NeuroTribes

0:01Juno: Four books and a reference episode, and every one of them about attention. Today the show turns. This is our first book about autism.

0:11Beck: NeuroTribes. Steve Silberman, a reporter for Wired, 2015. A history of who described autism, who got it wrong, and how a rare childhood diagnosis became a spectrum that takes in a great many adults.

0:28Juno: It won the Samuel Johnson Prize that year, Britain's big award for nonfiction.

0:33Beck: And three years later, an archive in Vienna rewrote one of its main characters.

0:39Juno: So we're checking a history book against history.

0:44Beck: And against the epidemiology. Both have moved since it came out.

0:49Juno: Today: NeuroTribes, Steve Silberman, 2015.

1:07Beck: Lone Star Telehealth presents The Observatory. One book, two hosts, no quizzes.

1:15Juno: Our last book, Scattered Minds, traced ADHD back to the nursery, gently, and we left without agreeing about Maté.

1:24Beck: Today's book is the history of a field that traced autism back to the nursery too, and it wasn't gentle.

1:33Juno: Give me the argument. The version Silberman would sign.

1:37Beck: Two halves. The first is history. Autism was described in the nineteen-forties as rare and narrow, and that picture stuck for decades, so most autistic people went uncounted, nearly every autistic adult among them. The second half is a claim about what autism is. He argues it's a natural variation in how human minds work, present all along, and that much of what disables autistic people is a world that won't meet them partway. That's the neurodiversity idea, and this is the book that argues it to a general reader.

2:13Juno: So the rise in diagnoses isn't an epidemic.

2:17Beck: Not in this book. More people found, not more people made.

2:22Juno: And the writing? What kind of book is it?

2:26Beck: Like a long magazine story that kept going for five hundred pages. It starts from his 2001 Wired piece on autism in Silicon Valley families, then goes back two centuries to Henry Cavendish, a chemist whose habits line up with the description today. Nobody can diagnose a man who's been dead that long, and a reviewer in a psychiatry journal pressed the book on guesses like that. Then Vienna, Baltimore, London, and finally autistic adults organizing for themselves.

2:57Juno: It's a book with villains in it.

2:59Beck: Several. Which is where I'll go slowest.

3:03Juno: Right.

3:11Juno: Logan put this one first among the autism books, and the best story tells you why.

3:18Beck: Go on.

3:19Juno: Lorna Wing. A London psychiatrist whose daughter, Susie, was born in 1956 and was autistic. With a colleague, Judith Gould, she set out to find every child in one London district, Camberwell, with serious trouble in social contact. And the children wouldn't sort into the category everyone was using.

3:42Beck: They wouldn't. The classic picture from Baltimore was in there, but it shared most of its features with the children around it. The edges blurred. There was no clean line where autism stopped.

3:55Juno: And then she finds Asperger.

3:58Beck: A 1944 paper from Vienna, four boys, almost unread in English. In 1981 she wrote it up for English-speaking clinicians and gave the pattern his name. The idea of a spectrum comes out of her work.

4:15Juno: So the history isn't two men in two cities. It's a mother in London with a district's worth of case notes.

4:24Beck: That's the book's best move. The person who opened the door wider was a parent. She'd helped found Britain's National Autistic Society with other parents back in 1962, so she came to that survey as both a clinician and a mother.

4:39Juno: Then give her the credit.

4:41Beck: Next segment. She's in most of it.

4:52Juno: Tell me what you make of it. And yes, I know you're about to fact-check a history book.

4:58Beck: I'd fact-check the foreword if it made a claim.

5:01Juno: The foreword's by Oliver Sacks. Leave him out of it.

5:08Beck: He's safe. Claim one, and it's Wing's legacy: the rise in diagnoses is mostly people being found. Held, from three directions. Denmark followed every child born there from 1980 through 1991, nearly six hundred and seventy-eight thousand of them, into adulthood. Two changes in reporting in the mid-nineties, new diagnostic criteria and counting outpatient diagnoses, accounted for about sixty percent of the rise.

5:38Juno: And the other forty?

5:40Beck: Not explained by that study. Sweden next. About twenty thousand twins born over a ten-year span, and their parents were interviewed by phone about the traits themselves, not about any diagnosis. The share of children with the trait picture stayed flat. Registered diagnoses for every child born in Sweden in those years climbed the whole time.

6:02Juno: So the traits held still and the paperwork moved.

6:06Beck: Yeah. The paperwork moved. And here's the one I'd hand to an adult listening. England, 2007. A national household survey screened about seventy-five hundred adults and assessed six hundred and eighteen of them in person. It estimated about one in a hundred adults was autistic, at the same rate in older adults as in younger ones, and most of them hadn't been recognized.

