Issue 12 / 8 April 2013

A RECENT article on Asperger’s syndrome in the Good Weekend got me thinking about the way certain diagnoses become part of the zeitgeist.

Back in the 19th century, diagnosis of neurasthenia was so popular it was known as “the fashionable disease”. The condition was associated with fatigue, muscle weakness and a range of psychological symptoms but its causes remained obscure.

American neurologist George Beard, who first described it in 1869, believed neurasthenia was due to a deficiency in nervous energy, often found in businessmen exposed to the competition, luxury and vices of modern society. It was more common, he believed, in those with a more refined nervous system, including intellectuals and professionals.

A good disease to have then, at least from a social status point of view.

You could argue the same about Asperger’s, which has increasingly become associated in the popular imagination with a combination of social awkwardness and intellectual brilliance.

A few years ago, I attended an international autism conference — unusual among medical conferences in that it brought together not just researchers and clinicians, but also people on the spectrum and their families.

It was my first in-depth encounter with “Aspie pride”, the wearing of an Asperger’s diagnosis as a badge of honour, an indication of superior intellectual function. In fact, several speakers at the conference referred somewhat dismissively to those of us not on the autism spectrum as “neurotypicals”.

Since then, I’ve come across people who include their Asperger’s status in email signatures alongside professional qualifications, as though being an “engineer with Asperger’s” makes them, by definition, better at that craft.

A quick Google search will produce a huge array of merchandise bearing the same message, including t-shirts with slogans such as “Today’s autistic kid is tomorrow’s genius”.

There’s nothing wrong, of course, with people taking pride in who they are, or with campaigns against the tyranny of the “normal”. Greater acceptance of the full range of human diversity would be a fine thing.

Still, I can’t help wondering if the fashion for Asperger’s might not run the risk of obscuring the enormous challenges faced by those at the more severe end of the autism spectrum and their families. Not everybody on the spectrum is going to found Facebook.

There’s not much evidence the actual incidence of Asperger’s has increased, but its diagnosis — or self-diagnosis — certainly has.

Tim Elliott’s Good Weekend article suggests its fashionable status may be a product of an “incessantly nerdy” society.

“Ours is an information age, ruled not by jocks, supermodels and other ‘neurotypicals’ but by millionaire geeks and rock-star hackers, by agoraphobic software coders and pasty-faced file-sharers …”, he writes.

“In an increasingly asocial world, where people would rather text than talk, the rise of Asperger’s as a cultural epidemic makes perfect sense.”

Historians of neurasthenia have linked its popularity to the industrial transformations of the late 19th century and the repression of the Victorian age.

Psychiatrist and historian Dr Howard Feinstein has written about the way a diagnosis of neurasthenia allowed the patient to escape the conventions of puritan America, including a belief in salvation through work and a suspicion of pleasure.

“In this age of very rapid development of society, neurasthenia and other medical labels began to replace religious categories for what today would be both popularly and professionally called ‘stress’”, he wrote in a biography of philosopher William James, who had been diagnosed with the condition.

Today the Asperger’s diagnosis is thrown at the pioneers of new technology, at the Einsteins and the Newtons.

Neurasthenia was perhaps associated more with creativity, reflection and the literary mind: novelist Henry James was said to have the condition, as were Sigmund Freud and Charles Darwin.

It’s interesting to wonder what the next fashionable condition might be and what social forces might lie behind it.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 8 April 2013

9 thoughts on “Jane McCredie: Fashionable disease

  1. John Quintner says:

    Jane, my reading of 19th C “neurasthenia” inclines me to the view that it was a condition to be taken very seriously because, if untreated, it could be the forerunner of more serious health problems. I am not sure how fashionable it was then, but it declined in popularity once Freud decided it was a “masturbation-induced neurosis”.

    Elements of “neurasthenia” can be found today in the construct of “fibromyalgia”.

    What we appear to be looking at in both conditions are the clinical consequences of undamped activation of evolutionarily conserved stress response systems. [Lyon et al. 2011]

  2. dr_HAM says:

    Actually, it was not Henry James but his (brilliant) sister Alice who was bedbound with neurasthenia.

