The Autism Matrix by Eyal Gil

Author:Eyal, Gil
Language: eng
Format: epub
Publisher: Wiley

The space between fields

Summing up the state of the therapeutic art in 1983, Rutter (1983, 210–11) admitted that the search for medical treatments for autism had led nowhere. The main advance was the rise of educational and behavioral methods of treatment that have replaced insight psychotherapy. The new therapies changed the site of treatment from the hospital and the laboratory to the school and the home, and involved parents as co-therapists. They have broadened therapeutic goals and were extended to ever younger children, no doubt due to deinstitutionalization (see also Rutter 1971, 376), yet none of them could significantly undo severe initial handicaps of intelligence and language (Oppenheim, as well, told Lettick that perceptual-motor therapy “has nothing to do with the basic problem,” that is, autism [Silverman 2004]) and in general the claims of therapy enthusiasts far exceeded what could in fact be accomplished. Fifteen years later, this was still the conclusion of a comprehensive assessment of the efficacy of autism therapies (Howlin 1997).

The success and spread of the new therapies, therefore, cannot be attributed simply to their technical superiority. They did not “cure” autism, nor did they claim to do so – in fact, the appeal of ABA and similar techniques in many respects lay precisely in not claiming to cure autism. One could say that they were “better” than earlier therapies, precisely in the sense that by not claiming to cure autism they freed themselves to offer parents pragmatic help with simple mundane goals of everyday functioning. This is no doubt true, but requires one to take into account deinstitutionalization and the change in the institutional matrix. Earlier autism therapies did not need to offer such pragmatic help because they existed within a custodial institutional matrix meant to relieve parents of such needs altogether. Long into deinstitutionalization, parents of autistic children continued to complain about the lack of residential custodial institutions and to lobby for their creation and funding (Sullivan 1981). They were not bad or unfeeling parents. No doubt, ABA is the most effective way to teach some of the basics without which life with a disabled child could be hell. But even with it life is still hard, incredibly so, and ABA outsourced much of its management to the parents. On purely pragmatic grounds, it is not clear whether the bargain was worth it, and certainly one cannot explain the success of ABA or other therapies simply in these terms. The success and spread of the new therapies had just as much to do with their social innovation and their affinity with the new institutional matrix of early intervention and community treatment.

Deinstitutionalization opened up a vast space between the fields of medicine/psychiatry and special education. It was a space of opportunity and entrepreneurship where it was possible to do things one could not do before, to combine things one had to keep separate if one was within the orbit of psychiatry or special education. First, it became possible to create new objects of discourse and intervention – indeed, a whole new domain of similarly constituted objects.

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