Bulletin of the History of Medicine 76.4 (2002) 821-822
Rab Houston and Uta Frith. Autism in History: The Case of Hugh Blair of Borgue. Oxford: Blackwell, 2000. ix + 207 pp. Ill. $54.95 (cloth, 0-631-22088-7), $22.95 (paperbound, 0-631-22089-5).
This study examines the odd behavior of an eighteenth-century aristocrat as a vehicle for addressing the question of whether autism is a new disorder or an older illness that was classified under then-existing categories. The authors, a respected early modern historian and a premiere cognitive neuroscientist, conclude that the syndrome we today call autism existed in eighteenth-century Britain and Europe and, by implication, long before. They believe that their historical and clinical collaboration has wider application in that it reveals the "underlying commonalities in the human condition," as well as reminding us "about changes in our self-understanding of others"; mental disorder reflects these changes, "even if the biological origin of the disorder remains the same" (p. 157).
A complex historical narrative provides the setting for a nuanced and accessible analysis of contemporary theories of autism. Although the book is a collaborative effort, the chapters were written separately, reflecting each author's expertise. The subject of this study is an eccentric nobleman, Hugh Blair (b. 1708), who manifested an array of bizarre behaviors beginning in early childhood, including collecting twigs, bird feathers, and pieces of cloth. In his thirties Blair insisted on always wearing the same garment, which he periodically repaired with patches of cloth cut from perfectly good clothing, often taken without permission from others. Blair's communication skills were weak and his actions were socially inappropriate. For instance, he attended every burial in his town, including those of persons he did not know. He would visit neighbors unannounced and remain oblivious to their cues about his being an unwelcome intruder. He socialized with servants who mocked him, unaware that he was the object of their pranks and humor. He demanded the same seat in church, performed a number of repetitive acts, and compulsively kept objects in the same order. While most who encountered Blair characterized him as feeble-minded, others remarked on his excellent memory. The record of his behavior was preserved only because he was the subject of a lawsuit in 1748 brought by his younger brother John, who in 1737 had become Hugh's legal guardian or "curator." In the action, brought before the Commissary Court of Edinburgh, John sought to obtain an annulment of Hugh's 1746 marriage to Nicholas [sic] Mitchell, the daughter of a surgeon. John, who wished to avoid the birth of a competing heir for land and title, claimed that Hugh was an idiot whose life history demonstrated his mental incompetence.
Historian Rab Houston, author of an earlier study of madness in eighteenth-century Scotland, weaves the issues raised in Hugh Blair's case into an enlightening examination of the meaning of mental incompetence. This exploration reveals how Hugh's behaviors were understood in the context of the meanings of madness at that time and place. Nevertheless, Houston is comfortable with psychologist Uta Frith's reinscribing the narrative as evidence for a diagnosis of Blair as autistic. Frith also draws on his case as an illustration of autistic experience, using this occasion to provide an informative and accessible discussion of the prevalence, diagnosis, possible etiologies, and treatments of autism.
Houston and Frith conclude that "if it is possible to recognize
autism despite vast differences in culture, then this allows us to
see more clearly the common and enduring, as well as the local and
transient, features of the condition" (p. 157). They have made a
convincing case for the persistence of autism in the West; it will
be the task of others to decide whether what seems persuasive for
Britain and Europe can be demonstrated even more universally.
Autism in History makes a valuable contribution on a number
of levels and will be appreciated by historians of medicine as well
as general readers.
Howard I. Kushner