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Gesnerus 2020-2.Indb Gesnerus 77/2 (2020) 279–311, DOI: 10.24894/Gesn-de.2020.77012 Vom «autistischen Psychopathen» zum Autismusspektrum. Verhaltensdiagnostik und Persönlichkeitsbehauptung in der Geschichte des Autismus Rüdiger Graf Abstract Der Aufsatz untersucht das Verhältnis von Persönlichkeit und Verhalten in der Defi nition und Diagnostik des Autismus von Kanner und Asperger in den 1940er Jahren bis in die neueren Ausgaben des DSM und ICD. Dazu unter- scheidet er drei verschiedene epistemische Zugänge zum Autismus: ein exter- nes Wissen der dritten Person, das über Verhaltensbeobachtungen, Testver- fahren und Elterninterviews gewonnen wird; ein stärker praktisches Wissen der zweiten Person, das in der andauernden, alltäglichen Interaktion bei El- tern und Betreuer*innen entsteht, und schließlich das introspektive Wissen der ersten Person, d.h. der Autist*innen selbst. Dabei resultiert die Kerndif- ferenz in der Behandlung des Autismus daraus, ob man meint, die Persönlich- keit eines Menschen allein über die Beobachtung von Verhaltensweisen er- schließen zu können oder ob es sich um eine vorgängige Struktur handelt, die introspektiv zugänglich ist, Verhalten prägt und ihm Sinn verleihen kann. Die Entscheidung hierüber führt zu grundlegend anderen Positionierungen zu verhaltenstherapeutischen Ansätzen, wie insbesondere zu Ole Ivar Lovaas’ Applied Behavior Analysis. Autismus; Psychiatriegeschichte; Wissensgeschichte; Verhaltenstherapie; Neurodiversität PD Dr. Rüdiger Graf, Leibniz-Zentrum für Zeithistorische Forschung Potsdam, Am Neuen Markt 1, 14467 Potsdam, [email protected]. Gesnerus 77 (2020) 279 Downloaded from Brill.com09/27/2021 01:45:02AM via free access «Autistic Psychopaths» and the Autism Spectrum. Diagnosing Behavior and Claiming Personhood in the History of Autism The article examines how understandings of personality and behavior have interacted in the defi nition and diagnostics of autism from Kanner and As- perger in the 1940s to the latest editions of DSM and ICD. It distinguishes three different epistemic approaches to autism: an external or third-person knowledge derived from observations, tests and parent interviews; a more practical, second-person knowledge, which emerges in the continuous daily interactions of primary caretakers; and fi nally the introspective fi rst person knowledge by autists themselves. The core difference in the treatment of au- tism derives from the following question: Can a person’s personality only be known by examining his or her behavior or is it an independent structure that can be accessed introspectively, endowing behavior with meaning? The answer to this question determines the attitude to the use behavior therapy in the case of autism and, particularly, to Ole Ivar Lovaas’ Applied Behavior Analysis. Autis m; Behavior Therapy; Neurodiversity; Asperger; Personality; history of knowlegde Einleitung Seit der Film Ra inman im Jahr 1988 Millionen von Menschen wahrschein- lich zum ersten Mal mit Autismus konfrontierte, hat die massenmediale Auf- merksamkeit für das Phänomen stark zugenommen und sich gerade in den letzten Jahren noch einmal intensiviert.1 Diese Aufmerksamkeitssteigerung resultiert nicht zuletzt daraus, dass die Zahl der Autismusdiagnosen in den letzten 40 Jahren vor allem im angloamerikanischen Raum, aber auch darü- ber hinaus sprunghaft angestiegen ist. Während epidemiologische Studien in den 1960er und 1970er Jahren schätzten, dass von 10.000 Kindern etwa vier oder fünf autistisch seien, ist diese Zahl im letzten Jahrzehnt in der anglo- amerikanischen Welt auf 157 angestiegen, so dass bei einem von 64 Kindern die Autismus-Diagnose gestellt wird bzw. gestellt werden kann.2 Nach den autoritativen Klassifi kationen des Diagnostic and Statistical Ma- nual of Mental Disorders (DSM) und der International Statistical Classifi ca- 1 Hacking 2009, 46. Zum Rainman-Effekt siehe Silberman 2015, 354–380 sowie exemplarisch Haddon 2003; Adam. A Story about Two Strangers 2009; Atypical. A Netfl ix Original Se- ries. Seasons 1–3 2017ff. 2 Evans 2017, 1. Etwas konservativere Schätzungen gehen von einem Prozent Autist*innen aus: Happé/Frith 2020. 