Well Being

Small & Great, Myth & Epidemic: Olmsted, Grinker, Kanner, Hippocrates, Virgil

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“if I may be permitted to compare small things with great ones”— si parva licet componere magnis—writes the Roman poet Virgil in Book 4, line 176, of his Georgics, his poem on Roman farming. The fourth book of the Georgics is about how to raise bees; Virgil, in describing the labors of the bees (“the work boils and the fragranced honey breathes of thyme,” 4.169), compares them to the mighty Cyclopes, the one-eyed monsters who hammer out the thunderbolts of Zeus. How can one compare small buzzing insects to a gang of gigantic Cyclopes, Virgil asks—-might he be making too much of a little thing? After all, as Virgil also writes, it takes a mere pinch of dust to break up a battle between warring bee kings (yes, Virgil was wrong about this).
Unstrange Minds: Remapping the World of Autism
Virgil's words—-his thoughtful musing about “if I may be permitted to compare small things with great ones”—-come to mind when reading Dan Olmsted‘s latest The Age of Autism column on Unstrange Minds: Remapping the World of Autism by Roy Richard Grinker. Olmsted's “The Age of Autism” series has consistently argued that a vaccine or “some new ‘environmental insult' interacting with genetic susceptibility is behind the rise” in diagnoses of autism, as he writes in his most recent column. Thus does he open his column on Unstrange Minds with a quotation from Grinker himself that was said to Olmsted: “‘”You're going to hate my book.'” If you (as Olmsted does) believe that there is an epidemic of autism, it might be thought that a book with an argument for why there is no epidemic of autism backed up by an “impressive body of research” might not be not one you might take pleasure in reading, however “beautifully written.”

Olmsted is indeed quick to note that he “does not hate” Unstrange Minds. Rather, as he writes in a characteristic single-sentence paragraph:

“I just disagree with it.”

Olmsted's reasons for “disagreeing” with Grinker's “there is no autism epidemic” argument in Unstrange Minds are quite specific, though not as in a list of objections to the complicated interplay of forces that Grinker describes as “acting in concert” (p. 171) and leading to “the perfect storm of the autism epidemic” (p. 172). Olmsted mines certain specific points from the 340 pages of Unstrange Minds and, while these are interesting to consider in and of themselves, they do not amount to a real critique of the thesis of Grinker's book.

Olmsted cites the “first words” of Leo Kanner's 1943 paper on “infantile autism”—-“‘Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits….'”; Olmsted writes “Does that sound like something that's been around for ages at the same prevalence? Not to me.” That is, he takes Kanner quite at his own words on the “marked” and “unique” characteristics of the children described—-and thereby does not at all acknowledge the lesson that Grinker bases his “there is no autism epidemic on,” namely that the new academic and conceptual disciplines of psychology and psychoanalysis gave us new ways—new words, new terms, new definitions, new ways of understanding—-conditions that have long and always existed. “Autism is new,” Grinker writes, “because over the past century we've described mental disorders more precisely, differentiating one from another, and giving them names” (p. 51). Before psychology and psychoanalysis, that is, there was autism, but we did not call it that and, in some parts of the world, there is still no name for autism, as Grinker notes:

There are still cultures in the world today that do not have a name for autism, or that do not even see as pathological the symptoms we call autistic; there are the so-called “marvelous children” of Senegal, called “Nit-ku-bon,” or the Navajo Indian children with autism in the American Southwest, who are seen simply as perpetual children. (pp. 52-3)

Olmsted's next objection to Grinker is described via a “thought experiment”: “If four psychiatrists brought their children to Kanner before the disorder even had a name, why was there dead silence afterward from psychiatrists with autistic teenagers?” Why, Olmsted asks, did no psychiatrist with a child born before 1931 approach Kanner? An answer to this objection lies, it seems to me, in Kanner's naming the disorder he saw as “infantile autism”—as a condition of very young children, if not infants. Olmsted notes that the oldest child cited in Kanner's 1943 article was but a year or two older—11 or 12, and Olmsted bases another of his objections to Grinker's argument on a matter of a child's age.

Grinker makes one inadvertent error worth mentioning. Among Kanner's original cases was a child called Richard M.; Grinker says Richard, “like many of the others … showed signs of normal cognitive development — or at least this is what the parents retrospectively argued — until he was about two. Then, as his mother wrote to Kanner, ‘It seems that he has gone backward mentally gradually for the last two years.'”

Grinker misreads Kanner. Richard regressed at about one year old, not two.

Picky? Well, consider this comment about Richard in the original study: “Following smallpox vaccination at 12 months, he had an attack of diarrhea and fever, from which he recovered in somewhat less than a week,” Kanner wrote.

