Today autism has become highly visible. Once you begin to look for it, you realize it is everywhere. Why? We all know the answer or think we do: there is an autism epidemic. And if it is an epidemic, then we know what must be done: lots of money must be thrown at it, detection centers must be established and explanations sought, so that the number of new cases can be brought down and the epidemic brought under control. But can it really be so simple? This major new book offers a very different interpretation. The authors argue that the recent rise in autism should be understood an "aftershock" of the real earthquake, which was the deinstitutionalization of mental retardation in the mid-1970s. This entailed a radical transformation not only of the institutional matrix for dealing with developmental disorders of childhood, but also of the cultural lens through which we view them. It opened up a space for viewing and treating childhood disorders as neither mental illness nor mental retardation, neither curable nor incurable, but somewhere in-between.
The authors show that where deinstitutionalization went the furthest, as in Scandinavia, UK and the "blue" states of the US, autism rates are also highest. Where it was absent or delayed, as in France, autism rates are low. Combining a historical narrative with international comparison, The Autism Matrix offers a fresh and powerful analysis of a condition that affects many parents and children today.
Introduction: The Autism Matrix. Why focus on therapies? Between mental illness and mental retardation. Chapter 1: The Puzzle of US States and International Variation in Autism Rates. Diagnostic substitution. Supply-side and demand-side explanations for diagnostic substitution. Deinstitutionalization as key to explaining diagnostic substitution. Deinstitutionalization and the variation in autism rates. Chapter 2: The Feebleminded. Chapter 3: The Surveillance of Childhood. The unification of mental deficiency and mental hygiene under child psychiatry. The role of the middle class family. The institutionalization of children as part of a comprehensive surveillance system. Chapter 4: Deinstitutionalization. A new look at the deinstitutionalization of the retarded. The middle class family and the "valorization of retarded existence". Chapter 5: "An existence as close to the normal as possible": Normalization. Normalization as therapeutic practice. Behavior modification and normalization. Chapter 6: Childhood Schizophrenia. Chapter 7: The Rise of the Therapies. Autism therapies in the 1950s and 1960s. Working on the child's brain. Inculcating habits and building skills. Fuzzifying the boundary between expert and layman. The space between fields. Chapter 8: Rimland and the Formation of NSAC. The problem of credibility. Schopler and the new economy of blame and worth. The implications of behavioral therapy. Conclusion. Chapter 9: The Atypical Children. The struggle over inclusion in the developmental disabilities act: Autism as analogous with mental retardation. "Items of autistic behavior": Autism as concurrent with mental retardation. Looping and the transformation of autism. Chapter 10: Asperger and Neurodiversity. The riddle of simultaneous discovery dissolved. "Personality trait" vs. "psychotic process". Twins reunited. Loops of self-advocacy. Chapter11: The space of autism therapies and the making and remaking of the Spectrum. The Return of Rimland. The agonistic network. Fuzzifying the boundary between medicine and alternative medicine. The space of autism therapies. Conclusion.