NeuroTribes: The Legacy of Autism and the Future of Neurodiversity
by steve silberman
avery, 560 pages, $19
The alleged link between vaccination and autism has been thoroughly studied and debunked, but its appeal is understandable. The symptoms of autism typically begin to appear around the same age when many vaccines are given (which can lead parents to take a correlation for a cause), and there has been a massive increase in the reported incidence of autism over the past fifty years. Today one in sixty-eight American children is diagnosed as having Autism Spectrum Disorder. But one part of the story often goes untold: The diagnostic criteria have changed; a broader group of people now qualifies as autistic. Because of this, we can’t know whether—or by how much—the actual rate of autism has increased over time.
Steve Silberman’s NeuroTribes tells the story of autism’s shifting diagnostic criteria, taking into consideration the non-medical factors which motivated the proponents of different standards. Autism was first described in a public lecture in Vienna, given by Hans Asperger, in October 1938. Seven months after the Anschluss, it was clear that the Third Reich did not look kindly on the disabled.t Just a year later, Hitler would sign his involuntary euthanasia decree. Hoping to protect the children in his clinic, Asperger presented autism not as a disorder, but as an unusual personality with accompanying superpowers. To this end, his lecture focused on his high-functioning patients: “this boy’s positive and negative qualities are two natural, necessary, interconnected aspects of one well-knit, harmonious personality. . . . [His] difficulties—which particularly affect his relationships with himself and other people—are the price that he has to pay for his special gifts.” With the correct cultivation, Asperger argued, autistic children might turn out to be immensely useful to the Third Reich.
Three years later an American named Leo Kanner claimed to have made an independent discovery of what he called, without reference to Asperger’s work, “early infantile autism.” (Whether Kanner was really unfamiliar with Asperger’s work on autism is questionable; one of the researchers on Kanner’s autism team had worked in Asperger’s autism clinic as a diagnostician.) Given contemporary psychiatric trends in the U.S., Kanner defined autism much more narrowly than Asperger had, with the result that a very small fraction of American children were diagnosed.
Asperger’s work remained largely unknown in the Anglophone world until a British psychiatrist named Lorna Wing rediscovered it in the 1970s. Wing, whose daughter had been diagnosed with autism (under Kanner’s definition), believed that a much broader range of children would benefit from an autism diagnosis. Finding Asperger’s approach more compelling than Kanner’s, she popularized it in a 1981 paper and worked behind the scenes to replace Kanner’s definition of autism with something much broader. This led to an increase in diagnoses, which led in turn to an increase in public interest, funding, and resources for autistic children—all good things for the parent of an autistic child.
Because of these diagnostic changes, Silberman argues, we have no reason to think that autism incidence is actually increasing. Unfortunately, he refuses to engage with some compelling and well-established reasons for thinking that it is. For instance, we know that delayed reproduction—by parents of either sex—is a risk factor for autism, and that delayed reproduction has been increasing since the 1950s. We also know that autism is highly heritable, and that autism rates are higher in families containing engineers, physicists, or mathematicians. Our economy is increasingly structured to sort people by type, particularly when it comes to technical skills. Cambridge neuroscientist Simon Baron-Cohen has proposed that changing social conditions coupled with assortative mating—the phenomenon in which people are attracted to, and disproportionately reproduce with, people who are similar to themselves—may lead to an increase in incidences of autism.
Silberman’s broader thesis is that autism isn’t a pathology; rather, it’s a neurological difference with an accompanying sacrosanct identity. His claim that autism rates aren’t on the rise serves this narrative. People have always been born this way, he says, so it’s our harsh and unenlightened society that needs to become more accommodating.
Silberman has good reasons for thinking that autism is more than a pathology. Industrial designer Temple Grandin—perhaps the most famous autistic person alive—has said, “If I could snap my fingers and be non-autistic, I would not, because then I wouldn’t be me. Autism is part of who I am.” If autism facilitates the development of some central human faculties, even while hampering the development of others, then it’s wrong to treat autism as a simple misfortune. Nonetheless, Silberman papers over the fact that autism often is pathological, and can entail real disabilities. In addition to various physical ailments—hypersensitivity to scratchy fabrics, epilepsy—autistic people can have extraordinary difficulty in relating to other humans.
Unfortunately, Silberman is unwilling to admit that this is a bad thing. Firmly committed to that strange mix of relativism and moralism that characterizes modern identity politics, he insists an autistic approach to socialization is just as good as a non-autistic one. Actually, he implies that it is better: It is the “neurotypical” folks who are shallow and status-seeking, whereas autistic modes of socialization are more authentic.
In support of this view, he praises “nerd culture” for its disdain of social niceties. Nerd culture indeed has its virtues: an appreciation for science, a devotion to the truth (or at least to a certain style of rigorous argument), a heightened ability to recognize and celebrate virtues of the intellect even when they are embodied in a less physically attractive person. But it has its vices, too: elitism, a dehumanizing snobbery toward people who aren’t bright, gnosticism, all manner of aesthetic relativism, status seeking of a different sort.
Silberman’s solution to autism is to encourage autistic people to form communities with other members of their “neurotribe.” It’s already happening. Capitalism, meritocracy, and technology have created a world that’s easier for smart but socially challenged people to navigate. Social interactions can take place online, rather than IRL (“in real life”). The tech industry provides lucrative jobs for coders on the spectrum, and draws them to hubs like Silicon Valley where they form communities.
Silberman’s approach suffers from a typical liberal reliance on Kantian and Lockean principles. We’re inclined to think of ethics in terms of rules (Kant’s “categorical imperative”) and to think of political justice in terms of rights. Silberman must decide either that autism is a disease (in which case we must promote its cure) or that it’s not (in which case it would be a violation of an autistic person’s rights to try to teach him to behave differently than he’s inclined to).
We could arrive at a saner approach to autism by drawing on Aristotelian virtue ethics. Unlike Kant’s approach, virtue ethics recognized that most ethical questions can’t be answered by the simple application of rules; good judgment is also required. And virtue is the precondition to exercising good judgment. On this approach, we can treat autism as a temperament: an aspect of the personality that affects how a person is disposed to grow in the virtues. This allows us to accept autism as an important component of a person’s personality—and as something which we shouldn’t try to change—without requiring us to be relativists about the good and the bad or to be fatalistic. Instead, a diagnosis can provide insights into a person’s strengths and weaknesses, set realistic expectations for her development, and provide a path for growing in virtue that is consonant with her personality. With a philosophically sound understanding of autism, perhaps we can finally broker peace between the neurotribes.
Audrey Pollnow is a B.Phil. candidate at the University of Oxford.