Rift between autism research and practice widens

The search to find neurobiological causes for psychiatric disorders is largely unsuccessful. Psychiatric research tends to get bogged down in complicated hypotheses about the neurobiological basis of syndromes, without being able to translate them into psychiatric practice. Ideas about autism, for example, have been in a constant state of flux since the Second World War. These are the conclusions of a thesis written by psychiatrist and philosopher of science, Berend Verhoeff, who will be awarded a PhD by the University of Groningen on 5 November.

Psychiatry has a stubborn tendency to see mental illnesses as independent entities. According to Verhoeff, psychiatric problems should be seen within the personal, social and cultural context in which they occur. He carried out a historical-philosophical study of all the research into autism conducted since the Second World War.

‘Autism epidemic’

Autism is a typical example of a controversial psychiatric disorder. There is no doubt that we are currently in an ‘autism epidemic’, in which the last forty years have seen a thirty-fold rise in the number of people diagnosed with some form of autism. This is quite remarkable when you consider that psychiatry is still convinced that the disorder must have a neurobiological or genetic cause. Opinions on autism are therefore an interesting subject for an academic psychiatric research project, says Verhoeff: ‘The illness has always been considered a ‘thing’ to be discovered, a constant that we want to know more about. Historical research, however, clearly shows that our understanding of autism is subject to continual change. The field of psychiatry has never been able to expose the biological nature of autism, which explains the highly diverse autism spectrum we have today.’

Normal or pathological behaviour

Verhoeff did not set out to prove that autism is not a neurological condition; he simply wanted to reveal the psychiatric way of thinking. ‘Psychiatry assumes the existence of separate disorders. There is nothing wrong with thinking that psychiatric illnesses exist, but it means that you must have some idea of the dividing line between normal and pathological behaviour.’ He points out that there are in fact alternative ideas about psychiatric problems, which take account of individuals in their specific situation. Verhoeff: ‘The humanities and social sciences have an important part to play in expanding the field of psychiatry so that it stops focusing primarily on the neurobiology of abstract illnesses, and starts looking at the limitations, vulnerabilities and painful experiences of individuals as a whole. A new way of thinking will obviously spark new problems and evoke criticism, but I suspect that when psychiatric research starts to pay serious attention to the complex relationship between people and their environment, it will have a better chance of finding its way into clinical practice.’

CV

Berend Verhoeff (Amsterdam, 1977) studied Medicine in Maastricht and Philosophy at the University of Amsterdam. He conducted his PhD research in the department of History and Theory of Psychology of the Faculty of Behavioural and Social Sciences. His supervisors were Douwe Draaisma and Trudy Dehue, and his thesis is entitled 'Autism's anatomy. A dissection of the structure and development of a psychiatric concept '. Verhoeff currently works as a psychiatrist in Amsterdam.