Marx famously opined that social phenomena — world-historic events, he called them — occur first as tragedy, then as farce. That was in 1852.
Today, it would be closer to the truth to say that tragedy only counts if it can be diagnosed. And diagnosis only counts if it’s biological.
That’s been the story of the conversation about autistic children, and the implication of so-called mitochondrial dysfunction.
Deficiencies of energy metabolism have been rumored in association with the autistic picture for a while now, and emerged in the Hannah Poling case a few years ago. They were given a boost by a small European case series (abstract here, PDF here) published in 2005 in Developmental Medicine and Child Neurology. (The authors of the article gave their paper the deceptive title “Mitochondrial dysfunction in autism spectrum disorders: a population-based study,” even though the research involved no population at all, just 11 kids. But business is business.)
Another boost came this week with the publication in JAMA of a methodologically careful study of energy metabolism in 10 California children diagnosed with autism, contrasted with 10 children drawn from a well-matched sample of comparable control children. The new study found reduced oxidative activity in mitochondria — the tiny energy-chain entities inside cells that produce chemically based, biologically derived power for the cells’ functions. The reduced oxidative activity was present in most of the 10 autistic children, and they showed a much-altered mean energy metabolism on several different measures.
Thus, altered energy metabolism at the cellular level has been documented in a small handful of children diagnosed with autism. It seems not to be present in all children with autistic diagnoses. It might be a result of autistic behavior rather than a cause, or a bystander phenomenon of some kind. Or it might be a feature that hastens diagnosis (in the ones who have the unusual metabolic pattern, it has not been shown to precede the diagnosis) without actually playing any predisposing role. Indeed, the authors of the JAMA paper remark that the
mitochondrial dysfunction observed in this preliminary study performed with children presenting with full syndrome autism may or may not indicate an etiological role.
But this minor and still untested finding on mitochondrial energetics, still not of any self-evident significance regarding the cause of autistic behavior, has created a major stir. Medscape weighed in. Business Week ran a story written by HealthDay reporter Jenifer Goodwin. And it’s no surprise that the story has been front page news at the autism blogs, like Age of Autism and Autism Speaks.
So it seems safe to say that we’re looking at the third coming of a fact.
That some children engage with the world differently than do most kids was the first discovery, an old discovery (some think the 18th-century Wild Child of Aveyron was autistic). It was codified in 1910 when the psychiatrist Eugen Bleuler labeled one of the varieties of childhood schizophrenia “autistic.” Identification.
Next came diagnosis — beginning with Hans Asperger in 1938 and Leo Kanner in 1943. In the grip of modernity, slow acquisition of words, quirky communication, fixity of focus, failure to multitask, preoccupation with parts rather than wholes, and so on, are no longer signs of diabolical possession, thankfully. But neither do they signal a broadened sense of what human experience is like. They’re just signs of disease.
Diagnosis has allowed all sorts of theories to summon support: about parenting, about the toxic environment, about thimerosal in vaccines, or about immunization itself. Autism is the diagnosis that lets people express their misgivings about modernity.
Now we’re seeing the beginning of step 3: biologization.
If autism is to stand up to 21st-century modernity, it has to have a biological basis. Otherwise it will go the way of the obsolete disorders of old, like neurasthenia, hysteria, or frigidity. The research on mitochondrial dysfunction in California won’t be the last or the only big-dollar expenditure aimed at finding a biochemical basis for the diagnosis of autism. And there’ll be DNA studies, too.
The sad thing is that the only good way for troubled parents to get services for their children is to have the kids diagnosed, and to help to get them labeled as biologically off-kilter (Autism Speaks was one of the sponsors of the study just published in JAMA). Get them labeled as dysfunctional, to use the term of art.
There’s no percentage in betting on need, or social disadvantage, or just plain poverty as an impetus to free up funds and services. The need doesn’t count if there’s no dysfunction. Your event doesn’t count as world-historic without a biological basis now. First as tragedy, then as diagnosis, then as biology…
Autism, ADHD, obesity, addiction — each time our society is confronted with a problem it can’t solve or an irritation it can’t salve, we feed the problem into the medical establishment’s diagnosis mill. Then we turn it over to the biologists to put some science on it.
Once the problem has a name and a diagnosis and a biological mishap to it — then we can see it.
This entry was posted on Friday, December 3rd, 2010 at 2:03 pm and is filed under autism, Behavior, Disease, epidemics, Health Professions, News, Physicians. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.