Autism Through the Ages
A Puzzle that Baffles Science
By Robert Williams Jr., June 12, 2000 at Health24 News
For years past people with autism were placed in institutions all over the world. Autism is not a modern problem, even though it has only recently gained vast recognition. It is difficult to discuss the history of autism treatment without paying particular attention to the history of "autism" as a concept and the ways in which autism has been conceptualized and theorized about over the past 100 years.
The ways in which we understand and think about autism have directly and indirectly formed our conceptual responses to autism over the years. The very concept of "treatment" carries with it many presumptions about the nature of autism, its origins and its potential outcomes. The history of autism is not a linear one, and regardless of the past or present debates over treatment, origin or outcome, as more and more studies and research are conducted the greater the understanding of autism will become.
Swiss psychiatrist Eugen Bleuler first introduced the term autism in 1911. Autism and autistic stem from the Greek word "autos," meaning self. The term autism originally referred to a basic disturbance in schizophrenia, in short, an extreme withdrawal of oneself from the fabric of social life, but not excluding oneself.
Bleuler also coined the term ambivalence to designate one of the major symptoms of schizophrenia, the others being autism, disturbances of effect (emotion) and association (thought disorders). Ambivalence is a coexistence of two opposing drives, desires, feelings or emotions toward the same person, object or goal. The ambivalent person may be unaware of either of the opposing wishes. Bleuler felt that there were normal instances of ambivalence such as the feeling, after performing an action, that it would have been better to have done the opposite; but the normal person, unlike the schizophrenic, is not prevented by these opposing impulses from deciding and then acting. Bleulers schizophrenia differs in terms from the Freudian theories, in which ambivalence was described as feelings of love and hate toward the same person. (E.L. Horwitz, "Madness, Magic, and Medicine: The Treatment and Mistreatment of the Mentally Ill." [Lippincott, 1977])
In the early 1900s, psychologist Carl Gustav Jung introduced the well-known personality types, extroverts and introverts, further broadening Sigmund Freuds psychoanalytical approach. However, this approach appears to have indirectly classified the autistic person as a schizophrenic introvert. Jung saw the activity of the extrovert directed toward the external world and that of the introvert directed inward upon him- or herself. Jung, who removed from the term the sexual character ascribed to it by Freud, called this general activity or drives of the individual the libido. The extrovert is characteristically the active person who is most content when surrounded by people; carried to the neurotic extreme, such behavior appears to constitute an irrational flight into society, where the extroverts feelings are acted out.
The introvert, on the other hand, is normally a contemplative individual who enjoys solitude and the inner life of ideas and the imagination. Severe introversion was believed to be characteristic of autism and some forms of schizophrenia. (C.G. Jung, "Psychological Types." [tr. 1923, repr. 1970]) Jung did not suggest strict classification of individuals as extroverted or introverted, since each person has tendencies in both directions, although one direction generally predominates. Jung theorized a patient could achieve a state of individuation, or wholeness of self. (E.H. Ackernecht, "A Short History of Psychiatry." [Hafner, 2d ed., rev., 1970])
In 1944, American Bruno Bettelheim directed the Chicago-based Ortho-genic School for children with emotional problems, placing special emphasis on the treatment of autism. Bettelheim believed that autistic children had been raised in unstimulating environments during the first few years of their lives, when language and motor skills develop. He saw parents unresponsive to their child as an underlying cause of autistic behavior. (L. Wing, ed., "Aspects of Autism." ) Although subsequent studies of the parents of autistic children have discredited Bettelheims psychological explanation, his ideology carried into the general populace for generations to follow, germinating red herring terms like "refrigerator mother."
The highly complex treatment of childhood autism began with the early-childhood development pioneers Leo Kanner and Hans Asperger, who each published accounts of this disorder. Kanner published his report in 1943 while at Johns Hopkins. He conducted a case study of 11 children who appeared to share a number of common characteristics that he suggested formed a "unique syndrome not heretofore reported." He titled the article, "Autistic disturbances of affective contact," and characterized the children as possessing, from the very beginning of life, what he called an "extreme autistic aloneness." The following year, Asperger published "Autistic psychopathy in childhood." The article presented a case study of several children whom he described as examples of "a particularly interesting and highly recognizable type of child." Both Kanner and Asperger believed that the children suffered from a fundamental disturbance that gave rise to highly characteristic problems.
