When most people think about autism, the horrible spectre of a criplling disabled, socially non-existent child who is likely to have an incredibly hard life with years of expensive medical and psychological treatment and will never live on their own. Well, many of those with autism spectrum disorders (which includes Aspergers) don't particularly view their condition as a "disease" or a "disability" but more as an alternate neurological wiring that gives them a unqiue, and ultimately beneficial, view of the world.

Andrew Solomon has a fantastic - and utterly convincing - piece in New York about the debates in the autism community that everyone should read. My thoughts below.

The way Andrew Solomon describes it, the autism activists are split into three camps. One, the vaccinists, think that autism (or autism spectrum disorders) is not only a crippling disease, but one that should be eliminated by fixing the environmental factors. The genetics also think that autism spectrum disorders are crippling, and think we should be trying to find a cure. The neurodiverse types are more of a mixed lot, but generally tend to view autism and Aspergers not as a disease, but as a different way of thinking. To them, autism is only a disability because of a normative view of what an abled person, and that if we tried to accept and accommodate those on the spectrum, much of the “symptoms” would go away, mostly because they wouldn’t be viewed as symptoms.

The vaccinists are clearly wrong on two points. One, vaccines don’t cause autism. But not only are they selling false hope, they promote a ridiculously regressive model of the disorder, seemingly excluding any possibility that someone on the spectrum could see some value in their neurological difference, just insisting that they’re not only disabled, but poisoned. The geneticists often adopt the same view of the vaccinists, seeing autism as purely negative. But they’re probably closer to the truth in seeing a genetic component of autism. Where they are right, in my opinion, is that looking to a genetic cause of autism won’t lead to the elimination of neurodiversity by means of abortion. The genetic component to autism likely involves hundreds of genes operating in a epistatic fashion to influence some traits that all add up to a spectrum disorder. It’s highly unlikely that well ever be able to point to some specific genes and say that a baby will be autistic.

Where the neurodiversity folks get it wrong, I feel, is in their (sometime) categorical objection to seeing any objective component to autism-as-disability. Oftentimes, their tributes to the benefits of autism can fall on the deaf ears of parents who spend massive sums and huge amounts of time just trying to get their kid not to have self-destructive tantrums or potty trained. To those parents, it’s hard to say that their kid is merely approaching cognition in a different way, he’s disabled (if the term is to mean anything at all).

I see no reason why we can’t come to some sort of compromise as outlined by Temple Grandin:

Neurodiversity has dawned since she began grappling with autistic pride, and though she has enabled it, she is too late to be its beneficiary. Grandin argues that both the autistic person and society have to make accommodations. “I won’t do all the neurotypicals want, but you have to go halfway,” she says. “We had manners pounded into us. We had fancy dinners at my grandmother’s, and I was expected to sit at Granny’s table for twenty minutes and I couldn’t monopolize the conversation. You can’t degeekify the geeks, but you can be a polite geek. Autism is a continuum from genius to extremely handicapped. If you got rid of all the autism genetics, you’d get rid of scientists, musicians, mathematicians. Some guy with high-functioning Asperger’s developed the first stone spear; it wasn’t developed by the social ones yakking around the campfire. The problem is, you talk to parents with a low-functioning kid, who’ve got a teenager who still goes to the bathroom in his pants and who’s biting himself all the time. This guy destroys the house, and he’s not typing, no matter what keyboards you make available. His life is miserable. It would be nice if you could prevent the most severe forms of nonverbal autism.”

Grandin’s desire to find a middle ground resonated with me. If there is one thing that everyone in the autism world seems to recognize, it is the pervasive confusion about what qualifies as “sick,” and what qualifies as “odd.” Some of the geeks, in Grandin’s parlance, are autistic; some are just geeky. Some people with no language make social connections; others are highly verbal but unable to understand social rules; others are paralyzed by anxiety, or have hyperacute sensory responses that cause them to withdraw. Some kids have full use of language, and others have echolalia (meaningless repetition of overheard phrases), and yet others have language for basic communication but no more; Alison Singer, an executive vice-president of Autism Speaks, told me that her daughter had language at last—“which means that she says, ‘I want juice,’ not that she says, ‘I feel that you’re not understanding how my mind works.’ ”

I guess the major question is if it’s even possible to integrate all the baggage associated with the concept of autism being a “disease” with some sort of program to recognize the perspective of those with spectrum disorders who don’t feel particularly sick. If we accept certain concepts of social interaction as desirable or normative, then basically anyone on the spectrum is going to be “weird” or “disabled.” But if we take some of the neurodiversity standpoint, will we still be able to say that there are some who really would benefit from some sort of treatment or something to let them interact with the world, or at least prevent active self harm?

Of course, I’m ranting on much too long. Clearly those with spectrum disorders and their parents are the ones who ought to be having this conversation, not bystanders like me.