The Historical Underpinnings of Neurodiversity: Part II

The following paragraphs were written for an editorial published by the Siberian Journal of Special Education in the early part of 2016. I asked the editor of the journal, Elena Chereneva, permission to reproduce the same in my blog. For those who want to read the original article, the same can be found at Researchgate (https://www.researchgate.net/publication/298424495_Leo_Kanner_the_Anti-Psychiatry_Movement_and_Neurodiversity). In part, my intent in writing the editorial was to give a broader perspective on the history of Neurodiversity than the one often cited in the literature (see for example the account offered by Silberman in his well-publicized account in Neurotribes). In addition, I found that Silberman’s view on Leo Kanner was extremely biased and I was hoping to correct the reader’s perception of this great man. Given the length of the editorial I have divided its content into 2 blogs. The first part was published a couple of weeks ago (https://corticalchauvinism.com/2017/07/26/the-historical-underpinnings-of-neurodiversity-part-i/).

The editorial was entitled: Leo Kanner, the Anti-Psychiatry Movement and Neurodiversity

The 1960’s were characterized by the emergence of the “New Left” in psychoanalysis when its implementation was seen as an uprising against the traditional ideas of society (Zarestsky, 2012). At that point in time psychoanalysis reigned over the way of thinking of medical professionals and Freudian verbiage became a fad within lay society. Causality was readily ascribed to parents, and they themselves were ready to accept blame if it could help establish a possible treatment and cure to their troubled children. Kanner was the first person to talk about refrigerator mothers for autistic individuals when mentioning how many of the parents in his series were strongly preoccupied with abstractions of a scientific, literary, or artistic nature. This opened the doors to medical charlatans like Bruno Bettelheim to dominate the lay literature with disturbing and false proclamations. In his book, The Empty Fortress (1967), Bettelheim provided a psychoanalytical study of different cases that made him suggest that autism resulted when mothers withheld their affection and failed to bond to their children. In this regard, he considered the worldview of autistic individuals as similar to what would have been attained in a concentration camp. The end result of these psychoanalytical ruminations made autistic individuals bear the brunt of ill-advised interventions leading to their isolation from loved ones and falling target to harsh interventions.

It really did not help that the psychoanalytical approach was followed by another movement heading in the opposite direction. This crude reaction turned away from the psyche in order to instigate the use of operant conditioning and thereby establish desired or targeted behaviors. The new approach, named behaviorism, was able to make accurate predictions and could be tested by rigorous scientific experiments. The major exponent of the method was Ivar Lovaas who used the principles of applied behavioral analysis (ABA) to train individuals in the comportment that he, or other therapists, considered normal. This early history into ABA was marred by the use of aversives and ultimately the dehumanization of the individual taught or trained by this method. Lovaas was keen on using physical methods to attract the attention of his patients, e.g., slapping the thigh, pulling the hair, or using an electric shock device known to some in the scientific community as the “mini-cattle prod”. He dissuaded doubts from his trainees as to the usefulness of these interventions by assuring them that they were punishing the behaviors, not the patients?! Fortunately, the use of aversives has been frowned upon during the last few decades and its present-day use is circumscribed to dangerous self-injurious behaviors like head banging. The use of licensure procedures for ABA therapists now allows families to raise disputes to regulatory agencies in an effort to prevent any abuse.

The flawed scientific thinking of some mental health professionals during the 1960’s lent the proper scenario for a valiant figure to stand up from the crowd in defense of both parents and autistic individuals. Bernard (Bernie) Rimland was the flag-bearer of a revolutionary movement advocating the existence of irrefutable medical evidence for an organic basis for ASD. Rimland was the father of an autistic individual and himself a psychologist with a penchant for research. Rimland aligned himself with Kanner and together tried to put an end to the reign of terror brought about by psychoanalysis.

In 1964 Rimland published a manifesto based on a large review of the literature where he debunked psychoanalytical ideologies thus helping parents assuage their grief. Rimland clearly pointed out evidence from twin studies indicating the hereditability of the condition, i.e., patients were born with the condition regardless of postnatal rearing. During his life Rimland was clearly the most ardent advocate for proper accommodations for autistic individuals, a fact that until recently was not acknowledged by members of the Neurodiversity movement. This willful neglect probably stems from Dr. Rimland’s writings where he acknowledged the disabling aspects of the condition, its comorbidities, and the need for more research and treatment interventions.

