Into the Suffering City
Page 29
While many, perhaps most, people diagnosed with ASD have lower than average intelligence (as measured by tests), there is evidence that some with autism have exceptional intellects, including “increased sensory and visual-spatial abilities, enhanced synaptic functions, increased attentional focus, high socioeconomic status, more deliberative decision-making, [and] profession and occupational interests in engineering and physical sciences.”
Broad public awareness of autism dates to the 1988 film Rain Main, which starred Dustin Hoffman as an intensely awkward savant who could perform amazing, but highly selective, mental tasks. The film was useful for educating the public about autism, but also led to a general assumption that every autistic person was just like the Hoffman character.
What we now call autism was largely unknown among the public prior to 1988. The first mention of autism appeared in the 1980 edition of the DSM; during the 1960s and 1970s autism was blamed on “refrigerator mothers” who failed to love their kids enough. Autism was also linked to schizophrenia as late as the 1970s. Leo Kanner in 1943 described a group of largely intelligent children who craved aloneness and “persistent sameness;” he called this “infantile autism.” During the late 1930s and 1940s Hans Asperger used autism in reference to people with a perceived milder form of the condition that came to be known as Asperger’s syndrome. Eugen Bleuler coined the term autism sometime between 1908 and 1911 (there is disagreement as to exactly when) as a symptom of schizophrenia, another term that Bleuler invented (more on that below). Bleuler derived autism from the Greek word meaning self, and used it in reference to people who lived in a world that was not accessible to others.
But autistic-like behavior was noted long before the term itself came into use. As Kanner noted, “I never discovered autism—it was there before.” Samuel Gridley Howe gets credit for first noticing, prior to the American Civil War, that some people considered “idiots” had a combination of skills and strengths that set them apart from others with intellectual disabilities. Looking back into history, it is arguable that many people, including Michelangelo, Emily Dickinson, Leonardo da Vinci, Isaac Newton, and Thomas Jefferson, were autistic.
The modern neurodiversity movement urges replacement of the term “disorder” with “diversity” to account for neurological strengths and weaknesses and to suggest that variations in brain wiring—such as autism—can be a net positive for individuals and for society as a whole. Neurodiversity and autism advocacy groups share an even more important goal: insisting that people whose minds work differently are treated with respect and compassion.
For more information, see:
Autism Speaks website, What are the DSM-5 diagnostic criteria for autism?
Autism as a Disorder of High Intelligence, frontiers in Neuroscience, 2016 Jun 30.
Spectrum website, The evolution of ‘autism’ as a diagnosis, explained.
Autism Independent UK website, History of Autism.
How autism became autism: The radical transformation of a central concept of child development in Britain, History of the Human Sciences, 2013 July.
The Early History of Autism in America, Smithsonian Magazine, January 2016.
The Myth of the Normal Brain: Embracing Neurodiversity, AMA Journal of Ethics, 2015;17(4).
Institutionalized Racism
During the early years of the twentieth century, Maryland, along with many other states, enshrined racism in a framework of law and social convention. A cornerstone was prohibition of “miscegenation”—the inbreeding of people considered to be of different racial types. Maryland had America’s first law criminalizing marriages between black men and white women (1661). The state had a statute on the books forbidding marriage between a black and a white person until 1967 (see the Epigraph), when it was the last state to repeal its law after the Loving v. Virginia case. In addition, there was a law punishing “Any white woman who shall suffer or permit herself to be got with child by a negro or mulatto,” as well as a law requiring railroad cars “to provide separate cars or coaches for the travel and transportation of the white and colored passengers.”
When a black lawyer bought a house in a posh Baltimore neighborhood in 1910, whites were so upset the city was officially divided into black and white blocks: No black could live on a block where more than half the people were white, and no white could live where more than half the residents were black. The New York Times contemporaneously declared this “the most pronounced ‘Jim Crow’ measure on record.”
A coalition of powerful forces tried during the first decade of the twentieth century in Maryland to prevent blacks from voting. Voters, however, defeated proposed amendments to the state constitution in 1904, 1908, and 1910. The principal reason for defeat seems to have been a fear among immigrants that they, too, would be kept from voting; that concern was well-founded, as immigrants were also often the object of scorn and discrimination at the time.
A more fine-grained depiction of racism is evident in the pages of newspapers from the era, including The Baltimore Sun. Articles from 1909 are rife with racial stereotypes and explicit bias against people of color. All the headlines and news stories recounted by the pharmacist in the jail cell with Jack in Chapter 20 are drawn from pages of The Sun. The same bias can, of course, be found in scores of other newspapers across the nation dating from that time.
For more information, see:
Evoking the Mulatto website, Timeline.
How Racism Doomed Baltimore, The New York Times, May 9, 2015.
