BRITAIN
Britain passed the Mental Health Act in 1959 in response to a series of scandals about overcrowding and inhumane conditions in the country’s mental institutions and homes of the “subnormal.” The Mental Health Act dismantled the legal apparatus that oversaw the certification process whereby patients were committed to hospitals against their will. It turned over the responsibility for the care of many people who would have been destined for institutions to local authorities. Thousands of children who would have been invisible in previous generations were dumped back into communities that had few resources and services for them.
MILDRED CREEK.
A psychiatrist at the Great Ormand Hospital in London, it was the first such facility in Britain to offer state-of-the-art medical care to the children of families with limited means. She contended that “psychosis” among children was not rare. The constellation of traits shared by many of these children – a lack of “social awareness.” “rigidity of behaviour and irregularities of speech could have been lifted directly from Kanner.
LORNA WING
She was a British psychiatrist who embarked on a quest to discover the kinds of assistance and services that would be most useful to families like her autistic daughter. When she was 6, she decided that what she wanted to do for a living was to figure out how things worked and studied biology, chemistry, and physics. At 16, she decided to study medicine. She married John Wing, a doctor with similar interests. Their first child had autism and one of her early teachers was Sybil Edgar who ran classes for autistic children in her house. With other parents, they founded what was to become the National Autistic Society in 1961. The logo adopted by the society – a puzzle piece – eventually became the universal symbol of autism parents organizations worldwide. The Sybil Edgar School found larger quarters and even the Beatles became involved with John Lennon a major donor.
As Elgar’s students became teenagers, she turned her attention to autistic adults, as she realized they were not “cured” and would require a living environment suited to their needs for the rest of their lives. “Children need praise and encouragement, but most of all they need the opportunity to continue their education and training so that they can maintain and extend abilities. . . and acquire occupational skills.” In 1972, the society launched Somerset House, the first residential facility and school in Europe for autistic adults.
These achievements put Lorna and her colleagues light years ahead of their American peers in the understanding of autism. They knew that autism might manifest itself in varying degrees of severity. She thought Kanner’s theories of refrigerator mothers were bloody stupid.
Michael Ritter conducted the first twin study of autism, providing proof of the genetic basis for the first time. He also untangled autism from schizophrenia, showing that they were separate conditions that only rarely occur together.
Using restrictive criteria, an attempt to determine the prevalence of autism came up with an estimate of 4.5 per 10,000, a very low number. This was replicated by other researchers and became the oft-quoted baseline against which all future autism prevalence estimates would be compared in the coming decades.
Lorna realized that the study left out most of the children likely to fall on the Asperger side of the line. She also had Asperger’s paper translated from German to English and realized that Asperger had seen the same thing in his Vienna clinic that she was seeing. They were kids that nobody knew what to do with. They didn’t fit into Kanner’s narrow box, and were also highly intelligent but couldn’t pick up subtle social signals from the people they were talking to.
There was no diagnostic label on the books that would enable them to access psychiatric services. There were many shades and hues along the autistic continuum and all autistic people seemed to benefit from the same highly structured and supportive educational approaches, just as Asperger had predicted. Some children remained profoundly disabled while others blossomed in unexpected ways when given an accommodating environment and special consideration by their teachers.
Lorna then introduced a new diagnostic label – Asperger’s syndrome – as autism had so many negative connotations. She then wrote a case series in 1981 and changed the continuum to the autism spectrum, indicating that the continuum shades imperceptibly into garden-variety eccentricity – all the features that characterize Asperger’s syndrome can be found in varying degrees in the normal population.
