Biomedical subjects
Publications and source records attributed to V D Sanua.
Leo Kanner headed the first child psychiatry division within a pediatric hospital at Johns Hopkins University. In 1935 he wrote the first book in English of child psychiatry which is still in print. His writings include both organic and environmental etiologies. He was an idealist, and he fought for liberal causes and emphasized an humanitarian approach in dealing with autistic children.
The most dominant view about the etiology of infantile autism is that it is biologically determined. None of the attributed causes have withstood the test of time. Arguments supporting the organic ideology is that parents of autistic children are not of higher SES, they seem to be adjusted and the disorder is to be found all over the world. An analysis of the literature indicates that such conclusions are open to question. Conflicting findings may be due to the fact that children that do not fulfill Kanner's criteria are included in the samples studied.
This paper reviews selected research on mental disorders which include Jewish subjects from large scale epidemiological surveys to clinical studies and psychoanalytical studies conducted up to the late 1980's. These studies were primarily conducted in the United States, which has the largest Jewish population in the world, and in the State of Israel. In view of the fact that Jews are a heterogeneous group the findings have not always been consistent, however, certain trends have been observed. Jews were found to undergo more psychotherapy than any other group. While the prevalence rate of schizophrenia seems to be lower, neurosis seems to be higher than among non-Jews. Because Jews tend to internalize aggression, they are less likely to be paranoid. There is some evidence that the Jews' strong attachment to their ethnic group and family solidarity seem to have a positive effect on their mental health. When Jewish alcoholics, drug addicts and criminals were studied, it was found that they had psychiatric problems. The author concludes that more effort should be devoted to the study of the psychopathology of the Jewish population around the world.
Explore the source record for details and available documents.
The general finding of this cross-national survey is that, contrary to expectation, professionals in the United States, irrespective of discipline, are more convinced that infantile autism is caused primarily by genetic/organic factors when compared to European professionals. Psychiatrists in the U.S.A. give priority to organic factors (97%), followed by constitutional factors (84%), genetic factors (77%), and metabolic disorders (58%). With psychologists and other professionals in the U.S.A. the trend is about the same. An analysis of the differences in responses to items on environmental factors, such as birth complications, viral infection, pollution and receptive language problems, again shows that professionals in the United States tend to attribute more importance to these factors than their European counterparts. In general, half of the Europeans believe in the importance of these factors as compared to professionals in the U.S.A. It is only when we deal with parental psychopathology that we find a reversal in trends. If we combine the "somewhat important" and "highly important," 35% of psychiatrists in the United States and 54% of psychiatrists in Europe indicate that parental psychopathology may be a factor in infantile autism. For psychologists, the percentages were 26% and 50% respectively. No difference was found when "other professionals" in the U.S.A. and Europe were compared. There are some contradictions in the findings. While the responses of 97% of the psychiatrists in the U.S.A. point to organic factors as being "somewhat" and "highly important" in the causation of infantile autism, 36% of them indicate that parental psychopathology might have some influence on the illness. Thus, while almost 100% of psychiatrists subscribe to an organic origin of the illness, about one third of them are still not willing to completely discount parental contribution. The 12th etiology which was added, "cultural factors," was considered to be of least importance. It is assumed that the respondents might have missed the implications of the question. For a discussion of the sociocultural aspects of infantile autism, the reader is referred to a number of papers published in this area (Sanua, 1981, 1982, 1983, 1984, 1985). As an analogy, there is still some controversy about the universality of the existence of schizophrenia. In a review of the literature on the subject, Torrey (1973) concluded that "process" schizophrenia is found in all cultures which have been exposed to Western technology. He points out the need to conduct well-planned field surveys of the prevalence among groups that are in varying stages of exposure to Western technology.(ABSTRACT TRUNCATED AT 400 WORDS)
Various theories have been provided in the literature regarding the etiology of infantile autism. It seems that the biological causation dominates the thinking of mental health practitioners and researchers irrespective of discipline. Areas of research include the following: neuropathological studies of the brain, autopsies, electroencephalograms, epileptic seizures, brain lateralization, studies in asymmetry; neurochemistry; genetics; and pre-, peri- and postnatal factors. A critical analysis of these studies has indicated that the evidence of organic factors tends to be rather weak and furthermore has been found to be contradictory. It is felt that the major problem lies in the fact that a large number of investigators include in their sampling children with various mental and physical disabilities and label them autistic. In general, there seems to be little information regarding the selection and little background information is offered on these children. It is suggested that a standardized and world wide diagnostic system be constructed which will provide objective etiological results.
What we have tried to do in this paper is to question the universality of Infantile Autism as implied by the various definitions which have been provided. Our research of the literature has convinced us that infantile autism appears to be an illness of Western Civilization, and appears in countries of high technology, where the nuclear family dominates. We indicated that no research studies were located in the U.S.A. on Hispanics, in spite of their large number. Furthermore, it was found to be quite rare among Black families. We also saw that the illness seems to be quite infrequent in Latin American countries, Africa, and India, while the rate is high in Japan, but only in westernized families. Tinbergen (1974) likewise feels that infantile autism is "actually on the increase in a number of Western and westernized societies". Two major variables which are interconnected seem to be responsible for the confusion in the findings. One of them is the problem of diagnosis. It would seem that many researchers have extended the definition of infantile autism to include other seriously afflicted children, including those who are brain-damaged. This is no surprise, since such conflicts exist as Ritvo (1981) estimating that there are 300,000 autistic children in the U.S., while a report by the National Institute for Handicapped Research estimates the number of autistic children to be 71,000 (1981). Another aspect of the findings which has been contradictory is that some investigators have found that parents of autistic children tend to be of higher S.E.S., particularly in European studies, while some studies in the U.S.A. did not find such a difference among the parents of autistic and non-autistic children. We have provided some illustrations to indicate that studies which have found no differences were not dealing exclusively with autistic children as defined by Kanner, and often used childhood schizophrenia and autism interchangeably. Cantwell, Baker, and Rutter (1978) have pointed out that this persistent difference of superior S.E.S. of parents of autistic children is an embarrassing finding which is very hard to explain if one holds that the disease is organically determined. In conclusion to his review of the literature on the universality of adult schizophrenia, Torrey (1973) wrote the following: "Studies must be done soon or it will be too late to do them at all. But, until the universal prevalence of schizophrenia becomes an open question, this task is unlikely to be undertaken". The writer of this paper is of the same opinion.(ABSTRACT TRUNCATED AT 400 WORDS)
After presenting an historical overview of the development of the concept of childhood psychosis, this paper discusses the various etiologies which have been offered to explain severe disturbances of childhood. Reference is made to the nature/nurture polemic. In spite of the general belief that the etiology is biologically determined, particularly in infantile autism, the actual evidence tends to be meagre. Furthermore, the literature includes a number of studies which have been found to be methodically weak and which seem to disclaim the intellectual and socioeconomic superiority of the parents of autistic children, contrary to Kanner's original finding that such superiority exists. The link between social class and autism, according to Cantwell's review, does not appear to fit a purely biological causation of autism. This remains an awkward finding which still demands an explanation. The contention of this paper is that contradictory findings could be explained, as stated by Kanner, by the 'inordinate' use of the label 'autism' to include various types of children's severe disorders, even brain-damaged children. Furthermore this review emphasizes the fact that a total neglect of sociocultural variables in the study of such children has led to confounding results. A careful reading of the literature and correspondence with numerous psychiatrists around the world have led the author to believe that infantile autism is more prevalent in highly technological countries where there is extensive geographical and economic mobility coupled with the nuclearization of the family. This paper offers supportive evidence for this speculation.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.