What Wittgenstein and Warhol had in common

Patricia Howlin finds a personal account powerful.

The effects of autism can be devastating for those living with this condition. It is a matter of some concern, therefore, that autism and Asperger's syndrome seem to have become very effective money earners for publishers in recent years, as witnessed by the plethora of new books on this topic appearing monthly.

Thus, my first reaction when this book appeared on my desk was "Not another one!". The cover blurb was not encouraging, with descriptions of how the author "embraces the strange beauty of her son Elijah's special neurological disorder" and claims that, by means of help from "visual artists" and "civil-rights organisations for autistics... Elijah reaches extraordinary heights in his sociability and emotional wellbeing".

Fortunately, the book itself turned out to be superior to many others documenting the experiences of living with autism. One of the problems with personal accounts is that, although they are interesting in themselves, they may be of little relevance to other families with a child who has autism. Autism covers a very wide spectrum of disorders, from children who are severely handicapped in almost all areas of their development, to children who, despite their autism, are extremely able in many domains.

Thus, parents of high-functioning children may gain little from reading books about children who are very disabled, and vice versa.

This book, however, while giving a powerful account of the author's own struggle in coming to terms with the disorder, also covers many issues relevant to a wider audience. The problems of getting a diagnosis and of coping with this when it eventually comes are described in vivid detail, as are the day-to-day difficulties faced in raising a child with poor communication skills and an overwhelming need for predictability, rigidity and repetition.

The impact on family life and the practical difficulties of balancing the child's needs with those of working or finding somewhere to live are also well documented. This is combined with more general information about what is known about autistic disorders and the history of Asperger's syndrome in particular. There are also fascinating anecdotes concerning individuals who may well have had characteristics of Asperger's syndrome, including Asperger himself, Andy Warhol, Wittgenstein and Einstein.

In her search to understand the nature of her son's problems, the author begins to recognise autistic traits within her own family. She becomes aware that many of her father's idiosyncrasies, for example, are probably part of a broader autistic phenotype. Gradually, too, she comes to recognise certain of these characteristics, albeit present in a milder form, in herself. This awareness of her family background, far from being distressing, represents a positive move forwards, which is further enhanced by her associations with other individuals with autism who have not only made a success of their own lives but have been instrumental in helping others too. Many of the successful management strategies she develops along the way come not from professional therapists promoting their own theories about psychoanalytic or rigid behavioural treatments but from the practical wisdom of individuals with personal insight into the disorder.

Despite the exaggerated claims of the "blurb", Elijah remains a child with autism who continues to find comfort in his routines and obsessional interests. However, by the age of 11 both he and his mother have "cracked the code" they needed to understand each other and those around them, and to carve out a life that, even if somewhat "whacky", is full of discovery and enlightenment.

Patricia Howlin is professor of clinical psychology, St George's Hospital Medical School, University of London.