This seems to me not so much an error, inadvertent or not, or even a misreading, as a basic difference of opinion on what autism is and what causes it. Olmsted (who, again, frequently writes suggestively about a connection between vaccines and autism) equates “regression” with “diarrhea and fever”; Grinker specifically notes the child Richard's “mental” regression. As the mother of an autistic son, I ought also to note that the kind of regression that alerted us to my son Charlie's having autism, was not the overtly physical symptoms Olmsted notes; while a stomachache can certainly lead to some tough moments for Charlie, it is in his differing cognitive and neurological processing of the world, of sensory stimuli, that signaled, and still do signal, his autism most to me.

Lastly, Olmsted writes that Grinker's notion of “referral bias”—“if you're a psychiatrist and you notice something wrong with your own child, you're much likelier to avail yourself of the services of an acknowledged leader in the field like Leo Kanner,” as Olmsted writes—misses a key point. Where Grinker notes that the parents of children at the only autism school in New Dehli were more highly educated than the norm—“10 of 10 fathers and four of 10 mothers were college-educated, and half the men had advanced degrees”—Olmsted zeros in on the fact that one of those mothers had her Ph.D. in chemistry. To him, this signals “not solely referral bias but professionals who had availed themselves of new medical interventions or medicines with ‘markedly and uniquely' tragic consequences.” Olmsted here means (I think) that these autism parents with academic backgrounds in chemistry (if not Ph.D.'s) were more likely to seek out remedies with a “chemical connection”—a vaccine? (Olmsted does not specify this) for their children's condition. That is, if I may follow this logic, parents with advanced degrees in chemistry would be more likely to seek out chemically-connectioned remedies to help a child, and the remedies thereby suggested would include vaccines, and there, then, is the culprit, for the rise in autism…….

To quote Olmsted quoting Grinker: “”I sympathize with these opinions, but I think they are wrong” (Unstrange Minds, p. 171).

Consideration of only these few points does not add up (if I may borrow Olmsted's computational metaphor, also noted in this post) to a real critique of a book, much less a refutation of its argument. With all apologies to Olmsted, simply taking on the stance of “I disagree with what X says” does not a thesis make, in the sense of a thesis being a “main insight or idea about a text or topic…….. true but arguable (not obviously or patently true, but one alternative among several),…….. and get[s] to the heart of the text or topic being analyzed (not ….. peripheral)” (see Gordon Harvey's Elements of the Academic Essay).

Grinker's argument for why there is no epidemic of autism is not, indeed, “obviously or patently true,” if one reads many of the emailed-in responses to Autism Speaks January 17th query for responses to the question “Is Autism an Epidemic,” a request which was itself prompted by recent media coverage of Unstrange Minds. “The schools are busting at the seams trying to accommodate these PDD-Autistic children”; “I think this Roy Grinker is out of touch with reality to suggest that autism is not an epidemic”; “Better diagnostics just simply doesn't hold water. This is all common sense,” are a few examples of the sorts of objections raised. I have discussed Grinker's “no epidemic of autism” argument in a previous post, What is there is no autism epidemic?, and posted my letter (on why I do not think there is an epidemic of autism) in this post, My letter to Autism Speaks about the autism epidemic. The comments on the former post reveal a developing discussion about whether or not there is a real epidemic of autism—whether there jst simply are more autistic children “out there,” or whether better diagnostics and a number of other factors have contributed to what seems like a massive, sudden increase in a disorder once thought rare. It is suggested that, in some ways, what we call an “epidemic of autism” is a metaphorical use of the word: That “epidemic” is being used in reference to autism to mean something like “a sudden and drastic rise in some condition,” but not to an actual, medical, disease caused (for instance) by a microbe or other molecular marker.

And here I would like to move from considering great, or greater things—-public health concerns, national organizations—to small. Specifically, to a few words from ancient Greek; even more specifically, to the etymological roots of the word “epidemic,” as I wrote in this post, Sure, there’s an autism epidemic (but watch your words): On the semantics of epidemic, ancient and modern:
Hippocrates, Volume I: Ancient Medicine (Loeb Classical Library, No. 147)

The ancient Greek physician Hippocrates was the first to use the word “epidemic,” or rather the ancient Greek word epidemios that is the root word of our word “epidemic,” in a medical sense. The original meaning of epidemios is “on/in one's own country”; epi means “on” and demos means “people” (as in democracy—“power of the people”—which is from the words demos and kratos, “power”). In Homer's Odyssey, epidemios refers to one “who is back home” and “who is in his own country,” as bacteriologist Paul M.V. Martin and professeur certifiée de lettres classiques Estelle Martin-Granel write in 2,500-year Evolution of the Term Epidemic (Epidemic Infectious Diseases, vol. 12, no. 6, June 2006). It is only with Hippocrates in the fifth century B.C. that epidemios is used in a medical sense.

