Abstract: It has become commonplace in the US to speak of the epidemic of autism, with approximately 1 in 68 children being diagnosed with the disorder as of 2014. Characterised by impairments in social interaction and communication, as well as repetitive behaviour, the disability is understood as a spectrum disorder ranging from low to high functioning, with some exhibiting savant traits. Autism also is associated with an inability to form a theory of mind, and may reflect impairments situated in the right brain hemisphere. As demonstrated via the application of a media ecology approach, the unique characteristics of the syndrome can provide insight into human consciousness, cognition, perception, language, culture, and the sense of self. At present there is no cure for autism, and while the current epidemic of childhood autism is leading to an epidemic of adulthood autism, and very little has been done to prepare for this eventuality.
Keywords: autism, disability, communication, language, theory of mind, perception, sense of self, media ecology
Today it has become commonplace to speak of both the epidemic of autism, and the enigma of autism. The epidemic seems to get worse and worse as the years go by. When I first began writing on the subject in 1999, estimates ranged from 1 in 1,000 individuals with autism in the United States, to what seemed to be an exaggerated estimate of 1 in 166. As of this writing, in 2014, the US government’s Centers for Disease Control and Prevention provide the statistics of approximately 1 in 68 children being diagnosed with the disorder (Baio 2014). No race, ethnic group, religion, political orientation, or socioeconomic class is exempt from the prevalence of autism, but there is a gender difference, in that the disorder occurs almost five times more frequently among boys than girls. No wonder then, that autism researcher Simon Baron-Cohen turned his attention to the overall differences in brain structure and function between men and women, in a book entitled The Essential Difference: The Truth About the Male and Female Brain and the Truth About Autism (2003). According to Baron-Cohen, autism is an example of the extreme male brain, which excels at analysis and abstract-thinking, and therefore working with complex systems, and is weak in contrast to the female brain in understanding feelings and emotions, in developing a sense of empathy, and in communication and social interaction.
I would not dispute the fact that there are biological differences between males and females, differences that are neurological as well as otherwise being physiological. And as scholars such as Walter Ong (1981) and Deborah Tannen (1990) have established, there are significant differences in the ways that men and women communicate, and therefore understand each other, and their world. But given the fact that over 20% of individuals with autism are female, it would follow that gender is probably not the causative agent, and probably not the main factor associated with its incidence, however much it may be among the most visible. And at this point, I should make it clear that I take this position based on personal experience with my daughter Sarah, who was diagnosed with autism in June of 1998, when she was two and a half years old. Like many other parents of children with autism, we noticed that her development was significantly behind the norm during her first year, and our concerns deepened over the course of her second year of life. She suffered from a series of seizures when she was twenty- one months old, and we later learned that about a third of individuals with autism also suffer from epilepsy or some other form of seizure disorder. Moreover, she often appeared withdrawn, disconnected from the world around her, lost in her own world or focused on things that typical children would not pay attention to. And we were quite alarmed about the fact that she failed to develop language normally. She did exhibit echolalia, repeating back words and phrases like “thank you” and “big” without any regard for their meaning, and she showed a remarkable ability to memorise songs such as Raffi’s “Baby Beluga” and Barney’s “I Love You” refrain. As it turns out, this echolalia is a symptom of autism, although among very young autistic children it can also be a positive indication of their potential for linguistic and cognitive development, at the very least about their chances of not having the most severe form of the developmental disability, and remaining nonverbal.
As you can imagine, the diagnosis was devastating. And just like everyone with even a modicum of education, reading is one of the coping mechanisms that we employ in times of trouble. It is as a parent, and not a scholar, that I read as much as I could on the subject of autism. And yet, as I reviewed the literature, I could not help but notice that what I was learning about this disorder intersected in numerous ways with my own intellectual background as a scholar of communication studies and media ecology. Integrating my experiences and reading as a parent with my scholarly work, I have spoken on the subject a number of times at communication conferences, and published on the subject as well (Strate, 2000, 2003, 2006), and my understanding of autism has influenced my work on other topics related to media and communication (e.g., Strate, 2011a, 2011b, 2013, 2014). It follows that what I found especially significant is that autism is profoundly linked to problems in communication and perception, and is associated with a different kind of consciousness than that experienced by typical individuals. As the name of the syndrome implies, autism is associated with a different sense of self than typical individuals, and at least in its moderate and severe forms, can be understood as a disorder of the self.
Autism was first identified in 1943 by Leo Kanner, while Hans Asperger described a high functioning variation of the condition in 1944, which came to be known as Asperger’s Syndrome. It has been firmly established that autism (and Asperger’s) are biological, specifically neurological conditions, generally believed to be present before birth, and affecting the development of the brain. No medical tests have yet been developed to identify the presence of autism. So instead, diagnosis depends upon behavioral observation and testing. This means that autism is a fuzzy category, with shifting boundaries. As a syndrome, autism encompasses a wide variety of traits, some of which may or may not be present in any given case, and which may appear in any number of combinations. This means that every individual with autism has a different mix of characteristics, requiring individually tailored intervention, therapy, and learning strategies. For example, unlike many individuals with autism, my daughter can be quite emotional, exhibits a degree of emotional empathy, and can be quite loving, caring, and affectionate (traits that mean a great deal to a parent). Because of the wide degree of variation in the way that the syndrome manifests itself from individual to individual, autism is generalised simply as a pervasive developmental disorder, meaning that there are multiple developmental issues. PDD as it is commonly abbreviated, or PDD- NOS (pervasive developmental disorder, not otherwise specified), sometimes appears as an alternative to a diagnosis of autism, or as a euphemism for it. Significantly, autism has come to be understood as a spectrum disorder, meaning that there is a continuum between the severest cases, through the mildest which may go undiagnosed, and perhaps extending to individuals with few, if any, autistic traits.
