Autism: A Very Short Introduction

Reflecting the psychiatrisation of our society, we live in a time where everybody seem to proudly have some sort of trauma or disorders of some kind, be it a mental illness or a disability or whatever. The autism spectrum is subject to such trend too, ranging from people self-diagnosing with Asperger to campaigners even demanding autism to be recognised as a difference and not a disorder! Uta Frith, Emeritus Professor of Cognitive Development at the Institute of Cognitive Neuroscience (University College London) has no patience for such cruel diluting of what is a real condition, and so you better be warned:

'Some campaigners... say that for the whole of the autism spectrum it is wrong to talk of brain abnormalities, wrong to focus on show more deficit in the mind, and wrong to highlight impairments in behaviour. Instead there should be only be talk of differences in brain and mental make-up, some of which represent the autistic mind. This is a strange proposition. To someone who is familiar with classic cases and other severe cases of autism, it seems perverse. You may disagree, but then this book is not for you.'

Sure, with an estimate of about 1% of the general population being on the autism spectrum it still is a common neurodevelopmental disorder. She obviously acknowledges that, as well as that one doesn't have to be a severe case to deal with the harrowing difficulties faced by being autistic. As she says of Asperger:

'It is not necessarily correct to call it the mild part, because these people have disabilities. They are sometimes rather thinly covered up by compensatory efforts... their autistic features are mild compared to the classic cases.'

'It is hard to imagine what it is like not to have social sense, not to be tuned in to other people, their actions, reactions, and the signals they give out to you and each other.'

But the autism spectrum implies some very specific characteristics which, sadly these days, tend to be mitigated among the general public. The author clearly here put it all forwards, clarifying a lot of misconceptions. She explains what the spectrum is, and what are the major differences between each features -PDD-NOS, autism, Asperger. She tentatively advance some explanations for the condition (mostly genetics), even speculating with her own. She debunks many of the silliness that have become dangerously popular (being a loner or introvert with narrow interests or an atypical personality doesn't make you autistic; and, no, there is no connection with the MMR vaccination...). She also dabbles with other questionings, like why is it more prevalent among boys than among girls; why there seems to be more diagnosis being made; or, again, touches upon 'savant syndrome' in very engaging passages…

In a word, ranging from brain science and psychology to our social perception, she offers a more than needed introduction to a supposedly well-known yet unknown disorder. Remarkable! show less

If you want a basic guide to the state of scientific research into the alleged nature of autism twenty years ago (and an insight into the attitudes of somewhat cold and clinical positivists) then this may be the book for you but I found it mildly creepy and even sinister at times.

What were the problems that I had with it? Partly it was a matter of the arrogance of tone towards those who had a view of autism closer to that of the much later book by Devon Price ('Unmasking Autism') which tried to claim autism as yet another 'identity' in a society already reeking of them.

There was an odd point (like an upsurge of atavistic feminism) where the author seemed to be playing with the idea of men being autistic simply by being men. She moves show more swiftly on but it gives us a clue to an attitude that sees 'normality' as 'normative' along lines that are peculiar to her own world.

In my earlier review, I criticised Price for going too far in accepting the language of victimhood and identity politics but Frith takes us to the other end of the spectrum in what appears to be an alliance of interest between a profession seeking research grants and worried middle class mummies.

Cultural alliances fascinate me because of their distorting effects within liberal democracies and the fact that they emerge without a central point of control. They are certainly not conspiracies but emerge naturally, like that between Greens and business, to distort reality.

Autism has certainly 'exploded' in terms of 'diagnosis' (always a reason to be suspicious in the world of clinical psychology) and in cultural awareness. It has become a blank sheet on to which fears, interests and ambitions may get projected with social and political consequences.

Now, do not get me wrong here. I do accept that autism in its extreme forms can and will be dysfunctional and that, if truly dysfunctional, it requires sensitive intervention to help individuals become functional - but this begs the question of what we may mean by functional.

Frith is undoubtedly expert in analysing, understanding and developing solutions to truly dysfunctional autistic behaviour. The quarrel here is not with her expertise (which is substantial and demonstrable) but its extension from the particular to the general.

I noted in an earlier review the insights of Richard Bentall in 'Madness Explained' where he suggested that professional diagnostics may have got out of hand so that (he speaks of classical insanity) we fail to see that much behaviour classed as 'mad' is, in fact, on an extensive spectrum.

