Autism, Explaining the Enigma

Autism

Explaining the Enigma

second edition
by
Uta Frith
2003

reviewed by Mira de Vries

This is a major overhaul of a book by the same name published in 1989 that established Frith as an authority on autism. Frith, who is a professor and senior scientist at University College in London, seems to be identified by a variety of professions, among them psychology, neuropsychology, and cognitive development.

Frith charms the reader with her warm and colorful writing. She draws on a rich mix of sources, including anecdotes from history, the cinema, and computer programming. Her book contains delightful, cartoon-like drawings. The cover is embellished by a painting by the 17th century French artist Georges de la Tour: The Cheater with the Ace of Diamonds.

In the first edition, Frith popularized her term Theory of Mind (ToM), replacing the word empathy, for the concept of the innate ability to gauge other people’s thoughts and feelings. She considers the absence of ToM the core disability of autism. In this edition she changes the term to mentalizing and its absence to mind blindness.

People who identify themselves as autistic, while accepting that they are different from most people in a major way, tend to deride Frith's theory by whatever name. They point out that non-autistics (whom they call neurotypicals or NTs) equally fail to attribute the right thoughts and feelings to autistics, and sometimes even to their fellow NTs. Other people who identify themselves as autistic reject the concept of mind in general, or question Frith's way of assessing it.

She apologizes for not always using the in her opinion politically correct term person with autism which nevertheless occurs frequently throughout her book. Worse, she speaks about sufferers of autism. One suffers from illness, yet Frith denies that autism is a (mental) illness. This is not because she questions the concept of mental illness, but because she considers autism a permanent, unamenable disability, whereas apparently she thinks that "mental illness" is real illness, from which one either becomes cured or dies. Autistic people understandably perceive attributions of suffering and disability as attaching a negative value judgment to autism.

Frith briefly claims that autism is a syndrome, correctly identifying the criterion a syndrome must meet, namely having a pattern of symptoms and signs that always occur together and are unlikely to do so by chance. She then claims that autism meets this criterion due to the presence of a triad of symptoms, which she lists only 147 pages later. The first of the triad is mind-blindness, her core thesis. The next is special talents, but, according to Frith, they are present in only about 10% of autistics, thus hardly qualifying as a symptom that fits into a pattern. The third is the absence of top-down control, a concept so complex that calling it a sign or symptom is unreasonable. Nobody comes to the physician complaining, "Doctor, I (or: my child) lacks top-down control." We are thus left with only one symptom, mind-blindness. So the definition becomes circular: someone who is called autistic is presumed to be mind-blind, and someone who seems mind-blind is labeled autistic. Compounding the confusion, Frith compares autism to schizophrenia, apparently either oblivious to or uninterested in the controversy over this concept.

In speculating about the causes of autism Frith treats only heredity seriously. This is in keeping with psychiatric tradition which in spite of the atrocities to which it has led continues to see genes as the cause of whatever is perceived by psychiatrists to be wrong with a person. Although she gives lip service to parents’ concerns about the MMR vaccine, she clearly does not take them seriously. She heads the section in which she discusses it The Great Vaccine Scare but she does not head the section on genetic factors The Great Gene Scare. She warns about the terrible things that might happen to children who don’t receive the MMR vaccine, whereas in reality the childhood illnesses against which it vaccinates are usually trivial, certainly compared to a lifetime of autism. Likewise, infants born premature, ill, or after difficult labor are at vastly increased risk for autism, yet Frith only slightly touches on illness in infancy as a factor, and totally neglects medical interference before, during, and after birth.

Whatever made someone autistic is probably different from person to person. To this much Frith reluctantly agrees. Genes may well have a lot to do with it in some people, but the stubbornness with which Frith and other professionals prefer this theory is appalling. It prevents other causes, which are more given to preventive efforts than genes, from being properly investigated. Naturally the professional world totally lacks the ability to introspect about its own contribution to causing autism. By defining it as a disability present at birth, professionals overlook the vast populace who turn autistic in adulthood after psychiatric treatment. This obvious link should open up at least one new avenue of investigation into the rise in incidence of presumed congenital autism: agents that depress the central nervous system such as drugs to induce or delay labor and other medical treatments, not to mention extensive pollution of the environment by copious amounts of psychiatric drugs unknowingly excreted into the sewage system by the people who take them.

The second edition of Autism contains a new chapter reporting on findings in brain scans. In theory these scans show the flow of blood through the brain. This is supposed to reveal something meaningful, particularly when researchers believe they see autistic people’s blood flowing differently from that of non-autistic people. Frith unconvincingly analogizes the autistic’s brain to a pruned garden.

More importantly, making the scans is unethical. Such scans are at best unpleasant, and at worst downright dangerous. PET scans require radioactive material being injected into the bloodstream to track the blood as it travels through the brain. Neurotypicals ("normals") often fail to grasp that the object of the scan is not their benefit but to enhance the careers of the researchers. If indeed autistics are mind-blind as Frith posits, then they are even less likely to understand this. Informed consent would not be possible.

Another causal theory Frith proposes is altered dopamine levels in the brain. She fails to report that no such altered levels have ever been detected in the brains of autistic people or anyone else. This totally unfounded theory is cultivated by the pharmaceutical industry and gratefully embraced by psychiatrists. It is particularly grievous, as autistic people are among the many victims of the unnecessary pandemic of iatrogenic neurological disease. Nowhere in the book does Frith acknowledge widespread pharmacological abuse of autistic people, let alone denounce it.

In summary, Frith’s book is fraught with conjecture, professional dogma, and scientistic gossip, while being factually anemic and almost criminally devoid of ethical concerns. It is offensively patronizing in failing to present the viewpoints of the people being discussed. It does not explain the enigma. It doesn't even define it.

The book's appeal is in reassuring parents that they are not guilty of their child's being different. In 1989, when people still remembered the psychoanalytic movement and Bruno Bettelheim's false explanation of autism, this was much welcome. Today the book joins many other works of biobabble, though it does so most charmingly.