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Unstrange MindsReview - Unstrange Minds
Remapping the World of Autism
by Roy Richard Grinker
Basic Books, 2007
Review by R.A. Goodrich, Ph.D.
Mar 4th 2008 (Volume 12, Issue 10)

Unstrange Minds has been widely reviewed on both sides of the Atlantic; indeed, so much so that it is in danger of being stereotyped as simply another example of those professional parents who have sensitively penned memoirs of their autistic children such as Clara Claiborne Park has done on two occasions.  However, Roy Richard Grinker, an anthropologist, biographer, and editor, actually weaves his memoir of daughter Isabel into "a cross-cultural study of autism" for "a general rather than an academic audience" (303 & 304).  In effect, the memoir of his daughter--ranging from the Grinkers' growing realization of her difference (23-35) to their efforts to find appropriate clinical and educational support (175-196)--acts as a means of comparing and contrasting other children and other families, other cities and other times. 

The seven chapters comprising Part One of the text chronicle the way in which the autistic spectrum of disorders came to be so widely diagnosed in the United States since the 'forties.  They include an account of how shifting definitions and how conflating the notions of prevalence and incidence have led to much hyperbole about an autistic epidemic.  Yet "defining it differently and counting it differently than in the past" (3), we are repeatedly reminded, need not mean that its incidence has increased.  All the while, moreover, Grinker grounds his exposition around the persons of Leo Kanner (38ff.), Hans Asperger (56ff.), and Bruno Bettelheim (78ff.) amongst others.  The next seven chapters comprising Part Two look at specific case studies in Cape Town, New Delhi, and Seoul amongst other communities and, by so doing, illuminate contrasting cultural attitudes towards and interpretations of what might otherwise be regarded as "a core set of symptoms" (11).  In fact, readers are given an early foretaste in Grinker's sketch of the baleful influence of psycho-analysis upon the French propensity to blame autism--still defined until recently as "infantile psychosis" or "psychic disharmony" (97)--upon families in general and mothers in particular.

Connecting both parts of the text is a distinction between illness and disease associated with the seminal writings of medical anthropologist Arthur Kleinman.  As summarized by Grinker, "a disease occurs when something is wrong with our bodily organs or systems, whereas an illness is the experience of negative or unwanted changes in our bodies or our ability to function in society" (230).  Autism--whether one or "many distinct disorders" (10)--is inescapably both as demonstrated by Grinker's detailed stories of the different ways in which so many women under relentless pressure have to cope with their autistic children.  Because narratives of illness gradually supplant narratives of disease, the bulk of this review will at first focus upon the more overtly anthropological dimension.  Grinker immediately foregrounds it with the words:

I'm an anthropologist, a social scientist who studies culture...and [is] interested in the intersection between culture and illness--that is, how culture affects the way we define and classify illnesses (2).

          What else shapes our author as an anthropologist?  Is he prone, as Clifford Geertz once confessed, to "a host of issues normally addressed by other disciplines" to the point where anthropology, not unlike "cultural psychology," becomes a "hopelessly miscellaneous and inconstant science"?  Grinker is quick to say that he does not research the pharmaceutical or biological or neurological realms.  Rather, he senses an affinity with the psychiatric realm, not merely because of his family's longstanding professional involvement in it (e.g., 38 & 110-115 in passim) but since most illnesses so treated and studied are "hard to describe and open to multiple interpretations" (2).  Psychiatric diagnoses, he continues, are

essentially just descriptions and classifications based on the behaviors particular clinicians have seen and chosen to emphasize at a particular point in time, and they can even reflect...personal and cultural biases...  (2).

Beyond that, little is added until, buried towards the end of Chapter Two, we encounter the speculation that famous figures such as Vincent van Gogh

were alienated and socially awkward.  They were insensitive to the subtleties of human expression, finding it difficult to tell the difference...between a normal contraction of the eyelid, a blink, a knowing wink, or a facial tic (63).