Autism is diagnosed by three main criteria. The first has to do with impairments in social interaction; Kanner referred to this as ‘autistic aloneness’ (quoted in Frith, 1989: 10). There are problems developing relationships, reciprocating emotions, and sharing interests with others, as well as a blindness to nonverbal social cues. The individual with autism seems lost in his or her own world, and an alien in our own, lacking in the common ground that typical individuals take for granted. The second impairment is in communication, both verbal and nonverbal, often including delays in language acquisition or sometimes a complete lack of speech. Moreover, the child may not take part in imaginative play, and lack interest in narrative. There may also be related problems with the processing of sensory information. At times, the individual may seem impervious to sensory stimulation, not reacting to sounds or to physical pain, while at other times he or she may be overly sensitive to certain sensory input. The third criterion is described as ‘restricted, repetitive, and stereotyped patterns of behavior, interests, or activity” (Siegel, 1996: 18). Both simple motions like hand flapping and complex behavioral patterns may be enacted repeatedly. There is a tendency to favor ritual and routine, and to behave obsessively and compulsively. Even in mild cases, interests may be pursued with unusual focus and intensity. These symptoms are related to echopraxia, as the behaviors may be learned by imitation; for example, my daughter was able to pick up and reproduce fairly complex hand maneuvers and dance steps from watching Barney videotapes.
While previously the majority of individuals with autism were also diagnosed with serious intellectual disabilities, the CDC now estimates that just slightly more than half have below average cognitive skills. Of course assessing intelligence is highly problematic when dealing with individuals who may be unable or simply unwilling to speak. Famously, some individuals with autism exhibit savant skills, highly developed abilities in one specialised area, such as mathematics, computer science, music, art, architecture, mechanics, biology, or simply memorisation, visualisation, or manual dexterity. Savants are usually well below normal in other areas, however, and individuals with autism are particularly handicapped in regards to social and emotional intelligence. The unevenness of autistic intelligence is in part what inspired Howard Gardner’s (1983, 1993) theory of multiple intelligences. In his book, Extraordinary Minds (1997), he writes:
When planning their political or religious campaigns or creating works of science or art, extraordinary individuals can focus their attention for many hours at a time, screening out even the most dissonant of stimuli. Such attention is desirable, of course, but it may be akin to autism – a pathological condition in which attention is so focused that the individual is unable ever to engage in normal human intercourse. It is not surprising that the incidence of autism is higher in the families of individuals who perform at a high level in certain academic disciplines, like mathematics, science, and engineering. (134)
Actually, academics of all types seem to have a high incidence of some autistic traits, such as absent-mindedness, intense and single- minded interests, and lack of certain social skills. This may well have been the case for Albert Einstein, who did not speak until the age of 5, had a great deal of difficulty with social interaction, and possessed savant skills in mathematics and visualisation. The philosopher Ludwig Wittgenstein also exhibited autistic traits; this adds new shades of meaning to his famous quote, “Whereof one cannot speak, thereof one must be silent” (Wittgenstein, 1922: 189) given the mutism characteristic of some individuals with autism, and the problems that many of them face in language acquisition. One of the founding fathers of the United States, Thomas Jefferson, may have been mildly autistic, and the same may be true of America’s greatest inventor, Thomas Edison, and his modern-day counterpart, Bill Gates. Along with intellectuals, artists appear likely to have a better than average incidence of autism, as social impairment would not be a factor in solitary creative pursuits, while visual and musical savant skills would be decidedly advantageous. Thus, Vincent Van Gogh’s seizures and psychological difficulties may have been the result of the syndrome, and possibly Andy Warhol’s antisocial tendencies and love of repetition; among musicians, Béla Bartók and Glenn Gould both exhibited autistic traits. Religion too, with its elements of repetitive ritual and spiritual isolation, would appeal to high functioning individuals, such as, possibly, the legendary follower of St. Francis, Brother Juniper, as well as the holy fools of Russian Orthodox tradition, and the Buddha. This sort of speculation focuses on extraordinary individuals because of their celebrity, and because history tends to ignore the ordinary and the low-functioning alike. One prominent exception, well known in the field of communication, is the 18th century wild boy of Aveyron, the subject of François Truffaut’s 1970 film, L’Enfant Sauvage (aka The Wild Child). A strong case has been made that the original “wild boy” was not raised by wolves, but rather was an autistic child who had been abandoned or run off (Lane 1977; Frith 1989; Ledgin 2000).
Accounts of autistic individuals can also be found in fictional form. Dustin Hoffman’s portrayal of an autistic adult in the 1988 film Rain Man is particularly well known, and the bestselling novel by Christopher Haddon, The Curious Incident of the Dog in the Night-Time (2003), takes the reader directly into the interior landscape of the autistic mind. The television series Parenthood, which debuted on the American television network, NBC, in 2010, features an especially realistic depiction of a relatively high-functioning autistic teenager. Another series, Touch, that ran for two seasons on the American network Fox from 2012-2013, followed the fantasy trope of the autistic individual with savant skills and near magical powers. Overall, the presence in various forms of popular culture of fictional characters identified as or characterised by some degree of autism and Asperger’s have increased dramatically over the past decade, owing both to growing autism awareness and the epidemic itself. Of no small importance was the fact that the grandson of Bob Wright, CEO of NBC and its parent company, General Electric, was diagnosed with autism in 2004, prompting the executive to found ‘Autism Speaks’ the following year, an organisation that quickly became the leading voice for autism advocacy in the United States. It should also be noted that there have been many popular culture characters who exhibit autistic traits but were created before the condition was identified (e.g., Sherlock Holmes), or who are not identified as autistic for other reasons. For example, often unacknowledged is the fact that Tommy, the hero of the 1969 rock opera written by Pete Townsend of The Who, was patterned after autistic children Townsend had observed. Although Tommy’s condition is the result of childhood trauma, his symptoms have little to do with repressed memories. Instead, he is unable to hear or see, even though there is nothing wrong with his sensory organs, and he does not speak, even though he is capable of it. Tommy spends his time gazing in the mirror, not out of narcissistic vanity, but because he is lost in his own world; and he displays savant skills of tactile dexterity when placed in front of a pinball machine. Tommy’s ‘amazing journey’ actually parallels the delayed development of high functioning individuals, who as adults gain the ability to communicate something about their experiences. Donna Williams, for example, has written five books about her condition (Williams, 1992, 1994, 1996, 1998, 1999); the following passage is from Sensing: The Unlost Instinct (Williams 1998):
