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The Controversial History of Autism

Am Spiegelgrund clinic in Vienna

A ward in the Am Spiegelgrund clinic in Vienna, in the 1940s.Courtesy of the Documentation Centre of Austrian Resistance.

According to Lincoln College (2022), autism as a word was first used to describe those who suffered from schizophrenia and who were also ‘withdrawn and self-absorbed’. In 1943, the word was first used to describe a condition of its own and individuals seemed perplexing to clinicians and were scrutinised heavily (Kanner, 1943); followed by the creation of Asperger’s disease in 1944. Later in the 1950s, it was believed that autism was a result of developmental trauma, and mothers of autistic children were heavily criticised as ‘refrigerator mothers’, indicating that they had no emotional warmth. 

Eventually, during the 60s and 70s there were changes initiated by parents coming together (and forming the National Autistic Society), and by scientists recognising the disease as biological. This recognition led to segregation schools being implemented for autistic children before a genetic link was discovered in 1974. Yet, it was not until 1979 that a psychological model called ‘the triad of impairments’ was proposed which highlighted difficulties in social interaction, communication, and imagination skills. Then, in 1980 the DSM first recognised Autism Spectrum Disorder,  and in 1989 the diagnostic criteria for Aspergers was created before being recognised in 1994. From there on there were national scientific and governmental initiatives to improve practice on understanding and working with autism. Finally, since 2009 World Autism Day has been celebrated. 

Currently, there are still people who think that autism happens only to children, or that it is not a disability. Furthermore, only a minority of people understand that autism has no cure. This shows that even though there have been a lot of developments in the history of autism, many misconceptions still persist. 

Theories

Initially, it was believed that autism was a form of schizophrenia. Furthermore, the way clinicians used to relate to autistic individuals was very derogatory and subjugating throughout history. Individuals with autism were labelled as ‘mentally retarded’, ‘idiotic’, ‘feeble-minded’, ‘slow or backwards’, or ‘autistic schizoid’ (Lincoln College, 2022). Now individuals are known to have a neurodevelopmental condition which they live with, and which has unique individual needs and no cure. Moreover, autism was considered to be a matter of moral degeneration until the genetic link was discovered and its biological construct was explored. 

Kanner (1943) cited in Lincoln College (2022) was the first to propose that autism was a condition of itself and that it was not schizophrenia. This was a major breakthrough. Later on, Aspergers (1944) cited in Lincoln College (2022) proposed that ‘autistic psychopathy’ was the cluster of symptoms now known as ‘Asperger’s syndrome’. He believed that these individuals could not change because autism had no cure. He identified symptoms such as ‘lack of empathy’, and poor ability to make friends, among others. This was another breakthrough. However, autism is not the same as psychopathy, and this should be emphasised. 

Moreover, Lincoln College (2022) also states that Wing’s and Gould’s (1979) theory was the first one to mention Aspergers syndrome in a research paper challenging Kanner’s theory and they introduced the model of the ‘triad of impairments’  (social interaction, communication, and imagination). Furthermore, Baron-Cohen et al. (1980) proposed the theory of mind (ToM) theory indicating that individuals with autism struggled to understand the mental states of others. It was stated that this impairment affected most or all aspects of the individual’s life. 

Another theory was the ‘extreme male brain theory’  which states that autistic individuals have been exposed to higher levels of testosterone than the average population. This might explain why most autistic individuals are male. Furthermore, Baron-Cohen also proposed the ‘empathising-systemising theory’ which states that autistic individuals can only be empathic by imitating the behaviours of others without really understanding the subjective states of mind of others. This is because autistic individuals are more systematic than empathetic and adapt based on organisational, structural, normative, and routine schemas. This might explain why these individuals have interpersonal difficulties. Finally, the ‘autism spectrum  condition’ theory states that individuals with autism have a life-long condition which can vary based on where they are in the spectrum which can range from interpersonal difficulties to verbal communication difficulties (Lincoln College, 2022). 

Treatments & Interventions

Electroshock therapy was often used to treat autism in the past and treatments heavily relied on the use of medication. Autistic individuals were placed in asylums and separated from their families during treatment even though a cure does not exist. Nowadays, treatment takes place in the community most of the time, medication is only used where necessary,  and psychotherapy is offered in order to help build coping and distress tolerance skills. Furthermore, in the past autistic individuals were segregated from society and placed in special schools. This is now known to have detrimental effects. Hence why nowadays autistic individuals are integrated into mainstream schools with extra support for their needs.  Finally, in the past autistic individuals had little or no autonomy and were passive receivers of interventions; whereas now person-centred approaches are the norm, and individuals are encouraged to be autonomous and to live meaningful lives (Lincoln College, 2022) even though the mental health industry still has a lot to improve when it comes to co-production of care plans in general. 

Furthermore, Lincoln College (2022) states that in the past autism was treated with medication on a trial and error basis, sometimes having dangerous and now-illicit substances administered such as LSD. Of course, this was harmful. Moreover, aversion therapy was used to operationally condition unwanted responses using punishment as the reinforcing method. Individuals were slapped on the wrist, splashed with cold water, and given electric shocks every time they displayed unwanted behaviours. This was done with the intention of extinguishing such behaviours, and was inhumane. Nowadays, this would be classed as unethical and degrading. 

Needless to say, in the past individuals were excessively put through electro-convulsive therapies which consisted of electrocuting the individual’s head in order to forcefully and drastically alter the biological make-up of the brain. This practice is known to induce seizures,  memory loss, and other effects. Sadly, this type of torture is still used as treatment in many countries, including the UK. There are several human rights movements such as the Citizens Commission on Human Rights (n.d.) which have made documentaries advocating against this form of therapy due to its many harmful effects. However, among the positive services offered to autistic individuals nowadays are community care (i.e. ensuring individuals are not hospitalised), speech and language therapy, occupational therapy, family therapy, behavioural therapy, medication, parent education, psychosocial treatments, and counselling (Lincoln College, 2022). 

References

Citizens Commission on Human Rights (n.d.) ‘Therapy or Torture? The Truth About Electroshock [Online]. Available at https://www.cchr.org/ban-ect/watch/therapy-or-torture-the-truth-about-electroshock.html (accessed 22 February 2022). 

Kanner, L. (1943) ‘Autistic Disturbances of Affective Contact’, Pathology [Online]. Available at https://neurodiversity.com/library_kanner_1943.pdf (accessed 22 February 2022). 

Lincoln College (2022) ‘The historical context of autism’, TQUK Level 3 Certificate in Understanding Autism [Online]. Available at https://lincolncollege.equal-online.com/courseplayer/autisml3/?ls=8663048&s=23416 (accessed 22 February 2022). 

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