Making sense of autism
Anthony Storr
LITTLE BOY LOST by Bronwyn Hocking
Bloomsbury, £14.99, pp. 192
Bronwyn Hocking was in her thirties when, 11 years ago, she gave birth to a son. Poverty, and tension between her and her child's father, made her pregnancy unhap- py. She developed a raised blood pressure; labour was artificially induced; and breast feeding proved difficult and unrewarding. The baby, Sam, did not thrive as he should have done, but seemed uncomplaining. But, as early as six months, it became clear that something was wrong. Sam did not reach out for objects; showed very little initiative; was slow to sit up and crawl; reacted to sounds and sights which unpre- dictably pleased him, but was curiously indifferent to others which should have interested or alarmed him. His mother became seriously worried by the lack of emotional rapport between her and her son; and, very sensibly, joined the Nation- al Society for Autistic Children. Her fears were soon confirmed. Sam was diagnosed as autistic by experts at Nottingham Uni- versity. He was already showing the car- dinal signs of language impairment, lack of social involvement, and ritualistic, obses- sional patterns of behaviour.
By the time Sam was five he was still unable to speak, played very little, and could not tolerate being alone. Various forms of therapy had been tried, with no very positive results. Around this time his father left home. By then it seems that Bronwyn Hocking was convinced that Sam's condition was due to her own inadequacies. She is notably frank about these; especially about the embarrassment she felt when in the company of others when Sam behaved eccentrically. This sometimes prevented her from responding to her child's needs, as well as making her angry. She is convinced that the stress she experienced during the first few months of Sam's life made him withdrawn from her, and therefore from life in general. He was always hypersensitive in his reactions; ecstatic at anything he liked, but retreating and covering his eyes and ears when confronted with the many sights and sounds which he found alarming.
Bronwyn Hocking believes that, because his first and most important relationship had become threatening to him, he avoided any and every relationship which was subsequently offered. Since learning, especially in the early years, depends upon interaction with others, it is not surprising that Sam is retarded in his development and that he can still make very little use of language. However, in recent years, Sam has learned how to ride a bicycle and how to swim. In spite of the severe nature of this disability, his mother is convinced that she is beginning to bridge the gap between them, and still hopes that Sam may one day know what it is to reach shared under- standing with another person.
Since Kanner first described autism in 1943, the literature concerning the condi- tion has become extensive. Many psychiat- rists would agree with the idea that a great deal of the autistic child's behaviour can be interpreted in terms of a failure to make a close bond with the mother or with anyone else. These children's avoidance of others suggests that they find people frightening; their obsessive, ritualistic behaviour and insistence on sameness suggests. that they find the whole world frightening. Never- theless, autistic children are happier with things than they are with people. Like Sam, they often carry around a particular object which seems to act as a talisman; and, again like Sam, they are often fascin- ated by trains, steam-engines, and other sources of power which contrast so strongly with what one presumes to be their own sense of powerlessness.
Bronwyn Hocking found the Tin- bergens' book, 'Autistic' Children: New Hope for a Cure (Allen & Unwin, 1983), extremely helpful. Drawing on his many years of observing animal behaviour and upon the ethological theories which were derived from this, Niko Tinbergen, with the help of his wife, was able to add a new perspective to the understanding of autistic behaviour. The Tinbergens interpreted many of the autistic child's actions as the consequence of conflict between approach and avoidance behaviour comparable with that observed in fish and birds. They also made helpful suggestions about the right way of approaching autistic children, based again on their observation of shy creatures who are naturally afraid of man.
Where most psychiatrists parted com- pany with the Tinbergens, and where most psychiatrists will also part company with Bronwyn Hocking, was their insistence that the failure of the autistic child to form a stable bond with its mother was somehow the mother's fault. In other words, their behavioural observations were sound, but their causal speculations were dubious. The same considerations apply to Freud, who was a splendid observer, but whose theories of causation do not bear scrutiny.
Bronwyn Hocking is touchingly honest, but too ready to accept total blame for her son's condition. If she had had more than one child, she might feel differently. Autis- tic children have been born to mothers who have not only had a number of perfectly normal children, but who have not been in a state of distress during the pregnancy resulting in an autistic child, and who have not been either poverty-stricken or emo- tionally disturbed during the early months of the baby's existence. In such cases, it is far more probable that the failure to make a secure bond with the mother is due to some defect in the baby than to any maternal inadequacy. One also has to remember that children who have had the most appalling starts in life not infrequent- ly grow up to be as 'normal' as any of us.
This is a courageous book; a notable addition to those personal accounts of loving dedication to a handicapped child which enlarge our sympathies in ways which textbooks cannot do. To my mind, the nature of the autistic handicap is still an unsolved problem; but one which modern methods of investigating the central ner- vous system are likely to unravel.
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