  3. john pollard says:

    After 12 years of incessant ‘assessment ‘ by various health professionals, my son was diagnsed with aspergers (which of course no longer exists under DSM5) at age 15 – the most common age of diagnosis.
    The societal aim is to place individuals in various boxes (pigeon holed). Unfortunately, so much repetitive and recurrent assessment across health professionals (OT, clin psychs, speech therapists) results in huge resources being allocated in assessment , leaving very little to actually assist and treat when the diagnosis is achieved.
    Tom is bright but his educational experience has been painful and spectacularly unsuccessful despite considerable expense and often admirable efforts by individual teachers.
    At least his belated diagnosis has helped his parents and Tom himself, to identify with some of his somatic and sensory experiences and I think have helped us to plan for a positive future outside the school system.
    I understand what the author is trying to say, but believe me, this condition exists and has profound impact on young people’s lives and is not merely a middle class explanation for parents unfulfilled expectations of their child.

  4. E says:

    This article shows an appalling lack of insight, especially taking into consideration it was written by a neurotypical journalist.

    A person including their Aspergers status in their email signature could be a valid strategy – suggested by a treating psychologist – for managing communication. It couldn’t state more clearly: “I’m a professional but perhaps communication isn’t my strong point. I’m open to further discussion if there is an issue”.
    Even if it is a bit weird, isn’t that subtle social misfire one of the hallmarks of ASD?

    I suspect the conclusion Jane came to says more about her own feelings of inadequacy than any boastfulness on the part of her correspondent.

  5. Janet Hammill says:

    The recognition of Asperger’s syndrome has allowed it to become an “alternative diagnosis” for individuals with fetal alcohol spectrum disorders (FASD). Few clinicians are aware of or do not recognise FASD. Consequently some parents and carers of children with FASD choose to pursue a diagnosis of Asperger’s in order to access services. For some obscure reason, this has been accomplished.

  6. elke says:

    An insulting article, dismissive of the actual reality lived by people with Asperger’s Syndrome and their families. A diagnosis can be liberating and change lives for the better. Articles like this rely on stereotypes and do nothing to increase community and medical practitioner understanding of the syndrome. Please do better MJA!!

  7. Dr Michael Gliksman says:

    ‘Doing better’ does not mean publishing only articles with which one agrees. Articles such as this one which challenge accepted paradigms are essential if debate and understanding is to progress. If you think the article’s premise is wrong, present your evidence.

  8. Neurodiverse says:

    There is a very good argument that neurodiversity of the sort that may lead to autism spectrum disorders, to ADHD or to dyslexia (for instance) is essential for the health of the genetic stock of the human race.

    Equally there is good evidence that in less stressful societies than ours these diverse genetics are not directly associated with dysfunction. In these situations the individual is probably far less dysfunctional, and is truly “differently abled”.

    As for Asperger’s pride- it’s probably a bit like gay pride – a backlash against a society that values conformity and insults and degrades those who do not fit well.

    I hardly think the author’s attitude shows much empathy.

    I am interested by George Quittner’s observation linking neurasthenia and fibromyalgia- that is a fair link.

    The work of Herbert Benson, a former cardiologist founded the Mind/Body Medical Institute at Massachusetts General Hospital, suggests that 60-90% of primary care presentations relate to stress- and the syndrome described as fibromyalgia probably fits right in this box.

    Why is nobody asking why our society has become so stressful?

  9. Sad says:

    You are quite right Jane. The generalisation that an Asperger is socially awkward but intellectually superior is incredibly unfair. My 13 year old niece was diagnosed quite young and it was obvious she was different from other youngsters. She does it tough – really tough – and if I happen to mention to someone that she has Aspergers they invariably assume she is super smart or a computer genius. Sadly, she is neither of these things. She is a honest, generous, often confused little girl who doesn’t understand the “language” her teenage classmates speak – although she tries really hard. She doesn’t do well in formal learning and is physically uncoordinated. Puberty is proving to be a special kind of hell for her, and I often worry about her finding her place in society. Fashionable? Not for my niece.

Leave a Reply

Your email address will not be published.