Review by David Kilgannon
The diagnosis of autistic spectrum disorders has seen a phenomenal increase in the past twenty years. Growing media representation, as seen through works like Mark Haddon’s The Curious Incident of the Dog in the Night-time (2003) and Steve Silberman’s Neurotribes (2015), alongside changing social norms now lead more individuals than ever to self-identify as being somewhere “on the spectrum.” Autism has become incorporated within our common parlance for understanding individuality and identity. Yet, this begs the question – how did autism become a spectrum and why has it occupied an increasingly prominent role in our understanding of psychology since the 1960s? In her new book, The Metamorphosis of Autism: A history of child development in Britain (Manchester University Press, 2017), Bonnie Evans tackles these vexing questions with aplomb, cogently tracing how the conception of autism has developed and changed across the twentieth century.
Beginning in the first half of the twentieth century, Evan’s book shows how the idea of autism was initially shaped within the early development of psychoanalysis, with the work of Swiss psychologist Jean Piaget being particularly significant. Drawing from the theories of Sigmund Freud, Eugene Bleuler and Henri Bergson, Piaget positioned autism within the normal range of human thought as a child “developed from primitive magical imagination through to logical reasoning” (44). Autism was simply a distinct form of thinking generally associated with childhood, which some individuals were more prone to throughout their life. This thinking brought with it a heightened propensity for imagination and daydreaming, alongside a general disinterest in wider social engagement. It is this conception, the text posits, that fundamentally changed during the 1960s.
Leo Kanner’s 1943 paper “Autistic Disturbances of Affective Contact” is commonly cited as a foundational document in the creation of the modern conception of Autism. Instead, Evan’s demonstrates how Kanner’s paper was an attempt to isolate autism as a specific medical condition, separate from its position in a psychoanalytic framework. Eschewing Piaget’s psychoanalysis, Kanner instead conducted an intensive examination of a set of children who shared a broadly similar range of symptoms. In doing so, Kanner managed to strip the term of autism from its existing psychoanalytic baggage and highlighted the shared behaviors that commonly demarcated the condition. These included a lack of physical interaction with others, obsessional behavior and the literal use of language. This change in the language used to describe autism was catalyzed by the widespread closure of ‘mental retardation’ institutions across the United Kingdom from the 1950s onwards. These changes, alongside the growing body of child development research, encouraged the growth of new techniques for understanding autism in children, in particular the idea of Autism as impairment. This notion, which flourished from the 1960s onwards, saw Autism as a unique impairment to a child’s ability to communicate and interact with others, requiring a new specialized range of measures. The book concludes with a chapter on autism in its current global context, examining the growth of the Neurodiversity movement, which in many respects represents a repudiation of the 1960s impairment model and a return to Piaget’s emphasis on Autism as a unique facet within a range of thinking.
There have been countless books examining the rise of Autism diagnoses across the latter decades of the twentieth century. Texts like the aforementioned Neurotribes have attempted to examine why Autism diagnoses grew throughout the latter decades of the twentieth century, looking back to understand the current landscape of debates on Autism. Yet, while undoubtedly valuable, such texts are all too frequently written from the perspective of journalism or social science and fail to capture the uncertain and nuanced development of thinking around autism throughout the twentieth century. Writing as a historian, Evans uses a vast array of government documents and hospital records to bolster her arguments, showing how the approach of a historian can offer clarity to current educational policy debates. Undoubtedly, this book will serve as a central text for those interested in the history of children, medicine, and psychology in twentieth century Britain. To all its readers, The Metamorphosis of Autism offers a masterclass in the creation of a cogent and stimulating historical analysis.
David Kilgannon is a Wellcome Trust PhD researcher based in the History Department of the National University of Ireland, Galway. He was previously a Hardiman Scholar, a Kirkpatrick History of Medicine Finalist and a Wellcome Trust MA student. His research looks at the varied experiences of persons with intellectual disabilities in Ireland from 1947 to 1996.