There is no reason to consider all 'abnormal'behaviours as dysfunctional. Neuro-diversity is often not a problem at all. People have, in fact, often become dysfunctional because of social demands and expectations. 'Sufferers' could often get on adequately with reassurance and a different society.

We should not have to sit there, whoever we are, and accept society when it clashes with our essential given nature or our existentialist ambitions so long as we offer no threat to others. Normalising us can be one of the nastiest forms of human oppression because it is so insidious.

We willoften see a power struggle between an individual who is who they are and a society who demands that they be something else. The obvious example in history were the demands made on LGBTQ+ people. Dysfunctionality in any situation requires careful analysis in this context.

Normality is a conceptual trap because what is normal shifts and changes according to culture. It would be normal to hate Jews in Nazi Germany, to believe in the virtues of the proletariat in the Soviet Union and to believe in a Christian commitment to marriage and corporation in 1950s America.

From this perspective, Price, although he/she goes far too far, is correct that many autists (like many people who hear voices) can and should kick back against attempts to diminish and control them, force them back into normality as once we tried to force gay people into binary sexual situations.

I must admit to something here. Everyone around me seems convinced that I am 'on the spectrum' when it comes to autism although it is fairly mild in my case. I am very high functioning. When it comes to matters of 'madness', I am possibly even hyperrational to my own distress.

This makes me believe that it is normality that is often dysfunctional. When it comes to human survival, it is normal to accept being conscripted for absurd wars and to deny your own desires sexually to maintain a historically-generated Judaeo-Christian mythic culture. But that is how it is.

Interest in Autism in certainly relatively recent - it possibly has not yet reached its half century of serious professional engagement. In this, it is unlike 'madness' which has troubled humanity in some form since the days of shamanism. A fully balanced approach seems yet to be developed.

So, neither Price nor Frith's books are entirely helpful because both tell only half the story. Both are polemical and rather rigid. Neither is prepared to critique the special interests and social conditions that define functionality (Frith) or the post-modern ideology that denies social reality (Price).

Just as I advised the Price-ians to persist in dropping their masks on their terms but without wasting time on constructing a group identity, so I would advise the Frith-ians to step back and define dysfunctionality with more care and to consider social dysfunctionality as of equal concern.

In the ideal situation, in dealing with the 'mad' and the 'autistic', individuals would be left to self-develop as much as possible with as much reasonable non-invasive support as possible. Those who collapsed into true dysfunctionality should receive the bulk of what resources there are.

It is the idea that autism is necessarily a disorder that most concerns me. To be fair, Frith does point out the aspects of autism that might be regarded as positive but her language of disorder always privileges some reified order to which it is necessary to adapt. Order is not the human condition.

The book retains throughout a certain implicit arrogance about the extent of neuro-diversity as disorder. The normal brain is treated as a biological and essentialist absolute, abandoning all awareness of the adaptiveness and resilience of the mind (and so of the underlying brain).

Perhaps 'normies' need to be taught more not to fear or to panic (especially middle class mums) and to loosen up a little. Nevertheless, boundaries need to be agreed where it becomes clear that the safety of the individual and of society might require someone to step in.

There is another consideration against enforced normality of any kind where there is no significant suffering or harm to the wider world or to the individual themselves. This is that (as we seem to forget) we are evolved animals and not machines or gods. We are a species with massive variation.

Neuro-diversity is not an aberration from some Platonic form of the brain, pickled in aspic for eternity (this is pre-Darwinian thinking) but variation. Neuro-diversity may be truly dysfunctional we have accepted, but it may also be massively creative as we see in Elon Musk.

OK, some people may consider Musk dangerous and abnormal (we have reviewed his biography at length elsewhere) but that is frankly a political decision or one based on classic 'ressentiment'. Whatever one thinks of him, he has made exceptional advances in business and engineering.

Variation is vital to the survival of a species. It may be become very important as our species, which has a weird aspect in being part-hive (a socialised unthinking culture) and part consciously individualist (the creative yeast in society), adapts to new technological conditions.

The bits of humanity that seem dysfunctional to 'normies' may contain the genetic seeds to future survival. Attempts to treat moderate autism or 'madness' as a 'disorder' and to seek to cure it may gain grants for ambitious academics but it may also lead us in a very dark direction.

