What is autism? What causes it? Is it genetic? Is it a consequence of something in our environment or lifestyle? What’s an “idiot savant” or an “autistic savant”? What happens when autistic children become adults? Why are so many of their parents scientists, academics, and engineers? If your grandfather’s Uncle Fred was a socially inept inventor with a lot of strange quirks, do you think he might have been autistic? Is autism really becoming more prevalent, or are we just getting better at diagnosing it? What’s happening with these people and what can be done to give them a better life?

Sorry to burden the list of recommended reading with yet another book, but if you are on the autism spectrum, if you know anyone who is autistic, if you think there is an epidemic of autism, if you think vaccines or environmental toxins cause autism, or if you are just interested in autism and want to understand it better, you will benefit from reading this new book by Steve Silberman: NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. You will walk away from the book with new insights and a new appreciation of the “neurodiverse.”

The history of autism

Silberman provides the most complete history of autism I have seen, and he makes it fun to read. He covers many of the main players like Kanner, Asperger, and Bettelheim, telling details about their lives that make them come alive. He describes how difficult it was to resolve different views of what constituted autism and to reach a consensus about what to call it. He describes the struggle to get meaningful diagnostic criteria into the DSM (The Diagnostic and Statistical Manual of Mental Disorders).

If you think autism is a new phenomenon, this book will make you think again. He gives many historical examples of people who were clearly on the autism spectrum, and he explains why most autistics would have been off the radar in the past. In the first chapter he gives us extensive details about the life of Henry Cavendish (1731-1810), a phenomenally productive scientist who discovered hydrogen and measured the mass of the Earth, but a seriously weird guy. He was socially inept and remarkably eccentric; he dressed in old-fashioned clothes and had fixed routines like taking exactly the same walk every day and eating the same food over and over. He was so upset by accidentally encountering a housemaid on the stairs in his house that he had a separate set of stairs built for his servants so it wouldn’t happen again. He was every bit as Sheldonish as Sheldon Cooper on The Big Bang Theory.

Silberman gives chilling details about how autism was treated in the past. Autistic children were labeled as hopelessly retarded or schizophrenic and were locked away for life in institutions, with no attempt whatsoever to educate them. Psychoanalysts made bizarre interpretations of their behavior (one thought a boy’s obsessive turning of doorknobs meant he wanted to have sex with his mother). Parents were blamed for causing the children’s troublesome behaviors by being too cold or demanding; they were labeled “refrigerator mothers.” Mothers who had jobs or intellectual interests were demonized. Children who couldn’t talk were seen as willfully refusing to talk. Children were physically punished to extinguish unwanted behaviors. Among other atrocities, electroshock therapy was tried.

Public awareness rises

The movie Rain Man was instrumental in raising public awareness of autism; he gives fascinating details about how that film came about. Temple Grandin provided a highly visible example of how an autistic child could learn, compensate, get a PhD, and make significant contributions in their chosen field. Parents and autistics themselves started banding together for support. Those who found face-to-face interactions difficult found a supportive community on the Internet.

As awareness of autism began to rise, parents found that with intensive early interventions, many of these children could overcome the worst of their handicaps, improve their language and social abilities, and even be enrolled in public schools. Laws were passed to ensure these children had access to educational and therapeutic services.

But at the same time, pernicious rumors spread about vaccines, and all kinds of quackery abounded. Some doctors (and some non-doctors) promised to cure autism with a regimen of diets, supplements, and other unproven interventions, even chelation and chemical castration. Silberman does a masterful job of cutting through the nonsense.

Neurodiversity is a good thing

The best thing Silberman does is to put a positive spin on autism. He sees autistics as different rather than as defective. Autism is many things; autistics are actually more different from each other than from neurotypicals. Autism may just be an exaggeration of traits we all have. There is a wide spectrum, and most of us can identify some autistic-like tendencies in ourselves. Some of the characteristics that define autism are also characteristics that make people successful in a wide range of endeavors. The child who spends hours lining up his toy cars just so may grow up to apply the same degree of fixation, dedication, effort, persistence, and total concentration to solving a problem in his chosen field of work. Some autistics have unique abilities in math, art, or other areas. Temple Grandin gives her autism the credit for her ability to design humane livestock facilities; she thinks in images rather than in words and is able to “think like a cow.” She has said she would not support curing autism because “The world needs all kinds of minds.”

Autistics can be thought of as a neurodiverse tribe. Instead of making them conform to our neurotypical world, we can try to accommodate their differences and create an environment for them that will allow them to thrive and contribute to society. Silberman gives many suggestions as to how that can be accomplished. He gives numerous examples of how parents have adapted to the needs of their autistic children rather than making the children adapt to the rigid expectations of society. Sometimes a behavior initially seen as negative can be encouraged and utilized for positive accomplishments.

Conclusion: “A brilliant and sparklingly humane book”

We are daily confronted with bad news about terrorist attacks, the idiocies of presidential candidates, and celebrities who have proclaimed themselves experts, and pseudoscientific misinformation in the media about everything from vaccines to evolution. In a world with all of those discouraging trends, this book is a welcome ray of clarity, sanity, and optimism about autism. It won the Samuel Johnson Prize, the UK’s most prestigious award for non-fiction, and one review called it a “brilliant and sparklingly humane book.” I agree; I highly recommend it.

Posted by Harriet Hall

Harriet Hall, MD also known as The SkepDoc, is a retired family physician who writes about pseudoscience and questionable medical practices. She received her BA and MD from the University of Washington, did her internship in the Air Force (the second female ever to do so),  and was the first female graduate of the Air Force family practice residency at Eglin Air Force Base. During a long career as an Air Force physician, she held various positions from flight surgeon to DBMS (Director of Base Medical Services) and did everything from delivering babies to taking the controls of a B-52. She retired with the rank of Colonel.  In 2008 she published her memoirs, Women Aren't Supposed to Fly.