are presented. Waltz uses rich literature and interviews to add colour to this chapter. The reader feels that insightful bits of information are given about the early works and backgrounds of well-known researchers, for example, when Gary Mesibov is quoted: “With Eric [Schopler] and [Ivar] Lovaas, it was hate at first sight”.

In the following chapter, Waltz describes how parent-blaming lead to parent activism, and then later to important research led by Lorna Wing and Bernard Rimland. Waltz devotes significant parts of the chapter to parental narratives where quotations give voices to mothers and fathers of autistic children. Grief, the struggle for diagnosis and services, and fights with professionals are all featured topics in these narratives. The author uses the social identity theories of Wolfensberger to highlight the importance of belonging to an advocacy group and to demonstrate the importance of parents’ transformed identities when facing their child’s diagnosis.

In the final chapter we read about the rise of autistic self-advocacy, neurodiversity and the social model of disability. It is Waltz’s clear intention to illuminate the overwhelming importance of the movement established by autistic people. In this historical perspective, self-advocates like Jim Sinclair or Michelle Dawson appear similarly significant to any of the previously mentioned professionals in the history of autism. In this chapter, identity politics meets parents’ attempts to “cure autism”, and first-person narratives are confronted with medical interventions rooted in the medical model of disability. The part on media representations of autism, including the examination of autism as it was featured in groundbreaking movies like Rain Man, is particularly fascinating as it sheds light on the significance of popular culture in our age and how it shapes common notions of disability.

Waltz’s book uses an accessible language, is richly referenced and its length makes it ideal for those who are interested in shorter introductions to the topic. The author uses a host of verbatim quotations from important figures and the literature, which works well within the text: the history of autism requires not a single narrative, but multiple ones, where voices of professionals, parents and self-advocates complement and often contradict each other. By giving importance to all three parties in the construction of autism as we see it, the book would be an ideal introduction to the topic for students.