The Causes of Autism (For Example)

by | Dec 1, 2013 | Habits of Mind, Psychiatry

The stubborn nature of belief

In the early 1960s, when I was trained, psychoanalysis had a death’s grip on the practice of psychiatry. All of the psychiatric disorders were explained as disturbances of childhood experience. Obsessive-compulsive disorder, for example, was thought to reflect some sort of difficulty with toilet training. Schizophrenia, an obviously more serious disorder, was attributed to an even earlier disturbance in the first year of life. Freud stated that all of the neuroses were due to unresolved feelings that dated to the age of four or five, the Oedipal stage. Entire books were written about the Oedipal stage so that I cannot summarize the theory in a way that would satisfy a psychoanalyst. But, in a nutshell: during the Oedipal stage the five year old boy wishes to possess his mother sexually and, therefore, contemplates ridding himself of his father, perhaps by murdering him. I think this fairy tale was supposed to be understood metaphorically.

During the fifty years I have practiced psychiatry, I have never come across any family, or child, in which  this psychological constellation could be detected. I have come across a few kids over the years who wanted to come into their parents’ bed at night, and one or two who wanted to sleep between their parents, but that is as far as it went. Judging from my experience, the Oedipal conflict does not exist at all; and it was supposed to be universal. During the years of my training, it was considered real by my teachers, all of whom were bright and many of whom were learned. How could that be?

During those years, childhood autism became a matter of interest. It was described for the first time in 1943 by Leo Kanner. It is a condition, as everyone now knows, of emotional blunting or emotional outbursts and profound difficulties communicating. The autistic child may indulge in repetitive, compulsive behaviors that seem meaningless to observers and that are very resistant to change. There is a need to be alone and an exaggerated sensitivity to a variety of stimuli, including sounds and sights, and touch. There is a tendency to engage in obstreperous behavior that makes being in ordinary social situations difficult. There may be other signs of neurological dysfunction. It was not recognized then that milder forms of autism could exist that presented in more subtle ways. Or that some particularly gifted individuals were also autistic.

In the year 1965, an autistic child came to the attention of the department of child psychiatry where I was a fellow. We presented this child in a clinical case study to a visiting professor from the distinguished clinic Anna Freud had started in England. This institute was dedicated to treating disturbed children. This particular six year old boy wandered around during the presentation touching objects briefly and then moving on to the next object. Human beings were touched in the same way that he touched the table and chairs. And in this way he went round and around throughout the conference. The child did not look at anyone’s face. He did not react to his name. He made repetitive sounds, but could not speak. He seemed oblivious to everything going on around him. When the visiting professor was asked for her thoughts about the cause of this striking syndrome, she replied: “Some disturbance of breast feeding.”

I do not know how to characterize this response. It is ignorant, certainly. In the first place, what could she mean by “disturbance of breast feeding”? Would that be trouble finding the nipple? An interruption in feeding before the child was satisfied? Inadequate milk?  These are all common-place occurrences during breast feeding and lead, at worst, to the child crying. If repeated, they may lead to an irritable child, no more. The autistic child we were looking at was so deviant from the ordinary way a child that age behaves, it was impossible to distinguish exactly what those deviations were. All meaning was lost. He was like an automobile that heaved and made clanking noises but did not move. And it was as if this visiting professor was making the case that this devastating defect came from using the wrong grade of motor oil.

The unkind word that seems to me to best describe this professional opinion is “stupid.” And yet this experienced and learned professor was plainly not stupid. I have a colleague who seemed to me bright enough who was still insisting as recently as ten years ago (the last time I saw him) that disordered breast feeding was the cause of all autism.

It can probably be said even now that we do not know all the causes of autism, but we know they include genetic influences, influences in utero, dietary influences, such as vitamin deficiencies and, possibly, other disruptions from immunological causes. They are associated with a variety of brain abnormalities. The presentation of autism differs considerably from one child to the next, and these differences reflect different anomalies in the brain. The causes of autism do not include disturbances of breast feeding.

During the time of which I am speaking, psychiatrists tended to blame mothers for the emotional illnesses of their children. Kanner thought cold and distant mothers were among the causes of autism. Others blamed “schizophrenogenic” mothers for their children’s schizophrenia, another stupid and destructive idea. These were mainstream ideas.

How beliefs are formed.

We all like to think we form our beliefs based on evidence presented to us, including what we are told by others, especially those in authority. We like to think we are reasonable and that those others who disagree with us are wrong, and stubborn.  The truth is, we are much more influenced by what we are told than by evidence. And we are all stubborn.

Think about religion. (Not your religion, someone else’s religion.) Think about the various Hindu gods swallowing evil and such. Or, better yet, think of the religions that used to be. Think of Zeus turning himself into a swan and raping Leda. Hard to believe, no? But it was believed. Why?

Gods are often portrayed in sacred literature as behaving in ways that are not consistent with their own purposes; and yet these unreasonable behaviors do not seem unreasonable. Would not God have been able to guarantee Joshua a victory at Jericho without going to the trouble of stopping the earth from revolving in order to give him more time?

Why does one political party dominate in certain areas of the country? Many people believe absolutely that their political ideas are correct and those in the other party and in other parts of the country are incorrect. Why? And why are these ideas shared by most of the other members of their family?

Is there no truth? Is there nothing that can be determined absolutely and that commands the assent of everyone? One would think science can give such answers. Scientists conduct experiments that—if they are well-designed—try to counter the prejudices of the experimenters. But, even so, some new scientific ideas, (such as relativity, or continental drift) never convinced those who had previously held contrary beliefs. These ideas gained sway only when those conservative scientists died off, and were replaced by younger ones.

The fact is, our beliefs grow out of those shared by our families and our communities. Our political beliefs are confirmed every day by the particular news outlets we listen to. We believe in our religions because that is what we were taught. In most religions, challenging core beliefs is a serious offense, sometimes a capital offense. If we hold a particular view of economics, we continue to hold to that view in the face of contrary evidence. The evidence of our senses and experience cannot stand up to the powerful influences of culture. None of us can be sure that what we believe is true. If we believe strongly, we see things that are not there. But I think there is one additional reason for folly.

When I was a child psychiatrist in training, I presented the case of a child who had an exaggerated fear of going to school. I spent considerable time interviewing the patient and, on other occasions, his parents. I wrote up a six page report including a “psychodynamic formulation,” which is an attempt to try to understand the patient’s symptoms in terms of his past experiences and his predilections, whatever they might be. It is an attempt to explain the patient.

I have to admit that there was a sameness to these explanations from one patient to the next. There was sibling rivalry, an absent father, a physical illness occurring at the wrong time, and so on. Still, I tried my best. We all tried our best.

In the middle of this presentation Charlie, one of the other child fellows, arrived late, sat down, and immediately began expounding his theory of the case. (His name was not Charlie.) He went on at length, speculating without the advantage of having heard any of the previous discussion. In the practice of those days, wild speculations were judged by how imaginative they were and not by any resemblance they might have to reality.

Charlie ventured a theory that was different than mine. He was articulate and might have been more convincing except that, uncharacteristically, he gave a reason for his opinion. “I hold this to be true,” he said, “because of the patient’s relationship to his sister.”

“Wait a second,” I said, “he has no sister.”

Charlie was not embarrassed, but he looked back at his copy of my presentation. Finally, he said, “Well, it must be true anyway, otherwise I would not have thought it.”

As usual, no one laughed. Being more annoyed than usual, even I did not laugh.

So, one cause of ignorance is arrogance, the self-confident belief that whatever I think I know must be true or I would never have thought of it in the first place.  (c) Fredric Neuman