Here Lies Jim Crow: Civil Rights in Maryland, C. Fraser Smith, 2008.
Bleuler: Schizophrenia and Synesthesia
Norbert Macdonald’s suggestion in Chapter 11 that Sarah suffered from schizophrenia would have been at cutting-edge of medicine in 1909. Eugen Bleuler coined the term in a seminal 1908 paper, which as far as I can tell, has not been made available in an English translation from its original German. Many of the paper’s main points are outlined in the Maatz and Hoff article noted below.
Bleuler’s ideas about schizophrenia challenged prevailing ideas about severe mental illness and were not broadly accepted at first. But over time psychiatry embraced his concept as the profession moved toward addressing individual suffering rather than treating seriously ill people as a homogeneous category. Bleuler emphasized use of Freudian psychoanalysis as a principal therapy, and while that has proved less effective than originally hoped, it was a vast improvement over earlier treatment methods, which included hydrotherapy and counter-irritation, as depicted in Sarah’s asylum experience in Chapter 13.
Before Bleuler developed his ideas about schizophrenia, he studied the phenomenon where some people experienced a sensation of color in association with specific words, letters, or numbers. He called this “double sensations,” which was also known as synesthesia. It is defined today as an unusual neurological trait involving cross-sensory experiences. Bleuler’s paper with Karl Lehmann in 1881, “Compulsory light sensations through sound and related phenomena in the domain of other sensations,” was the first survey and analysis of synesthetes, as those who experienced the sensation are known.
Despite Bleuler’s pioneering work, no one has yet written a comprehensive biography of the man. I hope someone undertakes that worthy project.
For more information, see:
The birth of schizophrenia or a very modern Bleuler: a close reading of Eugen Bleuler's 'Die Prognose der Dementia praecox' and a re-consideration of his contribution to psychiatry, A. Maatz and P. Hoff, History of Psychiatry, 2014 Dec; 25(4) (paywall protected).
The “golden age” of synesthesia inquiry in the late nineteenth century (1876–1895), Journal of the History of the Neurosciences, DOI: 10.1080/0964704X.2019.1636348.
Jack and PTSD-Like Symptoms
Jack Harden’s recurring emotional trouble from his memories of the 1906 Bud Dajo massacre during the Moro War would today likely be diagnosed as Post Traumatic Stress Disorder. The concept was unknown at the time, and the understand
ing that people could suffer enduring problems after trauma was embryonic at best. As Sarah mentions in Chapter 5, there were scattered studies in connection with Civil War veterans (soldier’s, or irritable, heart) and rail accidents (railway spine). By the first decade of the twentieth century, Sigmund Freud and others were speculating about the lingering effect of trauma in the subconscious, but broad public acceptance of what we now call PTSD would take decades.
Few men during this era would accept that any trauma, from battle or otherwise, could impair them. During the Civil War, newspapers reinforced the notion that men had to be tough and strong. “Commiseration felt for these unfortunate individuals [soldiers] is modified by the fact that they are men – men with strong hands, high hearts and hardened nerves – men, consequently, who will know how to battle successfully with the difficulties of their lot.” Another wrote: “To win [the battle of life] without a struggle is, perhaps, to win it without honor . . . . Difficulties may intimidate the weak, but they act only as a stimulus to a man of pluck and resolution … stand up manfully against misfortune.”
For more information, see:
Irritable heart syndrome in Anglo-American medical thought at the end of the nineteenth century, Yuri C. Vilarinho, História, Ciências, Saúde-Manguinhos, vol.21 no.4 Rio de Janeiro Oct./Dec. 2014.
Brainline: All About Brain Injury and PTSD website, History of PTSD in Veterans: Civil War to DSM-5.
Posttraumatic stress disorder and the nature of trauma, Bessel van der Kolk, Dialogues in Clinical Neuroscience, 2000 Mar; 2(1).
The Moro War: How America Battled a Muslim Insurgency in the Philippine Jungle, 1902-1913, James R. Arnold, 2011.
Note that all website citations were last accessed on December 29, 2019
About the Author
Bill LeFurgy is a professional historian and archivist who has studied the seamy underbelly of urban life, including drugs, crime, and prostitution, as well as more workaday matters such as streets, buildings, wires, and wharves. He has put his many years of research experience into writing gritty historical fiction about Baltimore, where he lived for over a decade. It remains his favorite city.
Bill has graduate degrees from the University of Maryland and has worked at the Maryland Historical Society, Baltimore City Archives, National Archives and Records Administration, and the Library of Congress. He has learned much from his family, including patience, emotional connection, and the need to appreciate different perspectives from those on the autism spectrum and with other personality traits that are undiagnosed, misdiagnosed, or unexplained.
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