6:32Juno: If it were new, the older adults would've had less of it.

6:36Beck: That's the logic the authors used.

6:38Juno: Fair.

6:39Juno: Then there's vaccines.

6:42Beck: The book dismisses the 1998 paper that started the scare, and it was right to. That paper described twelve children, and the journal retracted it in 2010. A 2014 meta-analysis pooled five cohort studies covering about one and a quarter million children, plus five case-control studies with about ten thousand more, and found no association. A Danish study in 2019 followed about six hundred and fifty-seven thousand children, roughly sixty-five hundred of whom were diagnosed. The MMR vaccine didn't raise the risk, including among children who had an autistic brother or sister.

7:20Juno: Held.

7:21Beck: Held, and about as firmly as anything this show will score.

7:26Juno: One more. That the mothers were never the cause.

7:31Beck: Held. A 2019 study pooled two million children from five countries and estimated heritability at about eighty percent. Same caution as always: that's about differences across a population, not a share of any one child. The theory that cold parenting caused autism didn't survive, and families carried that blame for years before it fell.

7:54Juno: That's where this one meets Maté.

7:57Beck: It does. A different condition, the same question about the nursery, and both times the twin and family data pointed somewhere else.

8:14Juno: Now what didn't hold.

8:16Beck: The hero. In the first edition, Hans Asperger comes close to being the book's hero: a Vienna doctor who saw his patients as individuals with gifts, and who, the book argues, put his most capable children forward to shield them from the Nazi program that was killing disabled children.

8:35Juno: And then 2018.

8:38Beck: A historian at the Medical University of Vienna, Herwig Czech, went through Asperger's personnel files and the clinical assessments he wrote on his patients, most of them never studied before. He reported that Asperger joined organizations tied to the Nazi party, though not the party itself, publicly endorsed race-hygiene policies, and on several occasions cooperated with the program that killed children. One case. In 1941 he examined a girl named Herta Schreiber, not yet three, and wrote that she needed permanent placement at Spiegelgrund, the Vienna institution at the center of that program. She died there within months.

9:22Juno: That's not a footnote.

9:24Beck: No. Czech's conclusion is that the account of Asperger as a protector doesn't stand up to the archive.

9:31Juno: And Silberman?

9:33Beck: Here's both sides of the record. Silberman says he leaned on the accepted account because those archives weren't open to him, that he'd already revised the 2016 paperback to cover the Herta Schreiber case, and that the new evidence has to be weighed in any judgment of Asperger. His own reading is of a man who was complicated and conflicted, neither a savior nor a monster. Czech's reading, from the clinical notes, is harsher. Both are published, and both are on the episode page.

10:02Juno: So the portrait didn't hold, and the author moved with the evidence.

10:08Beck: Yeah. Moved with the evidence. That counts for him, even where it can't count for the chapter.

10:14Juno: And Kanner? The book's hardest on him.

10:18Beck: Contested, and I'm not settling it. The book argues Leo Kanner knew about Asperger's work and left it out, and that his remarks about parents fed the blame that followed. In 2016 two psychiatrists, one of them at Johns Hopkins, where Kanner worked, argued the reverse: that he called autism innate from the start, and that in 1969 he told a meeting of parents he cleared them of blame. A historical paper the same year traced a third man, Georg Frankl, who worked with Asperger in Vienna and then with Kanner in Baltimore. Its argument is that both men drew on him, which is a simpler story than one of them hiding the other.

11:00Juno: I still think the book's closer to right about him.

11:03Beck: And I think it's too sure.

11:05Juno: Then Kanner goes in the disputed pile, next to Maté.

11:10Beck: Yeah. Next to Maté.

11:12Beck: One more name. The usual story has two founders, one in Vienna and one in Baltimore. In 1926 a child psychiatrist in Kyiv, Grunya Sukhareva, published detailed descriptions of autistic traits in a group of children, in a German journal, close to twenty years before either of them.

11:35Juno: So the first published description might be a woman's.

11:39Beck: By that account, yes. The paper that brought her back into view came out the same year as this book.

11:46Juno: The book spends a long time on behavioral treatment.

11:50Beck: On Ivar Lovaas, and it's critical. It describes his early use of electric shock with young autistic children, and it treats him as one of the book's villains. His 1987 study reported that nearly half of the nineteen children in its intensive group reached typical functioning. Independent researchers haven't confirmed that. A 2018 Cochrane review of early intensive behavioral programs found five studies with two hundred and nineteen children, only one of them randomized, and rated the evidence low quality, with some gains in adaptive skills.