This dark side would be genetic intervention to normalise our species within a narrow band. This would be a conservative attempt to preserve an existing order that may be doomed to fail. It is implicit in liberal panic at the fact that people keep coming up with the wrong political answers.

To identify serious dysfunctional abnormality in the brain is one thing (action to deal with this is beneficial) but contemporary professional liberal capitalist society is constantly engaged in mission creep - whether as NATO or human resources managers or clinical psychology.

This mission creep is the unthinking 'hive' at work. It is the sort of thinking by 'normal people' that tends to lead to problems like risking nuclear war, debt crises or the rise of populism in reaction to 'norms' imposed without true consent from above.

The point is that all attempts of authoritarian science to control humanity generally end in disaster for the professional classes and society in general (Adam Curtis' 'Pandora's Box' documentary series is good on this). Humanity is always best guided rather than forced. The 'hive' must be challenged.

Now, let us be clear, Frith is not (at least overtly) directing us to the dark side at all but the positivist attitudes and essentialism implicit in her account make things just that bit easier for those who might. For facts, this a good book. For ideological sophistication, go elsewhere. show less

Because autism manifests itself in so many different ways, it is hard to write a general introduction. And to do so in the limited space of "a very short introduction" is probably impossible. This book doesn't really try -- it doesn't attempt to cover all types, and it is in no way a treatment manual. There is no section on strategies, no advice to those on the spectrum, not even much in the way of diagnostic criteria. A person with high-function autism, trying to self-diagnose, would find little help in this book.

What the book does well is describe the various hypotheses about the causes and explanations of autism. In this regard it is helpful -- as long as one does not suffer an autism disorder one's self. Ah, but there is the key show more word -- the "self." After discussing the five "big ideas" that have been put forward to try to explain autism, Frith's conclusion seems to be that the self of the autistic person is damaged or even missing. Perhaps this is not a condemnation -- a robot is a useful thing even though it doesn't have a self. But what JUSTIFIES the existence of a human being who lacks a self? A person with autism may wish to do good -- but is it possible for this self-less (as opposed to selfless) person to do it? I do not know. Here, the lack of strategies is a devastating lack. To me at least, this book offers no sign of hope. The evidence is clear that there is no cure for autism. Must the victims, then, be comfortless as well? show less

Fiquei interessado no conteúdo do livro a ponto de fazer um resumo. Segue:

Uma pequena introdução ao tema do autismo, de 2008, relatando casos de crianças e suas dificuldades de convivência e comunicação e ligando os casos à tipificação e especulações mais teóricas. Trata da da ideia de espectro autista, em que há vários níveis, do suave ao severo, a partir de três principais características - dificuldades acentuadas na interação social recíproca e estabelecimento de atenção conjunta; dificuldades na prática comunicativa; âmbito reduzido de interesses e tendência a realização de atividades repetitivas (rigidez comportamental). Embora seja condição congênita, raramente ligada a causas externas, o autismo é show more um distúrbio de desenvolvimento que costuma se manifestar apenas no segundo ano de vida, muitas vezes dando a sensação de regressão comportamental por parte do bebê/criança, e por isso é de difícil diagnóstico antes dessa etapa.

Antigamente, o autismo foi formulado como envolvendo crianças superdotadas que teriam se recolhido internamente, se isolando do hostil mundo externo. A caracterização clássica, embora rara em indivíduos no espectro, inclui algo próximo da ideia de "idiot savant", de sábio tolo - são crianças indiferentes, que se comunicam pouco e tendem a falar chavões; realizam rituais elaborados envolvendo rotinas repetitivas repetidas fielmente e possuem talentos intrigantes, como memória extraordinária. No entanto, exceto no caso tipificado como síndrome de Asperger, ligado a alta inteligência, muitos autistas sofrem também de deficiências de inteligência, não caindo no estereótipo romantizado do indivíduo com interesses obtusos e dificuldades sociais que possui grande talento e hiperfoco. Ademais, com a terapia comportamental adequada, indivíduos autistas se desenvolvem, e de todo modo certamente não são eternas crianças.

