Why are we seeing more autism?: “Environmental injury” vs. “better diagnosis”

A “possible link between autism and the environment” is the focus of the fifth edition of the Advocate, the publication of the Autism Society of America. The purpose of this special issue and of the ASA’s Environmental Health and Autism website is to “increase awareness about links between autism spectrum disorders and environmental toxins.” The ASA does not include the word “possible” with “links” on this webpage , as if to make the statement that there are indeed “links” between autism and the environment, and this claim is the subject of three feature articles, all of which can be read as PDF files:

• Time to Get a Grip Martha R. Herbert, M.D., Ph.D.
• Can Exposure to Environmental Toxicants Influence Autism Susceptibility? by Isaac N. Pessah, Ph.D.
• The UC Davis M.I.N.D. Institute: Uniquely Designed to Study Gene-Environmental Interactions in Autism by Robert Hendren, D.O.

Herbert presents a rhetorically charged argument for a link between the environment and why “the number of people diagnosed with autism has skyrocketed, both in the U.S. and in other countries.” She argues for a “gene-environment interaction model,” suggesting that this is why it has been so hard to identify genes for autism. By using a “whole body model” of autism—-by not seeing autism as a brain disorder—she asks if, instead of thinking of autism as “neurobiological” that

we need to ask whether the brain is the primary target, or whether the brain could be affected at the same time as—“in parallel” with—or even “downstream” of, other bodily changes, such as in the immune system. Perhaps the brain is “caught in the crossfire” of whole-body changes related to environmental stress.

If we can locate an environmental cause for autism—if we can know the specific environmental agent or agents that trigger autism in a child with a genetic predisposition for autism—then “autism recovery,” Herbert writes, is “scientifically plausible,” as we will have then pinpointed the cause of autism.

The rise in autism diagnoses, along with the rise in other immune and chronic illnesses, is really a wake-up call. Put alongside the warnings about the ecological instability of our planet, it shows that our situation is serious. It calls for pulling out all the stops and throwing our best intelligence, resources and organization into getting a grip. Autistic individuals may not be “different” from the rest of us but simply “more sensitive” to environmental injury—they may be the “canaries in the coal mine” warning us of impending greater disaster. If the level of environmental insults continues to rise, more children and more adults—and more of life on earth—will experience harm.

Herbert’s last phrase echoes “evidence of harm,” which is of course the title of journalist David Kirby’s book that argues for a link between mercury in vaccines and autism and by the end of her article, Herbert argues for a link between autism and an external, environmental agent—even a toxin, too. Like Kirby in his Huffington Post article, Herbert quickly dismisses the notion that this “rise” might be due to our better understanding of autism.

Some say that the increases are merely due to better awareness and diagnosis of autism, or expanded diagnostic criteria. However, we would need solid proof of this claim in order to dismiss the possibility that something new, different and harmful is going on with our children—and such proof does not exist. Autism increases point to a role for the environment, since genes don’t change that fast.

But the question that Herbert leaves hanging is, might it be possible that our understanding, our knowledge, of autism in our culture might change so fast that we have only begun to realize this?

Herbert outlines a number of “major environmental changes” in Time to Get a Grip —but these changes have affected all of us, and not only autistic persons: “We are all polluted,” she writes. The notion of “better understanding of autism, better diagnosis, increased prevalence” cannot simply be dismissed as Herbert and Kirby so quickly suggest. The changes in the diagnostic criteria for autism are evident if one reads the various versions of the DSM and, even more, if one reads Roy Richard Grinker’s account of how the diagnosis of autism (and of child psychiatric disorders) has evolved in Unstrange Minds: Remapping the World of Autism (forthcoming in February 2007).

Why are we so quick to dismiss the notion of how better understanding of autism within our culture can account for those “skyrocketing” autism rates? Why do we need to find “links” between autism and something else outside of us?

A thoughtful discussion of this issue would merit its own special issue of an autism journal. “Diagnosis,” after all, is from the classical Greek word diagignoskein, ” to discern, distinguish” (from dia, “through,” and gignoskein, “to know”). Perhaps it is that we need to wake up to the notion that we are better able to see what autism is now at the beginning of the 21st century, and this is to account for why there is a lot more of it. We live not, as Herbert ends Time to Get a Grip, “in this time of great challenge and danger,” but in a time of “broader shifts taking place in societies throughout the world” that are epistemological—about how we see and know the world—rather than environmental. From the Unstrange Minds website:

…….there is no evidence for an autism epidemic. Instead, the high rates of diagnosis today are instead evidence that scientists are finally, after all these years, counting cases correctly. And this is a good thing, not only for the US but for the world, including cultures that have only just begun to learn about autism.