12:27Juno: And where does the show stand?

12:30Beck: The show doesn't provide it and doesn't endorse it. That's the book's view and the record, reported.

12:46Juno: Here's my question for this one. Most of this book is about children, and the people listening are adults. What does it hand an adult?

12:55Beck: Your turn.

12:56Juno: A place in the record. For decades the picture was a child who didn't speak. An adult who held down a job and missed every cue at the office party wasn't in it. Silberman writes that adult into the history, as part of human variety and not as a defect. That's a lot to be handed by a history book.

13:18Beck: I'll grant that. Here's what it's lighter on. The book is warm about autistic strengths and sharp about the world's failures, and it says less about what an ordinary day costs. Most of the research on that came after it. A 2017 study asked ninety-two autistic adults about camouflaging, hiding or compensating for their traits in social settings. They said they did it to fit in and to connect, and one of the consequences they described was exhaustion.

13:49Juno: Every meeting run on settings built for somebody else. That's the cost of doing business, and the book mostly leaves it off the invoice.

13:59Beck: Fair. And it's a qualitative study, so it tells you what people described, not how common it is.

14:07Juno: And neurodiversity itself? You've been careful around it.

14:12Beck: Because it's a position, not a finding. A reviewer in a psychiatry journal argued the book's version leans on identity politics. The book's answer is that neurodiversity is an argument for support and accommodation, not against them. No study settles which frame fits which adult, and I wouldn't trust one that claimed to.

14:33Juno: Then I'll take the book's side. For an adult who's spent years hearing that the way they think is a mistake, variation is a kinder word than defect, and it doesn't take away any help they need.

14:47Beck: Kinder, yes. Whether it's more accurate depends on the adult, and that's where we leave it.

15:02Juno: Stay with me a minute. Late in the book, autistic adults find each other in the nineties, a lot of it online. Typed messages that wait for you, instead of a room that doesn't.

15:15Beck: Talking on their own timing. Typed, no faces to read, no clock on the reply.

15:22Juno: Which is a lot of what people say they like about a chat window now.

15:26Beck: And it's a fair use. Paste in a message that reads two ways and ask what the likely meanings are. Draft the hard reply before you send it. Rehearse a phone call out loud. That's scaffolding you put up around your own day.

15:41Juno: And where does it stop?

15:43Beck: It's a tool for your own life, not a treatment for anything, and no trial lets anyone call it more. Try it on something small and keep the claims small too. And what you type sits on somebody's server, without the protections a medical record carries.

16:01Juno: The book's version was a crowd of strangers online who got it.

16:06Beck: That's the difference. A window can explain a sentence. It can't be a tribe.

16:12Juno: NeuroTribes, Steve Silberman, 2015. Read it for Lorna Wing and for the last chapters, where autistic adults start speaking for themselves. Read the Asperger chapters next to the 2018 archive paper, and get the paperback if you can.

16:32Beck: Here's the count. The rise as mostly finding people held. Vaccines held. The case against blaming mothers held. Asperger as protector didn't. Kanner sits in the disputed column. That's the third entry on the didn't-hold side, and the first one an archive overturned after the book was printed.

16:55Juno: Front of my shelf. This is the one I'd hand a friend first, with the Czech paper folded inside the cover.

17:02Beck: Another note tucked in a book.

17:05Juno: Yeah. Another note. This one's from an archive.

17:12Beck: Next time: Thinking in Pictures. Temple Grandin, 1995, expanded in 2006. Oliver Sacks wrote the foreword to both books, twenty years apart, and where today was the history from outside, next time is one autistic mind describing itself.

17:37Juno: Good. I've wanted to hear from someone inside it since Vienna.

17:41Juno: Same place, two days.

17:43Beck: Same telescope.

17:45Juno: Lone Star Telehealth produces The Observatory. Logan Williamson is a Licensed Professional Counselor in Texas and Louisiana. Today was education about a book, so it wasn't counseling, it wasn't an assessment of you, and it can't stand in for care. A diagnosis takes a real conversation with a real clinician, and this wasn't one.

18:08Beck: Every source is listed on the episode page, along with the full transcript. Next episode in two days.

18:22Juno: Last thing, and plainly. Juno and Beck are synthetic voices, not people. Neither of us is licensed, and nothing in this episode was about you. AI helped write the script, and it was edited and approved by Logan Williamson at Lone Star Telehealth. Logan Williamson is a Licensed Professional Counselor in Texas and Louisiana.