Up to the age of four, I sensed according to pattern and shifts in pattern. My ability to interpret what I saw was impaired because I took each fragment in without understanding its meaning in the context of its surroundings. I’d see the nostril but lose the nose, see the nose but lose the face, see the fingernail but lose the finger. My ability to interpret what I heard was equally impaired. I heard the intonation but lost the meaning of the words, got a few of the words but lost the sentences. I couldn’t consistently process the meaning of my own body messages if I was focusing in on something with my eyes or ears. I didn’t know myself in relation to other people because when I focused on processing information about ‘other’, I lost ‘self’, and when I focused on ‘self’, I lost other. I could either express something in action or make some meaning of some of the information coming in but not both at once. So crossing the room to do something meant I’d probably lose the experience of walking even though my body did it. Speaking, I’d lose the meaning of my own sounds whilst moving. The deaf-blind may have lost their senses; I had my senses but lost the sense. I was meaning deaf, meaning blind. (33)
What Williams describes is a world of fleeting and fragmentary perceptions, an inability to organise sensory data, form gestalts, and construct a meaningful reality. It was only with difficulty that she was able to build a world in which she could understand self and other, but not simultaneously. Either she would shut out her environment and turn inward, or give up her sense of self and become lost in her perceptions. At least in part, this stems from an inability to integrate mind and body. As Williams (1998) later writes (the awkwardness of her prose reflecting the awkwardness of describing the experience):
Back then, back in the beginning in the time before mind, ‘I’ was not my body nor even considered my selfhood necessarily to exist there. There was me and there was the thing others might have called ‘my body’ but there was no feeling that this thing belonged to me and the concept that it was actually part of me was a very difficult one to grasp in more than just theory. (35)
Lacking a sense of her own body, Williams could not fully separate self from environment, and therefore could not create a coherent and integrated conception of her surroundings. We think of perception as being about the external, but in many ways it begins with the internal, our ability to perceive and make sense of our bodies, and our boundary with the outside world. Lacking this most basic form of self-awareness, both meaning-making and language acquisition are impaired. While sight and hearing dominate our consciousness, the tactile sense is much more basic to our sense of self, and there are two other body senses we rarely acknowledge. One is the proprioceptive sense, which tells us about the movement and position of our joints and muscles; the other is the vestibular sense, our sense of balance, of gravity, of movement and position in relation to the earth (Kranowitz 1998). Essential to this sense of balance is the inner ear, which perhaps adds weight to McLuhan’s (1964) association of oral cultures with a balanced sensorium (see also, Tomatis, 1996). The point here, however, is that both perception and cognition have a common origin in the self-organisation of the nervous system.
The title of Donna Williams’s first book, Nobody, Nowhere (1992), reflects the difficulty she had in establishing a sense of self, and the consubstantial problem of establishing a meaningful relationship to her environment. What she describes, however, is not a static situation but an ongoing odyssey, a fact that is reflected in the title of her second book, Somebody, Somewhere (1994). As psychologist Oliver Sacks (1995) describes it, the brain is “dynamic and active, a supremely efficient adaptive system geared for evolution and change, ceaselessly adapting to the needs of the organism–its need, above all, to construct a coherent self and world, whatever defects or disorders of brain function befell it” (xvii). The self and world that individuals with autism like Williams tend to construct is concrete to an extreme. In other words, they tend not to use abstract, global categories in their thought and perception, instead focusing on the particular, on concrete details. In somewhat different ways, concreteness is a characteristic associated with the mental operations of children (Piaget 1954), the kind of culture known as ‘savage’ or tribal (Lévi-Strauss 1966), and individuals with various brain defects and disorders (Sacks 1987, 1995). Of the latter, Sacks (1987) writes that “their world is vivid, intense, detailed, yet simple, precisely because it is concrete; neither complicated, diluted, nor unified by abstraction” (174). He goes on to argue:
By a sort of inversion, or subversion, of the natural order of things, concreteness is often seen by neurologists as a wretched thing, beneath consideration, incoherent, regressed. Thus for Kurt Goldstein, the greatest systematiser of his generation, the mind, man’s glory, lies wholly in the abstract and categorical, and the effect of brain damage, any and all brain damage, is to cast him out from this high realm into the almost subhuman swamplands of the concrete. If a man loses the ‘abstract-categorical attitude’ (Goldstein) or ‘propositional thought’ (Hughlings Jackson), what remains is subhuman, of no moment or interest.
I call this an inversion because the concrete is elemental–it is what makes reality ‘real’, alive, personal and meaningful. All of this is lost if the concrete is lost. (174)
In other words, the concrete is the basis of human experience – the very term concrete is a material metaphor. Implicit in concrete mental operations is the experience of material reality, of being ‘close to the human lifeworld’ in Ong’s (1982: 42) memorable phrase. Sacks (1987) suggests that the quality of concreteness “which characterises the simple
. . . gives them their poignant innocence, transparency, completeness and dignity” (174). Abstracting, on the other hand, is a process that takes the individual further and further away from reality, a point central to the general semantics of Alfred Korzybski (1993), S. I Hayakawa (Hayakawa & Hayakawa, 1990), and Wendell Johnson (1946). But the extreme concreteness associated with autism is closely connected to difficulties with language acquisition and language’s concomitant capacity for abstraction. Language use for the autistic child may be so concrete that a word learned with a particular individual, in a particular place, and during a particular activity, may not be generalised to other people, places, or situations. Among the most difficult words for children with autism to learn to use appropriately are the highly abstract pronouns I and you; what could be more confusing than a pronoun that refers at one time to oneself, the next time to another? Of course, this may reflect problems in forming a sense of self and other, as well as difficulty in abstracting.
