Autism spectrum/A few impertinent questions/Would obsessing over a traumatic event ever cure any mental illness?
Psychotherapy, trying to talk people out of their psychosis, was the treatment of mental illness during most of the twentieth century. Trauma was the assumed cause of it all. Once a mentally ill person understood the trauma that had damaged them, it was assumed they would became healthy. Supposedly If a mother could be persuaded, during therapy, to acknowledge that she rejected her autistic child, the rejection would disappear, and the child would stop being autistic. No therapist ever succeeded in convincing me I rejected my children. I didn’t even believe traumatic experiences could cause mental illness. People survive some awful experiences and remain sane. We mothers of autistic children were apparently among the first to rebel against psychiatry's “treatments”. I'm sure the psychologists who tried to administer psychotherapy to me must have speculated about easier ways to earn a living. By this time my efforts at the typewriter had grown into a manuscript. I hadn't found anyone interested in publishing it, but I let teachers and anyone concerned with autism read it. I even sent a copy to my congressman, as a protest against government funding of secret, scientific studies.
One day I summoned the courage to return to the Child Guidance Clinic. I glanced uneasily around that familiar waiting room, the scene of such unpleasant memories. Dr. Zircon, Colonel Mann and Dr. Lavalle had all been transferred away from the clinic by this time, but I saw the same assortment of mothers and children who had populated the waiting room when we had been patients there. A psychologist in a white coat was behind the reception desk arguing with someone on the phone.
“That report was just our professional opinion," I overheard him declare indignantly. "We regret you don't find our suggestions helpful.” Apparently I wasn't the only parent to be skeptical of their scientific, psychiatric diagnoses.
I placed my manuscript upon the reception counter. "I've written a book about you guys. If this isn't an accurate account of what occurred here, maybe you can tell me what did happen." I couldn't think of anything to add except, "Here's my phone number. Call me when you finish."
They kept my story for a month, but someone finally phoned me to come for it. I returned to the clinic, wondering uneasily what they might possibly say. However they didn't say anything. A psychologist merely handed my manuscript back with a stony, expressionless look on his face, and a tight lipped, "We have no comment." There wasn't much I could do but pick it up and slink away.
In California, state agencies, called Regional Centers, are responsible for retarded people during their entire lives, providing appropriate services. Tony didn't need anything at the moment. He was attending school, had no health problems, and we had learned to cope with his mischief. We were thinking of his future needs when we applied for Tony's acceptance by the Golden Gate Regional Center. We signed a release allowing them to send for records from all of the people who had ever examined him. A psychiatrist from the Regional Center observed Tony briefly at school. When I met him in his office he said,
"Tony's teacher tells me you've written a book about your son. If I could read it, we might save time evaluating him."
When Freud first published case histories, the medical profession was horrified, accusing him of violating the confidential, doctor-patient relationship. Freud insisted that revelation of patients' private lives was acceptable so long as he didn't use real names. Psychiatrists had been publishing case histories ever since. In fact case histories were about all they published; so far as I could tell, they still didn’t conduct studies to determine whether their “treatments” were effective. However most psychologists apparently weren't prepared for the possibility of patients writing a “case history” about them. I did not use the real names of most of the doctors in my book. Nevertheless, their reaction to my story was always similar - a grim-faced, “no comment”. Now, this psychiatrist who was evaluating Tony for the Regional Center was asking to read my book. I suspected it might offend him, but I didn’t see how I could refuse. I took the manuscript to his office. After finishing it, he phoned and said I needn't come for it. He drove by our house and left it in our mail box early one morning before we were awake.
We returned to talk to the doctor at the Regional Center. She said Tony could not obtain services from the agency. “Your son is not retarded," she said. "He's schizophrenic. You’ll have to request services from an agency dealing with the mentally ill.”
"Schizophrenic!" I repeated. "How did you make that diagnosis?"
"Retarded children don't have the superior nervous system your son has."
The first day we came to the Regional Center, the doctor had asked Tony to draw a boy. Tony, always impatient to be done with doctors, quickly drew a boy with a penis, five fingers on each hand and five toes on each foot, without lifting the pencil from the paper. The doctor had commented that such a feat was difficult for normal children and indicated a superior nervous system. (I doubt Tony's nervous system is still superior. He has been taught to print his name and does so crudely and laboriously.)
"May I talk to the psychiatrist who made the diagnosis?" I asked.
"That won't be necessary," the doctor replied uneasily. "I diagnosed him myself. We merely asked the psychiatrist to confirm my opinion." She made it clear she had no intention of explaining Tony's "schizophrenia".
I went home and phoned the psychiatrist anyway. "I understand you believe my son is schizophrenic," I said. "May I make an appointment to discuss his diagnosis?"
"No," he answered, "That would not accomplish anything."
The psychiatrist had evaluated Tony for a state agency. His salary came from tax money. Tony had been diagnosed retarded by a government-run clinic. I was secretary for Marin Aid to Retarded Children, and Tony attended classes for the retarded. How could this psychiatrist, who had only observed Tony briefly at school, declare such a diagnosis as schizophrenia was official, and then refuse to discuss it with us? But I didn’t argue. Doctors and government agencies apparently felt entitled to use such diagnoses however they chose, with no obligation to explain anything. I remembered the child psychiatrist I'd consulted some years before, Dr. Gerald Jampolsky, the doctor who advised me to go tell Dr. Zircon "exactly what I thought of him" - and only charged me half-price for that advice. He had seemed like such an intelligent, forthright man. I phoned him for another appointment.
As I again seated myself in the psychiatrist's big comfortable chair and glanced through the big window at the small-boat harbor, I explained that I'd consulted him several years earlier. This time I didn't want to discuss my child, I said, I wished to inquire about the general subjects of autism and childhood schizophrenia.
