Autism across Cultures

Unstrange Minds, by the cultural anthropologist Roy Richard Grinker, is to my knowledge the first cross-cultural account to date of how autism is perceived and interpreted around the world. By interviewing parents (mostly mothers) of children with autism, as well as doctors and child advocates in South Africa, India, South Korea, and the United States, Grinker places autism at the intersection of culture and illness and examines how culture affects the ways in which it is defined. He aims to find new answers to contested questions, especially whether autism is an epidemic. He puts forth a convincing, richly supported argument that frames longstanding questions about autism in new ways. Grinker’s teenage daughter, Isabel, who was diagnosed with autism in 1994 when she was two and a half, is very much a presence in Unstrange Minds. Using Isabel’s compelling and theoretically relevant story as his narrative landscape, Grinker examines families’ experiences with autism across cultures, past and present theories of autism, issues of epidemiology, educational policy, legislation, and other concerns. Throughout the book, there are three interwoven subplots: the story of Isabel’s diagnosis and her family’s experience of struggling with, understanding, and accepting it; the story of autism itself, its evolution as a clinical category, and the unfolding of complex sociocultural processes culminating in the perception of autism as an epidemic; and the stories of families and practitioners living in places as diverse as India, South Africa, and South Korea whom Grinker visited and interviewed. These subplots form an array of local theories and interpretations that support Grinker’s argument: as a cluster of symptoms such as language delay and repetitive, stereotypical behaviors, autism looks very similar but is viewed very differently across time and cultures. The theme that permeates all three subplots of Unstrange Minds is whether autism is now as visible in the rest of the world as it is in North America and Europe and whether a cross-cultural examination of autism would lead to a better understanding of it in the United States. By the book’s end, even a reader not swayed on the epidemic issue will have a new cross-culturally informed understanding of autism. Unstrange Minds is divided into two parts, each with seven chapters. Part 1 is the chronicle of autism through time; part 2 is the cross-cultural account. Chapter 1 begins with a highly personal scene: as he watches Isabel fall asleep, Grinker thinks about how different she is when she is awake. Isabel’s story is anchored to this place of wonder and respect for her progress and the kind of person she has become. The story is reminiscent of those told by parents in India, South Africa, Korea, Trinidad, Croatia, Peru, Kenya, and Namibia. Yet Isabel’s story is unique in important ways. She attended a museum-based preschool at the Smithsonian, where her visual skills blossomed and she started to communicate more. Now a teenager, she is a good older sister, a cellist, an artist, and a caring owner of two French bulldogs. In this opening chapter, Grinker not only gives away the positive ending of Isabel’s story but also explains how Isabel’s autism entered so powerfully into his work. The subject of chapter 2 can be found in many texts on autism: Leo Kanner’s original articulation of autism as a diagnostic category. What makes Grinker’s chapter different, however, is the thoroughly researched, vivid account of Kanner’s family history and his childhood in Austria as “a lonely boy raised by bizarre unexpressive people” (p. 38). Grinker suggests that Kanner’s father may have had Asperger’s syndrome, a high-functioning form of autism, which may have prepared Kanner for later identifying autism as a clinical entity. This chapter ends with another familiar yet newly framed part of the autism story: the simultaneous identification of autism by Leo Kanner in the United States and by Hans Asperger in Austria and the importance of Asperger’s discovery for the notion of the autism spectrum. Chapters 3 and 4 address similar concerns: the stigma, shame, and secrets that may occur when raising a child with a disability. Grinker’s writing about Kanner’s idea of the “refrigerator mother” and about later developments in the psychogenic theory of autism is historically contextualized and filled with new information. Chapter 4 is dedicated to the sociohistorical context in which mothers were blamed for their children’s autism from the 1930s through the 1950s. Grinker writes that mother blame is very much alive in some parts of the world, especially France and Korea. The last three chapters of part 1 are unified by the theme of the autism epidemic. Chapters 5 and 6 examine the rise in autism diagnosis as part of the history of American psychiatry. This rise, Grinker argues, is a product of the standardization of psychiatric diagnoses and of the development of psychopharmacological treatments for psychiatric conditions. In chapter 7, he identifies the multiple forces that converged to create the controversy of the autism epidemic—scientists, the media and the Internet, politicians, philanthropists, advocacy groups, the general public, educators, and clinicians. He reminds us that the politics of knowledge production is and