Even savant skills are based on autistic concreteness. Many do quite well at jigsaw puzzles, because they pay close attention to shape rather than picture – in fact, it is just as easy for them to put the pieces together when they are turned upside down. Memorisation, which some autistic individuals excel at, is a concrete activity, as Sacks (1995) explains:
It is characteristic of the savant memory (in whatever sphere – visual, musical, lexical) that it is prodigiously retentive of particulars. The large and the small, the trivial and momentous, may be indifferently mixed, without any sense of salience, of foreground versus background. There is little disposition to generalise from these particulars or to integrate them with each other, causally or historically, or with the self. In such a memory there tends to be an immovable connection of scene and time, of content and context (a so-called concrete-situational or episodic memory) – hence the astounding powers of literal recall so common in autistic savants, along with difficulty extracting the salient features from these particular memories, in order to build a general sense and memory. (200)
Along with memorisation, savant skills in visualisation also reflect the absence of abstraction. Consider how one such individual with autism describes her thought processes:
I think in pictures. Words are like a second language to me. I translate both spoken and written words into full-color movies, complete with sound, which run like a VCR tape in my head. When somebody speaks to me, his words are instantly translated into pictures. Language-based thinkers often find this phenomenon difficult to understand, but in my job as an equipment designer for the livestock industry, visual thinking is a tremendous advantage. (Grandin, 1995: 19)
Temple Grandin who wrote this passage holds a PhD in animal science, and is on the faculty in that area at Colorado State University. In addition to designing livestock facilities, she has written one book on animal science, and two more on her disability (Grandin, 1995; Grandin & Scariano, 1986). Obviously, visual thinking has its inefficiencies in comparison with language-based thought, and does not have the same easy access to abstractions as does thinking with words, but it is probably best understood as a different mode of thought, rather than simply as an inferior, primitive, or undeveloped form of cognition. What Grandin clearly demonstrates is that thoughts are not reducible to words; however close the association between the two for typical individuals. Visual and other forms of nonverbal perception, communication, and mentation are even more basic than language to the making of meaning. It is in this respect that postmodernists such as Fredric Jameson (1972, 1991) and Jean François Lyotard (1984) fall short, mistakenly viewing language as the only game in town, a closed system that serves as our prison-house, to use the phrase from Jameson’s (1972) book title. This critique is forcefully made by Alexander Durig in Autism and the Crisis of Meaning (1996), where he champions Susanne K. Langer (1957) as an antidote to postmodern nihilism:
The premises of postmodernism hinge heavily on this conviction that language is the medium of meaning, and that it is not capable of formal logical consistency, or guaranteed communicative success, or purity of transmission of knowledge. This is best summed up in Zeno’s paradox. Recall how the Greek philosopher said that perfect communication is impossible because every word has to be explained with other words, which have to be explained with other words, ad infinitum. It is an infinite regress; it is all ends against the middle, and there is therefore no absolute base of knowledge or communication possible. This is one of postmodernism’s most powerful arguments.
Langer’s response is simple, however. Language is not the medium of meaning; meaning is the medium of language. And the fundamental aspect of meaning is symbolic transformation. (168)
Nondiscursive and nonverbal modes of communication, from the visual and iconic to ritual and significant gesture, are pathways to metamorphosis; parallel to discursive and verbal codes, they are alternate methods of translating our perceptions and experiences of material reality into other forms. More importantly, the nondiscursive and nonverbal precede language, and serve as the media within which linguistic communication takes form and makes meaning. They constitute the invisible environment that supports linguistic communication, an environment that becomes visible when language acquisition is delayed or disrupted, as is the case for individuals with autism. Typical language development is measured by an increasing ability for abstraction, while the nondiscursive and nonverbal are by nature concrete. Moreover, it goes without saying, or at least ought to, that the concrete and material reality of disability (not to mention disease and death) serves as a better context for understanding the human condition than the abstract and immaterial philosophical musings of postmodernists and Platonists alike.
Difficulties processing sensory input, concreteness, and atypical language acquisition all are interrelated with the distinctive quality of autistic aloneness, social impairment, and what Edgar Schneider in Discovering My Autism (1999) calls ‘the emotional deficit’ (94). This is not to say that individuals with autism do not have feelings they most certainly do. My daughter Sarah is quite capable of throwing temper tantrums, crying in sadness, demonstrating affection and love, or displaying a sense of humor and laughing appropriately (as well as inappropriately). The emotional deficit refers to the subtlety of emotions as a form of social behavior (Duncan, 1968a, 1968b). As Sacks (1995) relates in his discussion of Temple Grandin: “She said that she could understand ‘simple, strong, universal’ emotions but was stumped by more complex emotions and the games people play. ‘Much of the time,’ she said, ‘I feel like an anthropologist on Mars’” (259). This sense of distance, and the resultant difficulty forming close relationships, is manifested on the most fundamental of levels. For example, seeing eye to eye is one of the most basic forms of relating to others, but individuals with autism like my daughter tend to avoid making eye contact, not out of shyness, but out of meaning blindness.
The simple gesture of pointing at something in one’s environment is typically picked up very early in childhood as part of the individual’s natural course of development, but for Sarah and many other autistic children, intervention in the form of deliberate instruction is needed or the child may never learn how to point. Pointing implies an awareness of self and other, a shared gaze, a shared attention, a shared meaning. And it is a key step in language acquisition, as we ultimately replace our fingers with words that also ‘point’ to things in our environment. Meaning making is thus linked to empathy, a trait that does not come easily to persons with autism. A lack of empathy does not imply antipathy, however, nor does autistic alienation lead to immoral conduct, as Frith (1989) explains:
Some of the perceived abnormalities of autistic social behavior can be seen not so much as impairments, but as unusually positive qualities. These qualities can be captured by terms such as innocence, honesty and guilelessness. Autistic people are not adept at deceiving others, nor at impressing others. They are not manipulative or gossipy . . . they are not envious and can give to others gladly. Autistic people may not empathise in the
common sense of the word, but neither do they gloat over other people’s misfortune. Indeed they can be profoundly upset by the suffering they see, and they can show righteous indignation. (140)
The social, emotional and empathetic deficits of autism all are manifestations of what Frith (1989) believes to be the fundamental impairment of autism: the inability to form a theory of mind, that is, an inability to understand that others have a mind like one’s own, and a point of view different from one’s own. Typical individuals habitually ascribe emotions and motivations to others, and make inferences about others’ knowledge and beliefs. Baron-Cohen (1995), who studied under Frith, refers to what we do as ‘mindreading’ (2). By this he does not mean that we employ extrasensory perception to determine to a certainty what someone else is thinking, although it may appear that way to an autistic individual. Rather, Baron-Cohen points out that we simply employ everyday sense perception to speculate about what others are thinking and planning, with a fair degree of success. Arguing from the perspective of evolutionary psychology, he reasons that, as a species that engages in highly complex social interaction, we have a genetic predisposition towards mindreading.
