Autism Before Diagnosis: Understanding the Past and Present

The journey of understanding and identifying autism has evolved significantly over time. In the early years, the condition that is now recognized as autism was either undiagnosed or considered part of other diagnoses. This essay explores how autism was treated before it was identifiable and diagnosed, its prevalence in the past, and the trends in its diagnosis today.

Exploring the Past: Unrecognized Symptoms and Terminology

Autism as a distinct condition was first mentioned by the German psychiatrist Eugen Bleuler in 1911. However, before this period, the symptoms of autism were often disregarded or labeled as 'slow,' 'backwards,' or 'simple.' These terms were commonly used to describe individuals who exhibited behaviors or cognitive delays.

Historically, mental health challenges were often associated with supernatural explanations. In ancient times, particularly in Baghdad and Cairo in AD 918, there were hospitals to treat individuals 'afflicted of Allah.' In many cultures, people experiencing mental health issues were either considered to be religiously inspired or were ostracized and even persecuted. This treatment ranged from excommunication to being executed as witches or seen as being cursed or possessed by evil spirits.

Mental Asylums: A Historical Perspective

The concept of mental asylums dates back centuries. One of the earliest documented psychiatric institutions was a priory near London that was established in 1247. It gradually transformed into Bethlem Royal Hospital, a site synonymous with the treatment and containment of the mentally ill. In modern times, Bethlem Royal Hospital is a modern psychiatric institution. However, in the past, it was known as a 'lunatic asylum' and was notorious for housing individuals who were locked away due to their mental health conditions.

Many of these individuals, particularly in long-term psychiatric units, may have exhibited symptoms that are now recognized as autism. Unfortunately, due to the lack of modern diagnostic tools and understanding, they were often left unacknowledged or unaided. Many families and communities refused to talk about the individuals living in these asylums, often due to the stigma and shame associated with mental health conditions.

Diagnosing Autism: A Timeline of Recognition

It wasn't until the late 20th century that autism began to be recognized as a distinct condition. The journey to recognition and diagnosis has been long and complex. Before the 1970s, the term 'autism' was rarely used, and the condition was often misdiagnosed or underserved. For instance, the author of this essay was born in 1967 and was only diagnosed with autism in 2007.

Before the 1970s, there were few resources or understanding to identify and support individuals with autism. Those who exhibited signs of autism were often labeled as 'mentally retarded' or 'developmentally delayed,' which carried significant stigma and led to social isolation, discrimination, and exclusion from educational and societal contexts. These individuals were often subjected to harsh and sometimes abusive treatment in the name of 'care' or 'therapy.'

Current Trends and Prevalence

With the increasing awareness of autism, diagnostic tools and support systems have improved significantly. Today, autism is more widely recognized, and its prevalence has risen, partly due to better awareness and diagnostics. However, the debate over whether autism is 'getting more or less common' remains substantial. According to the Centers for Disease Control and Prevention (CDC), the prevalence of autism in the United States has increased from 1 in 150 children in 2000 to 1 in 54 children in 2020.

Modern diagnostic tools and a more inclusive understanding have meant that more individuals are being diagnosed and receiving the support they need. However, the increasing diagnosis does not necessarily mean an increase in the prevalence of autism in the biological sense. It could also be a result of better detection and awareness.

Looking back, it is clear that our understanding of autism has evolved significantly. As society continues to progress, it is hoped that there will be even greater acceptance and support for individuals with autism and their families.