PubMed1991
In a speculative and somewhat incautious frame of mind, I have tried to explore the question: What is autism? My suggestion has been that the essence of autism is, as Kanner indicates, an impairment in affectively patterned intersubjective personal relations. Such impairment usually has a predominant and often sufficient basis in biologic deficits intrinsic to the affected children. I have tried to indicate how such deficits might on the one hand be caused by heterogeneous physical afflictions and, even in some more broadly handicapped cases, a mixture of lower-order psychological impairments, and on the other hand give rise to the constellation of cognitive, linguistic, and motivational deficits that are characteristic of the syndrome. I have also referred to the dangers of circularity in defining too much of the clinical picture as essentially rather than characteristically autistic, and also in supposing that all children with this presentation are equally constrained in their developmental potential when selected patients might have an underlying psychopathology that allows for some recovery in cognitive as well as social functioning. I have not had space to give due acknowledgment to the ways in which many autistic children circumvent, compensate for, or otherwise overcome a number of their disabilities. Ultimately, it will be as great a challenge to explain what autistic children do achieve in their social relations, their thinking, and their language as to explain their characteristic deficits. In the meantime, autism may already reveal the degree to which human existence and human development pivot upon the capacity for genuinely interpersonal relations and interpersonal understanding. To inquire "What is autism?" is also to ask "What are the essence and implications of interpersonal life?"