Rimland’s efforts brought him into a close alliance with Kanner, both exchanging adulatory remarks as to their individual efforts. In effect, both individuals opposed the psychoanalytical ruminations of their day with Kanner openly mocking Bettelheim’s efforts (Kanner, 1968). For patients requiring medical assistance Kanner valued an integrative approach tailored to the individual, not psychoanalysis, institutionalization or the application of operant conditioning. Kanner’s plea to help affected children and provide them with adequate accommodations was extremely humane and characteristic of him using his own journal (as an editor) to call into action all of those involved in the care of children to become their advocates, acknowledging that intervention at the earliest ages would help those children with difficulties stay out of mental hospitals and prisons.

Kanner, recognized the historical existence of individuals who fell into the spectrum. He lauded their gifts and called for parents and educators to help pave their creative potential while publicizing the dire downward spiral for those who did not receive proper support. Indeed, Kanner promoted the civil rights of the individuals to be themselves (a right to their identity regardless of medical appellations). In a certain sense Kanner can be considered the father of the civil rights movement for disabled individuals which is now attributed to the Neurodiversity movement:

“This is the place to retell the story of Willy. Willy was the scion of a noted scientist father and a college graduate mother. He was in good physical health; socio-economic conditions were satisfactory; his I.Q. was phenomenally high. He absorbed erudition like a sponge. Already in pre-adolescence he achieved national fame as a wondrous child prodigy. At 12 years, he delivered a much-admired lecture before a distinguished audience of university notables. No one seemed to notice that Willy had no companions, that he was bewildered, lonely, and miserable in a world in which the everyday pleasures of childhood were denied him. Oversaturated, Willy threw all his learning to the winds, rented a room in a large metropolis, and spent the rest of his life as an obscure office clerk. When he died at 48 years of age, all that he left behind was an album of transportation tokens, the collection and mounting of which had become his interest”(Kanner, 1971).

“In the last few millennia our species has had its gifted and productive thinkers and poets and artists and scientists and explorers. Many of them have advanced our civilization by upsetting deep-seated archaic notions guarded zealously and at times cruelly by mighty autocracies of one kind or another. We are now in a position to spot potential talents at an early age and have the laudable desire to see to it that as many as possible reach their optimum. We can do this only if, as they mature, we as parents, educators, and human engineers can pave their way toward the developments of unhampered automaticity. It is up to us, then, to attenuate the hampering agents, be they organic, emotional, or social, and to encourage rather than crush, spontaneity and self-organization”(Kanner, 1971).

“I wish I could say that the Willys, the Stevens, and the Jacks are exceedingly rare exceptions. But they are not. They are some of the casualties of the neglect of their right to their right identity, being given no opportunity to think and to plan for themselves, painfully reacting to the kind of upbringing which does not differ too much from computerization and carrying with them the unmitigated results of the disharmony of the integrants of personality”(Kanner, 1971).

A schism exists among those critical of present day efforts at treatment and cures in favor of accommodations. This movement had a historical precedent in the medical nihilism of the anti-psychiatry movement and the humanistic work of Leo Kanner. In effect, both sides of the argument were held by prominent psychiatrists whose efforts helped steer psychiatry into a more focused biomedical field. In the ensuing decades, the anti-Psychiatry movement did not become an anachronism but rather evolved into a call for a transfer of power from the medical profession to those who had socio-political power (Micale and Porter, 1994). In the end, Psychiatry did not need to be deconstructed but rather improved by the feedback of patients.

References

  1. Bettelheim B. The Empty Fortress: Infantile Autism and the Birth of the Self. Free Press, new edition, 1972.
  2. Kanner L. Infantile autism revisited. Psychiatry Digest 29(2):17-28, 1968.
  3. Kanner L. The integrative aspects of ability. Acta Paedopsychiatrica 38(5):134–44, 1971.
  4. Micale MS, Porter R. Discovering the History of Psychiatry. Oxford University Press; Oxford, 1994.
  5. Rimland B. Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behaviors. Jessica Kingsley Pub, 2 edition, 2014.
  6. Szasz TS. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper Perennial, Anv edition, 2010.
  7. Zaretsky E. Psychoanalysis, authoritarianism, and the 1960s. In Damousi J and Plotkin B (eds) Psychoanalysis and Politics, Histories Under Conditions of Restricted Political Freedom. Oxford University Press:Oxford, 2012.

