Review: Murray, Stuart. Autism. London: Routledge, 2011. ISBN 978-0415884983

Reviewed by Sarah Gibbons, University of Waterloo

sgibbons@uwaterloo.ca

Stuart Murray speaks to the proliferation of discourse on autism in his new book by cautioning that, "autism is frequently talked about, but it is rarely listened to" (xiii). Autism, directed toward individuals from a variety of disciplines as well as readers outside the academy, employs accessible language and offers clear explanations, stepping back from the sense of urgency that characterizes contemporary discussion of the condition to attend to our cultural understanding and representation of autistic presence. Murray's Autism is part of the Routledge Series Integrating Science and Culture, which, explains Series Editor Lennard Davis, "aims to restore connections between the sciences and the humanities, connections that were severed over 150 years ago" (ix). Murray fulfills this mandate, offering a text that differs from other academic studies of autism that subscribe to a medical-model of the condition. He argues that although medical research has helped to resolve many controversies surrounding autism, such knowledge is necessarily limited. Murray makes a compelling and important case for reading the cultural narrative of autism in order to expose and critique many of our assumptions.

As Murray introduces the facts, histories and controversies of autism, he draws upon the theoretical paradigms established by disability studies to challenge contemporary characterizations of autism as an epidemic or a form of suffering, ultimately asserting that autism helps us deconstruct our understanding of the normative subject. He engages in a balanced exercise of describing the nuances of differing perspectives on autism with sensitivity, even as he clearly indicates when certain beliefs contradict basic truths or compromise the ability of individuals with autism to live meaningful lives. Murray's desire to represent the concerns of all affected parties extends to his own use of language. He explains different interpretations of the terms "autistic person" and "person with autism," as well as their implications for autistic identity, and resolves to employ both terms throughout the text (xiv). The purpose of the book, Murray explains, is to focus on how our understanding of autism affects people because, "if we cannot extend what we know about [autism] to make a real difference to individual lives then there is not much point to any research on the condition" (7).

The first section of Autism, "The Facts," is appropriately subtitled, "What We Know…or Don't". Although Murray summarizes key facts about autism, he emphasizes the provisional nature of medical knowledge, and highlights our ultimate lack of knowledge. He focuses on significant absences and definitions as he criticizes how the sensory experience of autism receives little attention in diagnostic manuals despite its centrality to individuals, and clarifies that neurological difference does not imply poor health. Most significantly, Murray supports his call to read the construction of autism as a narrative by explaining how the diagnostic process is evaluative in the absence of clear biological markers. The diagnostic process often supplies the 'patient story' (particularly for non-verbal individuals), and frames autism as a problem. For example, researcher Simon Baron-Cohen suggests that in order to receive a diagnosis of autism, there must be evidence that the individual in question is suffering. While Murray does not suggest that suffering never accompanies autism, he does highlight how other life experiences, such as poverty, cause suffering but do not necessitate the creation of individual diagnostic criteria. He argues that understanding autism as a form of suffering, "produces a working version of the condition that has an assumed negativity and a normalized value-judgment built into its medical/diagnostic baseline" (21). These normalized judgments position autism as a deficit in terms of executive function, theory of mind, and central coherence, which Murray argues are processing metaphors that create the perception that individuals host their autism.

In "Part II: Social, Cultural, and Political Histories," Murray chronicles the history of autism, moving from a discussion of the importance of thinking about autistic presence before the creation of autism (without simply "'outing' historical figures"), to contemporary modes of self-advocacy and neurodiversity movements (41). Murray returns to the idea of hosting autism by looking at the early work of Leo Kanner and Hans Asperger. He argues that Kanner's study of children and his writings on autism have led to associations between autism and childhood, and to the idea that, "autism somehow inhabits a body that is not autistic, and that the two might be prised apart in some way, with the non-autistic, 'real,' self saved from the disability" (49). Murray reviews the abuses that autistic people suffered when psychoanalysis, championed by Bruno Bettelheim, held that parental behaviour caused autism. As Murray unearths the trauma of psychoanalytic approaches to treatment, he notes that responses to such treatment led to the creation of many associations that helped promote widespread understanding and specialized education programs. Showing that associations remain central to autism debates today, Murray reviews the concerns that many individuals with autism have that such associations do not view them as representative of autism if they are capable of self-advocacy.

