Jane McCredie: Fashionable disease

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