Mitzi Waltz. Autism: A Social and Medical History. Basingstoke: Palgrave Macmillan, 2013. 200 pp. $90.00 (cloth), ISBN 978-0-230-52750-8.

Reviewed by Paula Hellal (Birkbeck University of London)
Published on H-Disability (October, 2015)
Commissioned by Iain C. Hutchison (University of Glasgow)

This timely book on autism considers the history of our understanding of the condition. Like David Wright in Downs: The History of a Disability (2011) and Howard Kushner in A Cursing Brain?: The Histories of Tourette Syndrome (2000), Waltz, by looking at the development of ideas underpinning diagnosis and treatment, puts contemporary concerns into context. In the eight fairly short chapters of Autism: A Social and Medical History, Waltz discusses how autism has been considered during various time periods and across cultures. As the book’s title implies, she gives more or less equal consideration to both social and medical history, focusing on the development of ideas and on how those ideas affected people with autism. As she points out, “over 65 years after the word ‘autism’ was first made shorthand for a pattern of child development and behaviour, no agreement has been reached about even the most basic issues, such as causation” (p. vii). Using case studies to provide authentic voices, Waltz looks at such aspects as drug treatment, mother blaming, and the rise of self-advocacy--mainly from an English-language perspective although some mention is made of the situation elsewhere (i.e., Russia). Her reference section includes a large number of online sources that will enable those without easy access to academic journals to follow up some topics of interest.

The book opens with a late nineteenth-century case from the archives of Great Ormond Street Hospital in London (Britain’s first specialist children’s hospital). Waltz fleshes out the meagre case note details of a two-year-old boy and asks why such cases did not provide the “foundation of growing understanding” of autism (p. 7). The focus then shifts to earlier centuries as Waltz considers how autism was seen through the lens of “folklore and religious belief” in the United Kingdom and elsewhere (p. 11). Brief mention is made of communication problems, the stigma of “idiocy,” early speech therapy, herbal treatment, and the folklore of the changeling. Using as exemplars two famous cases, Hugh Blair of Borgue[1] and Itard’s “wild boy,” Victor of Aveyron, Waltz points out that “the two faces of care and treatment for persons with autistic characteristics have been benevolence and control--often with the former a mere mask for the latter” (p. 23). She expands on this theme throughout the book. In her review of the early modern period, her focus is on England, but reference is also made to the United States, Canada, and Europe. Waltz considers what it meant for people with autism when the rise of psychology, Social Darwinism, and eugenics influenced how they were viewed. She looks at the origin of the child guidance movement and psychoanalytic methods used to “cure” autism and considers how inadequate or abusive parenting first began to be seen as a possible, even probable, cause.

In her chapter on the social construction of autism, Waltz considers the work of Leo Kanner (1894-1981) and the importance of the chosen nomenclature that saw autism framed as a psychological rather than organic disorder: “Accordingly, for the next four decades, breaking though the supposedly self-imposed psychological barriers of the autistic child became the focus of most mainstream research and treatment decisions about autism” (p. 51). Waltz describes Kanner’s use of case notes to make a narrative of autism, with the child’s own voice rarely heard. In the following chapter, with the emotive title “Refrigerator Mothers,” she returns briefly to the nineteenth century and Stanley Hall’s (1846-1924) child psychology clinic and the child guidance movement. Here she highlights the rise of voices blaming mothers for the condition by considering the work of Bruno Bettelheim (1903-90) and three female psychoanalysts, Margaret Mahler (1897-1985), Frances Tustin (1913-1994), and Melanie Klein (1882-1960).

Turning to behaviorism, Waltz uses a case study to describe the pre-1970s situation at Ely Hospital in the United Kingdom before considering the two major alternatives to psychotherapy-based practices regarding autism: operant conditioning/Applied Behavior Analysis (ABA) and experimental drugs. Medical issues such as the electroshock therapy practiced on children with learning disabilities in New York in the mid-twentieth century and the US hepatitis trials using children with autism in the 1960s are discussed. In the penultimate chapter, Waltz again considers parent blaming, this time in the context of the rise of parent power and the start of focused research. The “parent narrative” is illuminated through discussion of selected published works. Waltz stresses the role played by parent researchers such as Lorna Wing (1928-2014) in the United Kingdom and Bernard Rimland (1928-2006) in the United States in breaking “Freudian psychology’s stranglehold on autism” and getting the possible biological causation of the condition to be considered (p. 122).  

The final chapter brings the story of autism up to date with the emergence of people with autism as “actors with agency.” Online forums and the sharing of personal narrative have, Waltz claims, “been a touchstone for building a nascent autistic culture” (p. 134). The voices of campaigners, such as the Canadian Michelle Dawson (b. 1961), provide a counterbalance to the medical view that has prevailed throughout much of the history of autism. Waltz then turns her attention to autism in the media, arguing that media representations matter because “for most people, autism becomes ‘storied’ and understood through its depiction in popular culture, not through the pages of medical texts, parent narratives, or websites like Autistics.org” (p. 157). She ends the book with a look at recent medical developments and at the long search for a cure rather than a focus on living well with autism.

Autism: A Social and Medical History is an interesting book that looks at a number of important themes, including diagnosis and treatment, prejudice and abuse, medical perspectives, parent power, and self-advocacy. The wide focus is in one respect a weakness of the book’s design as Waltz is obliged to be highly selective in what she discusses and so cannot consider any aspect in depth. However, she makes no claim that this is a definitive account, and the brevity of analyses does not prevent the reader gaining a good idea of some of the main players in autism research, what the most important considerations used to be and are now, and how adopting a particular focus can have devastating effects on the lives not only of those with autism but also of those who love and care for them. Waltz’s empathy for the people she discusses, and her desire to see real change and improvement in the lives of all affected by autism, is apparent in her thoughtful text.

This book will be of interest and value to professionals in many fields: students and academics in disability studies and psychology, educators, those involved in social care, and, of course, people with autism themselves. In addition, it is a useful text for those interested in how medical conditions come to be shaped and defined by the terms we use to describe them and the focus we take in treating them. 

Note

[1]. Rab Houston and Uta Frith, Autism in History: The Case of Hugh Blair of Borgue (Oxford: Blackwell, 2000).

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Citation: Paula Hellal. Review of Waltz, Mitzi, Autism: A Social and Medical History. H-Disability, H-Net Reviews. October, 2015.
URL: http://www.h-net.org/reviews/showrev.php?id=43915

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