Along the same lines, Robin Dunbar (1996) argues for the close connection between language and theory of mind, both rooted in the primates’ need for social cohesion. Some of the elements of theory of mind are nondiscursive and nonlinguistic, developing during the first two years of normal childhood development; they are also present among individuals with autism and perhaps even among the higher primates (Baron-Cohen 1995). These elements appear to be a prerequisite for the evolution of language, making possible the nonverbal medium of meaning within which verbal communication takes place. The formation of a complete theory of mind, however, does not occur until the typical individual is already well on the way to language acquisition, sometime after the age of four (Baron-Cohen 1995). Thus, language and theory of mind appear to be mutually coadaptive systems. From an evolutionary standpoint, apart from the immeasurable value mindreading would hold for a social species, theory of mind also had tremendous survival value because it is an incredibly efficient way to think about any complex system, be it a human being, organism, or the physical environment. Even if it is inaccurate, looking at a thunderstorm anthropomorphically, as a thinking being that throws lightning bolts, is a more efficient way to understand the threatening quality of this meteorological phenomenon (and subsequently respond appropriately to it) than developing complex scientific explanations.
Rather than thinking in terms of mental states and motivations, individuals with autism tend to view others in the most concrete of terms, as objects and behaviors. They may understand many aspects of volition, desire, and intention in others, but have trouble coordinating understandings of self and other as independent consciousnesses that may or may not share attention, awareness, and belief. For example, a common measure of theory of mind is to test for understanding of false belief. In this sort of test, the subject is presented with a story in which characters A and B together hide money inside a box, which is then closed. A then leaves the room, and while he is gone, B removes the money from the box and puts it in his pocket. A then returns, obviously not knowing that the money has been taken by B. The subject knows something that the character A does not know, and he or she is asked where A believes the money to be. Typical individuals who are at least more than four years old correctly identify A as holding the false belief that the money is in the box, as do individuals with other mental handicaps such as Down’s syndrome with a mental age of four or greater. Most individuals with autism, even those with highly developed language skills, instead credit A with knowing that the money has been moved to B’s pocket. In other words, they cannot distinguish between their own knowledge as outside observers and the more limited perspective that A would hold. Baron-Cohen (1995) refers to this syndrome as ‘mindblindness’ (xxiii).
Mindblindness is related to both social impairment and difficulties in communication, as much of the common ground that we take for granted is not present. Even when verbal skills are well developed and intelligence high, individuals with autism have difficulty picking up the metacommunicational and relational cues (Watzlawick, Bavelas, & Jackson, 1967) that typical individuals take for granted. Nonverbal signals, such as what Baron-Cohen calls (1995) ‘the language of the eyes’ (108), are indecipherable. Consider the following passage from Dorothy Lee’s (1959) anthropological analysis of self-image in Greek culture:
The organs of highest significance are the eyes. They are the seat of the person. With them, lovers and friends communicate, and they are the pre-eminent medium of enjoyment. Love comes through the eyes, and the eyes are mentioned the most frequently in the personal poems. “We have not seen you” means “We missed you.”
In the folk songs, a beloved’s eyes shoot arrows, strike with a poisoned sword, catch a man in a net, they burn the heart or break it into pieces; they lead astray, they bewitch, they destroy. Glances are rarely sweet, and never soft or gentle, in the love distiches. Here eyes are always black, perhaps because one is apprehensive if they are blue, the color of the evil eye. It is difficult to overestimate the joy of sheer vision. When a long-absent
loved one is returning, people congratulate, saying: “Light for your eyes.” (145)
As Lee describes it, the language of the eyes overflows with meaning in Greek culture, which is a decidedly visual culture. But even in cultures where it is common to avert one’s eyes, there is an art to looking away, and a meaningfulness to the averted gaze that is entirely distinct from mindblindness and the related difficulty processing information communicated through facial expressions that is characteristic of autism. At best, high functioning individuals like Temple Grandin can try to learn the rules of mental states and social interaction in a highly self-conscious way, as a formal logic that lacks the flexibility, intuitiveness, and spontaneity of typical perception and communication. Lacking a theory of mind may also make it difficult to achieve full self-awareness, given that it would be all but impossible to try to see oneself as others do. Thus, Durig (1996) states that the severity of autism is inversely related to the sense of self. He also points to the similarity between autistic perception and meditation, mysticism and spirituality (which generally involve some form of separation and sublimation of the self); similarly, Durig suggests that mental illness might be better understood as the withdrawal, atrophy, and possibly the annihilation of the self. At the same time, individuals with autism may appear to be all self and no other (as the term autism implies), unable to recognise that others have beliefs and understandings that differ from one’s own; in this sense, they would seem to exhibit a worldview with somewhat akin to infantile narcissism, albeit with significant differences as well. Mindblindness may result in a failure to construct a self, or it may mean that alternate, atypical selves need to be created. For example, typical children engage in role-playing as part of the process of constructing a self, but individuals with autism tend to be impaired in regards to imaginative play. Still, high functioning individuals may appropriate roles without assimilating them fully or properly, or self- consciously acquire and put on personas as ‘pseudopersonalities’ (Sacks, 1995: 266; Williams, 1992). Thus, autism can sometimes bear a surface resemblance to schizophrenia (for which it was once mistaken), with its surfeit of selves.
Psychiatrist Iain McGilchrist (2009) draws on Baron-Cohen’s (1995, 2003) work on autism in his study of the differences between left and right brain hemispheres, noting that the deficits associated with the condition are associated with the right brain, with its emphasis on emotional connections and empathy, and its ability to interpret nonverbal cues such as facial expressions and eye gaze. This is also where the disproportionate incidence of autism relating to gender comes into play, as the female brain is more balanced between the hemispheres than the male brain, which tends to be more fully left-brain dominant (Baron-Cohen, 2003; see also Shlain, 1998, 2003). The differences are only relative, however, and McGilchrist emphasises the fact that the division between hemispheres is common to all members of our species, and present as well in other animals. As he explains the basic distinction:
The left hemisphere yields narrow, focused attention, mainly for the purpose of getting and feeding. The right hemisphere yields a broad, vigilant attention, the purpose of which appears to be awareness of signals from the surroundings, especially of other creatures, who are potential predators or potential mates, foes or friends; and it is involved in bonding in social animals. It might then be that the division of the human brain is also the result of the need to bring to bear incompatible types of attention on the world at the same time, one narrow, focused, and directed by our needs, and the other broad, open, and directed towards whatever else is going on in the world apart from ourselves. (McGilchrist, 2009: 27).
