Autism becoming a diagnosis in its historical context

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Leo Kanner's paper Autistic Disturbances of Affective Contact, published in 1943, in which he was the first to describe children whom he termed autistic, cannot be separated from its context in the history of child psychiatry.

All of the children described by Kanner came from middle class families. Before the 20th century there was very little concern about middle class children who were autistic, unless they were also severely mentally ret*d. Also the boundaries of normality were wider than they are nowadays. The first three decades of the twentieth century saw growing concern about child delinquency, but that was mainly directed at working class children and adolescents. It was predominantly the middle classes who were interested in ideas of child development which spread in the 1920s and 1930s.

The first child psychiatry clinic in the United States was founded by Leo Kanner in 1930 as part of John Hopkins Hospital, Baltimore. Kanner was the first doctor in the US who identified as a child psychiatrist.

So it was because of growing middle class concern about the emotional and intellectual development of children and the development of the discipline of child psychiatry, that parents consulted Kanner about their children, whom he described in his paper. The historical circumstances meant that it could not have been written before the twentieth century and probably not before the 1930s.

As far as I know the autistic children described by Kanner would not have been targeted by the contemporary eugenics campaign in the US.

If you're referring to more severely affected children, I know some of his kids never developed speech (and there was no AAC back then), so they would probably be considered "low-functioning."

It's true that no one really paid much attention to child development until the 20th century. Now it's under a microscope and people are still figuring out what's normal and what's not.

In the past, you either muddled through or they put you in an institution with whatever label they had handy. ret*d. Insane. Pick one.

That's true. Either you were an "idiot" and locked up in a scary brick institution that looked somewhat like a medieval castle "for your own good", or you managed to function ok in the larger world. Keep in mind that making a living was much easier in the Gilded Age for a HFA. The work itself was dangerous, but you didn't need much in the way of education to operate a big stamping machine in a factory or to work on a Model T assembly line. Kissing up to the boss was not a concern, because the boss didn't care squat about your home life or about your ability to operate in a team in the modern sense. Indeed, aspies may have been more valued as factory workers, since they were less likely to join a union or even worse a supermilitant socialist revolutionary cell. Aspies may have had radical opinions, but not the ability to ACT on them.

Going further back, aspies usually are physically able (with the exception of a few with dysplasia like Callista) so they could plow. If they could plow, they plowed. Subsistence farming was not particularly discriminating. If a man had little appetite for drinking and playing the fiddle around a campfire, it wasn't fatal as long as he could grow crops. The records of early Puritan farming settlements have some mention of strange men who never married or had kids. Usually the strange men were given less land to plow in recognition of the lack of leverage owned by a man who didn't have a wife and 8 kids. I'm betting that most of these oddballs were aspies. Earlier societies were much more tolerant of us.

Today, it's all about social interaction and how well you can manipulate a rigged system. People who can't or won't manipulate successfully are cast aside, and people talk of eliminating them. Value as a human being is linked to how much you produce, and that is linked to how well you manipulate the system. The "surge" of autism is really just the fact that fewer and fewer people are able to work within the system, so they're drugged to try and force them to fit. To be drugged, a medical diagnosis is needed. So the odd kid becomes an evil autistic, a useless eater, a claimant instead of a producer. In earlier times, he'd be a fully functional member of society, but a society of crass manipulators won't let him in.

One or two, max.

Coming from a family that were farmers on one side until one of my parents decided not to be, and which had many eccentrics, I very much agree with pezar. People do not realize how much cultural context makes the line between who's too weird to be there and who isn't, move around a lot.

I'd bet many of these men were gay rather than autistic, homosexuality being much more common. But yes, there used to be a lot more room for eccentrics in the workplace, back when most people were self-employed farmers.

I know the government here will find and give an Autistic person a job if they're "fit" for such (Oz), something that's at least equivalent to farming. So, I wouldn't go saying that people were more tolerant based on such a simple thing as the aforementioned point, in all cultures at least. It's common knowledge that a good portion of people with an ASD work within the family nowadays, so it may've been of a similar pattern in the past.

Rather than vocation, has a change in sociology made it harder for those with an ASD to "fit in" (i.e., everyone is connected nowadays, and slight differences are more easily spotted--differences have always been rallied against). Do people not allow us to interact with them now because our "slight" differences are the differences people can see (it used to be stuff like skin colour)?

Of note, I spent the first few years of my life in the middle of nowhere, and I'm quite certain I would have been picked up in a second if I were born to another mother in another place in another time and who put me in childcare.

Exactly. I've done genealogy, and there are lots of oddballs there. but also many that seemed to manage very well. My entire ancestry is actually rural. Not a single factory worker or person living in a city. Most lived on their own farm, producing children and seeingly doing well in bringing them up.

The main factor that seemed to have made life harder for Aspies is the move to cities and industrialism. These favor NTs. However, even today, Aspies seems to produce as many children as do NTs, they just live in less stable relationshops with higher divorce rates. Yesterday, divorce was not an option, and I don't seem to have a single illegitime child in my ancestry going back to the late 1700s, nor any couple that broke up unless they died.

It is society that has turned hostile against Aspies and not Aspies that have turned diseased.

It was not until the 1920 census that a majority of the population of the United States was classified as urban - 51.2% urban and 48.8% rural: http://www.census.gov/population/www/ce ... able-4.pdf .

In his book On Some of the Mental Affections of Childhood and Youth, published in 1887, Dr. John Langdon Down described children who were

http://www.wisconsinmedicalsociety.org/ ... octor_down .

He placed these children in the developmental category. His other two categories for mental retardation were the accidental and the congenital.

The book Considering Autism: Unravelling the 'truth' and understanding the social, by Majia Holmer Nadesan, Routledge, 2005, investigates the question
Most of the book is available here: http://books.google.co.uk/books?id=yT7P ... ing+autism .

I have read that Emily Bronte and Emily Dickinson have been retrospectively diagnosed as being on the autism spectrum.

Some early nineteenth century descriptions of mental retardation resemble later accounts of children labelled as autistic or psychotic. See Kauffman, J. M. (1976) Nineteenth century views of children's behavior disorders: Historic contributions and continuing issues. Journal of Special Education 10, pp.335-349.

It was not until the mid to late nineteenth century that mental illness was separated from mental retardation.

There were descriptions of autistic children before Kanner wrote his 1943 paper, but he was the first person to recognise a pattern of behaviour in the children he studied. Autistics did not properly fit into any of the existing psychiatric categories - mental retardation, mental illness, neuroses, behavioural problems etc, although by 1943 childhood schizophrenia was an established diagnosis in the United States.

It was practically inevitable that autistic children would have been described before autistic adults. If an autistic adult went to see a psychiatrist in the 1930s, for example, and described his difficulties, the psychiatrist would probably have diagnosed him as suffering from some form of neurosis, or possibly as schizophrenic.