Child psychiatrist Sami Timimi and his co-editors are not reluctant to blow their own trumpets. Re-Thinking Autism: Diagnosis, Identity and Equality is heralded as ‘the first edited collection that is firmly located in the previously non-existent field of critical autism studies’. It is, according to the editors’ introduction, ‘a unique text, the first of its kind’, ‘new and of great importance’, ‘radical’ and ‘deeply challenging’. Though Timimi’s 2010 book The Myth of Autism caused offence because of its egregious errors concerning the family of the late Lorna Wing, it is extensively referenced here. Indeed both Timimi’s chapters in Re-thinking Autism (co-authored with Brian McCabe) are substantially cut-and-paste jobs from The Myth of Autism. This suggests that the radical critique of mainstream autism science has not developed over the past five years, and it gravely undermines claims for the novelty of Re-thinking Autism.
Notwithstanding its assertions about being innovative, Re-thinking Autism is heavily influenced by a trio of outmoded theories. The ‘social model of disability’ was propounded by Michael Oliver, Britain’s first professor of disability studies, in the early 1980s. According to Oliver, disability was not caused by individual impairment (‘the medical model’) but was the result of the lack of appropriate adjustments by society (1). While recognising the insights provided by this approach, in 2006 disability activist Tom Shakespeare pronounced it a ‘dead end’. In his view it had led to the neglect of the real difficulties faced by many people with disabilities (2).
In the 1960s and 1970s, a disparate group of writers, including Thomas Szasz and Michel Foucault, Erving Goffman and RD Laing, elaborated a critique of the psychiatric mainstream. These writers particularly focused on the diagnosis of schizophrenia and the evils of institutional care. Though few would dispute its contribution to the closure of the old asylums, ‘anti-psychiatry’ has left a more ambivalent legacy in relation to schizophrenia. This remains, in Andrew Solomon’s memorable phrase, ‘in a class by itself for unrewarding trauma’ (3).
Several contributors to Re-Thinking Autism invoke the populist anti-capitalism that emerged in the wake of the collapse of the old left in the 1990s. They use terms such as ‘neoliberalism’, ‘late capitalism’ and ‘commodification’ without ever defining them. They do not explain what these concepts mean in relation to autism, nor indicate what they consider a viable alternative to market forces. In some places Re-Thinking Autism reads like a university seminar, in others like an Occupy discussion group.
The theoretical deficiencies of Re-Thinking Autism are particularly unfortunate because, like Timimi’s earlier book, it makes some telling criticisms of mainstream autism science and clinical practice. Contributors are right to point out, for example, that despite the consensus that autism is a ‘neurodevelopmental’ disorder, biomedical science has yet to confirm any definite pathological process. This remains true despite the sometimes extravagant claims made for researchers in genetics and neuroscience. Controversies around successive editions of the Diagnostic and Statistical Manual (DSM) of American psychiatry are reviewed in detail here. They confirm that political rather than scientific considerations have been the dominant influence on the expansion of autism diagnoses. The authors are justified in asking whether the diagnosis of autism is ‘scientifically meaningful’ or ‘clinically useful’. The expansion of the autistic spectrum to include geniuses like Wittgenstein and Einstein and people like my son, who has never said a word, indeed raises the question of whether the category has ‘become too heterogenous to have any prognostic value’. It is also true that the diagnosis does not lead to any treatment that can ‘specifically and differentially help those who have any form of autism’. In a well-argued chapter, clinical psychologist Graham Collins asks whether adding the label of autism to that of intellectual disability provides any benefit to individuals so labelled or their families.