Monday, July 11, 2016

Vaccines and Autism

This post is devoted to an "evergreen" of misinformation,  the well-known urban legend that links vaccines to autism. The opportunity is provided by a nice and informative post published by David Gorski, managing editor of ScienceBasedMedicine.org. Under the pretext of reviewing the movie VAXXED: From Cover-up to Catastrophe, which was in limelight a few month ago because of Robert De Niro' support, Gorski  revisits the long standing quarrel on vaccination and autism. Gorski's post is humorous and well documented, I do recommend to read it. 

Gorski sharply unravels rhetoric and suggestive mechanisms used by anti-vax  supporters. Similarly, he analyses the several, sometimes pitiful, personal reasons that have moved some medical doctors and researchers to promote a theory, not only false, but also nefarious. Yet, there is a blind spot in Gorski's approach. The hypothesis that vaccines cause autism is apparently airy-fairy, why so many people stubbornly believe in it? Are they just stupid?

There are some standard answers to this question. Yet, they capture only a part of the story and, above all, they fail to address the basic question, "why autism?".  Why, among hundreds of possible scary tales about vaccines, has autism been targeted by anti-vax people?

To find a possible answer, I suggest to give a closer look at the history of autism. The notion of "autism" is quite recent, dating back to Swiss psychiatrist, Eugen Bleuler, who first used it in early 1900 to refer to some schizophrenic symptoms. In 1940s, American psychiatrists  introduced this term to indicate children with emotional or social problems.  Autism was initially believed to be a disease chiefly caused by parents' coldness. This perspective was taken up by child psychologist Bruno Bettelheim, who coined the (infamous) expression "refrigerator mother" to mean a frigid, uncaring, mother. Bettelheim made a parallel between concentration camp survivors and children with autism and his theory put a heavy burden on families of autistic children. Bettelheim's hypothesis was then mostly rejected by the scientific community, but, as it often happens, the rejection of a theory, which was once in fashion, caused an extreme reaction in the opposite direction. Autism was conceived till 1970s as a psychological disturbance, then the pendulum swung and it became a pure biological disorder. Both approaches were clearly wrong because unilateral and inherently ideological. Today, even the existence of a condition called "autism" is put in discussion. Actually, this term is now  considered an umbrella term that gathers various conditions, which share some symptoms, but are qualitatively and etiologically very different.

If you put together these three elements, 1) families 
who "seek for revenge" - after having been put in the dock for two decades; 2) the scientific community, which now disdainfully rejects psychological theories  to uncritically espouse biological  explanations; 3) psychiatric classifications that consider autism just an umbrella term, lacking any  nosological  substance;  are you still surprised that anti-vax people have targeted autism?

In the 1950s, medical doctors "invented" a disease to label children with behavioral and developmental problems  of unknown nature, also including doubtful educational conditions. Then, they  "discovered"  the psychological aetiology  of such a disease, with parents playing  the villain role. Then, doctors changed their mind again, telling people that autism had nothing to do with psychological factors  and it depended only on genes and neurotransmitters. Finally, the same doctors are now explaining that – maybe – at the end autism could not exist at all.

 C'mon, let's be honest with ourselves.  We reap what we sow.       


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