AUTISM: STIGMA, DISCOVERY, AWARENESS

In today’s lexicon, the term “autism” emerges with a certain insistence: it echoes in public debates, infiltrates television schedules, dominates conversations on social networks and in press articles; yet, beneath this apparent familiarity lies a knowledge still uncertain, fragile and often anchored to media stereotypes or cinematic simplifications filled with cultural symbolism which, though suggestive, offers only a pale reflection of the actual autistic complexity.

Autism, instead, reveals itself in its multifaceted nature and advances, silently revolutionary, through the corridors of clinical centres and school classrooms; in the voices of those who live it and those who perceive it.

It's not reducible to a mere diagnosis and, above all, not to that kind of diagnosis which paradoxically fails to recognise a different functional mode: a different way of perceiving, processing, conceiving, thinking, interacting, acting, expressing and being.

In order to begin to understand it, it is necessary to conduct a (at least) brief retrospective investigation that does not start from a definition, but from a story.

The Prodromes: Autism as Symptom

Taking a step back, the genealogy of the term finds its roots in 1911; when the Swiss psychiatrist Eugen Bleuler coined the word “autismus” to describe one of the symptoms of schizophrenia.

In that context, autism was not yet considered a condition in its own right, but rather a pathological withdrawal from reality; a self-referential closure of the subject. Thus, it was born as a clinical sign, not as an autonomous nosographic entity and would remain confined (for decades) within schizophrenic taxonomies.

Only in the 1940s did the psychiatrist Leo Kanner (following the observation of some children) describe, for

the first time, a recognisable and distinct clinical picture: Early Infantile Autism.

The children he studied did not exhibit delusions or hallucinations, but displayed social isolation, repetitive behaviours, and a profound difficulty in establishing relationships. His was an innovative intuition that allowed autism to emancipate itself from schizophrenia and begin to take shape as a “Neurodevelopmental Syndrome”.

Almost in parallel, the Viennese physician Hans Asperger described a different clinical profile: verbal children, often with above-average intelligence, but with marked difficulties in understanding others’ emotions and a certain tendency towards obsessiveness about restricted interests. Thus was born the syndrome that would bear his name.

(His involvement with the Nazi regime remains, to this day, the subject of debate between those who deny and those who confirm it).

Let us move to categorical psychiatry and its ambiguities.

For several years, all these intuitions remained in balance between clarity and confusion.

In the first American diagnostic manuals (DSM-I and DSM-II), autism was still incorporated into schizophrenia.

In 1980, with DSM-III, it was recognised as an autonomous disorder, included under the category of “Pervasive Developmental Disorders”; a recognition as necessary as it was incomplete, as it was limited to the “most severe” and “manifest” forms.

With DSM-IV (1994), the classification expanded: alongside “Autistic Disorder” appeared “Asperger’s syndrome”, “Childhood Disintegrative Disorder”, “Rett’s Syndrome” and “PDD-NOS” (Pervasive Developmental Disorder

Not Otherwise Specified). It was an attempt to organise clinical chaos but ended up generating further insufficient and/or misleading labels.

A significant point that, however, is not given sufficient value and multi-perspective observation is the concept

of “maladaptation”.

Currently, in clinical practice, a rather recurring phenomenon is observed: autistic individuals do not seek

support for autism itself, but for the maladaptation it generates in relation to the environment.

It is the external world that proves inadequate, or rather inhospitable, and not the person’s neurological functioning. (As a clinician and autistic person, I can confirm this).

This observation paves the way for a new semantics: that of neurodivergences.

It was the Australian sociologist Judy Singer (already mentioned in one of my previous articles) who proposed

(in the 1990s) the term “neurodiversity” (neural equivalent of “biodiversity”), dismantling the deficit logic

and restoring dignity to natural neuro-peculiarities.

Consequently, the terms “neurotypical” and “neuroatypical” were born, extending the reflection beyond autism

to embrace ADHD, Dyslexia, Dyscalculia, Tourette’s syndrome and Other Specific Learning Disorders.

Subsequently, with DSM-5 (2013), categorical psychiatry implemented a synthesis introducing a single

diagnostic label (called “Autism Spectrum Disorder”) and eliminating previous subdivisions.

A substantial change is observed: the spectrum becomes a continuum and autism unfolds into infinite

nuances, more or less evident, more or less disabling, more or less accessible.

Ultimately, autism itself does not exist: there exist autistic people; each with their own mechanism and capacity

to coexist (like any other human being) with a brilliant intelligence, with ADHD, with mild or severe forms

of disability and so forth.

Today we still find ourselves at a crossroads: on one hand, an outdated vision survives that considers autism synonymous with cognitive deficit, ignoring the heterogeneity of autistic individuals; on the other hand, a legitimate and conscious movement asserts itself, demanding to be heard, given opportunities for expression, representation and adaptation of the background.

Taking care of it means alleviating the “minority stress” and the disharmony that a rigid and standardised

system imposes on those who deviate from it. It means ceasing to correct and supporting every attempt at conversion/standardisation of what does not need to be corrected, converted, or standardised.

It's not the nature that desperately needed recalibration, but the society.

Starting from the assumption that it is not a puzzle to be solved, but another reality to be understood and welcomed, questioning one’s ability to redefine the boundaries of “normality”, rewriting the grammar of

empathy, coexistence and collaboration, would already represent a good starting point for building a world

capable of supporting and responding to the needs of all minds, so that they may thrive (developing and

refining their potential) nurtured by fertile ground ready to welcome their fruits.

- 𝐷𝑟. 𝑉𝑎𝑙𝑒𝑟𝑖𝑎 𝐺ℎ𝑖𝑠𝑢

𝑆𝑝𝑒𝑐𝑖𝑎𝑙𝑖𝑠𝑡 𝑖𝑛 𝑃𝑠𝑦𝑐ℎ𝑜-𝐺𝑒𝑛𝑒𝑡𝑖𝑐𝑠