by Anushka Jain
A note from the author…
For the DAC blog, I wanted to offer this poem, “a brief psychiatric and physiological history of autism,” which melds the content I learned in my Disability in American Literature and Culture course with Brenda Brueggemann and Biology of Nervous System Diseases with Randall Walikonis. One of my main objectives in writing this poem was to showcase a brief history of how we have perceived and diagnosed autism, both in the psychological and psychiatric lens using the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), as well as the physiological lens of the neurons within the brain. I paid particular attention to the leading theories of mutations within synaptic transmembrane proteins, such as neurexin and neuroligin, that are linked to ASD (Autism Spectrum Disorder). As I was writing this poem, I noticed the pattern of diagnosing and defining: both scientists and society constantly attempted to understand the inner workings of ASD and how to fit them into tangible little boxes. They were seen less as people and more as labels, cases to be defined and diagnosed, puzzles to be sorted out. While the psychological and the physiological are both vastly different worlds, the two describe the uncertainty behind the disorder. I specifically wanted to focus on the collective journeys to make sense of such uncertainty, which many times disregards the actual individual they are seeking to “help.”
I hope this poem reaches the general audience, especially those like me who had little to no knowledge of our country’s long and tumultuous past before taking these classes, and that it teaches them more about disability and disability issues. Happy reading!
the DSM-I pioneers
autism is not a diagnosis
there is no word other than the whispered imbecile
when his repetitive movements surface
chromosomal abnormalities are found
hot spots for mutations
genetics form facts, but too late
the refrigerator mother is too frigid for her child
the DSM-II links
autism is a part of schizophrenic reactions
a byproduct to something more tangible
than his aversions and his preferences
the fronto-striatal brain circuit is disrupted
faulty wiring and axon pathfinding
the connections, the sparks, the jingles of electricity
broken up and fizzing out and spiraling
the DSM-III introduces
infantile autism: onset restricted to a crucial 30 months of age
a separation from the box of schizophrenia
but a new cage of time and symptoms has now emerged
neurexin and neuroligin, our two culprits, are identified
flanking and overloading the excitatory and inhibitory synapses of the overworked neurons
millions and billions of proteins, transcripted and translated, all ripe to disform
sneaky R45IC NLGN3 mutants overexpressing, changing synapse ratios and lives
the DSM-IV categorizes
primary diagnostic criteria permeate doctor’s offices
black and white checkboxes to tick off
life-altering decisions relegated to narrow definitions of disorder and disharmony
the scaffolding also poses an issue – another mystery, another disconnect
targeting the shankopathies, measuring and remeasuring synapse density
knocking out mice and mice genes
too much and not enough information and everything in between
the DSM-V combines and redefines
all the categories, the designations, the labels fan out into a spectrum
it’s cognitive, it’s behavioral, it’s genetic
see and define and decide – does it fit? why won’t you fit?
Works Cited
Chubykin, Alexander A., et al. “Activity-Dependent Validation of Excitatory versus Inhibitory Synapses by Neuroligin-1 versus Neuroligin-2.” Neuron, vol. 54, no. 6, June 2007, pp. 919–931, https://doi.org/10.1016/j.neuron.2007.05.029. Accessed 22 September 2024.
Kawa, Shadia, and James Giordano. “A Brief Historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and Implications for the Future of Psychiatric Canon and Practice.” Philosophy, Ethics, and Humanities in Medicine, vol. 7, no. 1, 2012, p. 2, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282636/, https://doi.org/10.1186/1747-5341-7-2. Accessed September 22 2024.
Jiang, Yong-hui, and Michael D. Ehlers. “Modeling Autism by SHANK Gene Mutations in Mice.” Neuron, vol. 78, no. 1, 10 Apr. 2013, pp. 8–27, http://www.sciencedirect.com/science/article/pii/S0896627313002638, https://doi.org/10.1016/j.neuron.2013.03.016. Accessed 22 September 2024.
Ylisaukko-oja, Tero, et al. “Analysis of Four Neuroligin Genes as Candidates for Autism.” European Journal of Human Genetics: EJHG, vol. 13, no. 12, 1 Dec. 2005, pp. 1285–1292, pubmed.ncbi.nlm.nih.gov/16077734/, https://doi.org/10.1038/sj.ejhg.5201474. Accessed 22 September 2024.
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