Hippocrates' seven-book treatise, Epidemics, uses the word to refer to something that “spreads” on and among the people; to “groupings of syndromes or diseases, with reference to atmospheric characteristics, seasons or geography, and sometimes propagation of a given syndrome in the human population.” Hippocrates' use of the term epidemios is to emphasize the extent to which a pattern of symptoms is pervasive in a human population at a certain time; there is no sense in Hippocrates of epidemios as indicating the severity of a disease.

In our contemporary world, we tend to equate “epidemic” with “plague”; to some extent, the two words have become synonyms. Thus, it can be said that autism is “epidemic” in the sense of the ancient Greek word that the prevalence of autism is higher than it has ever been (1 in 166)—that is, that autism is “upon the people” or “upon the population” more than it ever has been before: All the autism that we see is there because we are looking for it. If there is an epidemic of autism, it is something that we all have, because we are able to diagnose and see so much more autism; we have all been touched by, in the words of journalist Arthur Allen, an “epidemic of discovery” as regards autism.

And because we do not know, we do not exactly understand how we can be seeing so much of something—-of autism—-that we never in our previous lives knew existed, the myth of an autism epidemic has arisen.

I do not use myth in a derogatory sense here, and I do not wish at all to belittle the beliefs of those who argue for an epidemic of autism. When your child—your so little child—does not seem to be developing “right,” is not doing all or even any of that list of things the pediatrician handed you, has no words (and you know that you are doing, you have done, everything you could), the mind (my mind, at any rate) reaches for some explanation to make sense of the unfathomable. Explanations like vaccines, or environmental pollution, offer a sort of comfort because they claim a simple and direct connection between a single agent and what unknowable thing is going on with the child in one's arms. It is one thing to read how the DSM evolved over time, another to be so tired of reading a list of things your child cannot do that you just want to hide it in a drawer.

I started this reflection on Olmsted, Unstrange Minds, and the “autism epidemic” with a reference to Virgil's Georgics and I turn now to him again. More specifically, I turn to the middle of Book 4 of his poem when Virgil describes a curious rite called bugonia to explain the sudden death of the bees whose natural history he has so carefully detailed in the first half of the book. In the bugonia, a young ox is beaten to death and its carcass left for several days, after which—mirabile dictu—a new hive of bees are born (bugonia literally means “ox birth”).

If you think that sounds strange (especially in a post about the autism, vaccines, etc.), Virgil thought so too. And so he turns to myth for an explanation, and into the end of a poem detailing the techniques of Roman farming, inserts two intertwined myths, about Aristaeus the inventor of the plow, who loses his bees and learns from his mother, the nymph Cyrene, that this is because he has wrongly pursued Eurydice, the wife of Orpheus, the poet whose song was so beautiful that he could make the very trees move and tame the tigers. Aristaeus learns from the seer Proteus that he has caused Eurydice and, too, Orpheus, to die: In search of his lost wife, Orpheus ventures down to the Underworld, to Hades, whom he charms with his beautiful music so that Eurydice is allowed to return to the world above, provided that Orpheus does not look at her until they are out of Hades: But Orpheus does:

a whole seven month
by month he wept
to himself they say
the glacier caves charming soothing tigers
setting trees in motion with his song

Aristaeus must propitiate him and Eurydice with a sacrificial offering, and so he gains his bees back.

Yes, I have veered greatly away from my original topic, or maybe not: Should we not ask if we, faced with an unexplainable loss—the child we thought we were going to raise—have not, like Virgil, turned to the magically comforting power of myth to make sense of something that seems too strange? Let me put it another way: Why does Olmsted keep seeing references to vaccines and to some “chemical connection,” obvious and not so obvious, in every case of autism that he refers to? Why, while naysayers readily pounce on Grinker's basing his “no autism epidemic” argument in better diagnosis, are they ever careful to note the simple beauty of his writing about his daughter, Isabel (who can deny the joy of reading about how she changes after a visit to Monet's gardens at Giverny?), and his sympathetic accounts of the struggles of autism parents (mothers especially) in India and Korea? Unstrange Minds is not just a book about “why there is no autism epidemic,” and it is not just a father's memoir of raising a daughter with autism: It is about both together and simultaneously and if you critique one part, you critique it all.

When faced with something as great, as magnum, as autism, we search for ways to understand it, however parva, however partial, however small; however we can. It may be vaccines, it may be the different ways that “difference” or “disease” is understood within a culture. It may be in myth, or poetry; for some of us, it may be in DNA. It may be simply in the daily lived experience of being with one's child who has autism, all science, all theory, all academic insight aside—in understanding why, indeed, parva sunt magna: The small is the great.