evans-2013-how-autism-became-autism-the-radical-transformation-of-a-central-concept-of-child-development-in-britain
Abstract
The article discusses how the meaning of 'autism' significantly shifted in the early 1960s in Britain, marking a pivotal moment in understanding this complex neurodevelopmental disorder. This shift coincided with a rise in epidemiological studies in child psychiatry, enhancing the specificity and understanding of autism beyond its earlier, broader definitions.
Historically, 'autism' encompassed a range of behaviors, including hallucinations and unconscious fantasies in infants, influenced by psychologists like Jean Piaget, Barbara Bender, Leo Kanner, and Anthony. These early definitions primarily stemmed from psychoanalytic perspectives. However, as developmental frameworks and therapy evolved, autism began to be associated more with a lack of symbolic life, focusing on communication deficits and social impairments rather than fantasy enrichment. Researchers such as Michael Rutter and Helen Lotter played crucial roles in redefining autism through rigorous epidemiological studies, significantly affecting subsequent research on autism and related conditions.
Origins of Autism
Definition and Early Usage
The term 'autism' was first coined by Eugen Bleuler in 1911 to describe a symptom of severe schizophrenia, in which individuals withdraw into a world of fantasy to escape from unsatisfactory realities. British psychologists maintained this definition from the 1920s to the 1950s, associating it closely with psychosis.
Shift in Understanding During the 1960s
The 1960s marked a significant challenge to Bleuler's views, as psychologists sought scientific validation through empirical methods, including epidemiological research. From the mid-1960s onward, autism was reformulated to signify an absence of unconscious symbolic life rather than an excess of it. Michael Rutter emphasized that autistic children exhibit a deficiency of imaginative play and fantasy rather than a mere abundance of them, reshaping the dialogue around autism.
Impacts of the Mental Health Act of 1959
The passing of the Mental Health Act of 1959 catalyzed the closure of institutions for individuals labeled as 'mental defectives.' This shift coincided with the rise of speech therapy services, leading to altered perceptions of autism in society.
Parents began advocating for better diagnostics and support due to increased integration into mainstream educational settings. Organizations like the UK Society for Autistic Children emerged, advocating for treatment, recognition, and the enhancement of services for autistic children. The transition away from institutionalization prompted greater emphasis on behavioral treatment methods and challenged psychoanalytic explanations, paving the way for a more favorable public view of autism.
Epidemiological Studies and Changing Definitions
Emergence of Epidemiology
The 1959 Mental Health Act spurred significant developments in psychiatric epidemiology, enabling more detailed studies of child psychopathology, including autism spectrum disorders. Lotter's pioneering study established an initial prevalence rate of autism at 4.5 per 10,000 children, but later studies revealed much higher rates, suggesting an underestimation of autism in earlier diagnoses.
The disproportionate rise in autism diagnoses in the UK can be juxtaposed with the situation in France, where many children remained institutionalized and thus undiagnosed, highlighting cultural and systemic approaches to mental health care.
Diagnostic Criteria Changes
The diagnostic criteria for autism expanded significantly in the 1960s, moving from restrictive pathologizing terms to emphasize observable behaviors. Research by Creak identified nine key features defining childhood schizophrenia, which subsequently informed later autism studies. Importantly, the terminology around childhood psychosis evolved to underscore social impairments rather than associations with hallucinations or schizophrenia, thereby refining the understanding of autism as a distinct condition.
Key Historical Figures
Pioneers in Understanding Autism
Key figures in early discussions of autism included:
Cyril Burt: The first UK government psychologist to address child mental health issues, advocating for early intervention.
Susan Isaacs: A prominent psychologist who advocated for understanding the role of hallucination and fantasy in child development.
Melanie Klein: A therapist who explored the link between fantasy thinking and autism, positing that the ability to fantasize might relate to social interaction.
Michael Rutter: A pivotal figure in autism research, Rutter's studies laid the groundwork for contemporary definitions of autism, emphasizing behavioral aspects.
Evolution of Autism in Research
Transition from Psychoanalysis to Behavioral Approaches
By the 1970s, an emphasis on language deficits became increasingly central to autism definitions, reflecting broader trends within cognitive psychology and shifts in treatment priorities. Rutter's influential 1975 study established behavioral differences between autistic children and those with specific language disorders, cementing behavior as a central definition criterion for autism. This transition included a deliberate distancing from psychosis and hallucination concepts, creating a clearer boundary between autism and other mental health issues.
Conclusion
The transformation of the autism concept from hallucination-related conditions to a focus on behavioral disorders illustrates broader changes in child psychiatry and psychotherapeutic approaches. Autism is now largely defined by cognitive deficits relating to social interaction and communication, rather than through a lens of psychoses. Future research endeavors may continue to explore potential connections with schizophrenia, particularly in genetic studies, and could revisit earlier interpretations of autism to enhance understanding and treatment strategies.