Book Reviews in a Different Key: the Story of Autism
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Book Reviews years I escaped categorization. I was always an inference, not a given. So tasks such as regarded as rather strange, sometimes as judging the right amount of eye contact promising, sometimes as a sucker who could strike us as puzzling, however much practice be talked out of his allowance, sometimes we get at them. as the kid who could be goaded into saying funny things, and sometimes as someone In a Different Key stubbornly intent on creating disruptions. I I naturally approached this book with special have been regarded, in short, under a lot of interest, but with some anxiety as well. Per- headings, but never in my youth was I spo- haps it was because I find the easy resort to ken of as autistic or as an example of Asperg- institutional confinement a personal affront. er’s syndrome or as anything else of the sort. I’ll say more about confinement below. This is likely for the best: I was well beyond Autism as an intellectual and medi- all need for official diagnosis or classification cal construction is a product of the 20th before I started hearing such terms. century. As In a Different Key explains, the diagnosis of autism as it is understood Looking People in the Eye today can be traced back to the work of Leo Eye contact is a big thing. For years—for Kanner, the founder of the children’s psychi- decades—I struggled with it. It isn’t intuitive atric department at Johns Hopkins Hospital for me to look people in the eye while I speak in Baltimore. In 1942, Kanner wrote to the to them. But I’ve learned, slowly over the mother of one patient that he had “come decades, that it isn’t good to look away from to recognize for the first time a condition In a Different Key: their eyes either. People seem to associate which has not hitherto been described by that with dishonesty. (Why? I’m not sure. psychiatric or any other literature,” one that The Story of Autism Does the supposed “look me in the eyes and consisted of the inability of certain children, By John Donvan and Caren Zucker say that” lie detector ever work?) One relat- including her boy, to relate to other people. Crown Publishers, New York, NY, 2016. 670 pages, $30. ed problem, though, is that if I look at an in- He called this condition, “autistic disturbanc- Reviewed by Christopher C. Faille terlocutor’s eyes too intently, then he or she es of affective contact.” Autism is part of who I am. Or, at least, I will think I’m being creepy. So I’m between In 1943, he would use “Autistic Distur- believe so. There’s never been anything so Scylla and Charybdis. I try to get it right, to bances of Affective Contact” as the title of an formal as a diagnosis, but people who love look people just steadily enough in the eyes, article he published in a professional journal. me, including some with credentials as but no more steadily than that. It’s tricky. But the name obviously required shortening. health care providers, have told me, usually Neurologically, eye contact isn’t supposed Before this time, psychiatrists had some- with some effort at softening the presumed to be tricky. According to the dominant times used the adjective “autistic,” but they blow, that I am “on the spectrum.” I have working hypothesis in the study of autism, had generally used it to describe a symptom long since given up any impulse to argue the human brain, beginning even before the of schizophrenia, not as the name or part of the point. first birthday, develops neural pathways that the name of a condition unto itself. Turning I don’t believe I’ve ever owned the term allow for a “theory of mind,” a process that in on the self, auto-ism, an inner-driven “autism” in public before, so I will use this is supposed to be complete by about age 5. social withdrawal—this occurs periodically book review, then, as a coming-out moment. These pathways mean that one thereafter in the life of schizophrenics. But it is not a The readers of The Federal Lawyer know proceeds on the premise that the other per- defining characteristic of schizophrenia: For something of me, from my numerous book son, the one at whom you are looking, has sufferers with that condition, the social with- reviews in the magazine. You have had a subjective side too and that he is looking drawal comes and goes. For those with au- plenty of opportunities to judge both my at you, too, when your eyes meet. Autism, tism, by contrast, it is of the essence. This is analytical abilities and the sort of stylistic anywhere on the spectrum, is at its heart the case wherever on the “autism spectrum” quirks that enter into my prose style. That a consequence of some disruption in this one finds oneself. doesn’t make you diagnostic authorities, but process. it does mean that you are an appropriate Yes, autistic folks can figure out that The Legal Profession Since the community to whom to speak about this other people are thinking, too, but the Mid-20th Century aspect of my life. important point is this: We have to figure For a sense of why this should matter to the I am in the second half of my sixth it out—over and over again. The fact that bench and bar of the 21st century, one might decade, and am very glad that in my younger we’re surrounded by other minds is itself look at an anecdote early in In a Different 72 • THE FEDERAL LAWYER • June 2016 Key, about a distinguished midcentury Deinstitutionalization has taken some hits of the spectrum, those who seem utterly lawyer, John P. Frank (1917-2002). Frank’s lately, both in the popular culture and in the uncommunicative, nevertheless often have young son suffered from a severe brain trau- law journals. There is certainly the chance quite expressive faces. This observation was ma that impaired his intellectual develop- that it has gone too far in some respects or included, for example, in the writings of ment, speech, and growth. In the late 1940s, that it includes its own abuses. But the gist Kanner, who drew attention to the “impres- Frank found that every doctor he consulted of this book is right. Deinstitutionalization sion of serious mindedness” on the face suggested that there was no prospect for a has been much more of a blessing than a of one of his patients, and who wrote that life for “Petey” outside of an institution. So curse. It should be celebrated and prized in they were all “unquestionably endowed” he consulted with two friends of his who the hope that its gains will never be lost. with unexpressed cognitive potential. Such worked outside the medical profession: Jus- Lawyers, of all people, must under- impressions give their parents and other tices Wiley Rutledge and Hugo Black. Each stand that. Law is largely the business of observers hope that their loved ones’ com- advised him in strong terms against trying to classifying people where classifications are munication of those locked-away thoughts raise Petey at home. The father eventually necessary (felons versus non-felons, for can be facilitated in some manner, perhaps complied, and Petey remained institutional- example). But lawyers ought to get and stay by friendly hands assisting a patient’s own ized until his death from old age in 2010. out of the business of classifying people hands in typing on a keyboard. Petey Frank was not autistic, and his in- where such classifications are not necessary That hope became a movement, largely stitutionalization is but a very small piece in and where they can do disastrous harm to catalyzed by an Australian woman, Rose- the Big Picture of this book. His story is here innocent lives. mary Crossley, who first developed FC in to make the point that, even for someone order to communicate with a young woman such as his well-connected father, who was Three Controversies Involving Initials diagnosed with cerebral palsy. FC was intro- plainly disturbed by the idea of giving over Many fascinating questions are discussed duced to the United States, and to the world his son to the care of strangers, there was in the course of this thoroughly researched of autism treatment, by a Syracuse-area an almost irresistible momentum in that di- book. I’ll arbitrarily focus on three of them activist, Doug Biklen, after a visit to Australia rection because at-home care for a severely for a bit. Donvan and Zucker give space to and an eye-opening meeting with Crossley disabled child seemed unimaginable. If this controversies over “applied behavior analysis” in 1988. The FC movement grew exponen- was so in the minds of a former Supreme (ABA), “facilitated communication” (FC), and tially for a period, but its fortunes quickly Court clerk such as Frank and of two justices the measles, mumps, rubella vaccine (MMR). reversed in October 1993, with the broadcast who were close to him, one has to infer that ABA, a position in the lineage of Pavlov of a PBS documentary about a trial in Maine it was so quite generally. and Skinner, is the view that the cause of a few months before. That trial had sparked Around the time that John Frank was autism doesn’t really matter for purposes an experiment that demonstrated convinc- agonizing over this, Dr.