Definitions and their Consequences

The A.D.A.M. Medical Encyclopedia defines autism, in part, as follows:

Autism is a developmental disorder that appears in the first 3 years of life, and affects the brain’s normal development of social and communication skills. Autism is a physical condition linked to abnormal biology and chemistry in the brain.

This is a general definition, not the clinical one. That one is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Today the New York Times reports that the fifth edition of DSM may redefine the condition. Both the current text and the proposed change are accessible here, courtesy of the American Psychiatric Association. The link takes you to the proposed change; the old one is under the tab labeled DSM-IV. The change appears to be a tightening of the definition—and thereby hangs a controversy.

Under tighter rules fewer people will be diagnosed—and therefore qualify for various financial programs in support of autistic individuals. The new definition will no doubt continue to serve in the identification of genuine cases of children who really have this condition.

But there is another aspect to this story. Autism, a relatively newly recognized condition, has seen explosive growth, which may or may not be real. What do I mean by that? Here is a condition that manifests poorly developed social and communications skills; but its underlying physical causes are unknown. Thus it is similar to ADHD (attention deficit hyperactivity disorder), another very prevalent condition. Government funded support programs have developed for both. But where the condition is difficult to diagnose by physical tests and the behaviors may be caused by something other than physical conditions—and where program are present—the tendency of physicians is to diagnose a fundable condition and then to breathe a sigh of relief.

I call this a newly recognized condition. Indeed. My 1967 Webster’s Collegiate defines autism as “absorption in fantasy as escape from reality.” I find myself quite autistic, under this definition—to the benefit of mystery novel writers.

Let me wrap up this topic with a footnote. That A.D.A.M. in the medical encyclopedia stands for Animated Dissection of Anatomy for Medicine.

On the same NYT front page today the second lead story reports on sharply rising attacks by the new Afghanistani army on NATO forces. Here we have a definitional problem of another sort. Those whom we cajole or coerce to serve in an army we have created as the country’s occupying power are defined as allies. But the definition doesn’t seem to fit—because the alliance isn’t altogether voluntary.