What’s clear in the U.S. is that diagnoses of autism have increased tenfold over the last three decades; what’s unclear is why. Possible answers are many, including (of course) vaccination, which has been exculpated; a better ability of doctors and psychologists to diagnose autism, a change in the criteria for diagnosis (the DSM, for instance, expanded the criteria for “autism spectrum disorder”), unknown environmental causes like chemicals in the water or pesticides, and so on.

Steve Silberman’s new book, NeuroTribes: The Legacy of Autism and the Future of Neurodiversity, argues that the “epidemic” is due simply to changes in the diagnostic criteria (note: I haven’t read it, but am going on today’s New York Times review by Jennifer Senior).  He excoriates the anti-vaxers who blame autism on shots, or on the mercury in those shots, and extensively recounts the history of autism, beginning with Hans Asperger‘s work in Vienna.

Senior finds faults in the book, including an overly-short treatment of the vaccination controversy and a tendency to give too much backstory on patients, but in the end gives the book a strong endorsement:

But carry on nonetheless. “NeuroTribes” is beautifully told, humanizing, important. It has earned its enthusiastic foreword from Oliver Sacks; it has found its place on the shelf next to “Far From the Tree,” Andrew Solomon’s landmark appreciation of neurological differences. At its heart is a plea for the world to make accommodations for those with autism, not the other way around, and for researchers and the public alike to focus on getting them the services they need. They are, to use Temple Grandin’s words, “different, not less.” Better yet, indispensable: inseparably tied to innovation, showing us there are other ways to think and work and live.

The most moving chapter, one that had me fitfully weeping throughout, is the penultimate one, which chronicles that miraculous moment 20 or so years ago when autistic adults finally began to find their own tribe after lifetimes of mis­diagnoses and alienation. Silberman tells the simple story of an autistic woman named Donna Williams who had just written a memoir, visiting two compatriots she had never met. “Seeing the thrill that Williams got from the lights playing off a Coke can,” Silberman writes of one, “he later sent her a belt covered in red sequins from Kmart as a gift.”

It’s an apt metaphor for our culture’s evolving attitude toward autism: If the light bounces off something a little differently, it can be seen in a whole new way.

The first paragraph above is a bit confusing to me.  The “neurodiversity” movement sees the variation in behavior and thinking as part of a normal spectrum, which may well be true for autism, but not for something like schizophrenia. And yes, of course people who are described as being “mildly autistic” or “have a touch of Asperger’s” are often those who are brilliant achievers in some area, and don’t seem to need “special treatment” at all. But there’s nothing controversial in what Silberman is saying here. Some of those on the “neurodiversity spectrum” do need help, for, regardless of whether and how people regard them as ill, they can’t function in society without special attention.

So who has ever doubted that “the world should make accommodations for those with autism”? For severe forms, at least, we don’t ask them to squeeze, without help, into the Procrustean bed of society.

The last two paragraphs are also uncontroversial; we should of course treat these people as humans with human dignity, and avoid stigmatizing them as “odd” or “sick” as far as we can. What I wonder, though is whether the extreme forms of autism, even if they’re the end of a spectrum, are to be celebrated as “diversity” rather than treated as an illness. Some, like Kay Redfield Jameson in her book Touched With Fire, argue that mental illness (she suffers from bipolar disorder) has salutary side effects, giving many cases of artists, writers, and scholars whose achievements, she claims, were promoted by their illness.

But the celebration of “neurodiversity” claim can go too far. As I wrote in a previous post on the neurodiversity movement,

I agree that there may be a spectrum for many mental conditions like depression, autism, and even bipolar disorder, and that the spectrum may even be continuous rather than a bimodal one having peaks at “normal” and “disordered”. After all, neurological conditions likely reflect a nexus of genetic causes—with cognitive and behavioral differences based on many genes—as well as environmental influences. Nevertheless, the important question is this: what do we do about those who suffer from things like bipolar disorder or autism? And I say “suffer from” deliberately, for doctors clearly see most such individuals as suffering because of their conditions. By accepting the condition as “normal”, or writing it off as simply one segment of a spectrum, neurodiversity advocates implicitly—and sometimes explicitly—deny that these conditions should be be cured.

I find that odd and even reprehensible. In the desire to see everyone as “normal”—as part of the rainbow of human diversity—this movement totally rejects the idea that some people are actually suffering and could benefit from treatment. Why else are there drugs for bipolar disorder, and why do parents desperately seek help—both medical and psychological—for children with autism?

The neurodiversity issue seems to me an extension of “identity politics”—which I’ll take here as the view that everyone is special and unique, and deserves to have their desires, abilities, and personality not only accepted, but celebrated. It’s the same mentality that has decided that, in school contests, everyone should get a prize so that nobody will be disappointed, or feel stigmatized or inferior. In the neurodiversity movement, not only should one not stigmatize “mental illnesses” (something I absolutely agree with, for these conditions are, like all disorders, determined by genes and environment), but we should accept them to the point that we shouldn’t even try to cure them.

But ask those who suffer, or who live with the sufferer, whether we should seek cures. Since conditions like autism, bipolar disorder, or schizophrenia must surely reflect neurological issues, they can in principle be cured or controlled. Bipolar disorder, for instance, can now be largely controlled with drugs, and believe me, those who have this issue want those drugs, despite their often unpleasant side effects. And which parent with an autistic child wouldn’t want that child to be helped or cured through some kind of intervention? The “facilitated communication” scam, in which people claimed to help autistic children “speak” by guiding their hands on a keyboard (the facilitators proved to be the ones doing the communicating), shows how desperate parents are to help such children.

In its desire to celebrate mental diversity, the neurodiversity movement in fact promotes suffering. Making sure that all children get prizes is one thing, and not terribly harmful, but denying children or adults cures for mental disorders is a different matter. That’s both thoughtless and horribly selfish, placing a misguided liberal ideology above the well being of the afflicted.

Or, as my doctor, Alex Lickerman, told me when I asked him about this movement, “The issue is not how far from normal you have to be to be considered as having a ‘disease’. The issue is how much of the way you are ‘built’ is causing you to suffer—and what do we do about it. . . The neurodiversity movement is utter nonsense. Ask those who have these problems whether or not, if a cure was offered, they would accept it.”

If we’re going to celebrate neurodiversity, then why not celebrate “health diversity”, and say that those who suffer from various illnesses should be held up as part of a continuous spectrum of wellness? Yes, of course nobody with chronic conditions and illnesses should be stigmatized or mistreated, but we should think twice before we argue for withholding cures, as many “neurodiversity” advocates do.

Now Silberman may not hold the “celebrate all differences” view of autism, and I hope he doesn’t. What interests me about the issue is the dramatic rise in cases of autism, and what we should do when it causes suffering. What interests me less is celebrating severe suffering as simply one tail of a distribution.