          Here, readers may recognize an unacknowledged allusion to the constantly cited example of the difference between a wink and a twitch culled from the later writings of Gilbert Ryle by Clifford Geertz.  Strictly physiological descriptions of a wink and a twitch may well prove indistinguishable.  A more complete or "thicker" description, however, needs to contain some reference to the actual circumstances of the activity and to what, if any, objects or participants might be involved.  As Ryle states in his 1968 "The Thinking of Thoughts" paper, a "thick" description will distinguish between the two because a wink can involve "a voluntary, intentional...collusive and code-governed contraction of the eyelids."  "Thick" descriptions, in short, are multi-layered and presuppose a multiplicity of prior activities or accomplishments.  Indeed, Ryle and, by extension, Geertz also claim that there exists a range of ways of depicting or classifying activities which cannot lend themselves to "thin" descriptions of the above  physiological kind.  To describe an activity simply as, say, promising or pretending requires explicit contextualization to be fully intelligible in a way that scratching or sitting does not.  However, in Geertz's classic 1973 adaptation of Ryle for the purpose of interpreting culturally informed behavior, he is willing to concede that inferences or interpretations drawn from "thick" descriptions lack "explicit canons of approval."  Indeed, he contends, they face "serious problems of verification" to the point where there appears to be no means--beyond one's mere "grasp" of it--for discriminating "a better account from a worse one."  Now, if Geertz--and his anthropological adherents--assume that any act of "thick" description is not a matter of truth or falsity as such and that this somehow equally applies to any inference based on it, then what is it that they are asking of us?  Could it be that the notion of explanation or interpretation found in the biological and neurological sciences as the provision of causal reasons is being swapped here for the process of clarifying or making intelligible "thick" descriptions from the perspective of participants?  In other words, the issue at stake shifts, for example, from "What is the neurological cause of autistic disorders?" to "What does that person mean or understand by autistic disorders?"  But why would a Geertz or, for that matter, a Grinker want to construe explanation as a mode of clarification?  Surely the answer partly lies in the fact that, unlike causal explanations, "thick" descriptions by their very nature cannot be complete.  By labeling a description as "thick," Geertz and his followers seem to be asking, do we not always allow for the possibility of adding to that description?

          This apparent excursion into the intellectual milieu within which Grinker works is by no means incidental; it informs the very substance and strategy of his book.  Commenting on the title, Unstrange Minds, Grinker writes of the goal of making "the strange familiar":

The process of understanding autism parallels the work that anthropologists do, since the minds of people with autism are sometimes as hard to understand as foreign cultures (13).

Immediately after detailing the experiences of four women in the Indian subcontinent (207-227)--women whose "turmoil" captures the "total life-changing experiences for parents, families, and communities" (229)--Grinker reminds readers of his dual anthropological theme.  On the one hand, "the best way to learn about the rules of any society is to see them broken" and, on the other, this is why illness, "when it makes people unable to live up to the rules of social behavior, can teach us so much about ourselves" (229).  "Thick" descriptions of the Grinkers' world in Washington and Baltimore and similarly "thick" descriptions of diurnal realities in, say, Delhi and Seoul are one reason why concepts of "diversity" and "difference" (78 & 239) reverberate with positive and negative connotations of inclusion and exclusion respectively for readers.  Perhaps nowhere as a consequence does the author personally feel the contrast more than in the case of a rural woman in Seoul he interviewed in early July 2003 for whom "autism is not just a group of diagnostic categories, but a window into the strict rules and expectations of her society" (231).

          So far, we have concentrated upon Grinker's anthropological or cultural concerns in an effort to flesh out his sub-title, "remapping the world of autism."  Let us now conclude by focusing upon the psychological or individual dimensions.  Grinker, as already mentioned, does give his readers momentary glimpses of his daughter first diagnosed in April 1994 at 2 years 7 months before providing them with a more elaborate account of her initial school years in Chapter Eight from the age of five.  Of equal interest is the earlier period before entering kindergarten when Grinker recalls the growing parental alarm accompanying the realization of Isabel's difference, a realization precipitated after the birth of his second daughter in November 1993.  The obvious lack of speech became one litmus test.  Up to the age of three and in chronological order, Chapter One records the following "memories," which, Grinker concedes, "privilege events over process" (25):

·         Isabel's attempt to make sounds "that seemed like the beginnings of words" at 1.0 years (26).