"Autism is one of my specialties," he said.
Then I guess you've read Dr. Bernard Rimland's book on autism?"
"Well, no. . ." he shook his head.
I was taken aback. Dr. Rimland, a psychologist and the father of an autistic son, was one the founders of the National Society for Autistic Children. His book had questioned that maternal rejection could cause autism, but it was the only scholarly, factual book I'd found in this country on the subject, the only book that wasn't full of discussions about damaged psyches. It had won a scientific award. I couldn't imagine why anyone concerned with autism hadn't read it. I had also sent to England for books about autism and I asked if the psychiatrist had read those.
He had not.
I had sent to Germany for books and asked a German friend to make sure I translated them correctly. I didn't ask Dr. Jampolsky if he had read any books in German, but surely a psychiatrist claiming a specialty in autism must have read something on the subject. I asked if he'd read publications I had been unable to find. He mentioned a scientific paper written a decade before and offered to obtain a copy for me. It would never have occurred to me that I might know as much about the diagnosis of atypical children as the psychiatrist. The truth was, there were no guidelines at that time; each doctor felt free to invent their own diagnoses. The possibility that the entire field of child-psychiatry could be so chaotic was still too fantastic an idea for me to fully grasp.
"Do you still believe children become abnormal because of something in their environment?" I asked, again trying to refer to "maternal rejection" euphemistically.
He smiled and shook his head. “No. Many of my views on child psychiatry have changed in the past few years.”
Someone once said, "Obsolete ideas don't fade away; their proponents just die off." Maybe in the interest of stability, nature seems to have made flexibility a trait of the young. A psychiatrist who could discard beliefs to which he had devoted much of his life might be the reasonable, open-minded doctor for whom I'd been searching. If only I could persuade him to talk to me! I told him I'd written a story about Tony, adding that I'd described my consultation with him some years earlier.
"Have you!" he exclaimed in surprise.
"Would you like to read it?"
"I certainly would," he answered eagerly. "I'll call you when I finish," he promised, as he took the manuscript and began leafing through it with interest. My naturally optimistic nature surged. Rational discussion seemed so simple and easy. Maybe I'd finally found someone who would discuss Tony’s diagnosis.
A month passed before the psychiatrist phoned and gave me an appointment to return for my manuscript. "Just knock on my inner office door if I'm busy," he said.
Arriving at the appointed time, excited with anticipation, I knocked. A muffled "just a moment" sounded from within. There was a chair by the door, the same chair in which I'd placed Tony five years earlier, and I sat down in it. Presently the door opened a few inches, and I watched as the psychiatrist's head and one arm with my manuscript appeared.
"Well, er--ah, thank you," he stammered, handing me the envelope. His head and arm disappeared, and the door snapped closed.
Unable to move, I stared at the door. Apparently the psychiatrist was busy with a patient. He must have changed his mind about the scientific paper he had promised. Why? There was nothing unflattering about him in my book. I sometimes had trouble separating what I actually said to doctors from what I later wished I had said - things I just wasn't able to think of at the time. Nevertheless I was confident I had remembered my conversation with this psychiatrist accurately enough. He had given me a specific time to come for my manuscript, ten-thirty, a time when he apparently planned to be busy with another patient, so he was obviously determined not to speak to me – not even for a moment. I sat staring at the closed door, again immobilized by frustration as I slammed against the mysterious, invisible wall that prevented doctors from even talking to me. After so many disappointments, I must not allow another one to evoke such painful feelings, I told myself. Finally I got up from the chair and went home to cope with my anger at yet another doctor. The bill Doctor Jampolsky sent me that time was full price, despite the fact that we never had that discussion about autism and childhood schizophrenia for which I'd made the appointment.
I've since realized that I was placing doctors in an impossible position. What did I expect from them? An admission that concepts to which they had devoted their lives were nothing but nonsense? If psychotherapy doesn't cure autism, maybe it doesn't cure anything. Discussion - any kind of therapy - might increase understanding and help patients address their personal problems. But what does the therapist contribute? What scientific training can turn psychiatrists into professional personal-problem solvers? Psychiatrists may know more about medicine and biology, but I doubt they have exerted any more effort dealing with ordinary personal problems than the rest of us have.
Dr. Jampolsky was intelligent enough to be embarrassed. Whatever the medical profession was involved in concerning autism, it was apparently something they had agreed to conceal from the public, and Dr. Jampolsky must not have felt confident of his ability to deal with any of my questions. He apparently didn’t want to have anything to do with me. He managed to pursue his career for several years after that, but I think he gave up trying to convince mothers that they rejected their children. He seemed to devote most of his efforts to children with terminal illness and wrote books on that subject. Other psychiatrists and psychologists continued for several more years to psychoanalyze mothers as a treatment for their “disturbed children”. I abandoned my search for a doctor who would discuss Tony.
Public opinion changes slowly. We abolished slavery, but it took more than a century before we began to regard those former slaves as ordinary human beings. I suppose the amount of time we devoted to Freudian analysis was short in comparison to some of our other bizarre concepts. Science does progress though; it abandons concepts and adopts new ones. We don't have an institution to define science, or a committee to decide which science is valid. When courts and religious institutions have assumed such authority, they have generally turned out to be enforcers of some dogma. Fortunately a new consensus among scientists seems to eventually overturn most dogma. Public opinion can play a role when scientists become so dogmatic that even laymen notice. Waiting for a new consensus of the experts may seem agonizingly slow, but like democracy, it is merely the best of all known alternatives.
(Ike and I reapplied several years later, and Tony was accepted by the Golden Gate Regional Center, where he continues to receive excellent care.)
- The original images may be found on this pdf copy of the book.
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