The Laws of Medicine by Siddhartha Mukherjee

Author:Siddhartha Mukherjee
Language: eng
Format: epub
Publisher: Simon & Schuster/ TED

In 1908, when psychiatrists encountered children who were withdrawn, self-absorbed, emotionally uncommunicative, and often prone to repetitive behaviors, they classified the disease as a strange variant of schizophrenia. But the diagnosis of schizophrenia would not fit. As child psychiatrists studied these children over time, it became clear that this illness was quite distinct from schizophrenia, although certain features overlapped. Children with this disease seemed to be caught in a labyrinth of their own selves, unable to escape. In 1912, the Swiss psychiatrist Paul Eugen Bleuler coined a new word to describe the illness: autism—from the Greek word for “self.”

For a few decades, psychiatrists studied families and children with autism, trying to make sense of the disease. They noted that the disease ran in families, often coursing through multiple generations, and that children with autism tended to have older parents, especially older fathers. But no systematic model for the illness yet existed. Some scientists argued that the disease was related to abnormal neural development. But in the 1960s, from the throes of psychoanalytical and behavioral thinking, a powerful new theory took root and held fast: autism was the result of parents who were emotionally cold to their children.

Almost everything about the theory seemed to fit. Observed carefully, the parents of children with autism did seem remote and detached from their children. That children learn behaviors by mirroring the actions of their parents was well established—and it seemed perfectly plausible that they might imitate their emotional responses as well. Animals deprived of their parents in experimental situations develop maladaptive, repetitive behaviors—and so, children with such parents might also develop these symptoms. By the early 1970s, this theory had hardened into the “refrigerator mom” hypothesis. Refrigerator moms, unable to thaw their own selves, had created icy, withdrawn, socially awkward children, resulting ultimately in autism.

The refrigerator mom theory caught the imagination of psychiatry—could there be a more potent mix than sexism and a mysterious illness?—and unleashed a torrent of therapies for autism. Children with autism were treated with electrical shocks, with “attachment therapies,” with hallucinogenic drugs to “warm” them to the world, with behavioral counseling to correct their maladapted parenting. One psychiatrist proposed a radical “parent-ectomy”—akin to a surgical mastectomy for breast cancer, except here the diseased parent was to be excised from the child’s life.

Yet, the family history of autism would not fit the model. It was hard to imagine emotional refrigeration, whatever that was, running through multiple generations; no one had documented such an effect. Nor was it simple to explain away the striking incidence of autism in children of older male parents.

We now know that autism has little to with “refrigerator moms.” When geneticists examined the risk of autism between identical twins, they found a striking rate of concordance—between 50 and 80 percent in most studies—strongly suggesting a genetic cause of the illness. In 2012, biologists began to analyze the genomes of children with so-called spontaneous autism. In these cases, the siblings and parents of the child do not have the

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