McGilchrist argues that the right brain is primary, and the evolutionary development of the left hemisphere was essentially to serve as a tool for the right brain, or to use McGilchrist’s metaphor, an emissary of the master. His concern is the ways in which the left brain has become dominant, suppressing right brain function, to some degree in human biology, more so in human cultural development, especially in western culture. The dominance may be more apparent in the male brain, but takes its most extreme form in the autistic brain. Along with its emphasis on narrow, focused attention, the left hemisphere is characterised by a concern with what is already known and predictable, as opposed to novelty and the unexpected; with fragmentation and analysis as opposed to synthesis; parts as opposed to the whole; abstraction as opposed to context; categories rather than individual items; differences rather than sameness; an impersonal and objective view rather than a personal approach; disembodied mind as opposed to embodied self; abstract symbols as opposed to the concreteness of nonverbal communication; and interruptions in time as opposed to continuity. The differences might be summed up by characterising the left brain as digital in its orientation, and the right brain as analogical (for more on the distinction, see Bateson, 1973, 1978; Watzlawick et al, 1967). Not surprisingly, then, individuals with autism are sometimes compared to, and even identify themselves with computers, robots, and androids as depicted in popular fiction, such as the character Data in Star Trek: The Next Generation.
While biological evolution, and cultural evolution, especially in the west, has resulted in an inversion in the relations between right and left hemisphere, Gilchrist’s emissary coming to dominate the master, it is also true that there has been clear evolutionary advantage to the ability to construct integrated selves equipped with theory of mind, so it is worthwhile to consider how autism fits into human history. Even though is has only been recognised for a little over half a century, I think it reasonable to assume that autistic traits are much more ancient. As Gardner (1983, 1993, 1997) makes clear, traits with high survival value such as various forms of intelligence, along with the ability to maintain focus and concentration, are closely connected to many symptoms of autism. It may well be that autism is, to some degree, too much of a good thing, too extreme a combination of otherwise positive traits. But it is also possible that mindreading is a fairly recent evolutionary development (along with language), and that individuals with autism carry traits that were the norm prior to this development. Their repetitive behaviors and echopraxia, for example, are a form of mimesis, a mode of communication that was dominant before language, according to Merlin Donald (1991). Sacks (1995) makes this connection in his case study of Stephen Wiltshire, an individual with savant skills in the visual arts:
Mimesis—itself a power of mind, a way of representing reality with one’s body and senses, [is] a uniquely human capacity no less important than . . . language. Merlin Donald, in Origins of the Modern Mind, has speculated that mimetic powers of modeling, of inner representation, of a wholly nonverbal and nonconceptual type, may have been the dominant mode of cognition for a million years or more in our immediate predecessor, Homo erectus, before the advent of abstract thought and language in Homo sapiens. As I watched Stephen sing and mime, I wondered if one might not understand at least some aspects of autism and savantism in terms of the normal development, even hypertrophy, of mimesis-based brain systems, this ancient mode of cognition, coupled with a relative failure in the development of more modern, symbol-based ones. (240-241)
Along the same lines, perhaps the Neanderthals lacked theory of mind, depending instead on autistic traits such as memory and visualisation. Perhaps they disappeared because their mindblindness made them vulnerable to our own ancestors. Or maybe it was the development of mindreading that led to the creative explosion of art and ritual that occurred sometime between 20,000 and 30,000 years ago (Pfeiffer 1982). Julian Jaynes (1976) posits that self-consciousness (and with it, theory of mind) was an even more recent evolutionary development, simply a matter of a few millennia. No doubt, our ancestors could have survived without mindreading, as have other forms of life. But the introduction of theory of mind, whenever it occurred, may have had a revolutionary impact on our species.
Lacking theory of mind, individuals with autism would have been at a decided disadvantage in early human societies, and their social impairment would no doubt collide with oral societies’ emphasis on cohesion and conformity. At the same time, the parallels between autism and orality are striking. A concrete mindset is a characteristic shared by members of tribal societies, and as Jack Goody (1977) makes clear, such a mindset is a byproduct of oral tradition and nonliterate culture. Visual thinking has also been associated with oral cultures (Havelock 1963; Pfeiffer 1982), albeit not to the degree of individuals like Temple Grandin. Mimesis, too, continues to function as a powerful mode of communication after the evolution of language, in nonliterate and preliterate societies (Havelock 1963). Certainly, the autistic individual would work well with the structure, formality, and emphasis on ritual found in traditional cultures. The type of language use characteristic of higher functioning individuals, “a tendency to verbosity, empty chatter, cliché-ridden and formulaic speech” (Sacks, 1995: 245) bears a certain resemblance to orality’s own copiousness and reliance on clichés and formulas (Ong 1982). And there is no doubt that savant skills, and in particular a strong memory, would be highly valued, and would probably hold enough survival value to overlook individual idiosyncrasies, and to afford the autistic special status (i.e., shaman).
David R. Olson (1994) suggests that theory of mind is not just a product of language, but also of literacy as it encourages the growth of a more self-conscious self than was previously known. It is also true that the literate mindset allows for abstract thinking on a significantly higher level than the oral mindset (Goody 1977; Ong 1982). Therefore, autistic modes of cognition and perception may appear even more alien in a literate society than an oral one. And yet, however oral or even nonlinguistic individuals with autism may seem, we do know that they can thrive in a literate culture, and that they have a certain affinity for reading and writing. Whereas individuals with autism are usually socially impaired, reading and writing is often a private, individualised activity (Havelock, 1963, 1986; McLuhan 1962; Ong 1967, 1982, 1986). Whereas savant skills are isolated islands of ability, the written and printed word favors specialisation in knowledge and roles (Eisenstein 1980; Goody 1977; Innis 1951, 1972; McLuhan, 1964; Meyrowitiz 1985; Postman 1982, 1985). Whereas individuals with autism may perceive the world in fragments, literacy tends to foster fragmentation and analysis as methods of understanding phenomenon and solving problems (Goody 1977; Logan 2004; McLuhan 1962, 1964). Whereas individuals with autism may have difficulty taking in too much information at any one time, literacy favors linear thinking and the ‘one thing at a time’ approach, as we progress from letter to letter, word to word, sentence to sentence, page to page (Carpenter & Heyman 1970; McLuhan 1962, 1964; Ong 1967, 1982). Literacy is very much associated with the left hemisphere, and has the effect of rewiring the brain, as Maryanne Wolf (2007) has shown, a fact that Gilchrist has not given sufficient attention to (but see McLuhan & McLuhan 1988; Shlain 1998, for arguments that literacy significantly increases left hemisphere dominance).