They both chose the word autism, a term coined by Bleuler in reference to the aloneness experienced by schizophrenic patients, in order to characterize the nature of the underlying disturbance. The common feature of this disturbance was that the children seemed unable to entertain normal relationships with people.
In contrast to Bleulers schizophrenia, the disturbance observed by Kanner and Asperger appeared to have been there from birth. Kanners paper has become the most quoted, while Aspergers paper, written in German during World War II, was largely ignored. The belief has grown that Asperger described quite a different type of child, not to be confused with the one Kanner described.
Aspergers definition of autism or, as he called it, "autistic psychopathy," is far wider than Kanners, including cases that showed severe organic damage and those that shaded into normality. In 1943 and 1944, "autistic disturbances" and "autistic psychopathy" became known as syndromes. (U. Frith, "Autism: Explaining the Enigma." ) Aspergers syndrome as defined today is clearly not what Asperger intended, but having this special category has proved clinically useful.
Kanners syndrome is often used to indicate the child with a constellation of classic, "nuclear" features, resembling in astonishing detail the features that Kanner identified in his first, inspired description. Again, the category is clinically useful since it communicates a prototypical pattern. From the 1980s through the early 1990s, the cause, prognosis, and treatment of autism were vigorously under study. Research suggested that a genetic defect caused the disorder, which was presumed to be some form of autoimmune disease or degenerative disease of nerve cells in the brain. The preferred treatment for the autistic child was special education, stressing learning in small increments, and a strict behavioral control of the child.
In general, about half of the children with autism were considered mute; those who remained mute through age 5 were given a poor prognosis for recovery. The children with autism who spoke were given a prognosis that they would fare better, and possibly even recover. (Autism, ENCARTA95; Computer program; ) Since 1911, the understanding of autism has grown to such a degree that we know there is not yet a cure.
However, researchers all across the nation are working diligently to produce more information on autism, and possibly a cure. "Cure" means "restoration of health; recovery from disease." To "recover" means "to regain a normal or usual condition, as of health." While "cure" and "recovery" prognoses for autism might have been the expectation of 80s and early 90s, they do not represent expectations today.
Today we know that with highly structured and appropriate interventions the behaviors of a child or adult with autism may change to the point where he or she may appear to no longer have autism to the untrained person. However, while they have changed, they still have the autism.
In 1995-1996, only 5.6 million children (ages 0 to 21), or about 12 percent of public school children, were enrolled in special education programs. The number of students participating in federal programs for children with disabilities has increased at a faster rate than the total public school enrollment.
Between 1977 and 1995 alone, the number of students involved in federal programs for children with disabilities increased 47 percent, while the total public school enrollment decreased by 2 percent. These counts are based on reports from the 50 states and submitted to Congress to aid in the enactment of the Individuals with Disabilities Education Act by the National Center for Education Statistics, US Department of Education, "Digest of Education Statistics," 1997.
It is also noted in this study that as early as 1976, as new types of disability categories began to emerge (specific learning disabilities, serious emotional disturbance, multiple disabilities, other health impairments, autism, preschool disabled), the percentages of federal programs for students with mental retardation disability began to lower.
It is evident that autism as a diagnosis was nonexistent prior to the early 1900s, and the people who had what we call autism today were diagnosed with some other disorder. It was not until the mid 1900s that people with autism were no longer institutionalized for their problem. Despite the persistence of old theories, no factors in the psychological environment of a child or adult have been shown to cause autism. There is no proof that autism is due to bad parenting, neglect, abuse or tragedy. Children with autism are not unruly youngsters who choose not to behave. Professionals have long since disproved all of these "causes" and theories. Unfortunately, the general understanding of the word autism hasnt kept up with the newer medical research shared today. It is proven that people with autism can lead happy and productive lives when appropriate supports and therapies are provided.
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