Yet despite Murray's attention to research and advocacy, he argues that cultural representations continue to exert a powerful influence over public opinion. Murray presents Barry Levinson's Rainman as the canonical depiction of autism, commenting that, "it is hard to think of any other medical condition or disability that has had a similar breakthrough, one where a fictional narrative has seemingly provided central 'facts' about its nature. But, with autism, this is the case" (67). Although the film introduced popular audiences to autism, its portrayal of the autistic protagonist as a savant led to the popular association between autism and savantism; Murray notes that savantism is actually rare in people with autism. While Murray refers to how autism is often viewed as a "triad of impairments" with respect to theory of mind, executive function, and central coherence in Part 1, I think that cultural representations exploring these deficits also affects our understanding of autism in a manner that deserves attention. For instance, theory of mind influences representations of autism that project the stereotype that autistic people lack empathy, a myth that many people with autism challenge, such as autism self-advocate Rachel Cohen-Rottenburg who maintains the blog, "Autism and Empathy". I am also interested in how popular usage of labels such as "low-functioning" and "high-functioning", which Murray does address in his other works, affects our understanding of autistic presence. Murray concludes that despite persisting misrepresentations and disagreements regarding autism, "our own historical moment values autism as never before. It is no longer the default position to believe that all those with the condition lead lives that are tragic," concluding: "the difficult history that has led us to this point therefore has to be seen in terms of achievement, for all that the situation is far from perfect" (73)

The last section of the book, "Major Controversies," focuses on the two most central contemporary debates: causation and cure. Media reports play an integral role in shaping public knowledge; the way in which reports frequently misrepresent research to draw hasty conclusions reflects our cultural fascination with autism, as well as our desire for answers. At the heart of Murray's discussion is a comprehensive treatment of controversy surrounding the idea that the Measles, Mumps and Rubella vaccine caused autism, for which he insists, "blame…should not simply be laid at the door of certain individuals or groups who pursued specific ideas or theories…The failure of medical authorities to reassure the public itself betrayed confusion about the condition" (88-89). Yet Murray maintains that viewing autism as a contagion, whether contracted through a vaccine or some toxic aspect of our environment, affects how we value it: "if autism is constituted as some kind of poison, it becomes very difficult to make the argument that it is a form of human variation; we do not react well to thinking of difference in terms of some kind of noxious disease" (80). Murray contends that even as we desire to know what causes autism, we should recognize that having such knowledge might not affect the daily lives of autistic people. It is with consideration for how individuals with autism can live fulfilling lives that others do not construe as continual suffering that Murray takes up the issue of a cure.

Murray prefaces his discussion of curing autism by stating that it is impossible: "all serious research into autism acknowledges that it is a lifelong condition and that it is built into the fabric of the person who has it. It is, as we noted earlier, not an illness. As such, it cannot be cured" (89-90). Murray clarifies that while some people use the term "cure" to refer to eliminating the most disabling aspects of the condition, other groups, such as the Generation Rescue organization and, Son-Rise, an organization which invokes Christ to propose the possibility of resurrection from autism, believe that it is desirable for people to stop being autistic. Part of understanding autism, Murray argues, is understanding that it cannot be separated out from a person; he insists, in a passage worth quoting at length:

Where those that champion curing are definitely in the wrong is in their idea that somehow the autistic and the human can be kept apart, and that to eradicate the former is to liberate the latter. This is one of the worst by-products of the notion that the condition is some kind of toxin or malign 'visitation'. It is nothing of the sort, and that is a fact that will have to be accepted." (101)

Murray concludes his discussion of cure by aligning his own understanding of autism as difference with disability studies. Murray posits that posthumanism and its deconstruction of the normative subject is a productive critical mode for thinking about autism, claiming that, "the fascination with the cyborg that is typical of posthuman thinking maybe suggests a kind of autistic-being-in-the-world" (103). My criticism of this thoughtful and important discussion is that Murray's posthuman turn lacks a clear definition of his own understanding of posthumanism, which would be useful in a text directed toward a variety of disciplines, particularly considering that people define posthumanism in many different ways. However, Murray's engagement with posthumanism is crucial as it brings autism into conversation with disability studies as a whole, as he argues that just as humanism is inadequate for thinking about disabled bodies, so humanism is inadequate for thinking about neurodiversity as it continually casts autism as a tragedy. Murray's work creates a useful starting point for thinking about how autism fits into other theoretical discussions in disability studies, such as how the debates surrounding cure connect to the concept of 'the disability to come' that affects how we view disability studies in relation to identity politics.

Murray's work challenges contemporary rhetoric that frames autism as an epidemic, instead focusing on imagining a future that includes autism. Fulfilling his own imperative to listen to autism, Murray often defers to the words of individuals with autism who advocate for themselves, such as activist Amanda Baggs, who prefers to communicate through writing. Through a movement toward neurodiversity and the posthuman that troubles the often unquestioned social and medical view of autism as a lack, Murray's book sets an important precedent for attending to the meaningful ways in which science and culture intersect and inform one another.