 

 

8 responses to “The Historical Underpinnings of Neurodiversity: Part II

  1. Dear Manuel Casanova
    Very intersting view on dyslexia, autism and adhd.
    Since Poelmans PhD thesis in 2011 we know that the three are genetically ‘family’ as they emerge from the same cluster of genes.
    I specialize in special brains (www.equisto.eu), coach employees with amongst others these three properties and train coaches in this field.

    In the nineties two types of dyslexia were labelled. One that reads a bit too fast and sort of guesses what is written and makes small mistakes. Evidently the ADHD type. With like you say, a gestalt approach, seeing the big picture very fast but missing details.
    The other dyslexia type reading slow and spelling. With evident problems with makes words out of letters and sentences out of words. Typically the hypoconnectivity of an autistic person.
    I sometimes postulate that there are only two types of dyslexia: emerging from adhd or from autism.
    Hope to read what your opinion in this matter is.

    Liked by 1 person

    • Very interesting. Not sure what to say. In general, we agree on the spectrum view of dyslexia and autism. My wife would probably offer more information on the genetics- hoping that she reads this.

      Like

  2. The last blog´s words caught my atention: “the anti-Psychiatry movement… evolved into a call for a transfer of power from the medical profession to those who had socio-political power (Micale and Porter, 1994)”. I used to associate the medical profession with differents concepts: knowledges, health-science authority, self denying, or caretaking role. But… “Power”? It is a curious word´s choice.

    Power (and control) involve conflict and violence notions. I´m not sure we need this type of problems between healthcare professionals and their patiens. This woud be a dangerous game.

    Many times we are worried about wich rules we must follow. But sometimes I think we can look beyond rules and try to discern wich game we chose to play. The neurodiversity paradigm is not related to power fight, but represents some principles and values such as freedom, respect, tolerance, cooperation, solidarity, symbiosis…

    I would like to invite you to play another game, with another rules. I would like to invite you to think in new ways about the type of world we wish to live in.

    Liked by 1 person

  3. Someone professional just needs to have a televised public debate with a leading neurodiversity advocate such as Steve Silbermann or SImon Baron Cohen. A debate over something objective that can be backed with science. I know if there would be a debate, it could easily be rigged in in such a way to be one over moral or subjective issues to prevent it from going anywhere. A debate with plenty of MRI and Brain scans as evidence, plenty of statistics on seizure mortality, plenty of evidence of enviromental insults during pregnancy contributing to the risk of Autism. I’d love to see how they would respond.

    It would be nice and civil like this debate between Bill Nye and Ken Ham:

    It would be a slam dunk victory if you could just, JUST get them to debate over the scientific facts. You have to avoid falling into the trap of arguing about “what an autistic person can contribute to the spice of life yadda yadda”. Just stick to the scientific facts.

    Ever thought about that Manuel? You would gain a lot of more support for your research if you could gain positive publicity.

    Liked by 1 person

    • A warning if this should ever happen, for Pete’s sake, at all costs, avoid letting it turn into a shouting match like on Fox News or Msnbc. It would be an automatic victory to the person with currently more media admiration and notoriety (which would be the neurodiversity advocate).

      Liked by 1 person

    • I would be more than happy to do so. However, neurodiversity proponents do not believe in science. Their opinions are dogmatic rather than emiprial. I am not sure that a debate would change their minds.

      Like

      • But it would not be them a person would be going after, it’s the uncountable onlookers, you would want to convince or at least get an equal amount of opposing views out there to balance out the sheer amount of neurodiversity views that has been pumped out already. The people to go after are the same people who have already or would later read a newsweek article, watch a Tedx talk, or watch a youtube video supporting neurodiversity. The same groups of people who picked up Neurotribes from a bookstore one rainy day out of boredom. The huge crowds of people who are not autistic or have never known an autistic person who clap when Temple Grandin gives a speech.

        Liked by 1 person

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