Casting Light on Shadow Syndromes

Our lack of knowledge casts shadows on our ability to diagnose certain illness. Mental illness is sometimes seen in a pejorative way because psychiatric diagnosis still relies largely on patients’ own perceptions.

Modern medical science is illuminating and eliminating shadows cast on the mildly mentally ill and alleviating prejudice and suffering. The disease of autism offers an excellent example of this progress.

A glance at the history of medicine shows that when a new disease is recognized, at first only the most serious cases are described. These extreme examples then become the templates for future diagnoses and only after extensive clinical experience are milder forms of the same disease recognized.

The example we often cite to medical students is that while most heart attacks start with chest pain and lead to death, many just as serious start only with a stomach ache, weakness or nothing at all.

So has it been with autism, a disease we have been studying intensively at UCLA since 1963.

The first cases described in 1942 were of the most serious kind. They were children who could not relate to their parents, were mute or had aberrant language, were intellectually retarded in many areas, and were beset with unremitting, bizarre, rhythmic mannerisms. They had the words “institutionalize for life” stamped on their future.

And so it was for 30 years. Then, as our clinical experience widened we discovered milder cases. It came about this way. The mother of a young, seriously autistic boy we were evaluating took us aside and whispered, “Dr. Ritvo, this might sound crazy, but would you take a look at my (autistic) son’s dad? He’s a real ‘odd duck’; I swear he is like my son in so many ways, only in a very mild way.” Sure enough, when we looked at Dad, he did turn out to be an “odd duck.” A kind, well-intentioned man who could barely comprehend the intricacies of interpersonal relationships. Yet he had memorized the old and the new testaments and the book of Mormon, and talked about them incessantly and inappropriately. His wife appeared right: He had “a touch of the hair of the dog that bit his son.” Needless to say, we were surprised.

After many other similar surprises we realized that there was a previously unrecognized mild form of autism. In 1994, we published data on 14 autistic parents, 12 fathers and two mothers. They had 54 children among them and half of these children had autism. Each autistic parent had extreme difficulty in understanding the nuances of interpersonal relations, problems interpreting sensations from their body and senses, and each possessed special interests or talents. These are the characteristics we defined as the templates for the diagnosis in adults. Among these parents are a college professor, an electrical engineer, an attorney and several others equally successful in having completed their education and supporting their families.

This recent recognition of a shadow form of autism has already alleviated suffering in countless numbers of people throughout the world.

In the dark ages, people suffering from mental illness were believed to be possessed by the devil. Today, unfortunately, this pejorative stereotype has been replaced by an equally pejorative stereotype: They are not ill but simply don’t have the moral fortitude to meet life’s demands. Let’s hope that our new understanding of shadow syndromes soon sends this moral damnation back to the devil.