280 Gesnerus 77 (2020) Downloaded from Brill.com09/27/2021 01:45:02AM via free access tion of Diseases and Related Health Problems (ICD) bezeichnet Autismus eine tiefgreifende und umfassende Entwicklungsstörung («pervasive deve- lopmental disorder»), die sich in einer Kombination bestimmter Verhaltens- weisen, einem «behavioral syndrome», ausdrückt und deren genetische, neu- ronale oder physiologische Ursachen unbekannt sind.3 Dabei besteht auch Unsicherheit darüber, ob es sich überhaupt um ein Krankheitsbild handelt oder nicht vielmehr um eine Sammeldiagnose, die momentan für verschie- dene Störungen vergeben wird, welche aber durchaus unterschiedliche Ursa- chen haben können. In der öffentlichen Diskussion – vor allem in den ein- schlägigen Internet-Foren – werden bisweilen spektakuläre Theorien über die Ursachen der sogenannten «Autismus-Epidemie» diskutiert.4 Neben den Diskussionen über mögliche auslösende Faktoren herrscht allerdings weitge- hende Einigkeit darüber, dass für den raschen Anstieg der Diagnosen auch die Veränderung der diagnostischen Kriterien, die dadurch bedingte Ver- schiebung von Aufmerksamkeitsstrukturen bei Eltern, Psycholog*innen und Pädagog*innen sowie die Bereitstellung besonderer Unterstützungsangebote verantwortlich waren.5 Zur Entstehung des Autismus als psychiatrischer Diagnose und ihrer Verän- derung liegen für den angloamerikanischen Raum bereits erste Untersuchun- gen vor. Aus der psychiatrischen und neurowissenschaftlichen Forschungsdis- kussion heben Francesca Happé und Uta Frith sieben Trends hervor, entlang derer sich das wissenschaftliche Verständnis des Autismus seit den 1970er Jahren verändert habe: «(1) from a narrow defi nition to wide diagnostic criteria; (2) from a rare to a relatively com- mon condition […]; (3) from something affecting children, to a lifelong condition; (4) from something discrete and distinct, to a dimensional view; (5) from one thing to many ‘autisms’, and a compound or ‘fractionable’ condition; (6) from a focus on ‘pure’ autism, to recogni- tion that complexity and comorbidity is the norm; and fi nally, (7) from conceptualising au- tism purely as a ‘developmental disorder’, to recognising a neurodiversity perspective, op- erationalised in participatory research models.»6 Weiter historisch zurückgreifend, hat Bonnie Evans gezeigt, dass Autismus bis in die Mitte des 20. Jahrhunderts meist als kindliche Schizophrenie ver- standen und mit überbordender Phantasie und Halluzinationen verbunden worden war, wohingegen seit den 1960er Jahren gerade die Abwesenheit ei- nes inneren symbolischen Lebens zum Kriterium wurde.7 Diese akademische Diskussion wurde wesentlich von Eltern autistischer Kinder mitgeprägt, wie 3 Silverman 2012, 30–31. 4 Eyal et al. 2010. 5 Evans 2017, 4–5. Nadesan 2005, 1–2 . schließt daraus «the idea of autism is fundamentally so- cially constructed»; siehe auch Happé/Frith 2020. 6 Happé/Frith 2020, 1. 7 Evans 2013. Gesnerus 77 (2020) 281 Downloaded from Brill.com09/27/2021 01:45:02AM via free access Chloe Silverman herausgearbeitet hat.8 Deren Verbände hatten eb enfalls ei- nen großen Einfl uss auf die Verbreitung von Autismuswissen und die Bereit- stellung von Hilfsangeboten.9 Stärker kulturwissenschaftlich angelegte Arbei- ten betonen darüber hinaus die Bedeutung des Autismus als «Diagnose der Gegenwart», anhand derer Menschen und Gesellschaften verhandeln, was sie sind bzw. nicht sind.10 In diesem Sinne meint etwa der Wissenschaftsphilosoph Ian Hacking, es sei nicht zufällig, dass Autisten oft als Außerirdische be- schrieben werden; ihr Verhalten erscheine uns so fremd wie ihnen das unsrige und sie dienten der kontrastierenden Diskussion über u ns selbst.11 Eine Kernannahme der noch jungen Autismus-Geschichtsschreibung be- steht darin, dass Autismus sozial konstruiert ist bzw. die Entwicklung der Dia- gnose durch sich wandelnde Vorstellungen von normalem und abnormem Ver- halten und die veränderlichen Techniken, dieses zu beobachten und zu klassifi zieren, geprägt wurde.12 Während das Therapieziel, Menschen vom Au- tismus zu befreien und damit «normal» z u machen, bis in die 1980er Jahre hin- ein universal anerkannt war, änderte sich dies mit der Entstehung von Self-ad- vocacy-Gruppen im Rahmen der allgemeinen Behindertenrechtsbewegung.13 An der Spitze der Neurodiversitätsbewegung reklamierten Autist*innen in den letzten 20 Jahren verstärkt das Recht, solche zu sein, und wehrten sich gegen die von außen an sie herangetragene Zumutung, von ihrem Autismus befreit werden zu müssen.14 Die Frage, ob Autismus therapiert werden muss oder nicht, berührt die grundlegendere Debatte darüber, was legitime Formen der Persön- lichkeit und ihres Ausdrucks sind und inwiefern die Fähigkeit, bestimmte kom- munikative und soziale Beziehungen zu anderen aufbauen zu können, ein kon- stitutives Merkmal für die Identität als Person ist.15 In den wissenschaftlichen und öffentlichen Diskussionen über den Autismus und dessen Therapie wird also auch die Frage verhandelt, was es bedeutet, eine Person bzw. ein Subjekt zu sein. In kognitions- und kulturwissenschaftlichen sowie philosophischen Diskussionen dient Autismus gewissermaßen als Grenzfall, um die Bedingun- gen des Menschseins auszuloten.16 Wenn ich im Folgenden die Geschichte des Autismus, seiner Diagnose und seiner Therapie untersuche, frage ich danach, inwiefern diese von sich 8 Silverman 2012. 9 Silverman 2012; Silberman 2015; Donvan/Zucker
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