Similarly, whereas individuals with autism have difficulty taking in sensory data from more than one sensory channel at a time, written communication, in contrast to speech, relies solely on the visual stimuli of the printed or written page (Carpenter & Heyman 1970; McLuhan 1962, 1964; Ong 1967, 1982). And whereas some individuals with autism excel at visual thinking, writing and especially print fosters the development of a visual culture and mentality (Eisenstein 1980; McLuhan 1962, 1964; Ong 1967, 1982). In fact, some children with autism can draw in perspective without training, the most remarkable case being that of Nadia, a three and a half year old savant (see Selfe, 1977). McLuhan (1962, 1964) believed that such abilities are purely a product of alphabetic literacy (see also Romanyshyn 1989; Wachtel 1995), and it may well be that writing and/or other technologies are needed for the widespread diffusion and adoption of perspective in art. But the basic technique is to draw exactly as one sees, to refrain from any additional processing of sensory data, any additional meaning making. Actually, individuals with autism are naturally capable of a kind of detachment and objectivity that has for long been an ideal of western literate cultures. Along the same lines, individuals with autism tend to ignore context in their communication and behavior, while the act of writing by its very nature takes language out of its context of sound and accompanying nonverbal cues, and out of the context of social interaction, place, and time (Goody 1977; Ong 1982; Postman 1982, 1985). Literate decontextualisation is often associated with abstraction (to abstract is to take something out of a more specific and detailed context), but the experience of individuals with autism shows that it may also involve the removal of an abstract context, leaving behind nothing but the most concrete of elements.
It therefore makes perfect sense that some children with autism are hyperlexic, that is, they learn to read at a much younger age than typical children. (This is not to suggest that their reading comprehension is comparable to typical children, nor even measurable.) Some may find typewriters and keyboards to be a more comfortable communication mode than speech, or possibly the only mode they can use, one example being Jasmine Lee O’Neill, a mute savant who authored Through the Eyes of Aliens: A Book about Autistic People (1999). The affinity for the written word is also apparent in one of the more controversial forms of therapy, facilitated communication. Here, adult facilitators assist the individuals with autism in typing on the keyboard, leading them hand over hand in an attempt to overcome difficulties with motor control and coordination. There is a strong possibility that the output might originate with the facilitator, however, which is why facilitated communication has been labeled a pseudoscience and charlatanism by some (see, for example, Maurice, 1993a, 1993b; Siegal, 1996; in contrast, Cohen, 1998, is willing to wait for more evidence before closing the book on facilitated communication). Regardless of the validity and effectiveness of facilitated communication, the literate quality of autism remains.
In our electronic age, individuals with autism encounter an often hostile media environment. From the fluorescent lighting that many find painful, to the sensory bombardment and information overload which disrupt the thought processes of us all, our culture offers neither the routine predictability and slow pace of primary orality, nor the quiet concentration of traditional literacy. As one individual with autism argues, “the way of life of this age is ever more demanding of a certain way of living that is the WORST case of living, for many autistic people, and there are fewer and fewer places to hide, to be sheltered from the media Storms. and even the ‘normal’ kid may become mind-fractured
into Autism. under all the sense stress and overloads!” (Wilson 2000:
no pagination). This comment was posted on 2worlds, an electronic discussion list set up by and for high functioning individuals (who object, by the way, to being characterised as disabled, as suffering from a disorder and in need of a cure, rather than simply being different). Electronic media have allowed for greater affiliation and stronger group identity for all manner of social subgroups (Meyrowitz 1985), including the disabled (Linton 1998). Creating a sense of community is particularly difficult among individuals with autism, and many who are high functioning instead find a niche in the solitary activity of computer programming. But individuals with autism do feel more comfortable in the company of others who share their mindset than they do with typical individuals, and in fact take comfort in identifying and understanding the nature of their difference (Grandin 1995; Grandin & Scariano 1986; Schneider 1999; Williams 1992, 1994, 1999). Indeed, especially through computer-mediated communication, high functioning individuals have joined together to argue that theirs is not a disease to be cured, that they are the victims of bias on the part of neurotypicals against neurodiversity, and to form an autism rights movement in support of being recognised as a culture in their own right. This is somewhat controversial, especially as to whether it applies to individuals with severe or moderate autism, and in regard to the parents of children with autism, who want to do whatever they can to improve their children’s lives. More generally, Durig (1996) uses the phrase ‘culture of autism’ (11) to refer to the subculture that encompasses individuals with autism, their families, and professionals who work with them (e.g., physicians, therapists, educators). For both cultures, individuals with autism have been well-served by the electronic era’s information explosion, as it is only in this period that the syndrome has been recognised and facts about it disseminated, resulting in an increasing public awareness of the condition.
While members of the autism rights movement would object to references to an epidemic of autism, the phrase and concept has become widespread in mainstream American culture. What remains unclear and somewhat controversial is the reason for the increased incidence of the disability, and even the cause of the syndrome, whether it is due to stresses of our environment, or contaminants and pollutants, or diet and allergies, or infections and vaccinations, or genetic predisposition, or simply improved diagnostic procedures (and it may well be a combination of all of these factors). At present, there is no established medical treatment for the disorder, and in lieu of a method to act upon the brain directly, the only course of action is to work through the interface of behavior and the mind, in other words, through therapy and education. Therapy and education do not undo autism, but they can help individuals with autism cope with their environments (and some who are diagnosed with the disability are later mainstreamed, and on rare occasion declassified). But not all types of therapy are effective.
