What's Normal? A Look at Asperger Syndrome

By DAVID CORCORAN

t was an exciting moment for me — and, I imagine, for other parents of children with the baffling neurological disorder called Asperger syndrome — when The New York Times Magazine published Lawrence Osborne's "Little Professor Syndrome" in June 2000.

The title may have been condescending, but the article itself was terrific, perhaps the best yet about Asperger's in a mainstream publication: a 4,500-word exploration, in remarkably vivid and sympathetic language, of a world that few readers had visited.

So it was doubly exciting when Mr. Osborne, a widely published health and science journalist, expanded the article into a book, "American Normal," published last month.

Asperger's, as most readers probably still need to be told, is a lifelong disorder of unknown origin that usually shows up around 18 months to 3 years. Generally thought to be a form of autism, it is characterized by normal or above-normal intelligence, social awkwardness, verbal rigidity and, most conspicuously, a fixation with an obscure topic that can be learned by rote.

People with Asperger's have a hard time relating to other people. But they can and do go on for hours about their obsession — Civil War battles, lighting fixtures, members of Congress, train engines (hence, "little professors").

The syndrome has no known cure. But growing awareness of it, coupled with the federal law that requires schools to provide appropriate services to students with disabilities, means that many more children than in the past are receiving needed attention and can hope to grow into happy and productive adults.

Still, what Asperger's awareness has lacked is a wide-ranging book by a writer with journalistic and literary credentials — a book that could do for Asperger's what Oliver Sacks's "Man Who Mistook His Wife for a Hat" did for other obscure brain disorders. But those of us who were hoping that "American Normal" would be that book are in for a severe disappointment.

It takes the form of a transcontinental odyssey in which Mr. Osborne drops in on children with Asperger's and adults who are too old to have had it diagnosed in childhood but who clearly show its symptoms. (Some are parents of Asperger's children, suggesting that the condition may run in families.)

He is an acute observer, and his descriptions are penetrating and tinged with empathetic humor. Nicky, a 9-year-old in Adelanto, Calif., who writes tiny poems in the shape of diamonds and has already scored in the 99th percentile on an SAT, has a mind that is "disturbingly hyperfactual and blithely associative."

A. J., whose obsession is vacuum cleaners, "loved the promotional video that came with the new Phantom model and watched it over and over, while rocking back and forth." When his grandmother disciplines him by telling him he won't be able to touch the new vacuum, "a sullen look of castigated impotence would suddenly come over his face."

But when Mr. Osborne leaves the company of people with Asperger's, the book runs seriously off track. Much of it is devoted to long, tangential and unrewarding meditations on the American psychiatric establishment, the horrors of highway sprawl and the possibility that various figures — Thomas Jefferson, the Canadian pianist Glenn Gould — may have had Asperger's. Mr. Osborne himself suspects that he may have undiagnosed Asperger's, and he returns at tiresome length to his obsession with the "Iron Chef" television program and his insistence on staying in Red Roof Inns.

His larger point, and the meaning of the title "American Normal," is that Asperger syndrome may be less a disorder than a societal and psychiatric construct — a condition that he concedes is real, but one whose diagnostic criteria are "so complicated and so contradictory and so blurred around the edges as to sometimes stretch credulity." The implication is that society's obsession with "normality" has led it to diagnose anything abnormal as an illness, one that needs to be treated with expensive drugs and psychotherapy.

It's a familiar indictment. (The introduction approvingly quotes Dr. Mel Levine, a pediatrician at the University of North Carolina, as saying, "We're pathologizing all human behavior, and in so doing we're creating an institutionalized nightmare — a truly mad system in which everyone is `sick.' ") But Asperger's is an odd candidate, because few experts believe that drugs and psychotherapy can do anything more than relieve some of its side afflictions like depression and attention deficit disorder.

In one of his digressions, Mr. Osborne takes us to a Malaysian tribe, some of whose members have an exaggerated reflex called latah, which causes them to go into a trance when startled and behave in ways that would embarrass them if they knew what they were doing — cursing, taking off their clothes, singing bawdy songs. Yet in the tribal culture, such people are treated with affectionate amusement. By contrast, Mr. Osborne says, Americans with Asperger's are viewed as having a "disorder" that needs "curing."

What if "around a core biological illness," he asks, "a large superstructure of behaviors and moods had been created by the society itself?"

But the difference between latah and Asperger's is plain from Mr. Osborne's descriptions of the two syndromes. One is limited to special circumstances, and it does not disable its sufferers; the other is pervasive, meaning that it invades nearly every aspect of a patient's life.

This book trivializes its subject by making it a vehicle for a diatribe against psychiatry and the larger ills of society. In the end, it turns out to be less about Asperger syndrome than about its author. The subject is not as fascinating as he seems to think it is.

"American Normal: The Hidden World of Asperger Syndrome," by Lawrence Osborne. Copernicus Books, $27.50.