·         No evidence recollected or video-taped of Isabel saying single words in either English or Korean up to the age of 2 years.

·         At a time when she "began flapping hands and arms occasionally," Isabel did not respond to her name "consistently" and there appeared to be a "diminished" ability to make sounds at 2 years 1 month (29).

·         At the time of being first diagnosed six months later at 2.7 years, the use of "repetitive speech" is noted in passing (30).

·         Assessed by a Washington speech pathologist at the age of 2 years 8 months as being capable of uttering about seventy words, Isabel's vocabulary comprised "all...nouns," two-thirds derived from the Wilbert Awdry names of trains in the Thomas the Tank Engine series and from various names of Walt Disney characters (29).  Lexically, neither "mommy" nor "daddy" figured as terms of address; syntactically, utterances in the form of statements or commands were never constructed (or, from a more semantic point of view, the informative and the regulative were never verbalized); and, pragmatically or interactionally, she could not say "yes" or "no," let alone "use gestures to communicate" (30)

·         Despite being diagnosed with spatio-visual and articulatory strengths, in the next five months Isabel by the age of 3 years 1 month "had yet to learn a single new word" (30).

Only after this period do we encounter more explicit samples of Isabel's speech, ranging from her use of sentence frames with stranger such as "Mickey is a -----" (32) to the use of "four- to five-word" utterances within a working vocabulary of "200 words, mostly nouns and proper nouns" when six years old (186 & 33); from "learning how to sound out words and read" (190) upon joining a mainstream classroom to numerically expanding single-word utterances at her parents' behest at 6;8 (for instance, to the instruction, "Ask for juice using five words," Isabel would respond, "Want juice please dad juice" (191)). At this juncture, it becomes apparent that speech or language--the two are treated synonymously here--is, for all Grinker's awareness of its delay and impairment in Isabel, curiously transparent.  One wants to know, to take the last example of what is seen as a case of "longer sentences" (191), whether it was articulated as "want juice//please dad//juice" or "want juice please//dad//juice" or "want//juice please//dad//juice" or "want//juice//please//dad//juice."  Are we actually dealing with a longer sentence here or with a set of three or more "telegraphic" utterances?  The point here is not one of demanding undue linguistic expertise of the author, but of questioning "thick" descriptions which appear truncated and therefore cast doubt upon whether all the relevant or required information has been supplied. 

Finally, Grinker's "general...audience" (304) with a more professional cast of mind may want to question whether his "remapping of the world of autism" conveys a more conceptual than geographic edge.  On closer inspection, we are initially told that there may be

many distinct disorders, perhaps defined not only by their different symptoms but by the many genes involved.

and that

we know that autism is a brain disorder that can affect anyone in any culture (10);

claims eventually referenced to the thinking of Michael Rutter and colleagues (61-62 & 72).  Subsequently, the work of one such colleague, Lorna Wing (61, 62 & 157), is invoked when elaborating on the contention, "if Kanner was the father of autism as a diagnostic category, Asperger was the father of the concept of the autism spectrum" (59).  Indeed, Grinker attributes Rutter's four criteria for the presence of autistic disorders as enabling "a coherent and a conventional diagnosis" (109) underpinning their recognition in the 1980 DSM-III.  And, although having difficulty comprehending Simon Baron-Cohen on "theory of mind" (60), Grinker returns to the hypothesis of weak "central....coherence" (185) associated with Uta Frith in his accounts of Isabel.  In other words, there appears to be a strong reliance upon what we might call the "London School," not only upon its core hypotheses to the late 'nineties but also its emphases upon the scientifically empirical and the communally engaged.  But this adherence is never abstracted from the immediacy of Grinker's own familial and professional world, a world so potently introduced by his night thoughts on watching his daughter sleeping which open Chapter One (23-25).

© 2008 R.A. Goodrich

R.A. Goodrich teaches in the School of Communication & Creative Arts, Deakin University, Melbourne, Australia, co-edits the online refereed arts-practice journal, Double Dialogues, and currently co-ordinates with Maryrose Hall a pilot study of a number of children within the autistic spectrum of disorders.


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