In the first decades following the identification of the syndrome, psychoanalytic approaches dominated. Bruno Bettelheim, who laid out such a perspective in The Empty Fortress: Infantile Autism and the Birth of the Self (1967), was typical of such practitioners: he manufactured a theory out of whole cloth that blamed mothers for their children’s disability, and prescribed long-term analysis for both as the way to draw out what he asserted was a normal child hidden behind an autistic shell. Because of this nonsense, parents were consumed by guilt, their life savings were consumed by psychiatrists’ fees, and their children’s chances for a better life were consumed by inappropriate and ineffectual (and sometimes harmful) therapies. Bettelheim eventually became the bête noir of the autism community, but despite the fact that Bernard Rimland demonstrated the groundlessness of psychoanalytic theories of autism as long ago as 1964, there still are psychoanalysts who continue this sort of practice today. And because psychoanalysis is considered a medical procedure, health insurance is much more likely to cover this form of fraud than truly effective therapies, as I myself found out to my dismay.
Client-centered approaches of the sort championed by the Rogerian school of psychology proved to be only slightly helpful. It is hard to make the child the center when the child lacks a center. For this reason, such approaches have been criticised as a waste of time and money, however well meaning they may be. Having been educated at a time when Rogers and Maslow were in vogue, I was surprised to learn that the only approach that had any history of helping children with autism came from the children of Pavlov and Skinner, the behavioral school. This approach had been dismissed by the Freudians for relegating the mind to a black box, vilified by Rogers and Maslow for reducing human beings to inhuman automatons, and delegitimised by Chomsky for failing to account for the complexities of language acquisition. And yet, as it turns out, operant conditioning and behavior modification, or what is referred to as Applied Behavior Analysis and the discrete trial method, held the only hope of helping my daughter. The specific method was pioneered by UCLA psychologist Ivar Lovaas (1981) and involves breaking down activities into their smallest units. Whereas a complex behavior may be too difficult for the child to grasp, leading the child to give up in frustration, smaller, simpler units can be successfully learned, providing the child with a sense of satisfaction and motivation for further learning. Thus, teaching children to speak would begin with teaching individual phonemes, and teaching children to brush their teeth would involve teaching the child a series of separate behaviors such as turning on the water, picking up the toothbrush, wetting the toothbrush, etc. (Lovaas, 1981: 129). Through a process of discrete trials involving drill and rewards, each unit of behavior is taught until mastered.
Scientific research indicates that the Lovaas method is effective (Maurice 1993b; Smith Groen & Wynn 2000), at least for the high functioning, and for moderately autistic individuals such as my daughter; the method is particularly effective if the program is begun during early childhood, and the intervention is intensive – preferably 30 to 40 hours a week of one-on-one behavioral treatment. This may seem like too much for a young child, but the truth is that individuals with autism work best in a highly structured environment that keeps them engaged with the world. As for the nature of this behavioral approach, some question whether it turns children into robots. Based on my own experience I believe that nothing could be further from the truth. The behavioral units may be learned in a mechanical way, but they accumulate into a human whole greater than the sum of its parts, a self. Given the plasticity of the brain during early childhood, this form of therapy is an attempt to work through the interface of human communication and rewire the autistic brain so that development can proceed in a way more closely approximating that of the typical child. It is not so much an attempt to program children as it is to jump start neural self-organisation. Additionally, the fact that Helen Keller’s teacher, Anne Sullivan pioneered the technique of discrete trial serves to underscore the humanistic aspect of this approach. The contemporary Lovaas method focuses on language acquisition, cognitive development, and self-help skills, and therefore is probably best supplemented with therapy focusing on emotional development and social interaction, as practiced by Stanley Greenspan, for example (see Greenspan, Wieder, & Simons, 1998). It is also possible to teach high-functioning individuals about mindreading (Howlin, Baron-Cohen, & Hadwin, 1999).
Given that in the United States we have been experiencing an epidemic of autism over the past two decades or more, it is not surprising that considerable time, energy, and resources have been devoted to helping children who are diagnosed with the disability to overcome and/or cope with the syndrome as best they can. What has been overlooked to a large degree is the fact that these children are growing up, and if there has been an epidemic of childhood autism that first became apparent some 20 years ago, then we are on the cusp of an epidemic of adult autism. For high functioning individuals able to live independently, there is less of a concern, and their needs may be answered through efforts such as the autism rights movement, in advocating for accommodations to be made by the neurotypical majority. For those who have moderate or severe autism, there has been very little planning for arrangements. Once the individuals turn 21 they are no longer served by our public school system. What can be done to keep them occupied during the day? With assistance, most individuals with autism can contribute to society in some way, be productive, and take pride in their accomplishments, especially because growth, learning, and development continue throughout their (and our) lives. But this requires political will, and economic support, which has become especially problematic following the recession that began in 2008. And the need for day programs for adults with autism does not address the need for living accommodations. Many parents may be resigned to the fact that they have children who are not able to leave home, that they will be caring for their adult children as long as they are able, as we will be for my daughter. But what happens to the adults with autism who may become violent on occasion, or who do not realise their own strength and cause injury? And what happens when parents become too old, or too sick, or otherwise are unable to care for these individuals. This is a society-wide time-bomb, and it is going off as I write these words. And this may seem like a problem peculiar to the United States, or the western world, but it would be a mistake to think that other populations are somehow immune and will escape unscathed from what is, after all, a human epidemic.
The enigma of autism, then, begins with understanding a sense of self and a form of consciousness that is extraordinarily alien to the majority. The enigma extends to the question of what is the cause of autism, what is the reason for the current epidemic of autism in the United States, and how much lag will there be until other populations experience a similar explosion in the incidence and diagnosis of the disability. The enigma also includes the questions of can there be a cure, should there be a cure, what treatments, therapies, and approaches can be applied in absence of an outright cure, and to what extent should we stop trying to force individuals with autism to adjust to society, and instead adjust society to accommodate greater neurodiversity, and ultimately how to deal with the increasing numbers of both children and adults with autism. And more broadly, there is the enigma of what autism tells us about the structure and function of the brain, about consciousness and the sense of self, and about what it means to be human.
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LANCE A. STRATE. He is Professor of Communication and Media Studies at Fordham University in New York City. Lance A. Strate is the author of Amazing Ourselves to Death: Neil Postman’s Brave New World Revisited, On the Binding Biases of Time and Other Essays on General Semantics and Media Ecology, Echoes and Reflections: On Media Ecology as a Field of Study and the poetry collection, Thunder at Darwin Station. He is founder and past president of the Media Ecology Association, and a Trustee of the Institute of General Semantics.