Aspergers, como forma suave de autismo, muitas vezes são diagnosticados tarde ou muito tardiamente, dado não se tratarem de indivíduos indiferentes ou não-comunicativos, muitas vezes tendo interesse forte em outras pessoas (os adultos são, para as crianças, importantes fontes de informação e escuta) e habilidades verbais avançadas. Por não ser tão socialmente desvantajoso e uma forma leve de autismo, Hans Asperger tratou os indivíduos como "psicopatas autísticos", indicando ser mais um traço de personalidade do que uma patologia problemática (mas o limite entre isso e um distúrbio é sempre móvel e em discussão). Há então controvérsia se essa síndrome seria algo separado do autismo, ou mesmo apenas um tipo de tipo de personalidade, ou algo no entremeio, como auto-diagnosticados "Aspies" declaram - um tipo especial de personalidade não-neurotípica, e a associação com genialidade eventual torna ser "um pouco autista" uma declaração da moda.

A polêmica do aumento do número de autistas é abordadas, com a estimativa de alguma forma de autismo afetar 1% das pessoas. A autora tem a paciência de considerar hipóteses descreditadas (como vacinas, toxinas, bactérias, alergias), mas a causa é um aumento de diagnósticos e conscientização sobre o problema. O autismo é muito provavelmente originado geneticamente, muito embora o número muito maior de homens autistas leve também a especulações adicionais sobre um possível papel da testosterona no processo (a autora não discute a maior habilidade socialmente incutida das mulheres de esconderem sintomas e assim amenizarem a aparência de comportamentos desviantes).

Na psicologia, há três grandes ideias que tentam captar a essência do comportamento autista. (1) Autistas tem dificuldades em ler a mente dos outros (o ponto de vista, as intenções, as crenças) e assim de reagir a esses. Comumente, há mais ajustes via inferência. Não é conclusivo porque o nível das dificuldades variam e não-autistas também podem exibir esse problema. (2) Autistas não são motivados a serem sociáveis, não possuindo a programação biológica necessária. A dificuldade de estabelecer atenção conjunta seria um sinal forte disso. Indiferença a outros seria outros sinal e falta de memórias ligadas a pessoas (que são comuns - não lembrar o que disse para quem, sendo um caso ameno). Essa teoria não explica, entretanto, o processo de regressão social que ocorre em autistas, no início da vida (quando passam de um comportamento social perfeitamente comum para um desfuncional). (3) Autistas não espelham comportamento humano nos níveis esperados (e gestos faciais) e há assim comumente "falta de empatia", - desfuncionalidade no espelhamento de emoções e no contagiar-se por emoções de outros. Essa grande ideia é mais controversa, mais difícil de testar e cujos resultados tem interferência da dificuldade quanto a (1). Há ademais, algo falho em processos de inibição de imitação, como no fato de que tipicamente autistas realizam ecolália.

(4) Uma quarta grande ideia diz que autistas tendem a se preocupar mais com detalhes do que com a visão geral em vários tipos de situações, e que esse processamento de informação diferenciado também contribuiria para uma inteligência diferenciada, o que, como deficiência, está associada a coerência central fraca (contextos exercem pouca força cognitiva). Mas não existiriam autistas com algo contrário a isso, uma qualidade - facilitação perceptiva aumentada? (5) Uma quinta diz que há uma falha no sistema executivo do cérebro, gerando situações em que fica-se preso em um comportamento difícil de sair, ou ainda capturado por fatos incidentais, acabando por dirigir esforços e atenção neles (mesmo se socialmente não tem prioridade alguma), e falta de inibição de comportamentos que não são socialmente aceitos (e há vários casos de garotos autistas que perseguem as garotas que gostam). O problema com essa ideia é que vale para quase qualquer tipo de neuro-deficiência.

Um elo entre essas 5 ideias, proposta pela autora, é a de desencontro entre processos de cima para baixo e de baixo para cima, o segundo funcionando bem - regulando percepção e o contato com o mundo externo, enquanto que o primeiro, ligado a controlar o que fazer em seguida, atribuindo diferentes níveis de importância, como consequência da informação que lhe foi entregue, funcionaria mal. Ademais, há também a ideia de tentar usar as 5 ideias como fenotipos cognitivos, talvez classificando diferentes tipos de autismo, em combinações com maior presença ora de um, ora de outro. show less